Health and Wellbeing Health Service Executive Healthy Ireland – The policy context for addressing health inequalities in Ireland Dr. Stephanie O’Keeffe, National Director, Health and Wellbeing

2 2 Why: Health Check EU goal +2 years of healthy life expectancy & reduction in health inequalities Life expectancy has improved but… obesity and predicted increases in chronic diseases and cancers stand in the way Population Growth Population Ageing +65s and +85s

3 3 Health Check Half of people over 50 have one chronic disease, 11% have more than one (TILDA). 20% to 40% increase expected in major chronic diseases by Three quarters of deaths in Ireland are due to three chronic diseases – cancer, CVD and respiratory diseases, which are largely preventable. Death rates: social class gradient % higher in lower SES. This pattern is true for cancers and CVD and markedly so for respiratory disease.

Context - Health Trends Diet and nutrition Smoking Alcohol Physical Activity Hypertentsion Mental wellbeing Ageing population Chronic disease ↑ Healthcare sustainability €

International Strategic Context

Deviation of life expectancy at birth from average life expectancy by deprivation ranking Social determinants of Health Inequalities 1

Life Expectancy by Social Class, Republic of Ireland, 2010 Social determinants of Health Inequalities 2

Low High Educational inequality and obesity Obesity and education level, females, Eurothine Study, 2009

Obesity: Systemic risks require systemic solutions

Healthy Ireland Healthy Ireland A Framework for Improved Health and Wellbeing 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.

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

12 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

National Strategic Context Improved health and wellbeing one of four pillars of reform in Future Health A Strategic Framework for Reform of the Health Service Future Health and Healthy Ireland underline commitments at national level and service wide to reform our services and systems toward a renewed focus on chronic disease prevention and improved health and wellbeing

14 Context: Health Service Reform

What works: learn from tobacco Price Fiscal measures Regulation settings Restrict marketing Advertising Labelling Change norms Support Services Multiplier effects

17 Health and Wellbeing: Priority Areas for Implementation Reform H&W objectives embedded across health reform programmes Capacity for system-wide implementation and reporting National Leads and implementation plans for: child health and wellbeing, positive ageing, tobacco control, healthy eating and physical activity, alcohol misuse, sexual health

Health and Wellbeing: Priority Areas for Implementation Models of care: Integrated clinical care programmes underpinned with prevention National Framework for self care in 2015 National model for brief intervention – every contact counts Consistent data capture on HIPE for lifestyle factors and interventions Generic model of care for chronic disease prevention and management Health Service Staff improved levels of health and wellbeing Site specific Healthy Ireland implementation plans: Hospital Groups & CHO

Key enablers Fit for purpose H&W Division Evidence and building a ‘Knowledge Management’ function & capacity Communications strategy: patient and population empowerment Partnership and strengthen frameworks and infrastructure for delivery Capacity for sustaining the agenda nationally Setting the groundwork for increased investment in prevention

Thank you. Questions