Considerable comment has followed the recently published report of the Institute of Public Health in Ireland, Inequalities in Mortality 1989-1998: A report in All Ireland Mortality Data. I watched a Prime Time special on the issue the week before last which made much of the large and growing mortality differential between those who are economically comfortable and those who are not.
It was an interesting programme, outlining a broad and detailed analysis of the problem and the likely reasons for it. A number of factors were mooted as explanations for early mortality among the poor: low income, the harshness of manual labour, heavy cigarette smoking, limited control over one's life, and so on. In the studio discussion the point was strongly made that Irish society was developing a kind of apartheid system in the area of health.
Two weeks ago also, my colleague Vincent Browne devoted a column to the subject, emphasising what he called the "systematic inequality" indicated by the report. "These mortality figures," he wrote, ". . . provide an insight into the deep levels of inequality that exist throughout lifetimes that give rise to these startling differences in mortality rates. Inequality is not just about unequal incomes and unequal wealth or unequal power or unequal opportunities. It is also about unequal lives, not just of years of life but of quality of life and of health throughout lives."
This was all excellent stuff. The consensus was that here was evidence of major inequality in Irish society, that life expectancy was a massive indicator of social and existential deprivation, and that there was an onus on State and society to put this right.
But there is another dichotomy visible in the Institute of Public Health report which, though referred to in passing, was not given anything like the same emphasis as the rich-poor divide. I refer to the gap between the relative life expectancies of men and women.
Vincent Browne noted a couple of the facts, although he did not draw any inferences from them: almost three times as many men as women die in road accidents; four times as many men as women die by their own hands. In fact, the same pattern is to be found throughout the statistics, including almost all major diseases. For cancers, male mortality is 45 per cent higher; for respiratory diseases, 48 per cent; for circulatory diseases, 61 per cent; for injuries and poisonings, 169 per cent. It is, of course, important to stress that, for poor men, this lethal gender dichotomy exists concurrently with the socio-economic one. The report states: "excess mortality amongst males represents a fundamental inequality in health".
You would think, then, that a society with the requisite levels of good conscience and compassion to become exercised about one set of disparities would become equally so about the other, especially when the core issue in both instances would appear to be equality or its absence.
Why is it that, whereas we are willing to examine inequality in the socio-economic area, we refuse to grapple with the same set of statistics when it comes to gender? I know the answer: health is not a gender issue, and could be defined as such only if the evidence of inequality suggested discrimination against women. Because any exploration of the facts might lead us to consider the possibility of discrimination against men, it is mandatory to ignore the gender aspect and concentrate on the class inequalities.
But if disparity between the relative mortalities of rich and poor lead us to the conclusion that the rich are treated better than the poor, how can we avoid reaching the same conclusion in respect of the disparities in the respective mortality rates of men and women?
Some vested interests would have us believe that the male-female differential, unlike the rich-poor one, is a natural phenomenon, but the facts betray that this pattern began to develop only in the last century.
And if lower life expectancy among poor people has to do with issues of money, work, status and the individual's perception of the degree to which he or she has control over his or her life, why do we, when confronted with the overwhelming evidence that men die younger than women, refuse to consider the possibility that men in this society may have more concerns about money, work harder, enjoy lower status and less control over their lives than women in this society?
Oddly, or perhaps not, on the same day as the Prime Time programme, it was reported that several political parties, the ICTU and RTE are being given large amounts of money to promote gender equality, meaning equality for women.
Would it not be odd if, in the week of the publication of the Institute of Public Health report, such organisations had received money to promote the inclusion of more rich people in their ranks?
Or is Vincent Browne wrong in suggesting that health is more important than issues of money, opportunities or power?
The answer to all these questions is that, although it is ideologically acceptable to reflect on the deprivations of poor people, it is unacceptable to worry about what happens to men. Even poor men, it appears, are less worthy of our societal sympathy than rich women.
jwaters@irish-times.ie