Healthy Ireland framework can deliver if all sectors of society work together

Plans for health utopia omit breastfeeding, lack synergy and ignore need for trust


Will Healthy Ireland (Hi), the Framework for Improved Health and Wellbeing 2013-2025, make any difference to people’s lives? If all 64 actions are implemented, by 2019 nearly 100,000 more children than today and 160,000 more adults will be a healthy weight.

Nearly a million more people will be physically active and eating the right amounts of fruit and vegetables. By 2025 there will be a half a million fewer smokers and 70,000 fewer teenagers will have started smoking.

Children born in 2025 will be more likely to be immunised, have high self-esteem, be mentally resilient and less likely to live in consistent poverty. In fact, there will be almost 200,000 fewer poor people. More children will finish secondary education and their parents will have high levels of health literacy.

Modest targets
These changes may sound utopian but they are achievable provided the framework is fully implemented. If anything the targets are on the modest side. Hi smoking targets have already been achieved by a number of countries including Sweden, where smoking rates are now 14 per cent in comparison with Ireland’s 29 per cent.

France has 11 per cent fewer obese and overweight people than Ireland. Surprisingly, the targets do not include improving breastfeeding rates which are still abysmally low.

The Growing Up in Ireland study found that being breastfed for 26 weeks or more is associated with a 51 per cent reduction in the risk of obesity at nine years of age so this omission is inexplicable or a mistake.

Hi is designed to bring about measurable changes in health status and is based on an understanding of the determinants of health. About 80 per cent of health is created by factors outside the health sector, such as educational attainment, employment and social class.

The framework calls for a partnership approach to the actions set out and the need for partnership and cross-sector working is referred to 70 times in this 60-page document. Clearly the group who developed the framework thinks that a healthier Ireland will come about when all sectors of society work together. And I agree with them.

Most of Ireland’s health and social problems have happened and have remained unsolved because of an almost complete absence of partnership working. Take children’s safety. The Independent Child Death Review Group 2012 noted that the lack of inter-agency work has “emerged repeatedly in child protection reviews conducted in Ireland”.

Better partnership
The framework does not say how to bring about better partnership working between health and other sectors. There is convincing international evidence that partnerships generate more frustration than results. This is true of all countries, not just Ireland.

Professional rivalry, mistrust, power imbalances and organisational cultures are huge obstacles. Most importantly, partnerships have to achieve more than can be achieved by any one sector working on its own. This is known as synergy and is as rare as hen’s teeth, particularly in the public sector where there is still a lot of duplication. Without synergy, partnerships will fail.

The same communication rules apply to the cross-government and cross-sector partnerships identified in Hi, as apply to good marriages and friendships. Trust is the most important factor and no amount of energy from the partners can compensate for its absence.

Unfortunately, trust between different sectors of Irish society is at an all-time low yet the only reference to trust in the framework is to “bolster public trust” in Appendix 2. Trust, trust and more trust must be built between sectors if this framework is to work. This will not be an easy task.

On the plus side Irish people are good at working together when they want to and there are many examples of good practice around the country including Galway Healthy Cities. Check it out at

Measurement tool
An outcomes tool to measure the impact of Hi on population health will be produced by the end of 2013. Since health is influenced by factors outside the health sector, such as jobs and educational attainment, it seems obvious that the tool must include these factors.

Most of them are already identified in the How’s Life OECD annual reports so there is no need to reinvent the wheel. Hi is a worthwhile framework and will deliver results if it is not left on some shelf as were so many strategies over the past 30 years. Let’s just get on with it.

Scales to measure trust and synergy in partnerships are available from