SECOND OPINION:Catholic Church's accurate critique is well worth reading, writes JACKY JONES
FOR THE first time in 50 years I agree with Catholic Church opinion. When I was in 6th class, the school principal asked me to deliver a letter to the then Bishop of Galway, Michael Browne. Her strict instructions to kiss his ring as a mark of respect engendered such a burning sense of injustice that from then on I began to question the church’s teachings, in particular those relating to women. This got me into a lot of trouble in school as I was constantly arguing about women’s rights during lessons from Apologetics and Catholic Doctrine. Anyone over 60 will remember this textbook.
My disaffection was complete when I was told I needed to be churched following the birth of my first child in 1970. Churching was a ritual performed to “cleanse” a woman after childbirth. These experiences among others freed me from religious influences forever.
Imagine my surprise when I found myself in total agreement with church thinking after reading Caring for Health in Ireland (CHI) published last month by the Irish Episcopal Conference. This report analyses plans for health policy reform in the current Programme for Government and makes important observations which have received little media coverage.
First, CHI points out that reforms proposed by government actually deal with sickness services and not health. It is an important distinction because as long as health is confused with sickness, population health will never improve.
This is not a new idea. In 1986 the government of the day published Health the Wider Dimensions which was “a first attempt to view health policy . . . in a broader perspective than simply health services”.
Unfortunately, in spite of the many strategy documents that followed, Irish health services are still focused on disease with at least 95 per cent of the budget spent on curative services.
Vested interests have prevented their reorientation towards health.
Secondly, CHI notes that the Programme for Government does not define the health gains that reforms in health policy are designed to achieve. Its focus is almost entirely on inputs (staff and budgets) and outputs (volume of services), rather than on health outcomes (healthier people).
This lack of focus on outcomes is a key weakness of Irish public services generally. It seems to be part of our culture to reverse the accepted order of things: to put the cart before the horse. Deciding on inputs before outcomes is preposterous.
Over-medicalisation of health policy in Ireland is another major problem identified by CHI. One solution proposed is that public opinion must be “educated on the imperative of controlling expenditure on high-tech, high-cost hospital services in order to free up resources for interventions which can deliver real health benefits by other means”.
The HSE’s Service Plan 2012 illustrates the problem. The entire plan is written from the perspective of inputs and outputs. We are told €13 billion will be spent on services with no reference whatsoever to outcomes.
Most of the outputs are “ongoing”, meaning no one knows when or what the end result will be. Targets are numbers of people receiving services without a word as to whether the recipients will feel better. Travellers will receive health screening but will this improve their health when their educational attainment levels remain abysmally low? No, it will not.
Nearly five million people will receive a hospital service in 2012. Will their health be better or worse? Who knows? A PHN will visit 95 per cent of new mothers within 48 hours of discharge from hospital. Where is the proof that the baby or woman’s health improves as a result? It is not there.
Ireland needs an evidence-informed approach to health policy. A 2011 study by the Health Research Board found that demand for research from policymakers and managers is weak. Few ask the most important question, does it work?
The Department of Health is developing a new public health strategy designed to cover the period 2012-2020. CHI recommends a vigorous strategy to tackle social and educational disadvantage which are still the main causes of ill health.
It would be a pity if the reputation of the Catholic Church meant the CHI report was ignored. It is well worth a read by policymakers. And no, I did not kiss the ring.
Dr Jacky Jones is a former regional manager of health promotion with the HSE