Insipid start to Healthy Ireland
Delays and a notable absence of ministerial support for the ‘Healthy Ireland’ public health policy launch suggests future ambivalence to implementing the strategy. Here is my Medical Independent column from 25 April 2013.
The launch of Ireland’s first ever public health policy ‘Healthy Ireland’ took place on 28 March, a month after it was originally meant to happen. Invites went out far and wide. The Taoiseach was meant to launch it. The Mansion House was bursting with ‘Healthy Ireland’ green logos and ministers wearing green ties. The spin machine was in full swing.
It made sense for the Taoiseach to launch ‘Healthy Ireland’. After all, any decent public health strategy requires a government-wide approach. Lessons from other countries tell us that the most senior political and cross government leadership is critical to achieving real improvements in health and reducing health inequalities.
It had been postponed a month previously because Jose Manuel Barroso, President of the European Commission, was in town. And on 28 March, at the last minute, there was a no show from Enda Kenny. He was in Waterford at the opening of a tapestry and the reannoucement of 200 jobs, which had been announced, but never materialised, four years previously. At least he was not opening a pub.
So the Taoiseach was missing, but so too were Michael Noonan, Brendan Howlin, Richard Bruton, Ruairi Quinn, Phil Hogan and Joan Burton. You can be sure that if the launch had gone ahead a month previously and Barroso had turned up that the Cabinet would have been out in force. And that would have been the strongest symbol of support from the highest European and Irish political leaders for Ireland’s return to the status of a healthy country.
Secretary General at the Department of Health, Ambrose McLoughlin, chaired what turned out to be a tedious non-event. There were nine or ten long, cliché ridden speeches, spanning over two hours and delivered to an ever-dwindling crowd.
What was meant to be Ireland’s first public health policy morphed into a framework for improved health and well-being 2013-2025. ‘Healthy Ireland’ has four overriding goals: improving everyone’s health; reducing health inequalities; protecting the public from threats to health; and creating an environment where every sector can play a part. It contains 64 actions. Many are woolly; some are aspirational. Critically, many are contrary to the policies of austerity currently being pursued by the Government.
Advocates of the policy have argued that if and when ‘Healthy Ireland’ is achieved: There will be one-quarter of a million more adults and children of healthy weight in 2025 than there is now; That by 2025, one more million people will be taking the right amount of daily fruit and vegetables and physical activity; Fewer young people will start smoking and overall there will be half a million less smokers; Children will stay longer in education; Health literacy among adults will be improved and fewer people will live in poverty.
Obviously, all of these would be a most welcome success by 2025. However, these are a rehash of many previous unachieved targets set as far back as the 2002 National Anti-Poverty Strategy. Most of the targets in the 2010 cardiovascular strategy and 2012 substance misuse strategy are restated in ‘Healthy Ireland’, but, critically, not one new target has been set. An ‘outcomes framework’ is promised by the end of 2013, where apparently ambitious and specific targets for improved health and reduced health inequalities will be set.
At the launch, Minister Reilly spoke with passion about the cost of obesity and alcohol misuse, and his plans to introduce logo free cigarette packs. He also articulated his desire to increase tax on cigarettes so that they became a euro each and to introduce a sugar tax. Minister of State for Primary Care Alex White and Minister for Children Frances Fitzgerald spoke about their determination to ban alcohol advertising of sporting events. James Reilly concurred, saying he would like to see the alcohol sponsorship ban in place by 2018, but admitting 2020 was probably more realistic.
However, Ministers Reilly, White and Fitzgerald do not have the support of their government colleagues. Fellow TDs have spoken out against the alcohol sponsorship ban, Cabinet rejected the sugar tax and if Noonan wanted more revenue from fags, he would have increased them already to a euro each in these desperate times.
The first of the 64 actions, a “Cabinet Committee on Social Policy chaired by the Taoiseach [which] will oversee and monitor the implementation of ‘Healthy Ireland’ is described as “probably the most important of them all”. However, the Taoiseach and other key senior ministers were notable merely in their absence. Maybe that is just pure optics. Yet, not walking the walk from the outset is a poor indicator of the Government’s commitment to really achieve a ‘Healthy Ireland’.