Dáil Éireann debate -
Tuesday, 24 Jun 2003

Vol. 569 No. 3

Written Answers. - Health Strategy.

Eamon Gilmore

Question:

92 Mr. Gilmore asked the Minister for Health and Children if his attention has been drawn to the recent report from of the Combat Poverty Agency showing that poorer people get sick more often and die younger than those who are better off; his plans to address the health needs of the less well-off; and if he will make a statement on the matter. [17540/03]

Minister for Health and Children (Mr. Martin)

I am aware of the Combat Poverty Agency Report, Against All Odds: Family Life on a Low Income in Ireland, to which the Deputy refers. My Department has received a detailed briefing on the study from the Combat Poverty Agency and has had initial discussions with the agency on how the Department and the agency might work together to address relevant issues raised in the report.

The report is an in-depth study of 30 families. The high level of poor health found in the study reinforces the evidence already available in Ireland and internationally on the links that exist between poverty and ill-health. This evidence has been clearly set out in a number of studies in the last few years in a Irish context, most notably in the Inequalities in Mortality 1989-1998 study carried out by the Institute of Public Health. The chief medical officer of my Department has also highlighted the evidence of the links between poverty and ill-health in his recent annual reports.

As the Deputy is aware, the national anti-poverty strategy, NAPS, is the main vehicle through which the Government's response to the problems of poverty and social exclusion is being channelled. The targets to reduce health inequalities set out in the Government's review of the national anti-poverty strategy were developed in the course of an extensive consultation process and have been integrated into the national health strategy. Key health targets are to reduce the gap in premature mortality and low birth weight between the highest and lowest socio-economic groups by 10% by 2007, and to reduce differences in life expectancy between Travellers and the rest of the population.

As a result of the wide range of factors which affect health status and health inequalities, the national health strategy, Quality and Fairness: A Health System for You, envisages these targets being met through a range of actions including greater focus on multi-sectoral work and health impact assessment (HIA).

The national health strategy asserts quite clearly that to achieve better health for everyone and to reduce health inequalities, health must be put at the centre of public policy. In this context, health impact assessment, HIA, is being developed so that relevant policies, strategies and legislation undergo a comprehensive process of health proofing so that their impact on the physical, mental and social well-being of the population is positive. The Institute of Public Health is already involved in some initiatives in this area and the Department of Health and Children, in partnership with the institute, is developing a programme in this area which will include: policy seminars for senior management, the first of which is scheduled to take place in early July; training courses for health impact assessment practitioners – project management, hazard identification, risk management, health gain interventions, HIA appraisal, inter-sectoral action; and review of health impact assessment tools.

The important role of primary care in effectively addressing health inequalities was highlighted in the national anti-poverty strategy consultation process and in the report of the national anti-poverty strategy and health working group. The primary care strategy provides for an interdisciplinary team-based approach to primary care provision. Clients may self-refer to any team member and appropriate procedures will be in place to facilitate referral between team members and, where necessary, joint management by the team also. I have approved the establishment of an implementation project in each of ten locations.

In relation to primary care, there is now a general practitioner co-operative providing an out-of-hours service operating in each health board area and the network of GP co-ops is being extended to cover wider areas, except in the North-Eastern Health Board where it is already region-wide.

The primary care strategy model includes mechanisms for the involvement of the community. The community and voluntary pillar is represented on the steering group for the implementation of the strategy and is also working with four of the ten initial implementation projects. Sustaining Progress includes a commitment that the learning from community involvement will be used to inform models of participation appropriate to the wider national health strategy. The document, Community Participation Guidelines, published last December by the Health Board Executive, HeBE, sets out the spectrum of ways of involving patients and communities.

My Department recently co-hosted a conference with the Combat Poverty Agency to launch its Building Healthy Communities programme, which has a special focus on community development approaches to reducing health inequalities. My Department also supports financially, in the context of the implementation of the primary care strategy, a number of research projects under the aegis of the Building Healthy Communities programme.

The report, Ireland's Changing Heart, the second report on the implementation of the cardiovascular health strategy published recently, highlights the importance of addressing health inequalities in the context of strategy implementation. Consideration is being given as to how this can best be addressed. Targets to reduce health inequalities will also be taken on board in the review of the cancer strategy under way. Mechanisms for developing an injury prevention strategy are under discussion between my Department and the Health Board Executive, HeBE.

In the 2003 letters of determination, and in other correspondence, my Department has asked health agencies to prioritise actions to reduce health inequalities. The chief executive officer of each health board was asked to prioritise its funding allocations in favour of the RAPID and CLÁR programmes.

A number of awareness raising exercises have been undertaken among staff in the Department of Health and Children in relation to targets to reduce health inequalities. A work programme is being progressed with the Institute of Public Health to develop a programme of awareness raising and training for health board staff in con junction with the Health Board Executive regarding the targets to reduce health inequalities and also in relation to the indicators and data needed to monitor and evaluate the targets.

The NAPS and health working group has been reconvened in a consultative capacity in relation to monitoring progress towards achievement of the targets. The social partners are represented on the working group.