The Institute of Public Health in Ireland has been instrumental in encouraging the two Irish governments to address disparities in health related to socio-economic factors. Owen Metcalfe, Associate Director, describes the process, the emphasis on partnership between government departments and disciplines, and the hopes for the future.
The focus on health inequalities has sharpened on the island of Ireland recently. At a policy level this is demonstrated in Northern Ireland where the consultation process for the "Investing for Health Strategy" emphasised that "the better off you are the longer you can expect to live; the less likely you are to be ill, or to spend the later years of your life suffering from a chronic disease or disability". In the Republic of Ireland the commitment is evident in the new Health Strategy "Quality and Fairness" where it is stated that "the most powerful influences affecting health and the promotion of health are socio-economic factors, in particular poverty".
The principle of consultation has been important in formulating these strategies which provide the framework for the health of people on this island for the next decade. Individuals and organisations participated, and the emphasis on inequality has undoubtedly been strengthened by the broad consultative process that was engaged in North and South. This participation has helped government departments to develop informed and relevant policy.
What people now want to know is will this process and the rhetoric contained in the strategy documents make a difference? The setting of specific targets is an opportunity to assess progress and over time we will know if we are moving in the right direction. A good example of a specific target is the target contained in the Southern Ireland strategy of "reducing the gap in premature mortality between the lowest and highest socio-economic groups by at least 10% by 2007".
This particular target was set following extensive work by the Institute of Public Health to establish health targets for the National Anti Poverty Strategy. While there is a growing awareness that every major health problem has a significant social gradient, and a realisation that target setting is an important process, this specific target and others aimed at reducing inequalities will not be met by the health sector acting alone. It is important that the health sector prioritises this area, but it is also critical that inter departmental and inter disciplinary work form part and parcel of initiatives that address inequalities. Without this partnership framework and philosophy the efforts of the health sector will not prevail. The Institute of Public Health has produced a framework document for working in partnership which will help in this regard. Both governments’ strategies recognise this requirement but structures are needed to facilitate effective cross departmental working.
The direction and priorities of the new EU public health programme form an important backdrop for work at national level and it is important that links are established so that public health at national and European level is strengthened. On paper these strategies and the new EU public health programme offer the opportunity to address inequalities and raise the profile of public health but capacity building and strong leadership will be required to seize this opportunity.
Of course financial and personnel resources, as well as commitment, are needed to make an impact and given a recent downward trend in many western economies these resources may not be as forthcoming as they were a year ago. To be optimistic, the words are in place and tackling inequalities has assumed a significant place in important strategies. The articulation of specific targets means we are hopeful that we can move beyond the rhetoric and achieve a reduction in health inequalities in the next decade.
The Institute of Public Health aims to improve health in Ireland, by working to combat health inequalities and influence public policies in favour of health. The Institute is an EPHA member.
Info:
Owen Metcalfe, Associate Director
Institute of Public Health in Ireland
Royal College of Physicians
6 Kildare Street
Dublin 2
Ireland
Tel: +353 1 662 9287, Fax: +353 1 662 9286
E-mail: iph@RCPI.ie
Website: http://www.publichealth.ie
