Yes, the Government can make you thin
The Healthy Ireland plan, launched in 2013, aims to address the deep-rooted inequalities that lead to poor health
Shortly after Dr Leo Varadkar became Minister for Health he was interviewed by RTÉ about the challenges facing the health sector, including Ireland’s growing obesity problem. The latest report from the Irish Longitudinal Study on Ageing (Tilda) had just been published, and showed that 79 per cent of adults over 50 are overweight or obese and 52 per cent of over-50s have “a substantially increased” waist circumference. Varadkar emphasised the importance of a healthy lifestyle and said “The Government can’t make you thin”.
Actually, it can.
Furthermore, the Department of Health already has a plan in place to do just that.
It is called Healthy Ireland: A Framework for Improved Health and Wellbeing, 2013-2025. In fairness to the Minister, he had only just been appointed to his new role and had probably forgotten posing with the rest of the Cabinet for a group photograph when Healthy Ireland was launched in March 2013.
Healthy Ireland is about a lot more than lifestyle, and aims to create a more equal society, to empower people and communities, and to make policies that make the healthy choice the easier choice.
About 80 per cent of health is created by factors outside the health sector – such as educational attainment, employment and social class – so the framework is based on a whole-of-government approach and the need for all sectors to work together to achieve Healthy Ireland’s goals.
Biggest challengeThere are 70 references to partnership and cross-sector working in the 60-page document. If the 64 actions are implemented, by 2019 nearly 100,000 more children than today and 160,000 more adults will be a healthy weight. A Healthy Ireland Council, a Health and Wellbeing Programme within the Department of Health, and A Healthy Ireland Cross-sector group are now up and running.
Cross-sector working is the biggest challenge for Healthy Ireland. Recent reports show that public-sector organisations are not good at it. The National Review Panel reviewed the services provided to Luke, a young man who died while in the care of the HSE, and found “that strategies to promote inter-agency co-ordination at a formal level did not exist until recently”. The review team “could find very little evidence of effective interagency planning”.
The Report of the Independent Review Group on the Department of Justice and Equality published last month shows that two of the top five issues to be addressed are: “a closed, secretive and silo-driven culture” and “relationships with key agencies tend to be informal and unstructured”.
The Department of Justice and Equality is not the only Government department to operate in silos. Virtually all public sector and civil society organisations have silo-driven cultures. Silos develop because people are trained in a particular discipline with others from the same discipline, for example teachers, nurses, solicitors.
Their trainers are usually from the same discipline. They then take up employment within a system that supports silo-type working, learning the language and the mindset. Professionals from one sector are blind as to how their counterparts in another sector see problems.
The language of lifestyle complicates things needlessly. Health and other professionals have been trained to see the cause of, and solution to, unhealthy lifestyles, differently. Some view lifestyle as an individual choice amenable to health education and advice. Others see lifestyles as symptoms of the way society has structured power and privilege. It is no coincidence that well-educated, better-off people have the best health and poor people have the worst health and the unhealthiest lifestyles. We need a shared language that does not refer to lifestyle and instead uses the language of empowerment, equity, equality. These concepts are understood and uncontested by all disciplines, all sectors and the public.
The health problems that Healthy Ireland and the Minister have to solve are the same now as they were 50 years ago.
Dr James Deeny, who was chief medical officer of Health from 1944 to 1962,listed the main causes of ill health in his 1971 monograph, The Irish Worker. Poverty, low wages, high unemployment rates, high numbers of long-term unemployed,and an overreliance on welfare were responsible for chronic diseases then and still are today. Almost no progress has been made in solving these problems.
Healthy Ireland is a good framework that goes beyond behaviour change. Its full implementation might be a last ditch attempt to avoid becoming the fattest people in Europe by 2030, as predicted by the European Society of Cardiology. Unfortunately, Irish people will be the fattest if we continue to believe that lifestyle change is all that’s needed.
Dr Jacky Jones is a former HSE regional manager of health promotion and a member of the Healthy Ireland Council.