I thank the committee for the invitation to meet with it this morning. I accompanied by Mr. Chris Macey and Ms Kathryn Walsh, whom all members know.
Almost 9,000 people die here annually from heart disease and stroke. Given that 80% of cardiovascular disease is preventable, all but approximately 1,800 of these lives could be saved if the right evidence-based policies were put in place. The financial cost of doing so would be far from prohibitive. Much larger amounts of another currency are required to tackle this grim toll of death and misery, that is, political will. We need more political will to address the factors fuelling preventable cardiovascular disease, including overweight and obesity, uncontrolled blood pressure, smoking, physical inactivity, excess alcohol intake and air pollution. Strong action on these issues, along with cost-effective measures to remove chronic deficits in heart and stroke services, will impact innumerable lives in every corner of the country.
Today, we ask the committee to work with us on what we can do right now within the realms of budgetary constraints to save lives that should not be lost and to create a healthier Ireland. In addition to unnecessary deaths, approximately 2 million people are at risk, or living with, the long-term effects of heart disease and stroke. No family is left untouched and we are not doing enough to help them. Better treatments, public health measures and awareness campaigns drove down the burden of heart disease and stroke in the previous generation, but the curve is turning due to a combination of an ageing population and the impact of lifestyle factors.
What can we do now to make a difference? It may sound extraordinary that for the world's biggest killer disease, the first thing we need is a plan. The previous national cardiovascular strategy expired two years ago. Not only has it not been replaced, it was never evaluated. This is even more galling given how neatly a good cardiovascular policy would dovetail with the objectives of Sláintecare. A national cardiac services review has been mothballed by Covid and a stroke strategy focusing on acute services, but we have no overarching framework and no intention currently to create one. This, we believe, is a recipe for failure, with services reliant on piecemeal strategies and HSE firefighting, no long-term planning and, therefore, much-reduced prospects of funding, regardless of patient need, all against a background where services decimated by the pandemic and subsequent cyberattack desperately need to recover.
Cardiac services face many severe challenges due to Covid, on top of significant historical service deficits. Chronic heart disease patients comprise 44% of Covid deaths and 49% of related ICU admissions in Ireland, while the future impact of reductions in heart attack admissions, which peaked at 80%, remains unknown. In the absence of a national cardiac register, real-time data is hard to establish. We know from cardiologists that outpatient waiting times for new cases were as high as 14 months and have deteriorated further. Echocardiogram waiting times that were seven months are now 12 months in some hospitals and waiting lists for angiograms can be more than a year depending where a person is treated. Cardiologists also report that their patients are generally sicker due to cancelled clinics and reduced GP access. In this information twilight, it is not possible to estimate the impact of Covid-related service deficits on death and disability.
We have accurate information on the impact on cardiac rehabilitation from our own national survey and the picture is grim. Evidence shows this service can reduce cardiac mortality by 31%, but 77% of centres closed during the pandemic and 69% had services fully suspended for 12 weeks, the longest for 35 weeks. Even before Covid, services were in crisis with a national waiting list of 2,818, seven centres having a four- to six-month waiting list; seven, more than six months, and three, more than a year.
Stroke services also face a bleak outlook. It is estimated that stroke incidence will increase by 60% in a decade, from approximately 7,500 to 12,000 per annum. Almost four years after the commitment was made to our first national stroke strategy, it remains unpublished. Meanwhile, the window of opportunity to future-proof stroke services, preventing a devastating spillover of cases affecting all emergency services gets ever smaller. The stroke strategy addresses acute service deficits, but it contains no measures to aid the recovery of stroke survivors living in the community. Nothing typifies the neglect of post-discharge services more starkly than the failure to establish how many stroke survivors we have. The estimate used by the HSE and Department of Health of 30,000 is based on an estimate that is almost a quarter of a century old. Institute of Public Health research and extrapolations from UK statistics suggest the real figure is approximately 90,000.
Other aspects of cardiovascular health have also been grievously harmed by Covid. There is evidence of significant weight gain and lower physical activity levels among children and adults and already shocking rates of high blood pressure are getting worse. Surveys suggest people are smoking and drinking more and that the most damaging forms of air pollution to people's health have increased.
What steps can we take now? Given time restrictions, I refer members to our accompanying submission for a fuller explanation, but I particularly highlight the need for a new cardiovascular health policy underpinned by a national cardiac register to provide an evidence-based framework for service recovery and development and urgent implementation of the stroke strategy, with additional measures to support recovery in the community. We also must address the causes of cardiovascular disease rather than just its aftermath. Being overweight and obesity is the biggest threat to the health of our children. Similar to tobacco with the previous generation, we cannot tackle this scourge without first loosening the grip of advertising and require an outright ban on junk food marketing, at the very least to under 18s, in the promised public health obesity Bill. Almost 6,000 people die here annually from smoking. We need increased momentum in the tobacco-free Ireland policy. Teen smoking rates are increasing for the first time in decades amid an explosion in vaping that we know is a gateway to smoking.
This should be addressed in new legislation, including a full ban on e-cigarette advertising and child-friendly flavours. High blood pressure is the biggest cause of cardiovascular disease but we have among the lowest rates of awareness and treatment of it in the developed world. About two thirds of over-50s are affected. A comprehensive plan is required, starting with a rolling national awareness campaign, which would have huge impact at minimal cost. Air pollution costs 1,500 lives here every year, mainly due to heart disease and stroke, yet clean air continues to be addressed from a largely environmental standpoint. We urge the committee to take a lead on addressing this issue through a health lens and a thorough investigation of the actions that may save many lives.
It was always assumed that Covid would end and the world would return to normal, but we are now realising we have to learn to live with this virus. We therefore have to tackle the drivers of Covid-related deaths and hospitalisations, including obesity, smoking, high blood pressure and air pollution, in addition to health service recovery, particularly treatment of chronic heart disease responsible for half of the most serious Covid cases. We therefore ask the committee to support strong action combining a package of preventive measures with improved service planning and development. Doing this would also have a huge impact on preventable death and chronic disease rates generally and, ultimately, help to secure the future of our health services.