I welcome the Minister of State, Deputy Simon Harris.
Commencement Matters
Public Health Policy
I also welcome the Minister of State. I raise this matter following a recent presentation by Professor Michael Turner, UCD professor of obstetrics and gynaecology. He explained how the incidence of neural tube defects, NTDs, varies from 0.05 per 1,000 in some parts of the country to six per 1,000 in others and that there are huge regional and population specific variations.
What is of concern to me is recent studies have shown that in the past four to five years there has been an increase in NTDs from 0.92 per 1,000 to 1.17 per 1,000. An analysis of 236 cases over three years found 45% had anencephaly, 49% spina bifida and 6% another medical condition which I cannot pronounce. Of the 94 babies born with spina bifida 90.4% survived the neonatal period. We have an increase in the number of NTDs compared to other countries. A UCD study found that of 564 women booking for antenatal care at the Coombe hospital, only one in four took folic acid for longer than 12 weeks before pregnancy, as is ideal. Women who planned their pregnancy or who were having their first baby were more likely to take pre-pregnancy folic acid.
It is extremely important to take folic acid pre-pregnancy and during pregnancy. Professor Turner highlighted the need for a new media campaign on this matter. He also made the point that with social media it should be possible to target the campaign at specific groups of people and it does not need to be the usual massive campaign. We could do a very good campaign on this issue as there is a need to highlight it.
Another issue raised during Professor Turner's presentation was the fortification of food. The point was made that because food is imported from all parts of the world fortification of food may not necessarily work. I spoke to another medical colleague who said the one place it could be used is milk. One company, Avonmore, produces milk with added folic acid, but we need to plan for this. The number of cases over three years was 236, which is quite a high number. It also involves a huge cost and huge trauma for families and is something at which we need to look. It is in that context I raise the issue.
I thank the Senator for raising this issue for discussion. I am taking this matter on behalf of my colleague, the Minister for Health, Deputy Leo Varadkar, who is unable to be here owing to Government business.
Neural tube defects, NTDs, include a range of serious congenital malformations as a result of incomplete closure of the neural tube within a month of conception. They include anencephaly, which is not compatible with life, to the more common forms of spina bifida and other forms which can be symptom free. Approximately 80% of infants with spina bifida survive. However, the condition is associated with varying degrees of disability. These include a poor ability to walk, problems with bladder or bowel control and hydrocephalus.
The level of neural tube defects varies from 0.05 to six per 1,000 births. However, this can change from year to year and there are regional and country variations. Neural tube defects are believed to be due to a combination of genetic and environmental factors. If one child or a parent has the condition, there is an increased chance that the next child may also be affected. It is now considered that not having enough folate in pregnancy also plays a significant role. There is evidence that many cases of NTD are preventable if the mother increases her consumption of folic acid before and during the early days of pregnancy. There are a number of sources of folate. Folate is found naturally in green vegetables, fruit, dairy products, eggs, seafood and grains.
This is recognised in the Department of Health's healthy eating guidelines which have been widely disseminated and are available on the Department's website. The guidelines are due to be reviewed again this year.
Folate is also available as folic acid supplements. It is recommended that the optimal dose for supplementary folic acid relating to pregnancy is 400 mg orally a day. The supplement is readily available in pharmacies throughout the country. However, clinicians also recognise that women at increased risk of NTDs should take a higher dose per day which requires a prescription. The third source of folate is food fortification. At present fortification is voluntary in Ireland and includes a range of food products.
While the level of NTDs has fallen considerably in recent years, there has been an increase in 2009 to 2011 where the level is now 1.17 per 1,000 births. This trend is under active review and may relate to better case detection, a reduction in food fortification levels or a reducing trend in folic acid supplementation among women booking for antenatal care. In recognition of this, safefood Ireland has recently awarded a research grant to conduct an all-Ireland study to measure red cell folate levels in women booking for antenatal care in Dublin, Cork and Belfast. In addition, the Food Safety Authority of Ireland is preparing a report for the Minister of Health on food fortification with folic acid.
The HSE has developed a guide called Healthy Eating For Pregnancy which includes the importance of taking folate to prevent spina bifida. There is further advice on the HSE's website. The Department of Health is reviewing its national guidance on folate for women of childbearing age.
In July safefood will launch a campaign entitled Babies: Know the Facts about Folic Acid. The campaign will be targeted at younger women who may be sexually active but not considering pregnancy, women who are considering pregnancy and women who already have a child but may have become complacent about taking folic acid. The key message of the campaign is to stress the importance of getting into the routine of taking folic acid every day irrespective of whether a pregnancy is being planned. As the Senator has suggested, it is mainly a digital campaign that uses social media. However, traditional communication channels will also be employed. Key partners include the Department of Health and the HSE in the Republic and the Public Health Agency and the Department of Health, Social Services and Public Safety in Northern Ireland, pharmacists, GPs and public health practitioners, as well as the support group for Spina Bifida Hydrocephalus Ireland.
I thank the Minister of State for his comprehensive reply. I note the manner in which the issue is being dealt with by the Minister and the Department. It is welcome that a campaign will start in July. It is important to involve GPs in the campaign because they are the first point of contact when people are concerned about medical issues. I ask that a real effort is made to engage with general practitioners as part of the campaign. I also ask that information is shared between maternity units and GPs.
I thank the Senator for his comments. I am pleased to note that the HSE and the Department of Health have informed me that GPs are key partners in this campaign which is due to be rolled out this month. I shall pass his comments on to the Minister for Health. I also thank him for the timely opportunity to remind people of the importance of this issue in advance of the new advertising campaign.
Eurozone Crisis
I thank the Cathaoirleach for allowing me to raise the matter of the ongoing crisis in Greece and the impact and knock-on effect it has on all eurozone countries and the entire political consequences for the European Union and beyond.
A few days after the Greek election last January I tabled a Commencement matter to the Minister of State on the aftermath of the election in Greece. At the time we were at one in pointing out that much of what had been promised and offered by way of a political manifesto by the incoming Greek Government would be difficult to fulfil and that there were no easy answers to the Greek problems. If there were easy answers then the matter would have been solved a long time ago. We agreed that it was a developing situation and it was one that could become very dangerous from an economic and political perspective. Sadly, that has all come to pass.
As I said in the House last week, it is fair to say that for the vast majority of politicians and political parties, in this House and in the other House, Mr. Tsipras and Syriza would not be our chosen political cup of tea. However, we must respect the fact that he and his party have been elected to govern by the people of Greece and that they have a mandate in that regard. In politics we must accept that political factors always impact on decision-making. From a Spanish perspective, the Podemus party offers a variation of Syriza. From an Irish factor, the Sinn Féin Party has presented the Syriza election as some sort of new dawn. Therefore, we must be cautious in our dealings with the new Greek Government. We should not cave into the thinking and ideology that has been put forward by Syriza. That is the politics of the short term. I urge Members to look beyond the short term to the medium term and beyond. We must see the impact of what is happening in Greece, not just from the politics and economics of today, but from a long-term European perspective.
As of now the failure of Greece to make its IMF repayment has marked it down as the first developed country, in almost 70 years, to fail in that regard. There is a crisis on the streets of Greece, people are unable to obtain cash, pensioners have found it difficult to access money and a huge level of human misery has been created. I would be the first to acknowledge that much of the crisis in which Greece now finds itself stems, not just from decisions made by the current Greek Government, but from a lot decisions that were taken and not taken in the past 20 years in Greece. These problems will not be solved overnight.
Speaking of the medium and long term, it is only 70 years since there was a civil war in Greece. At that time it was communists versus colonels and the military. A referendum may be held next Sunday and a similar ideological divide appears to be gearing for battle with a rather simplistic left versus right. Any further division of Greek society at present is very unhelpful. I believe eurozone Finance Ministers will participate in a conference call this afternoon which was postponed this morning. I hope that means some degree of talking is going on in the background and that some solution, even at this late stage, can be found.
Ireland is geographically removed from Greece, but we must accept that, as a member of the European Union and the eurozone, we are equal partners on the field of play. If Greece leaves or is forced out of the eurozone then such a development will come with very significant negatives. It will clearly show that the eurozone is not a fixed project. It will clearly show that countries can either opt out or be forced out. It would also be a major blow to the concept of a strong and united European and financial union. If it happened then it would come months ahead of a referendum in the United Kingdom on its relationship with the Europan Union. If Greece left the eurozone, it would pose serious fundamental questions about what the European Union is and what it wishes to be and to become.
The European Union is a great political project that united a divided continent and was built from the blood of millions of people. This fantastic project will be at risk if problems such as Greece continue to be unresolved. Obviously, the first and longest mile must be walked by the Greek Government but Ireland must try to walk with it in a spirit of co-operation and unity. In the next crucial few days our political priority must be to ensure that a fair and balanced solution is reached. Even if Ireland must swallow a little political pride, I ask the Minister of State to convey to the Government that we should look at the bigger and longer picture, and at the great vision of what the European Union is and what it can become.
I am pleased to have an opportunity to outline to the House the efforts being undertaken by the Irish Government and our euro area colleagues during Greece’s current difficult economic times.
I thank the Senator for providing me with the opportunity to do so. I agree with much of what he said. It is important that solidarity is shown in Europe and people walk together. It is difficult to do so, however, when the partner one is walking with leaves the table and runs home, which is what happened at a very late hour on Friday night last. Not only did this take Greece's eurozone colleagues by surprise, it also took some people in the Greek Government by surprise and certainly took many ordinary citizens in Greece by surprise.
Greece remains a full member of the euro area and it is in all our interests that this remains the case. However, each member of the euro area has responsibilities and obligations and this applies as much to Greece as to other members of the eurozone.
I accept the Senator's point about democracy. We will defend to the death the right of Greek people to elect whomever they wish to government. However, all the others around the table also have a democratic mandate. There is no monopoly on democratic mandates when European Finance Ministers sit down around the table. The very essence of democracy is working one's way through problems to arrive at a solution.
The International Monetary Fund has confirmed that the €1.5 billion due to be paid by Greece yesterday has not been received and Greece is now in arrears to the fund. This is the first time a developed country has gone into arrears with the IMF in a long time. In terms of the practical implications of this development, Greece can only receive financing from the IMF once the arrears have been cleared.
As of midnight last night, the second economic adjustment programme for Greece expired, with associated disbursements. Nevertheless, there remains time for a deal to be agreed and the door is still open. Greece must, however, put reasonable proposals on the table. It is in everyone's interest that agreement be reached.
Senators will be aware of the decision by the Greek authorities to impose temporary restrictions on capital flows. This measure appears to be appropriate in view of the current unique and exceptional circumstances faced by the Greek financial sector. It is, however, causing significant difficulty for Greek citizens. The European Commission confirmed on Monday that the introduction of capital controls by the Greek authorities is justified under the Treaty on the Functioning of the European Union in light of the current circumstances in Greece and with a view to maintain financial stability.
Senators will be aware that the Greek Parliament approved the call for the referendum on the policy conditionality proposals submitted by the institutions. The referendum is expected to take place on Sunday, 5 July 2015, which is after the expiration of the current programme period.
The Government and Irish citizens have great sympathy for Greek people, a view expressed by the Minister for Finance on several occasions. The Minister has also been helpful to the Greek authorities in moving to the position whereby realistic negotiations were taking place. Unfortunately, following months of negotiations between the Greek authorities and the institutions, a substantial easing in the onerous fiscal targets agreed by the previous government and a series of meetings at political level, talks concluded without a successful agreement following the unilateral decision of the Greek authorities to withdraw from negotiations.
Euro area Finance Ministers met five times in ten days to discuss the position in Greece. While there were still divergences, there was enough commonality to bridge the gap and agree a single document to which all parties could sign up. This would have been a very favourable offer to Greece as it would have addressed future financing needs and the sustainability of Greek debt. It also included support for a Commission-led package for a new start for jobs and growth that would boost the recovery of investment in the real economy. Any solution must provide Greece with an opportunity to grow the economy again. Greek people need a solution and I believed we could have found one last Saturday.
Ireland, with the other member states, understands and empathises with the difficult circumstances faced by Greek people. These have been exacerbated in recent weeks by uncertainty surrounding the programme negotiations. For this reason, there has been a willingness to negotiate a way forward which takes account of the realities of the circumstances in Greece and the political priorities of its new government, while also respecting existing commitments. The same process occurred when a new Government was elected here and we managed to reach an agreement.
The Eurogroup is closely monitoring the economic and financial position in Greece. As stated last Saturday, it stands ready to reconvene to take appropriate decisions, where needed, in the interest of Greece as a euro area member. Euro area Finance Ministers intend to make full use of all the instruments available to preserve the integrity and stability of the euro area. I note that a conference call is scheduled to take place between euro area Finance Ministers this afternoon. I hope progress can be made in this matter. Again, I thank the Senator for providing me with an opportunity to provide the Seanad with an update on the position.
Sitting suspended at 10.55 a.m. and resumed at 11.30 a.m.