ANALYSIS:The Pfizer Health Index reveals a drop in the level of interaction with medical services and the health system as the recession hits people's pockets, writes DR MUIRIS HOUSTON
THE PUBLICATION yesterday of the 2010 Pfizer Health Index couldn’t be better timed. With a draconian budget just weeks away, in which health will take a one billion euro hit – a 7 per cent reduction – the survey offers an up-to-date picture of how the recession is hitting the health of the nation.
On a broad measure of how the downturn has impacted so far, more than two in five people have been affected by either job loss, salary reduction or an involuntary reduction in working hours, the index shows. That is a significant economic hit and one that has implications for people’s health.
These implications are clear. If you come from the lower socio-demographic groups, you are 2.5 times more likely to suffer from arthritis, twice as likely to have heart disease and three times more likely to experience depression. And we know from previous research that mental health has a knock-on effect on our physical health.
Depression doubles the risk of developing coronary heart disease. People with schizophrenia and bipolar disorder die at a younger age than the rest of the population. This is because of the physical health problems they experience as part of their psychological illness.
And the relationship exists in the other direction also – people with two or more long-term physical illnesses have a seven times greater risk of depression than those who are physically healthy.
But this year’s health index points to some critical pressure points: a consistent reduction in the level of people’s recent interaction with the health system and a marked vulnerability among the C2 socio-demographic group.
Almost a quarter of the population, the C2s are principally skilled manual workers. They could be described – in less politically correct terminology – as the upper working class. And they are hugely vulnerable when it comes to accessing medical care. They are the largest segment of the population who do not have either a medical card or private health insurance.
Arguably the group who benefited most from the economic boom, they have most to lose from unemployment and reduced wages, and are those least likely to afford healthcare, even when acutely ill.
A marked reduction in the level of interaction with medical services and the health system emerges from yesterday’s data. When feeling unwell, just 66 per cent said they would visit their GP in 2010 compared with 73 per cent two years ago, a significant and worrying drop.
Whereas 19 per cent of the population had gone to hospital for a medical procedure or surgical operation in 2008, this had dropped to some 16 per cent this year.
The decline continued across the board: there was a fall-off in the numbers visiting a family doctor for a check-up as well as a drop in the percentage of people availing of medical screening between 2008 and 2010.
If this trend continues – and there are good reasons to suspect it will – the implications for the nation’s health are serious. It means a later diagnosis of disease that will require more costly treatment in a hospital rather than a community setting. It means a greater mortality from cancer and heart disease because of delayed diagnosis.
And it means less prevention because even those least affected by personal debt are cutting “discretional” health spending in the form of check-ups and health screening.
Of note, some 15 per cent of the population feel they have experienced some form of healthcare inequity, with more than nine in 10 people wanting to see it eliminated.
But it is the 23 per cent of people in the C2 socio-demographic who have most to worry about where equity is concerned. They are the meat in a resource sandwich that is being squeezed ever tighter by the system.
While the DE demographic is more likely to have a screening mammogram or a flu jab and the ABC1s are more likely to have their children vaccinated or to have a cervical smear test, the C2s are not well served by a health system where access is controlled by affordability.
Those at the top can afford to buy healthcare while those at the bottom have both doctor visits and medication largely paid for.
But if you are in the middle, no matter how much chronic illness you suffer, there is no fair and equitable way that the presently structured system can look after you. It’s time we did better by the “forgotten quarter”.
If you come from the lower socio-demographic groups, you are:
2.5times more likely to suffer from arthritis,
twiceas likely to have heart disease and
threetimes more likely to experience depression