Healthy Ireland: in a state of wellbeing?

Michael McKernan reviews the Government’s public health strategy. Healthy Ireland sets out high ambitions but progress has been slow to date.

In March of 2013, the Taoiseach, the Health Minister and the entire Cabinet were to the fore in the launch of Healthy Ireland – a major joined-up government initiative in the health sector to run for an initial three-year period.

‘Healthy Ireland – a Framework for Improved health and Wellbeing’ was established in recognition of the fact that the challenge of improving health and wellbeing in Ireland was complex and multi-faceted and could not be addressed effectively by the Department of Health on its own. Many health and wellbeing outcomes actually result from inequality, poverty, lack of education and lifestyle choices – issues often beyond the reach of the formal health structures.

The idea therefore was to establish a framework for improving health and wellbeing which would be driven from the top of government (by the Cabinet Sub-Committee on Social Policy) but which would build strong working partnerships across government, central and local, and with the voluntary and community sector. The target was to have evidence-based interventions which could cross organisational and societal boundaries to tackle, in a joined-up way, issues like childhood obesity, substance abuse and addiction, self-harm and mental health, and active old age.

Then Health Minister James Reilly summed it up: “Evidence and experience clearly shows that to create positive change in health and wellbeing, it takes the involvement of the whole community, the whole of government, all of society working in unison. Healthy Ireland draws on existing policies but proposes new arrangements to ensure effective co-operation and collaboration across government, the health system and other relevant areas.”

Healthy Ireland was launched with a clear vision of a healthy Ireland “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.”

The organisation’s vision was accompanied by four overarching goals:

• to increase the proportion of people who are healthy at all stages of life;

• to reduce health inequalities;

• to protect the public from threats to health and wellbeing; and

• to create an environment where every individual and sector of society.

Although some of these goals may seem quite general and difficult to measure, a key step would be to develop an ‘outcomes framework’ which would draw together the relevant metrics to measure performance over time. In addition, a research work programme would be established which, among other things, would fill knowledge gaps so that where useful credible metrics did not already exist, they could be established for measurement in the future.

The framework also envisaged a strong governance structure to enhance delivery across different themes and across different organisational boundaries. In addition to leadership from the Cabinet, there would be a Health and Wellbeing Programme Unit established in the Department of Health and the HSE would create a new Health and Wellbeing Directorate to deliver on those health-specific aspects of the framework. Programme units would be established across other government departments to deliver components of the framework which fell outside the ambit of health and a series of cross-sectoral partnerships established including a high-level steering group – the Health and Wellbeing Council – bringing together the statutory authorities with experts on health and wellbeing in the NGO and community sectors.

Delivery

Although much of the Healthy Ireland implementation architecture is now in place, the roll-out of the overall initiative has been slow. While the directorate in the HSE has been established and the programme unit in the department is in place, work on other aspects of the programme has in some cases slipped significantly.

The Health and Wellbeing Council has now been set up under the chairmanship of Irish rugby legend Keith Wood and comprises an impressive array of public officials and sectoral experts – 37 in total.

However, the council only had its first meeting in June 2014, some 15 months after the launch of the Healthy Ireland Framework – a long time to establish the steering group for a major initiative with an initial three-year time horizon.

Perhaps of more concern is the failure to date to deliver the outcomes framework which had been promised by the end of 2013. The framework is considered essential to monitoring current trends and to forecasting and evaluating the performance of interventions aimed at delivering the four main goals.

As recently as late August, the Department of Health indicated that work on the outcomes framework was “ongoing”. Similarly, work on the development of the research and data plan to support the implementation of the Healthy Ireland framework is still described by the department as “ongoing”.

Although slow to actually get up and running, Healthy Ireland has had some initial success. In October 2013 as targeted, safefood, in partnership with the HSE, launched a three-year nation-wide campaign to raise awareness around childhood obesity and to remind parents in particular of the dangers of excess weight in their children. This is one of a number of collaborative initiatives anticipated under the Healthy Ireland framework. Another is a National Plan for Physical Activity, which is to be published later this year.

There is no doubt that an integrated cross-sectoral national framework for raising levels of health and wellbeing is a great idea and an initiative that very few organisations or people in Ireland would not support. It is not, however, a completely new idea as similar initiatives have been launched in other countries.

It will be interesting to see if the Healthy Ireland initiative, despite the support from the top of government, can cross Ireland’s notoriously entrenched departmental, sectoral and organisational boundaries. This will require government departments to allocate resources to programmes and measures that are not an immediate priority within their traditional remits in order to deliver the central objectives of the health sector. The slippage to date in getting elements of the package up and running suggests an initial element of foot-dragging, although delivery may accelerate once some momentum has built up.

The recent Cabinet changes may not have helped Healthy Ireland in the sense that some of the incoming ministers may lack the commitment and buy-in of their predecessors. Importantly, however, newly appointed Health Minister Leo Varadkar is committed to the framework and may well give it the extra push that it appears to need. The overall picture will become very much clearer over the next 12 months.