Opinion Vincent BrowneA modest attempt was made yesterday in Dublin to inject some substance into political debate in the wake of the airhead Euro campaign. An independent alliance of community groups and voluntary organisations from around the country, the Public Health Alliance of Ireland launched its policy document, Health in Ireland - an Unequal State, outlining the facts of stark inequality in health.
Among its key points were the following:
Between 1989 and 1998, the rates for all causes of premature death were over three times higher in the lowest occupational class than in the highest.
The death rates for all cancers among the lowest occupational class is over twice as high for the highest class; it is nearly three times higher for strokes, four times higher for lung cancer, and six times higher for accidents.
Perinatal mortality is three times higher in poorer families than in richer families.
Women in the unemployed socio-economic group are more than twice as likely to give birth to low-birth-weight children as women in the higher professional group.
The incidence of chronic physical illness has been found to be 2½ times higher for poor people than for the wealthy.
Men in unskilled jobs were four times more likely to be admitted to hospital for schizophrenia than higher professional workers.
The rate of hospitalisation for mental illness is more than six times higher for people in the lower socio-economic groups as compared with those in the higher groups.
The incidence of male suicide is far higher in the lower socio-economic groups.
The 1998 and 2002 National Health and Lifestyle surveys found that poorer people were more likely to smoke cigarettes, drink alcohol excessively, take less exercise, eat less fruit and vegetables than richer people.
On average, 39 per cent of people surveyed in 2003 identified financial problems as the greatest factor in preventing them from improving their health.
Some groups experience particularly extreme health inequalities. For instance, Travellers live between 10 and 12 years less than the population as a whole. The 2002 census found that only 3 per cent of all Travellers were aged over 65, as compared with 11 per cent for the population generally.
The rate of sudden infant deaths among Travellers is 12 times higher than for the general population.
Researchers have found that many expectant mothers in direct provision suffer malnutrition, and babies in these communities suffer ill-health because of diet.
Homeless people experience a high incidence of ill-health - a 1997 report found 40 per cent of hostel dwellers had a serious psychiatric illness; 42 per cent had alcohol problems; and 18 per cent had other physical problems.
The incidence of injecting drug abuse use is almost entirely confined to lower socio-economic groups.
The scale of these inequalities seem to me to be astounding. Yet they feature hardly at all in political debate. These inequalities cannot be rectified by tinkering with the health system or even the radical reform of the health service. For these inequalities are rooted in the deep-seated inequalities in income, housing, education and status in Irish society.
Addressing such inequalities requires a radical distribution of wealth, a transformation of the education system whereby investment is poured into pre-school and primary education and outcomes in second- and third-level education equalised (the old mantra of equal opportunity isn't enough for it disguises inequalities that frustrate equal opportunity).
It also requires changes to the political system to permit equality of political representation and participation.
Inequalities in the health system itself are an important contributory factor. Micheál Martin's health strategy of two years ago acknowledged the inequalities and the suggestion was that something would be done. But the absurd incentivisation of hospital consultants to prioritise their private patients, the inexplicable allocation of publicly funded private beds in public hospitals and the continuance of the two-tier hospital waiting lists are testimony to the Government's lack of resolve to do anything about the issue.
But, in the main, the political consensus, far from seeking to confront such inequalities, celebrates it as confirmation of our high rating in the international competitiveness league. You would expect that of the Progressive Democrats and perhaps of Fianna Fáil and Fine Gael. But Labour, The Greens and Sinn Féin? They seems so bedazzled by the prospect of power as to be ideologically frozen, afraid to do anything that might alienate the comfortable voters it believes essential to electoral success.
The idea that politics is about persuading people to one's point of view, winning support for policies that are fair and equitable, is lost. In the process, fairness is lost too.
PS: I must declare a minor role (very minor) in the preparation of Health in Ireland - An Unequal State and my membership of the board of the Public Health Alliance Ireland.