Health and social costs of poverty


Sir, – Your editorial on gangland killings (“When life is cheap”, February 1st) outlines the multipronged approach needed to address such problems, but fails to mention one of the vital components of such an approach, namely the health service.

Life is indeed cheap in some parts of this country, where death rates from illness can be more than twice the national average due to social deprivation.

Despite the much higher health needs, such areas have far less than adequate services to meet the demands, a phenomenon called the inverse care law. Nowhere does this apply more starkly than the areas of psychosocial services for children.

GPs and public health nurses at the frontline of the health service can readily identify the vulnerable families and children who urgently need services to prevent the spiral of behaviour problems and drug use that culminates in gang problems. We see them long before they come to the attention of the law - sometimes when they are still in preschool.

Unfortunately all the services that could make an enormous difference to these children and their families are effectively closed to them – the two family therapy services in this area are currently closed to referrals from everyone except Tusla – the Child and Family Agency, and child psychology in Dublin 15 currently has a waiting time of 18 months (versus four months in nearby parts of the city).

I have too often watched the “slow-motion car crash” of a young person’s progression from problems at school, through drug use and into criminality (or death), and witnessed all the lost opportunities to intervene, because none of these severely under-resourced services was available when the family needed it and was willing to engage. And then I have marvelled at how the funding always seems to be found to fund a prison place, at €70,000 a year.

This is a matter of Government policy – unlike the education service, for example, health services are not weighted to take account of the much higher needs in areas of disadvantage, with very predictable consequences.

The current debate on abortion has triggered, yet again, intense focus and concern for the welfare of unborn children. A fraction of this energy directed towards the born children of this country would be very welcome . – Yours, etc,


Riverside Medical Centre,


Dublin 15.