Tackling inequality in access to treatment would lead to a fall in premature fatalities, writes Dr MUIRIS HOUSTON
“Social injustice is killing people on a grand scale” – WHO 2008
COMING AS it does early in the lifetime of a new Government, the report by the independent think tank Tasc on health inequalities is timely. With the Minister for Health committed to developing the universal healthcare model, the report’s observations on this aspect of Government policy are especially relevant.
Health inequality is the difference in the experience of health among different sections of the population. Although some people will live longer, healthier lives due to genetic or hereditary factors, health inequity refers to inequalities which are unnecessary, unjust and avoidable, and can be addressed through public policies.
Income, wealth, education, environment, work and life opportunities all impact upon our health. Lifestyle and psychosocial factors also play a big part. While money is not the answer to all of life’s problems, being poor limits your chances. If you are brought up in a mainly working class area, the housing you occupy is likely to indirectly affect your health. The educational opportunities available to you are limited, which again negatively affects your attitude to health. Even your transport options, because they are limited, go against your future health status.
Whether it is cardiovascular disease, cancer or infant mortality, if you are unemployed or work at a manual job, you are more likely to die prematurely than if you are a professional. It is also well documented that the wider the gap between socio-economic groups in terms of health indices, the poorer the health of that nation as a whole.
And research published today in The Lancet shows that homeless men and women have mortality rates some six times higher than the general population. Furthermore, homeless men and women aged 15-24 years have life expectancy that is shorter than the general population by 22 years (men) and 17 years (women).
A 2004 report from the Public Health Alliance of Ireland, Health in Ireland – An Unequal State, found that death rates for all cancers are more than three times greater in the lowest occupational class compared with the highest. Death from lung cancer is four times greater for people in the lowest occupational class, while death from stroke is three times greater.
Today’s analysis from Tasc says health services matter because the prevention and treatment facilities provided can mitigate some health inequalities, as long as those services are accessible, universal and free at the point of delivery. However, if there are inequalities in access to public health services, existing health inequalities will be exacerbated. And so, rather than helping an already disadvantaged group, this increases the burden of illness on those with low incomes.
Analysis of recent Central Statistics Office (CSO) data by the Institute of Public Health shows that eliminating socio-economic mortality differentials in Ireland would mean more than 13.5 million extra years of life for Irish people. These extra years would be added to the end of people’s lives, and the benefits would be realised over an extended period of time. This represents an enormous potential health gain for the nation.
But where to start? Firstly, there is a direct relationship between social spending and health status. Recent work evaluating social spending across 15 EU countries found that, for each additional $100 (€69) of social spending per person, there was a 1.19 per cent drop in all-cause mortality. So despite our economic woes, we must be aware that any indiscriminate “slash and burn” cuts to health and social services will reduce, rather than increase, the life span of Irish people.
To this end, the Tasc proposal to create a Cabinet Sub-Committee on Population Health – whose role should be to drive the process of inter-departmental co-ordination of health and the addressing of health inequalities across all relevant Government departments – merits serious consideration. It would send a strong public signal of the administration’s commitment to social justice.
An independent review of health inequalities, similar to that carried out in the UK by Sir Michael Marmot, would help to identify the most effective evidence-based strategies for reducing health inequalities here. Such a review would provide the basis for a new population health policy.
Tasc also proposes that the CSO should be given responsibility for preparing regular monitoring reports on health inequalities in Ireland to verify that progress is being made on the health status and outcomes of the population over time.
And its suggestion that an “Equality Statement”, which would explain how the Government is ensuring that budgetary decisions are informed by equality considerations, be published as part of the annual budgetary process is a constructive one.
On the key issue of universal health insurance, Tasc differs from the Coalition’s plan to have a number of competing entities providing insurance. “There are many variations of universal health insurance, and Tasc proposes that the merits of a single social health insurance fund be evaluated alongside the option of competing public and private insurers in the forthcoming White Paper on Financing Universal Health Insurance,” the report says but then adds that Tasc supports the analysis put forward by the Adelaide Hospital Society that a single not-for-profit fund should be established in the initial phase of implementing universal social health insurance.
Prof Joe Barry, the chairman of the Tasc working group responsible for today’s report, concludes: “However, these policy choices need advocates across a wide spectrum of stakeholders and they need to be prioritised and resourced. Our response to health inequalities and, indeed, health status for all has tended to be dominated by rhetoric rather than action. This report should therefore be used as a resource to wider civil society to make demands for action on health inequalities.”
It is up to each and every one of us to act on his rallying call.
“ Analysis of recent Central Statistics Office data by the Institute of Public Health shows that eliminating socio-economic mortality differentials in Ireland would mean more than 13.5 million extra years of life for Irish people
Whether it is cardiovascular disease, cancer or infant mortality, if you are unemployed or work at a manual job, you are more likely to die prematurely than if you are a professional