Ireland’s Health: A Policy Perspective Health Impacts on the Fuel Poor Monday 6 th 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 All cause mortality rate in lowest occupational classes is % 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 Male ‘000sFemale ‘000s Age

Male ‘000sFemale ‘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: –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 - 13 th 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 13 th 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 involved Health 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

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