Madam, – Minister for Health James Reilly is reported as saying that equal access to healthcare was one of the key principles underpinning Government policy. Muiris Houston quotes the recent Tasc report on health inequality which notes that there has been more rhetoric than action to date (HEALTHplus, June 14th), and Tony Bates has most poignantly described the recent surge in suicide among young people in areas of deprivation.
Despite the clear evidence of hugely increased sickness and mortality in such areas, resources are largely allocated on a population basis irrespective of need.
This has resulted in the health system seriously aggravating the inequality in health caused by social circumstances. While some ad hoc extra services emerge periodically, the core statutory services such as general practice, public health nursing, child psychiatry, family therapy and adult psychiatry cannot possibly meet the extra demand that is inevitable in such areas. Services that vulnerable families need at times of crisis have waiting times of anything from four months to one year. GPs in newer deprived urban areas are paid 40 per cent less than the average capitation fee (a fixed amount whether a patient is seen once or 20 times a year) because the payment is based on age, and takes no account of psychosocial complexity and the more than twofold mortality rates from chronic illness.
The depth of un-met need in such areas is frightening. There are many skilled and dedicated professionals working in these areas, and the teamwork of some new primary care teams is very effective, but there are not nearly enough of them to deliver adequate services.
Your Editorial (June 14th) urging men with health problems to seek help rings hollow. We have no difficulty recognising problems when we meet them, but providing an effective response is not possible with current resources.
According to Pobal (2008), 4 per cent of the country’s electoral divisions are either very or extremely disadvantaged. A disproportionate level of illness, death, criminality and child protection problems emerge from these areas, ultimately costing the State a great deal of money, and the individuals involved untold suffering.
Mr Reilly is right to say socio-economic inequalities precipitate inequalities in health. But health policy to date has worsened health inequality by failing to take account of deprivation when providing services. Ministers Reilly, Shortall and Fitzgerald have an important opportunity now to take action to address the reality that whether you die young, end up in care or prison, or suffer premature chronic serious illness, mainly depends on where you live. – Yours, etc,