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Column: Ireland has a postcode lottery for health

Good citizenship in conjunction with some collaborative working between communities and government could build better and healthier communities, writes Anne-Maree Quinn.

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HEALTH INEQUALITIES ARE often observed along a social gradient, a postcode lottery of sorts. The more favourable your social circumstances such as income or education, the better your chance of enjoying good health and a longer life.

There is no shortage of examples of health inequalities in Ireland. Last month, figures from the Growing up in Ireland study showed that one in four children at three years of age were obese. Twice as many children in this obese category were identified as being from the disadvantaged group category.

The Irish Medical Association reports that mortality rates are higher among those residing in accommodation rented from local authorities or voluntary bodies compared with those in owner occupied accommodation.

People from less affluent groups are less likely to participate in positive health behaviours such as moderate to high levels of physical exercise. They are more likely to eat fried foods and also to smoke. Smoking rates are highest (56 per cent) amongst women aged 18-29 years from poor communities, compared to 28 per cent of young women from higher social classes according to the Healthy Ireland policy document.

The postcode lottery is also evident in the area of mental health. Levels of depression and admissions to psychiatric hospital are higher among less affluent socio-economic groups. Increased mental health problems are related to deprivation, poverty, inequality and other social and economic factors.

Lack of forward thinking

One of the problems that exist with the current health system is of a lack of forward thinking. Often policy documents such as the Healthy Ireland policy provide excellent analysis of existing and future concerns. Unfortunately, however there is a real disconnect between policy and its application. In practice, what happens is a budget-to-budget approach that fails to take into account long term considerations.

The Disability Federation of Ireland identified this lack of forward thinking in its recent pre-budget submission to Oireachtas Finance committee. They called on the Government to end its contradictory policy of on the one hand having national policy objectives that support, for example, community living for people with disabilities, and on the other, continuing to implement cuts that undermine this policy to promote community-based living. The ongoing dismantling of the existing community and social infrastructure makes no sense in the context of the Government’s own policy objectives.

A second significant concern is the problem of double dipping. In a time of economic downturn cuts will inevitably effect the entire population. It is particularly concerning that marginalised individuals who face difficulties due to ill health, disability or age are doubly penalised.  They face the same austerity measures as the general population and then suffer further cuts due to their circumstance such as to the respite care grant. This is a heavy burden to carry and it further increases vulnerability and risk of ill health.

What is the answer?

Solutions to such complex problems rarely lie within the boundaries or responsibilities of any single institution. What is certainly required is approaching the problem with a two-pronged solution that requires at the government level, good leadership to see thorough the implementation of policies and at the grass roots level community initiatives and involvement.

Governments need to continue to push programmes and services that seek to prevent health inequalities. For example, there is an increasing number of households in Ireland who are at risk of poverty. At the moment, council housing transfer and re-housing lists are stagnant as there are either no funds to repair vacant accommodation or a lack of available accommodation on the rental market. Landlords are reluctant to take on families in receipt of rental allowance. Our lawmakers can and should intervene here to prevent those at risk of poverty from entering into this state. The immediate fiscal investments made here will have long term preventive outcomes reducing the numerous problems associated with homelessness.

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The second part of the solution involves the community at grass roots level seeking to create a culture of better citizens. This culture should not solely expect others such as the government, to provide for our everyday flourishing. We should instead be actively responsible for our lives and the lives of those around us operating within the resources which we have.

Tackling health inequalities

Such measures do not have to cost a lot of money or time. A new initiative happening in Ireland at the moment called the One Percent Difference. The idea of One Percent Difference is that everyone gives one percent of their time or one percent of their income, to a charity or cause they believe in. A lot could be achieved in tackling health inequalities via this method in local communities.

Good citizenship requires a level of awareness and acknowledgement of who my neighbour is in our communities. It also requires stepping out of the group mentality that that this is someone else’s problem or someone else will fix it.

This model of good citizenship in conjunction with some forward thinking and collaborative working between communities and government could realistically build better and healthier communities.

Anne-Maree Quinn is an independent candidate in the 2014 Local Elections, as well as a Senior Occupational Therapist working across the Pearse Street and Ringsend/Irishtown Primary Care Teams.

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