Seanad Éireann díospóireacht -
Thursday, 18 Sep 1997

Vol. 152 No. 2

Adjournment Matters. - Louth Mortality Profile.

Mr. O'Dowd

A Chathaoirligh, ba mhaith liom comhghairdeas a dhéanamh leat as ucht an post nua atá agat agus tá súil agam go mbeimís go léir ag obair leat don tír agus don áit seo. Is mór an onóir domsa freisin a bheith anseo inniu agus an tAire Sláinte a bheith romhainn chun deiléail leis an argóint mhór ó thaobh sláinte i gContae Lughaidh.

If I make errors in my contribution, it is because I am not used to the procedure of the House. I hope I will make my point as clearly and succinctly as I can. I welcome the Minister here to reply to the matter I wish to raise. This concerns the Central Statistics Office's Louth Mortality Profile 1991-1995, which shows serious health problems for the population of County Louth. There is a significantly higher death rate from heart disease in females, respiratory disease in males and females, deaths due to motor vehicles in males and females and cancer of the trachea, bronchus and lungs in males.

In an index of 27 counties — Tipperary North and South Riding are counted as two — Louth has the highest rate of cancers of the trachea, bronchus and lungs. It is also the worst county for deaths from all respiratory system diseases. There are also very high rates of malignant neoplasms and as regards the incidence of breast cancer we are 22nd of 27 counties.

These are serious health issues which must be addressed. The Journal for Health Gain, published with support from the Department of Health, and Children, includes two fine articles on this issue by Dr. Alan Kelly, Dr. Hamish Sinclair and Dr. Dennis Pringle, “Mapping Inequalities in Health” and “Identifying the Blackspots — An index of deprivation”, which indicates poor health in a particular location, includes the factor of unemployment. Unemployment in County Louth is higher than anywhere else in the country. Counties Meath, Cavan and Monaghan have a combined population of 218,000 and Louth has a population of 82,000. Yet the cumulative unemployment figures for Meath, Cavan and Monaghan are basically the same as for County Louth. Based on indicators of black spots for unemployment, County Louth has a serious problem. The population of County Clare is similar to that of County Louth, but County Clare's unemployment rate is half that of County Louth. The population of County Waterford is also roughly the same as County Louth, but the number unemployed there is 2,000 fewer than in County Louth. The indications are that the unemployed tend to suffer from poor health and County Louth has the worst record in that regard. Drogheda has an unemployment figure of 4,500 which is 200 greater than the total number of people unemployed in County Meath. There are 3,900 on the live register in County Offaly.

Car ownership is another indicator of health deprivation. In the North Eastern Health Board region County Meath has the highest percentage of car ownership, with at least one car per family. The rate of car ownership is 78 per cent in County Meath, 71 per cent in County Cavan, 70 per cent in County Monaghan and 62 per cent in County Louth. We must examine the effects of unemployment and the lack of ability to purchase facilities necessary for a healthy lifestyle. One is three times more likely to die in a road accident in counties Louth or Meath than in anywhere else in the country. Male and female deaths in road accidents in County Louth is particularly high. I hope the Minister will address those points. The health board and the Departments of Education and Science and the Environment and Local Government should also get involved.

The question surrounding Sellafield is of tremendous importance in County Louth. STAD has promoted an awareness of the effects of low level radiation in the county. I am not sure whether funding has been provided for the legal case being taken by that group, but public representatives in the area are anxious the money should be provided.

Lung cancer is another major cause of death in County Louth and throughout the country. Ninety per cent of deaths from lung cancer are caused by smoking. Departments and voluntary agencies should make a co-ordinated effort to encourage people, particularly the young, to stop smoking. As a school teacher I am aware it is difficult to stop young people smoking; young female students tend to smoke most. The Minister and the health boards should endeavour to tackle this problem.

We should find out what is different about County Louth that is causing such high levels of ill health among the people there? There is only one way to do this. A lifestyle survey should be carried out in the county to find out what is causing the health problems. Professional research indicates that some of the matters I have mentioned are high on the list of causes. A minis-terial-led task force should also be appointed to address in particular the problem of unemployment in the county. Despite the efforts of the IDA and other bodies, we could not provide a serviced site for a new industry in south County Louth if one wished to locate there. Long-term unemployment impacts on people's health and the Government must respond by appointing a task force to attract more employment to County Louth and better health for its people. Ba mhaith liom mo bhuíochas a ghabháil duit as éisteacht liom agus tá súil agam go mbeidh toradh maith ar an chaint seo.

An Cathaoirleach

I compliment Senator O'Dowd on an excellent maiden contribution.

Minister for Health and Children (Mr. Cowen)

I congratulate you, Sir, on your appointment. I also welcome Senator O'Dowd to the Seanad where I am sure he will have a fruitful career and move on to other places if he wishes.

I assume the Senator is referring to data from the recently introduced public health data information system produced by my Department. It is intended as a minimum common data set of public health indicators and is designed for use, in the first instance, by the directors of public health in the health boards. Data at this level of detail have not been readily available until recently and it is important to interpret the information with a great deal of caution for a number of reasons. Rates of death or illness based on small areas and specific causes can show considerable variability. To be meaningful they must be interpreted in the context of long-term time trends. Even where a given rate of death or illness appears to be higher than the national average, the difference may not be statistically significant. Differences in mortality rates may be due to lack of standardisation between regions in the recording of causes of death.

It is clear that further analysis will be required by the directors of public health to determine whether the data to which the Senator referred are significant. Subject to the comments I have made about reliability and interpretation difficulties, the following observations can be made about the individual diseases raised by the Senator. The death rate from heart disease is best indicated by data on cerebrovascular and circulatory illnesses and heart attacks. In the case of cerebrovascular disease, the death rate for females in Louth was very close to the national rate during the period 1991 to 1995. The number of deaths per 100,000 population from this disease was 76 in Louth compared with 75 nationally. The same applies to diseases of the circulatory system. The Louth rate was 300 per 100,000 compared with 298 per 100,000 for the country as a whole. In the case of heart attacks, the death rate among females in Louth has decreased somewhat in recent years, although it still remains above national rates — 134 per 100,000 population in Louth compared with 118 per 100,000 nationally. Deaths from diseases of the respiratory system in both males and females appear to have remained stable in Louth while rates nationally have shown a gradual decrease. The reasons for this divergence are not yet clear and will require further research. In the case of cancer of the trachea, bronchus and lung, the death rate has fluctuated considerably in Louth. Cancer mortality rates in urbanised areas along the east coast tend to be higher than the national average and Louth appears to follow this pattern. The National Cancer Strategy notes these apparent regional variations and indicates that further research will be necessary to determine whether they are significant.

My Department has been conscious for many years of the importance of identifying and addressing the causes of preventable deaths in Ireland. The diseases referred to in the Senator's motion are among the chief causes of premature mortality, defined as deaths among those aged under 65, in Ireland. Cancer and cardiovascular disease are two of the three biggest causes of death in the population aged under 65 years. I emphasise that smoking is the single biggest preventable cause of cancer and cardiovascular disease.

The data for Louth indicates that the death rates among those aged under 65 from the diseases referred to by the Senator have been coming closer to the national average in recent years. For example, the death rate from lung cancer among males under 65 in Louth has dropped much more steeply than in the country as a whole since 1980. Similarly, Louth's death rates in the under 65 age group from diseases of the respiratory system have also been moving steadily towards the national average.

The Senator will be aware of two important policy documents dealing with heart disease, respiratory disease and cancer that have been implemented by my Department. These are the Health Strategy, Shaping a Healthier Future, and the National Cancer Strategy. Both documents, which were published by my predecessors, have my full support and I am totally committed to implementing their proposals.

The Health Strategy points out that 20 per cent of deaths in Ireland every year are among those aged less than 65. It identifies the key areas of risk that contribute to the likelihood of getting cancer and cardiovascular disease. It then sets targets for each of them under the main headings of reduction in smoking; responsible use of alcohol; balanced nutrition and diet; and control of cholesterol and blood pressure.

Cancer accounts for 7,500 deaths in the population as a whole every year and for about 6,000 deaths among those aged under 65. The National Cancer Strategy aims to achieve a key target set in the health strategy: "To reduce the death rate from cancer in the under-65 age group by 15 per cent between the years 1994 and 2004". The strategy includes such initiatives as reorganising cancer treatment services, developing medical oncology and specialist palliative care services and organising targeted national screening programmes to combat breast cancer and cervical cancer. These and many other developments under the National Cancer Strategy will be of benefit to the Louth area.

The Government is committed to implementing the Health Strategy, Shaping a Healthier Future, and the National Cancer Strategy to best effect in all parts of the country. I am confident that good progress will be made in reducing the rate of preventable mortality in the years to come.

The Seanad adjourned at 4.35 p.m. until 2.30 p.m. on Wednesday, 8 October 1997