SECOND OPINION:Corruption revealed in Mahon report has taken its toll
THE “RAMPANT” corruption uncovered by the Mahon tribunal is inextricably linked to the health of Irish citizens and the health system. Local authorities and planners are as important to health as the services provided by the HSE. The Institute of Public Health (IPH) published a report in 2006 showing the huge influence of the built environment. The concept of zoning introduced in the early 20th century aimed to improve health through better spatial planning, land-use mix and transportation infrastructure.
Unfortunately, planning in Ireland has often worked against health. Before the publication of the Mahon report, planning mistakes could be attributed to ignorance and councillors being unaware of the health impact of the built environment. While the ignorance bit is undoubtedly true, as I know from my five years’ experience with the Regional Health Forum West which has 40 councillors as members, bad planning means that many Irish people live in buildings and environments that will damage their health for years to come.
The IPH report says that buildings, open spaces and streets influence health. An average person in the developed world spends 85 per cent of their lives inside a building or an enclosed form of transport travelling from one building to another.
Residents need to have easy access to parks, leisure facilities and a town or neighbourhood centre with pedestrian-friendly places. Environments surrounding buildings also influence health and views of nature are particularly beneficial. Having no garden is associated with higher levels of depression.
Safety is increased when houses are configured to facilitate “eyes on the street”. Access to well-maintained public places encourages physical activity. Land-use mix has a massive influence on social networking and poor networking is associated with increased heart disease and mental health problems. The healthiest neighbourhoods are those that mix houses with business and pleasure, and enable people to carry out their activities without a car. Poor people are more likely to get sick than others and they are also more likely to live in poor quality environments, thus compounding their health problems.
The Mahon report concludes that “corruption in Irish political life was both endemic and systemic”, and perpetuated unfairness. Is this why Ireland has such an unjust health system? From the time I joined the health service in 1975 until I retired in 2010 there were 12 Fianna Fáil ministers for health and seven from all other political parties.
Forty years ago, research from countries with well-developed health services such as Canada, showed that all health services should be reoriented towards prevention.
Hi-tech hospital-based services were, even then, seen as unsustainable in the long term. Every time a minister was appointed, health service staff hoped the new one would bring about this reorientation and develop a more equitable system. This did not happen: if anything the policies of successive ministers increased the power of the medical model.
The hospital consultants’ contract B typifies this approach. Consultants on this contract are supposed to treat 80 per cent public patients and 20 per cent private patients. If they treat too many private patients, they are given six months to bring their practice back into line. If not, they have to donate the extra fees to the Research and Study Fund, which is controlled by another doctor. This is a joke.
Politicians have always tried to manipulate the health system. Following the death of Ann Lovett in 1984, the Western Health Board wanted to provide better sex education resources for schools. Local councillors insisted on viewing the materials in case they got complaints from constituents. Most are not interested in evidence-based practice if it means they will lose votes.
During the boom years when they should have been building public transport infrastructure which would have been good for health, they enabled dreadful housing estates to be built all over the State. There are estates with no facilities, no shops, no centres, where people have to use their cars to buy a pint of milk. Children cannot walk to school because it is too dangerous.
Irish people have been passive recipients of bully-boy politics for too long. No doubt there is a deep-rooted reason for Irish people being so subservient. It is time to grow up, become more assertive, embrace responsible citizenship, and challenge power abusers. Maybe then we will get an equitable health system.
Dr Jacky Jones is a former regional manager of health promotion with the HSE