To live longer, healthier lives require very different health and public policies
Column from the Irish Independent on 3 March 2015
So what would it take for Ireland to be the best little country in the world to be healthy in?
For a start, it would take all of us being more healthy, not just exercising more but eating less processed food and more home-cooked, fresh food; drinking much less alcohol; not smoking; looking after our mental health; being more caring of ourselves and each other.
Each of us has to take responsibility for our own health but Government has a major role to play in making this possible: by providing well-lit foot paths so that everyone can go for a walk and many more parents can walk their children to school; safe cycle routes; access to healthy food at reasonable cost; help with giving up smoking; access to good counselling if and when we hit bumps on our mental health journey.
Ireland has made great progress in terms of life expectancy over the last 50 years. We are all living longer, but the improvement was not shared equally.
Recent ESRI research showed death rates rose more among lower socio-groups than higher socio-economic groups, between the 1980s and 2000s.
There is strong international evidence to show that inequality in income, wealth and death rates are bad for everyone, not just the poorest. Therefore, tackling these issues through public policy is key to improving everyone’s health.
This involves a greater distribution of income and wealth, through progressive taxation, better housing, environment and education policies so that all children have chance of progressing and being equal to those born from higher socio-economic groups.
Education programmes for women and access to good quality childcare can be key to reducing inequalities in child health.
High quality universal services are also central to improving everyone’s well-being. When everyone has a stake in such public services – whether it is childcare, school or health services – standards are always higher as the middle classes push for better services. This benefits everyone.
Some socially and economically deprived groups and communities may need additional supports, whether that is income supports, special needs assistants in schools, after-school programmes, local community development projects or access to therapies such as psychology, physiotherapy and occupational therapy.
These need to be in addition to quality, universal services, not instead of them.
Making the longer years gained by Irish people healthier and improving all of our health are central to making our health system sustainable. If chronic disease continues to increase at present levels, our already burdened health system won’t be able to cope.
In the short term, some of the most high-profile ’emergencies’ in the health service need to be solved – the long waits of people on trolleys in emergency departments, the ever-increasing wait times for planned hospital care, the older people who get stuck in hospital beds unnecessarily, the waiting lists for nursing home beds.
But the urgent should not deflect from the important. The most important changes that are needed to make our health system comparable to our European and OECD counterparts are making our health system universal; transferring care out of hospital and into the community; and improving the quality of care.
Ireland is unique in a European context in that there is no universal primary care. Sixty per cent of the population have to pay €50 or more per GP visit and €144 per family per month for medication. This puts people off accessing essential care.
For the 40pc of the population who have medical cards, they too have to pay for medication (up to €29.50 per month) and many have to wait years for essential diagnosis and hospital treatment.
Over half the population can skip the queue into the public hospital system and the complex financial incentives mean that the money spent on private health insurance is very bad value for money.
Getting rid of the perverse financial incentives that stop people accessing medical care on the basis of medical need, that push people unnecessarily into the hospital system and make the system extremely difficult for citizens to negotiate is essential if we want a health system comparable with most other high income, civilised democracies.
There is much rhetoric and opposition about ‘free GP care’ for all. Allowing all Irish people to go to their GP without charge is a first and important step towards a universal health system and shifting care out of hospital into the community.
Over 90pc of healthcare, including the management of chronic diseases, can be carried out by primary care services. Making this actually happen requires increasing the investment in GPs, in community and specialist nursing, in a whole range of therapies as well as high quality social care for those who need it.
Improving standards of care is also key. Care is not just about not killing or harming people, but supporting and caring for people to live the best possible life, even if very sick or disabled.
Achieving all of this is a political choice. Many say we cannot afford it. But even spending the money we currently do differently could do a lot of this. Also over time, as the economy improves more money will be invested in health, in basic infrastructure, in staff.
But if we keep on spending it the way we are spending it, it will not make much difference.
Therefore fundamental change is required in health policy which moves us on the path to universal health care, towards strong and effective primary and social care, to high quality services to which we all can access.
These combined with progressive tax policies which lead to a more equal distribution of income and wealth, better education, housing and environment policies are not just needed but vital to the very fabric of the sort of country we want to live and die in.
These are all political choices – isn’t it time we made them?