Sir,– It's good to see The Irish Times focussing on how where you live might affect your health ("Get involved: Rate the health of your main street", Health + Family, June 8th), looking at the built environment and local amenities. As a group of GPs working in areas of disadvantage, we would like to suggest you consider some other variables that can be very revealing. Death rates, for example, are more than twice as high for the commonest causes of death in areas of greatest disadvantage – the death rate from cancer in Blakestown, Dublin 15, is the highest in the country (and three times higher than nearby Castleknock).
The most powerful determinants of these outcomes are poverty and inequality. Lack of access to health services are a significant contributor to this.
While your series considers the presence of a pharmacy to be a good sign, it doesn’t look at whether you can afford the co-payments for medicines or access a GP, which many people can’t. It doesn’t look at services for children – psychology, for example, where there is a two-year wait in many areas (compared with six months in others).
Deep End Ireland had our annual meeting last week focussing on children’s mental health, and heard overwhelming evidence not only that most mental illness in adults starts in childhood, but also that poverty and adverse childhood events contribute to major physical illness. So areas of disadvantage have many more people with health problems than more affluent areas. Such high needs, yet reduced service provision, is a combination we call the Inverse Care Law, where those who need services the most are the least likely to get them. It results from resources being allocated on the basis of population numbers, not need, and is how the health service in this country operates.
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While “you are where you live” might be one way of putting it, a more accurate description might be that where you live in this country is, in fact, a matter of life or death. – Yours, etc,
Deep End Ireland GPs,
Dr EDEL McGINNITY,
Mulhuddart,
Dublin 15;
Dr SUSAN SMITH,
Inchicore,
Dublin 8;
Dr PATRICK
O’DONNELL,
Limerick;
Dr DAVID GIBNEY,
Ballymun, Dublin 11;
Dr ANNE O’BRIEN,
Corduff,
Dublin 15;
Dr NIAMH IRVING,
Rialto,
Dublin 8;
Dr DAVID GIBNEY,
Ballymun,
Dublin 11.
Dr ANNA BEUG,
Dolphin’s Barn,
Dublin 8.