Health and care services

Tackling inequalities in health

Vanessa Hetherington Vanessa Hetherington sets out the case for closing the health gaps between rich and poor.

Ireland has significant levels of health inequalities. Throughout the boom years these inequalities were evident and since the recession, these inequalities appear to be widening.

Addressing health and social inequalities is important for our country; it is a long-term undertaking. Improving the health of all our citizens (particularly the poorest and most deprived) will reap long-term dividends by ensuring a healthier population, and a more productive workforce, who will have less need for expensive health interventions and social economic supports. ‘Healthy Ireland’ lays the Government’s framework for improving health reducing health inequalities. Now we need leadership, planning and resources to implement it.

The Irish Medical Organisation have been highlighting for a number of years now, the significant inequalities in health that exist between wealthier and poorer socio-economic groups in Ireland. The IMO position paper on health inequalities points to the evidence which shows that poorer socio-economic groups have relatively high mortality rates, higher levels of ill health and fewer resources to adopt healthier lifestyles.

A wide range of factors – such as poverty, inequality, social exclusion, employment, income, education, housing conditions, transport access to health care, lifestyle and stress – all impact significantly on an individual’s health and wellbeing. While absolute poverty has been a recognised risk factor for a range of diseases, it has only been relatively recently appreciated through the work of Sir Michael Marmot that relative disadvantage has a harmful impact on health. Wilson and Picket, having examined international data, also found that more equal societies have both lower levels of health problems and lower levels of social problems.

As Sir Michael Marmot states, reducing health inequalities is primarily a matter of fairness and social justice but reducing health inequalities also makes financial sense. A healthier population leads to improvements in the productive capacity of the country and to long-term savings in health and social spending.

Because good health is socially, economically and environmentally determined, policy choices implemented by all departments – not just the Department of Health – can significantly impact on a person’s health. Thus, a Health in All Policies (HiAP) approach is needed to address the socio-economic determinants of health.

As included in the IMO’s recommendations, evidence-based policies and initiatives are required across all departments and across sectors to tackle the unequal distribution of wealth and ensure that all children have the opportunity to realise their maximum potential. All policies should be subject to a health impact assessment. The IMO have also highlighted the role of universal access to GP and other primary care services in reducing health inequalities.

In March 2013, the Government published ‘Healthy Ireland – A Framework for Improved Health and Wellbeing 2013-2025’. The document sets out 64 actions required to achieve the following high-level goals:

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

• reduce health inequalities;

• protect the public from threats to health and well-being; and

• create an environment where every individual and sector of society can play their part in achieving a healthy Ireland.

The framework adopts a Health in All Polices (HiAP) approach and most government departments have signed up to partner its implementation. ‘Healthy Ireland’ is a welcome document and reflects the views of the many stakeholders and contributors. No-one can argue with its aspirations but too often worthy strategies have remained aspirational due to lack of leadership and responsibility, no detailed implementation plan and insufficient resources.

The Government must recognise health as a basic human right of every person in Ireland and health preventative measures should underpin every activity of government. Ireland cannot afford not to tackle health inequalities. ‘Healthy Ireland’ urgently requires a detailed implementation plan accompanied by appropriate multi-annual ring-fenced funding to support evidence-based actions and initiatives.

In view of the large contribution that social determinants make to the health status of the population, the Taoiseach should appoint a Minister for Public Health with responsibility for its delivery and implementation.

Vanessa Hetherington is Assistant Director for Policy and International Affairs with the Irish MedicalOrganisation.

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