Healthy Ireland:Addressing Health Inequalities

Diarmuid O’DonovanDirector of Public Health, HSE West

Senior Lecturer, Social & Preventive Medicine, NUIG

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•Determinants of Health

•Health Inequality in Ireland– socio-economic dimensions of health differentials

•Ireland’s response to improving health and wellbeing of the population

What is health?

What do we need to be healthy?

Health inequality… Health inequity• A difference in which disadvantaged social

groups systematically experience worse health or greater health risks than more advantaged social groups

Braveman 2006

• Differences in health that are not only unnecessary and avoidable but, in addition, are considered unfair and unjust

Whitehead 1990

Source: Central Statistics Office (2010A, p10) Mortality Differentials in Ireland (online). Available at: http://www.cso.ie/en/media/csoie/census/documents/Mortality_Differentials_in_Ireland.pdf

Deprivation ranking in quintiles of Electoral Divisions, Republic of 

Ireland, 2010

Change in deprivation rate Ireland 2004‐2010

Deprivation rate for individuals living in households with/without children by year

A household with children is substantially more likely to be materially deprived than one 

without

Source: Central Statistics Office. Survey on Income and Living Conditions‐ thematic report on Children 2004‐2010. CSO Dublin, 2012. Available online at: http://www.cso.ie/en/media/csoie/releasespublications/documents/silc/2010/children0410.pdf

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Socioeconomic gradient in health • Many studies have documented a socioeconomic gradient in 

mortality, morbidity, perceived or self reported health and lifestyle factors:– Unemployment, low income poor housing– More than double the death rate in the lowest SEG compared to the 

highest SEG for most diseases– Marked differences for some conditions: mental and behavioural 

disorders, diseases of the respiratory system, and diseases of the digestive system.

– Significant difference in the social distribution of a range of cancers

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Socioeconomic gradient in health– Chronic illness is more prevalent in the unskilled manual workers

and for those with lower incomes– People in income poverty are less likely to reporttheir health as

good or very good health – Evidence of social class differences in risk factors such as BMI,

waist circumference, blood pressure.– Social gradients in smoking, physical activity, dietary intake,

alcohol use

Source: Central Statistics Office (2010B, p3) Mortality Differentials in Ireland (online). Available at: http://www.cso.ie/en/media/csoie/census/documents/Mortality_Differentials_in_Ireland.pdf (Accessed 26th February 2014)

Life Expectancy by Social Class, Republic of Ireland, 2010

Deviation of life expectancy at birth from average life expectancy by deprivation ranking

Source: Central Statistics Office (2010A, p3) Mortality Differentials in Ireland (online). Available at: http://www.cso.ie/en/media/csoie/census/documents/Mortality_Differentials_in_Ireland.pdf(Accessed 26th February 2014)

Health Inequalities: Heart Attack and Angina

Population prevalence rates of angina and heart attack amongst adults across the deprivation bands in the Republic of Ireland within each sex and age group, 2007

Balanda KP, Barron S, Fahy L and McLaughlin A. Making Chronic Conditions Count: Hypertension, Stroke, Coronary Heart Disease and Diabetes. Dublin. Institute of Public Health in Ireland. 2010. Available at: http://www.publichealth.ie/files/file/Making%20Chronic%20Conditions.pdf 

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Healthy IrelandA Framework for Improved Health

and Wellbeing2013-2025

Vision: where everyone can enjoy physical and mental health and wellbeing to their full potential, where wellbeing is valued and supported at every level of society and is everyone’s responsibility.

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Healthy Ireland Goals• Goal 1: Increase the proportion of people who

are healthy at all stages of life

• Goal 2: Reduce health inequalities

• Goal 3: Protect the public from threats to health and wellbeing

• Goal 4: Create an environment where every individual and sector of society can play their part in achieving a healthy Ireland

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Framework of Actions

• Governance and Policy• Partnerships and Cross-Sectoral Working• Empowering People and Communities• Health and Health Reform• Research and Evidence• Monitoring, Reporting and Evaluation

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Participation

• Work with Social Inclusion Unit• Local health partners will work with local

authorities• Prioritise community based programmes

for those most at risk• Support and link existing partnerships

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Healthy Ireland:Priority Areas for Implementation

• Research Plan and Outcomes Framework • Healthy Ireland Council• Positive Ageing Strategy • Substance Misuse policy• Tobacco Free Ireland

• Physical Activity• Dementia Strategy• Early Years Strategy

Key enablers–Fit for purpose Health &Wellbeing Division–Evidence and building a ‘Knowledge Management’ function & capacity–Strategic Communications: patient and population empowerment–Partnership and strengthen frameworks and infrastructure for deliverySetting the groundwork for sustained engagement and community mobilisation on this issue and for increased investment in health improvement for all

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Socioeconomic gradient in health• References• Central Statistics Office, Mortality Differentials in Ireland . 2010.• All Ireland Traveller Health Study Team UCD, Our Geels, All Ireland Traveller Health Study –

Summary of Findings DOHC, 2010• Balanda, K.P., Barron, S., Fahy, L., McLaughlin, A. 2010. Making Chronic Conditions Count:

Hypertension, Stroke, Coronary Heart Disease, Diabetes. A systematic approach to estimating and forecasting population prevalence on the island of Ireland. Dublin: Institute of Public Health in Ireland, 2010

• Morgan K, McGee H, Watson D, Perry I, Barry M, Shelley E, Harrington J, Molcho M, Layte R, Tully N, van Lente E, Ward M, Lutomski J , Conroy, R, Brugha R , 2008, ‘SLÁN 2007: Survey of Lifestyle, Attitudes & Nutrition in Ireland.’ Main Report. Dublin: Department of Health and Children

• R. Layte, C. McCrory, 2011, Growing up in Ireland – National Longitudinal Study of Children: Overweight and Obesity Among 9-Year-Olds,Department of Children and Youth Affairs Dublin: Government Publications

• Office of Tobacco Control, Ireland: Current trends in cigarette smoking, downloaded from http://www.otc.ie/research.asp

• EU-SILC EuroStat in Dept. of Health and Children, Health in Ireland Key Trends 2011• CSO Survey on Income and Living Conditions Preliminary Results 2010• EU Survey of Income and Living Conditions 2009, in Health in Ireland key trends 2011, DOHC

healthandwellbeing@hse.ie