ireland’s health: a policy perspective
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Ireland’s Health: A Policy Perspective
Health Impacts on the Fuel Poor
Monday 6th 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 1989-1998
• All cause mortality rate in lowest occupational classes is 100-200% 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
140
135
148
167
169
160
138
134
129
122
114
93
75
63
51
37
22
14
131
127
141
159
166
157
137
138
132
121
112
91
75
66
60
52
36
30
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-85
85+
Male ‘000s Female ‘000s
Age
143
146
157
166
158
152
140
130
140
162
176
164
139
122
101
74
46
27
134
138
148
157
151
146
137
128
139
162
177
164
143
135
119
98
73
60
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-85
85+Male ‘000s Female ‘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: 2012-2020
– 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 - 13th 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 13th 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 involvedHealth 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
Thank You
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