1. Population Mortality and Morbidity in Ireland n April 2001

2. Irish Population Mortality 1962-1996

3. Mortality Improvement by Age Group

4. Mortality rates by cause for 15-34 year olds

5. Mortality Rates from Road Traffic Accidents 1962 - 1996

6. Mortality Rates from Suicide 1962 - 1996

7. Mortality rates by cause for 35-64 year olds

8. Mortality Rates from Circulatory Diseases 1962 - 1996

10. Mortality rates by cause for over 65 year-olds

11. Mortality Rates from Lung Cancer 1962 - 1996

13. Mortality Rates from Pneumonia 1962 - 1996

15. Male mortality improvements by decade & age group

16. Female mortality improvements by decade & age group

17. International Experience Comparisons Source – Calculated from WHO Statistical Information System Mortality Data. Countries: Ireland, Scotland, Denmark, Germany, US, England & Wales, Australia, France, Greece, Sweden, Japan. 1996 for all except Australia 1995.

18. International Experience Comparisons Source – Calculated from WHO Statistical Information System Mortality Data. Countries: Ireland, Scotland, Denmark, Germany, US, England & Wales, Australia, France, Greece, Sweden, Japan. 1996 for all except Australia 1995.

19. Assessing impact of diseases on population health n Cause of death analysis n Years’ lost analysis n Disability years’ lost analysis

20. Males Cause of Death versus Years’ Lost

21. Females Cause of Death versus Years’ Lost

23. Part 2 n Impact of particular causes and lifestyle on Mortality

24. Agenda n Causes –Cardiovascular conditions –Cancer –Road Traffic Accidents –Suicide –AIDS n Risk factors –Smoking –Diet & Lifestyle

25. Cardiovascular diseases n 43% of all deaths are due to such conditions n Covers many illness types such as heart failure, diseases of the arteries, stroke and hypertension related diseases n Mortality varies significantly by age and gender n Certain types of these disease are affected by geographic area of residence n Main cause of death for those over 65 years of age n Trend in EU is downwards in relation in to incidence of such diseases n Though need to consider each individual cause separately

26. Cardiovascular - Heart disease n For heart disease, trend is downwards for both males and females n Mirrors international experience, though fall is at a faster rate than EU average n However, is still higher than EU average

27. Cardiovascular - Stroke n Trend is downwards for incidence of death due to a stroke for both males and females n Fall again is at a faster rate than EU average n So, much so that there is no statistical difference between Ireland and EU average experience

28. Cancer n Like cardiovascular conditions many different forms of cancer (Over 200 known) n Not all cancers cause death n Second largest cause of death in Ireland n Incidence rate varies significantly between males and females n Also, within geographic areas depending upon the form of cancer n In international terms, Ireland’s cancer mortality rates are higher than the average

29. Cancer – Breast cancer n Ireland has one of the highest rates of breast cancer in the EU n Trend for incidence at younger ages is downwards n For older lives, trends appears to be upward n Could be explained by differences in screening programmes n Western world has significantly higher incidence of breast cancer than developing world

30. Road Traffic Accidents n Road Safety performance over last 30 years has shown considerable improvement n However: –Still one of main cause of deaths within 15-34 age group –By international standards relatively high n At all ages, higher incidence among males than females n By number of deaths largest number within 15- 24, 25-34 and 65+ age groups

31. Suicide n Rate of suicide has risen sharply over the last 20 years n Possible reasons for the increase include: –Underlying rate has increased significantly –Reporting may have increased –Coding may be more accurate n One of main cause of deaths within 15-34 age group n Significantly higher incidence among males than females n Particularly high incidence rate among young males

32. Suicide n Significant differences between countries n These differences also are by age group Unable to find any conclusive reason to explain this variation though climate is a possibilty

33. AIDS Pattern for AIDS: n Low number of cases and deaths in 1980’s followed by a rapid increase in mid-1990’s n Appears to have been dramatic fall since late 1990’s

34. AIDS n Same picture reflected internationally

35. AIDS n However, the AIDS pattern is not reflected in HIV rates n Upwards trend since mid-1990’s

36. AIDS n Could be explained by a change in the development times between onset of HIV, onset of full-blown AIDS and death due to AIDS n Working Party believes significant health issue around increase in HIV levels n However, caution needed in predicting doom as theory that death is only deferred is open to debate n If people are living longer then heretofore increased cost of treatment of AIDS needs to be considered

37. Smoking n Lifestyle factor with most widely known impact on health n Peto has completed extensive research on smoking patterns between countries n SOA study on Irish Assured Lives has found that mortality for smokers was appproximately twice that for non-smokers n Experience from Peto suggests it is could be as high as three times that of non-smokers

38. Smoking n 6,000 people die each year as a result of causes attributed to smoking n Certain causes affected more than others from smoking e.g. lung disease, heart disease n By international standards, Irish smoking rates comparatively low for males but high for females n Continued innovative ‘no-smoking’ campaigns are to be encouraged

39. Diet & Nutrition n No data for working party to consider effects of diet explicity n Long term relationship between health status and diet n International studies have found that there is a change in mortality depending upon the in-take of certain food groups

40. I have good news

41. …and even better news

42. The good news is n mortality will, we believe, improve over the immediate future

43. Reasons for this

44. n Continuation of past trends

45. Reasons for this n Continuation of past trends n Cohort Effect

46. Reasons for this n Continuation of past trends n Cohort Effect n Increasing Wealth

47. Reasons for this n Continuation of past trends n Cohort Effect n Increasing Wealth n Screening

48. Reasons for this n Continuation of past trends n Cohort Effect n Increasing Wealth n Screening n Smoking behaviour

49. The Even Better News n The scope for improvement is considerable

50. Reasons for this

51. n Many of the areas where we have been performing comparatively poorly are fixable

52. Reasons for this n Many of the areas where we have been performing comparatively poorly are fixable n Suicide levels can be brought to the levels of our neighbours

53. Reasons for this n Many of the areas where we have been performing comparatively poorly are fixable n Suicide levels can be brought to the levels of our neighbours n Similarly RTA

54. Reasons for this n Many of the areas where we have been performing comparatively poorly are fixable n Suicide levels can be brought to the levels of our neighbours n Similarly RTA n Heart Disease can be brought down to Swedish Levels

55. Reasons for this n Many of the areas where we have been performing comparatively poorly are fixable n Suicide levels can be brought to the levels of our neighbours n Similarly RTA n Heart Disease can be brought down to Swedish Levels n Breast Cancer can be detected earlier and this will lead to more survival

56. Reasons for this n Smoking levels can be reduced

57. Can we fix it

58. Can we fix it --- Yes We Can

59. n As a state we are aware of the “problems”

60. Can we fix it --- Yes We Can n As a state we are aware of the “problems” n We have the financial resources

61. Can we fix it --- Yes We Can n As a state we are aware of the “problems” n We have the financial resources n Do we have the collective will?

62. “Rage, rage against the dying of the Light” Dylan Thomas