Ireland’s Health: A Policy Perspective

1. Ireland’s Health: A Policy Perspective Health Impacts on the Fuel Poor Monday 6th Feb 2012

2. Overview • What is Health • Governance for Health • Health Status of Irish People • Public Health Framework • Challenges • Opportunities

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

4. 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

5. Social Determinants of Health • Social and economic circumstances • Housing • Ethnicity • Stress • Gender • Early life Development • Social Exclusion • Work and Unemployment • Social Supports

6. 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

7. Life expectancy at birth

8. Life expectancy and healthy life years at 65yrs.

9. Age standardised death rates

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

11. 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

12. Programme for Government • Special delivery unit • Universal health insurance • Care/cure split • Hospital trusts • Patient Safety Authority • Emphasis on prevention e.g. obesity

13. Male ‘000s Female ‘000s Population Pyramid for Ireland 2001 Age

14. Population Pyramid for Ireland 2031 Male ‘000s Female ‘000s Age

15. 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

16. Profile of Adult Risk Factors in Ireland (SLÁN 2007)

17. Cigarette and Alcohol Consumption

18. Obesity & Overweight Irish Children

19. 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

20. 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.

21. 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.

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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 involved Health is everyone’s business

30. Opportunities • Economic Downturn • Refocus from health services to health • Health is Everyone’s Business • All of Government Approach • Cross Sectoral Working • Reduce Health Inequalities

31. 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

32. Thank You