A large Healthy Ireland banner is one of the first things you see when you enter the Department of Health headquarters on Hawkins Street, Dublin. As we take the lift – though we should really use the stairs – to her eighth-floor office, Kate O'Flaherty, the director of the health and wellbeing programme, speaks off the cuff about the difficulties of maintaining focus and concentration of what is probably the most wide-ranging effort ever to improve the health and wellbeing of our citizens.
“It is about cultural change, operational change and mindset change so that health and wellbeing is on everyone’s agenda in a meaningful way,” she says brightly once we’re sitting down.
Waving her Healthy Ireland banner, O’Flaherty is central to everything from interdepartmental health-focused Government initiatives to public health surveys to partnerships with voluntary and State agencies to Healthy Ireland council meetings and briefings to the Cabinet Committee on Social Policy. So expect to see more of “hi”, Healthy Ireland’s visual symbol of the country’s efforts to fulfil the World Health Organization Europe’s Health 2020 policy to improve the health and wellbeing of European citizens.
An increased proportion of people who are healthy at all stages of life, a reduction in health inequalities and an environment in which everyone can play their part in achieving a healthy Ireland are the chief goals laid out in the Healthy Ireland framework document (2013-2025).
It’s worth noting that each of these goals aims to address serious societal issues: an ageing population with greater numbers who have chronic diseases and disabilities related to poor diet, smoking, alcohol misuse and physical inactivity; large groups within our population with less access to healthcare, childcare, adequate housing and employment; and a belief that if real possibilities exist for people to be healthier, they will eat better food, exercise more and look after their mental health better.
As with many WHO initiatives, there isn’t a new budget. The “change agents” are already employed or working voluntarily and just need to be encouraged, cajoled, nudged or pushed to embrace change. The rest is up to us, to take up the personal challenge to live healthier lives.
So, yes, with cooperation and collaboration at the heart of this global approach for change, it quickly becomes obvious why progress is slow. This framework also involves setting up large – some would say unwieldy – committees (the Healthy Ireland council has 35 voluntary members).
The Healthy Ireland council has met three times since its inaugural meeting this time last year. The published minutes give the impression it is still getting to grips with its role to support and promote all the Healthy Ireland initiatives.
If you take the glass half-full approach to this process, you might consider how different Irish society is from 25 years ago when people drove cars home after drinking alcohol. Or remember the smoky atmosphere in pubs, cinemas and the top floor of double-decker buses that we took for granted without question. Can we say campaigns led by the Road Safety Authority and ASH Ireland drove these changes that are no longer part of this slicker, social-media saturated 21st-century Ireland? But, if you take the glass half-empty approach, you would note that our population is expected to become the most obese in Europe by 2030, according to a recent report. And more than two years into its programme, Healthy Ireland doesn't seem to have done much to tackle this obesity problem.
“We got a lot of reaction to that study with people saying, we don’t want to be the fattest country in Europe,” says O’Flaherty. “One of the critical issues is to halt the rise in childhood obesity because if you’re overweight or obese as a child, you’re likely to be overweight or obese for the rest of your life and that impacts on your long-term health,” she says. A new obesity policy and action plan is one area that Healthy Ireland is currently working on with its partner organisations.
O’Flaherty also points out the OECD data used to calculate our obesity levels come from a 2007 survey. “We are also currently carrying out a national Healthy Ireland survey which will report its finding in the autumn,” says O’Flaherty.
This baseline survey of population health is one of the key focus areas for 2015 as is the National Physical Activity Plan also to be launched in the autumn. “Taking physical activity as a public health issue for the first time and highlighting the physical and mental health benefits will be our first flagship project. We’ll link with the Departments of Education, Tourism and Sport, city and county managers, schools, and the health service,” says O’Flaherty.
Attempts to increase the population’s levels of physical activity will be linked into the recently launched healthy workplaces, current mental health campaigns (#littlethings), sports policy and use of public spaces for walking, running and cycling.
Let's also hope that they address walking, running and cycling space for those who live near busy roads or in outlying housing estates miles amenities. O'Flaherty says that supporting local authorities to improve infrastructure for exercise through the Pfizer/Irish Times healthy towns project is key to this issue.
So after 90 minutes or so talking about the breadth of the Healthy Ireland agenda, I still feel unsure whether it’s a rubber stamping of everything that’s already happening or a genuine extra effort to seriously improve the health and wellbeing of Irish citizens. “Come back to us in three years and assess us then,” says O’Flaherty.