I would like to thank you, a Chathaoirligh, for giving me time to have this debate and, indeed, I would like to thank the Minister for coming in to hear it. There was, as we know, widespread public disbelief when the announcement was made of the abolition of the Health Education Bureau by the Minister in September last. No one really could decide what the motivation was or what the reason was behind this Government decision. Why had they decided to axe this very relevant and very effective bureau? The question was asked: was it a saving to the Exchequer? Well no, not really, now that it is being funded and as it was funded to the tune of £2 million by the national lottery. This presumably would have been how it would continue to be funded. The question was asked: had they completed their role in that the type of campaign they mounted was no longer valid or necessary? Certainly this could not be the case. They had only really started their work and got the public familiar with and accustomed to their campaigns.
Given the potential disaster in the spread of AIDS, given the high place Ireland occupies in the league table for cardiovascular disease, given the likelihood that smoking will rise again — and it is rising among some sectors notably women and younger people — this could neutralise the anti-smoking campaign of past years which was very effective, which had great impact and which cost a lot of money. Above all, what is to happen to the health education needs — and I have a special interest in this — of women and children, given the horrific neglect of this Government to even maintain, for instance, the cervical and breast cancer screening facilities, much less to expand them as is happening in neighbouring European countries. It is ironic and sad to realise that this is taking place on a date which coincides with the women in health week which was held between 11 and 19 October last year. It was organised by a separate committee in the office of women's affairs and was regarded as highly successful and extremely practical in terms of community education and encouraging self help. It involved five major conferences in Dublin and meetings, seminars and conferences in every health board area. It proved to be a seminal project so that when the week was over the issue of health education for those groups was not over. Small groups and associations sprung up around the country to expand their knowledge and information on illness prevention.
That health week was very much a collective venture with the active support of a number of voluntary groups of doctors, social workers, health boards and politicians. A splended role was played by the Health Education Bureau. For instance, they staffed an information kiosk in the ILAC centre, Dublin, which was visited in that one week by 15,000 people seeking information leaflets. This was the story all over the country. That health week stimulated interest. Women flocked to the events in their areas. Above all, they were seeking information. We had a very fine array of information literature but they were looking for more. They were looking for dialogue, discussion and answers to many questions.
The initiative for this week came from my office. Everyone involved wanted it to be an annual event. People from the HEB assured me that they could and would take it over and use the same module as we used last year. Presumably it would have been as successful this year as it was in other years. However, it has not happened. I am very sorry about that.
The move in the Department was a stupid and shortsighted one. Health education and preventative medicine ought to be the cornerstone of any effective health policy. No reasonable person could accept the reasons given by the Minister in his press statement as an improvement on what we have. The Irish Medical Times in their editorial of 25 September says:
Ostensibly, it might appear to signal the Minister's desire to see health education exercise much more clout within the actual health service and health professions. We suspect, however, that more sinister reasons are operating and, in particular, the remorseless intention to make savings and equally remorseless intention to get absolute control of every aspect of health care in the country.
There is the need for an informed public regarding the risks of cervical, breast and testicular cancers, the need for public discussion about sensible drinking and public action against excessive drinking and driving.
There is, in short, a need to awaken the public to the fact that since the diagnosis and treatment of disease is an expensive business which threatens to overwhelm countries very much richer than our own, it makes sense to do as much as we can to improve our own health through attention to what we eat and drink, to the exercise we take, the behaviours we approve, and the risks we take.
All of this was the work of the Health Education Bureau. There are many reasons that the Minister's statement is poor and has to be challenged. We have seen very successful campaigns run by the Health Education Bureau. These have consisted of a campaign for the immunisation of children which was very badly needed as was shown by the response to it, with mothers bringing their children for immunisation against rubella and whooping cough. Their anti-smoking campaign must have been one of the best that has ever been put together and was effective. Their drugs and alcohol campaign and the publication of their book, The ABC of Pregnancy were both incredibly successful. They were written in plain, clear, simple English and given away free to all parents through maternity hospitals and clinics. They were reaching the target groups who most needed them. That was the good thing about the HEB publications. Parents who cannot afford to go into bookshops and buy books by, say, Dr. Spock, Dr. Jolly or whoever is the guru of child rearing at present, still need to have their anxieties resolved and points clarified and to get direction about child rearing or pregnancy. The HEB developed the life skills programme for schools with great caution and consultation.
What have we been promised instead of the Health Education Bureau? We have been promised three new bodies: a health promotion unit in the Department of Health, an advisory council on health promotion representative of the interests involved in the health status of the community and a committee under the chairmanship of the Minister for Health which will include the Ministers for the Environment, Agriculture and Food, Education, Labour and Energy who will coordinate the health promotion policy. The main point of all these new bodies is that they are all under the jurisdiction of the Department of Health. This is the nub of the matter. It is a case of the over protection by a cautious parent chastising an offspring and confining it to the backyard where the parent can watch, monitor and control its activities.
I have no doubt that the main reason the Health Education Bureau have suffered the fate they have is to control them. The agency have been in the past embroiled in controversy over their excellent life skills programme and were subjected to a systematic campaign waged by organisations such as Family Solidarity earlier this year. Several members of the Church hierarchy, included Bishops Comiskey and Newman, criticised the agency's approach in the area of sexual morality. I know that there have been grave reservations in the Department about what sexual or moral areas might be involved under the aegis of health education.
During my four years as Minister in charge of women's affairs I tried to push out the boundaries of health education and help in promoting awareness of special relevance to women because I felt there was a great lack there. Given that the majority of doctors are male and that many women are isolated in areas where they cannot get to special clinics for, say, advice on the menopause or on family planning I felt that a lot more needed to be done to meet the needs of women. I had great difficulty with the Department of Health. I fooled myself by trying to believe that it was just bureaucracy and not something specific or sinister. However, it was very clear after a while that the people in the Department with whom I had to deal were terrified and cautious when it came to dealing with questions of women's health. There seemed to be the attitude that if it was a question of below the waist it might involve some moral issue. That was very regrettable because it hindered and inhibited much worthwhile work and things that could have been done. When I went initially to the Department about the women's health week I got at least 100 reasons why it should not be held, could not be held and was not needed.
The Health Education Bureau were beginning to have a mature and responsible approach to women's health in the last year or two but the whole issue now goes back to zero with little hope that under the jurisdication of the Department of Health real contentious issues of concern and need to women will be dealt with. In this context I want to point out — perhaps it has changed since I was dealing with them — that there are no women in senior positions in the Department though perhaps there is one at decison making level. One sees the effects of this. There is a need to have women at all levels so that they can bring their influence and experience to bear on any area of their work and campaigns. This is particularly important in Government Departments.
I despair for the health education and information needs of women under the new arrangement. I further suspect that we will see the systematic dismantling of the life skills programme. I regret to say that the Government and unfortunately the Fianna Fáil Party have very often capitulated to groups who make enough clamour in the name of morality. There was no need either on economic or financial grounds to bring in this change and there is a very definite risk that whatever body are responsible for health education they will be impotent because they will not have the independence that the Health Education Bureau had.
