Health Inequalities: Report of the Committee for Health, Social Services and Public Safety

Part of Committee Business – in the Northern Ireland Assembly at 1:00 pm on 18 February 2013.

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Photo of Sue Ramsey Sue Ramsey Sinn Féin 1:00, 18 February 2013

I beg to move

That this Assembly welcomes the Committee for Health, Social Services and Public Safety's review of health inequalities; notes the recommendations relating to the restructuring of government Departments; and calls on the Minister of Health, Social Services and Public Safety to discuss the recommendations in the report with the ministerial group on public health and to action those that are within his remit.

Go raibh maith agat, a LeasCheann Comhairle.  I am delighted to move the motion on behalf of the Committee for Health, Social Services and Public Safety.

I would like to begin by providing some background to the Committee’s review of health inequalities.  The Committee has been concerned about the issue for some time.  We are aware that, although the general health of the population has been improving over recent years, the rate of improvement is not equal for everyone.  Health outcomes are worst in the most deprived areas in overall terms.  There continues to be a large gap across various measures of health, including life expectancy, drug- and alcohol-related deaths, suicide, teenage pregnancy, smoking during pregnancy and cancer-related deaths.  The main cause of these health inequalities is poverty.

Back in June 2012, the Committee was aware that the Department was in the process of producing a new public health strategy to follow on from Investing for Health.  Members will remember that, when 'Investing for Health' was published by the then Minister, Bairbre de Brún, it was seen as one of the most radical documents of its time.  We, therefore, believed that a review of health inequalities would be useful work that could feed into the Department’s development of the new strategy.

The Department’s draft strategy 'Fit and Well: Changing Lives 2012-2022' was published in August for public consultation.  That consultation ran until the end of October 2012, with the strategy expected to be published in spring 2013.  Parallel to that process, the Committee carried out its review of health inequalities so that the results of that could feed into the final version of 'Fit and Well'.  I want to take the opportunity not only to welcome the Minister to today's debate but to thank him for agreeing to wait until we had finished our report.  It is important that the value of the Committee's work is seen by the Department and the Minister because we can add to the process.

The terms of reference of our review were to identify effective interventions to address health inequalities in other regions that could be applied here, with a particular focus on early years intervention.  We invited a range of expert witnesses to give evidence to the Committee.  We were keen to be outward-looking and see what we could learn from other places.  We heard from people working on projects across Ireland — in Ballymun and the Midlands — from Scotland and the European office of the World Health Organization.

As a Committee, we also agreed to carry out a study visit as part of the review.  That involved the Deputy Chair and me going to Cuba to attend an international conference on public health and see for ourselves various aspects of the Cuban healthcare system.  The Cuban healthcare system spends $585 on each person a year, whereas we spend almost $4,000.  Despite that huge variance, Cuba achieves health outcomes that compare with and, in some cases, exceed those produced by our system.  Therefore, we thought that it was important to go to the conference and see at first hand whether there was anything that we could learn about Cuba's system and use here to tackle health inequalities. 

One of the striking aspects of the Cuban approach is the focus on primary care.  We got the chance to visit a GP surgery and a polyclinic.  We learned that, in 1984, Cuba introduced the system of a family doctor and nurse service because they realised that they relied too much on hospital services. Cuba wanted to put a bigger emphasis on prevention and on treating people in the community first and foremost to prevent them needing hospital treatment, where possible.  The family doctor lives in the community that they serve.  So, at any point in time, they can provide an overview of all his or her patients' general health.  As I mentioned in a previous debate, that is partly because they carry out annual health checks, which means that they can prevent ill health or, when needed, intervene early.  The Committee fully accepts that some parts of the Cuban health system cannot be directly transferred on to ours.  However, the focus on prevention, patient education and primary care all fit in with the vision that the Minister has set out in 'Fit and Well'.

We visited a polyclinic where various clinics and minor operations were carried out, and we learned that the one that we visited had an infant mortality rate of zero in the past 15 years and had had no maternal deaths in the same period.  We also heard that a lot of emphasis is put on the care of pregnant women, who have 12 antenatal appointments.  The breastfeeding rate is also very impressive, with 95% of women breastfeeding for up to six months.  That means that children get the best possible start in life, because the system prioritises the needs of pregnant women and supports them in breastfeeding.  Again, that ties in with the Fit and Well strategy, where the focus is on early intervention.  My colleagues from the Committee will speak later about some of our recommendations on breastfeeding and parenting.

Another thing that struck us was that there is a strong focus in Cuba on empowering people to deal with their own condition rather than simply writing them a prescription or giving them a pill.  We observed classes and spoke to the instructors.  The classes were held in a hall that had been pretty damaged by the recent weather in Cuba.  However, it was decided that the hall could still be used, and work was still going on.  The classes were held in that public hall, which had basic facilities.  Throughout the day, different classes were held for people with health problems such as diabetes, high blood pressure, arthritis and depression.  Those people had been referred to the classes by their doctor.  So, instead of automatically being given a prescription or a pill, they were referred to a class.  All the classes were free of charge, and the instructor was employed by the state.  There was no modern gym equipment, but there was a can-do attitude from both the instructor and the participants, who made best use of the buildings and facilities that were available to them.

We also talked to men and women who participated in daily grandparent circles, and we attended one such circle.  The circles involve people aged from their 50s to their 80s meeting every morning in a public park to do a set of exercises together.  We met a woman who was over 80 and still had her own teeth.  She had lost only one tooth, which is impressive for somebody of that age.  The members of the group were enthusiastic about the benefits of exercise.  Importantly, however, they were also enthusiastic about the social aspect of such groups, which is often forgotten.  Sometimes, we talk about our elderly being excluded and isolated, but I thought that the social aspect of that group was hugely important.

The group is peer-led, but an instructor visits twice a week to ensure that people do the correct exercises.  A doctor also visits every couple of weeks to monitor blood pressure and so on.  Again, they were using a public park.  There were no special facilities, and it was free to everyone.  If we are serious about tackling health inequalities, we need to make better use of our assets.  We have so many leisure centres, parks, schools, school playing fields, halls, church halls and government buildings that could all be opened up a lot more widely so that people could take part in activities that would benefit their health.  In fact, in Cuba, there was even a project for children with learning disabilities that was based in the local zoo.  The staff were using the animals in the zoo and factoring them in to the weekly work programme for the children, which involved therapy and exercise.  We need to think outside the box.

The report says that, if we are to get a handle on health inequalities, there must be a united front across all Departments.  It is not an issue for the Department of Health alone; in fact, the Department cannot deal with the issue on its own.  As part of the review, I wrote to all Departments on behalf of the Committee asking for details about the programmes that they currently run to tackle health inequalities through early years intervention.  Unfortunately, a number of Departments simply stated that they had no such programmes.  It is my impression that some Departments have not quite grasped the fact that we all have a role to play in improving the health of our people.  It goes across the board: we need to look at education, housing, job creation, access to the arts and sport and so on.  It is important that all Departments accept that they have their part to play.

The Minister is keen to secure cross-departmental buy-in and action for the Fit and Well strategy.  I assure the Minister today that the Committee is more than willing to be part of the push to tackle health inequalities.  I urge members of other Committees to take the time to ask what their Department does to promote public health.  If Departments are not doing anything, they need to do something.  If Departments are doing stuff, can they do more?

I thank Committee members for the part that they played in the report and staff from the Committee and the Research and Information Service, who helped us to produce the report.  I also thank the witnesses who gave the Committee the benefit of their knowledge of and information about the programmes that they run.  I commend the report to the Assembly.