Ireland’s Health: A Policy Perspective

Health Impacts on the Fuel Poor

Monday 6th Feb 2012

Overview

• What is Health

• Governance for Health

• Health Status of Irish People

• Public Health Framework

• Challenges

• Opportunities

Health

• Health is defined as a state of “complete physical, mental and social well being”. This definition was formulated in 1946 by the WHO

Governance for Health

• ‘Governance for health’ is defined as the attempts of governments or other actors to steer communities, countries or groups of countries in the pursuit of health as integral to wellbeing through both a ‘whole-of-government’ and a ‘whole-of-society’ approach

Social Determinants of Health

• Social and economic circumstances• Housing• Ethnicity• Stress• Gender• Early life Development• Social Exclusion• Work and Unemployment• Social Supports

Inequalities in Mortality: A report on all Ireland Mortality Data 1989-1998

• All cause mortality rate in lowest occupational classes is 100-200% higher

• For circulatory disease, it is 120% higher

• For cancers, it is 100% higher

• For respiratory disease, it is >200% higher

• For injuries and poisoning, it is >150% higher

Life expectancy at birth

Life expectancy and healthy life years at 65yrs.

Age standardised death rates

Self-perceived health by income quintile: good or very good health

The case for change

• Disease burden– Demography, epidemiology– Global trends shaping health and illness

• Practice changes– teamworking, specialisation etc.

• Policy developments - patient safety• Public perception • Technology - medical and ICT• Cost• Third era of health care

Programme for Government

• Special delivery unit

• Universal health insurance

• Care/cure split

• Hospital trusts

• Patient Safety Authority

• Emphasis on prevention e.g. obesity

Population Pyramid for Ireland 2001

140

135

148

167

169

160

138

134

129

122

114

93

75

63

51

37

22

14

131

127

141

159

166

157

137

138

132

121

112

91

75

66

60

52

36

30

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-85

85+

Male ‘000s Female ‘000s

Age

143

146

157

166

158

152

140

130

140

162

176

164

139

122

101

74

46

27

134

138

148

157

151

146

137

128

139

162

177

164

143

135

119

98

73

60

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-85

85+Male ‘000s Female ‘000s

Age

Population Pyramid for Ireland 2031

Preventability

• 60% disease burden due to tobacco, alcohol, cholesterol, high blood pressure, diet, overweight & physical inactivity

• 80% chronic disease (cardiac, stroke, diabetes) avoidable

• Unacceptable levels chronic disease over next decades

Profile of Adult Risk Factors in Ireland (SLÁN 2007)

Cigarette and Alcohol Consumption

Obesity & Overweight Irish Children

Policy response• To develop a public health policy

– Your Health is Your Wealth: A Policy Framework for a Healthier Ireland: 2012-2020

– Tied into WHO Health 2020• To bring to reality the provisions in the Programme for

Government with regard to the health and wellbeing of the whole population

• A healthier population – Protected from public health threats– Living in a healthier and more sustainable environment– Increased social and economic productivity – Greater social inclusion

Terms of reference…(1)

• To develop a policy framework for public health which addresses– wider determinants of health and health

inequalities– chronic disease and lifestyle – inter-sectoral and cross-sectoral approaches at

policy and practice level– protection from and responses to public health

threats.

Terms of reference…(2)

• And which will encompass ethical, legal, organisational and professional practice issues for public health having regard to:– the Programme for Government– current resource constraints– prevailing economic circumstances– the views of stakeholders as identified through consultation– the strength and weaknesses of the current system– the policy framework for Health 2020 as set out by the WHO Euro

region– policies, practices, structures and other developments in other

countries– the evidence base for public health policy and practice.

Methods

• No steering group– Working group to develop proposals based

on• SWOT analysis using WHO framework• Consultation• Evidence• International Models

• Highly consultative approach• Five strands

Consultation- Five strands• Strand 1 – National consultation day - 13th June, RCPI

– WEBLINK from RCPI website• Strand 2 – Regional meetings to mirror national consultation day

with local HSE Local Authorities, schools and sporting organisations.

• Strand 3 – General consultation, inviting targeted organisations, as well as the general public, to respond to specific questions on public health priorities

• Strand 4 – Targeted consultation for Health Sector engagement - HSE and funded agencies

• Strand 5 – Bi-lateral meetings with relevant Government Departments, agencies and community/voluntary organisations

June 13th 2011

• Minister• Speakers included

– Zsuzsanna Jakab, WHO– Michael Marmot, UCL– Michael McBride, CMO Northern Ireland

• Invited audience• Workshop- structured questions• Weblink- RCPI.ie

Three strands

• Health protection– Emergency planning and preparedness– Communicable disease control– Environmental health– Food and water safety

• Health promotion– Health inequalities– Health improvement– Lifestyle related risks

• Health service delivery– Population planned services deliver to individuals– A public health approach to service planning, delivery and

evaluation

Related policies

• Child health • Healthy workforce• Positive ageing • Participation in society

– disabilities – mental health issues

• Framework Sustainable Development Ireland• Climate Change Policy• Active Transport Policy

Process must

• Define the problem, highlight the successes, acknowledge the weakness/failings, find balanced solutions

• Seek to engage leaders and policy makers across government and society– health and wellbeing lie outside the health sector – improving the public’s health is the responsibility of

all sectors of society• Identify practical ways to strengthen working

between sectors– Policy level– Local level

Final product

•Presented in three sections–Analysis–Plan–Implementation

•To be completed by mid year and launched by Minister for Health

–Action oriented–Integrated/ value added

Key messages

• First ever policy on public health in its widest sense– Once in a generation opportunity

• Timing is good– Refocusing of health system– Tie into WHO Health 2020

• We need you to become involvedHealth is everyone’s business

Opportunities

• Economic Downturn • Refocus from health services to

health• Health is Everyone’s Business• All of Government Approach• Cross Sectoral Working• Reduce Health Inequalities

Challenges

• Health is Everyone’s Business• All of Government Approach• Cross Sectoral Working• Economic Downturn• Reduce Health Inequalities• Increase in chronic disease• Demography• Research Agenda

Thank You