MEDICAL MATTERS:An institute of many achievements in need of a change of focus, writes Muiris Houston
ONE OF the first advocacy groups I got to know well, shortly after starting work as a journalist with The Irish Times, was the Institute of Public Health (IPH). A cross- Border body set up 10 years ago, it works to a number of objectives: creating awareness and disseminating information on public health; influencing health policy and practice; and capacity building for public health.
Among its many achievements has been to put flesh on the bones of an internationally accepted maxim. We know inequalities lead to poor health, but the IPH was one of the first to show the extent of this influence in an Irish context.
The institute's 2001 report, Inequalities in Mortality 1989 - 1998: A report on All Ireland Mortality Data, was truly groundbreaking.
It found that the poorest people in Irish society were twice as likely to die from cancer, while the death rate from heart disease was 120 per cent greater.
Perhaps one of the most striking socioeconomic links with health was the report's findings on chronic lung disease. Some 2,600 people die on average every year from chronic lung disease.
However, in both the Republic and Northern Ireland, the death rate from chronic lung disease in the lowest socioeconomic grouping was more than 340 per cent greater than the rate for those in the higher socioeconomic groups.
One of the report's authors, Dr Kevin Balanda, told me at the time that "there would be 5,400 more people alive if we could reduce our death rate to those of our European neighbours".
Fast forward seven years to the publication last week of the IPH and the Combat Poverty Agency report, Tackling Health Inequalities - An All Ireland Approach to Social Determinants.
The opening paragraph of this paper's news story on the report said: "up to 5,400 preventive deaths could be avoided each year if policy makers took a more robust approach to tackling social deprivation and health inequality".
Plus ça change, plus le même chose?Some seven years later there are still 5,400 avoidable deaths due to health inequality. Despite the work of the IPH and others, has nothing changed? And, most importantly, is anyone listening or responding?
Reading the institute's 10-year report, published earlier this year, one cannot but be impressed by the long list of its achievements. It must be one of the most successful bodies set up under the Belfast Agreement and has achieved a broad coalition of support for public health across the island. It has made us think of health as something other than emergency department waiting lists and high-technology medicine.
But is any of this filtering down and making a difference to people faced with the day-to-day challenges of health inequality? The IPH 10-year review hints at some community penetration in Northern Ireland, where it carried out an evaluation of 19 healthy living centres and looked at tackling rural fuel poverty in Armagh and Dungannon.
However, there is no indication that the impressive work of the institute has been applied on the ground in the Republic.
All of which suggests a vacuum between the identification of specific areas of health inequality and detailed local intervention. This lacuna is not something that can be laid at the institute's door. Its brief does not extend to setting up and running local projects.
Rather, it reflects the failure of the Health Service Executive (HSE) here to use the information generated by the IPH. And while there is a sense of more co-operation in the North, health authorities there could do more to make change happen.
What about the politicians? Chris McGimpsey, the North's Health Minister, has spoken about his commitment to tackling health inequality. Mary Harney, however, has not shown much interest in public health matters. Definitely a case of a lot more to do on the political front.
Is it time, therefore, for the institute to realign its focus? To work on a number of local projects designed to make a small but tangible difference to an identifiable inequality?
Otherwise it may risk going round in circles, and producing another report in another seven years showing the same number of avoidable deaths as there were in 2001 and 2008.
• Dr Houston is pleased to hear from readers at mhouston@irish-times.iebut regrets he is unable to reply to individual medical queries