Perhaps the most salient feature of modern Ireland is entirely and wilfully ignored by the political class and by the media.
We have panics, almost on a daily basis, certainly on a weekly basis, on all sorts of issues: cocaine, murders, anti-social behaviour, suicide, drugs in prisons, road deaths, traffic jams, errors in cancer diagnosis and treatment, MRSA, A&E chaos, waiting lists, mobile phones in prisons, e-voting, the M50.
But never, ever a mention in public that more than 5,000 people die here every year because of inequality and deprivation. This is 14 times the number of people killed on the roads, about 2,000 more per year than were killed in the entire 25 years of the conflict in Northern Ireland; nearly 75 times the number of murders.
What is it that causes such pervasive silence? Is it that the statistic is disbelieved? If so, why is the data not confronted and disproved?
The information comes from the Institute of Public Health, which published its seminal report some years ago: Inequalities in Mortality, on the basis of which the director of the Health Research Board, Ruth Barrington, has made the calculation about 5,400-plus premature deaths every year because of the huge inequality that pertains in Irish society.
Or is it that the significance of the data is such as to challenge the "core values" which underpin our society, "core values" that celebrate and consolidate inequality? To anybody interested in the issue of inequality in mortality there is nothing really surprising about the Irish figures, aside from the scale of the inequality. Even last Monday there was a report in the New York Times which reported on a higher incidence of fatal cancers among blacks as compared with whites.
Several studies in the UK have shown similar results: a gradient in mortality between people in the higher social groups as between people in all other social groups, with the poorest faring the worst. But it is a gradient and the more inequality in society the steeper the gradient.
Two months ago, Tom Keane, the new director of the national cancer control programme, gave evidence to the Oireachtas Committee on Health and Children. He said the goals of cancer strategy in Ireland were to reduce the incidence of cancer, to reduce cancer mortality and to improve the quality of life of people living with cancer.
He spoke critically of cancer care provision in Ireland. He said: "Perhaps I should not use the word 'disorganised' but it is certainly not organised." The thrust of his presentation was that cancer specialities had to be concentrated in a few centres and that opposition to this from around the country made no sense in terms of quality cancer care.
"When I ask doctors in Ireland where they send their family members, their mothers and sisters, for cancer care, it is very interesting to hear that they send them to centres of excellence, sometimes not even in Ireland. When doctors, who should be in the know, send family members to a centre of excellence in Dublin or out of the country, while adopting a different standard for patients in their own community, it says something."
All very telling. But how was it that it seems nobody brought Inequalities in Mortality to Tom Keane's attention, which tells a great deal about cancer here? Dealing with the decade 1989 to 1998 it showed the largest percentage of fatal cancers occurred in the larynx/trachea/bronchus/lung. They accounted for about 20 per cent of all cancers. This was followed by colon cancer at 9 per cent, female breast cancer at 9 per cent of all cancer deaths, at 78 per cent and male prostate cancer at 6 per cent.
For all cancers it showed there was a mortality rate of 83.1 per 100,000 for the highest social group, for the next highest it was 107.7, for the next 116.1 and for the lowest social group it was 185.2. That is over twice the mortality for the poor as compared with the rich.
In relation to cancers of the larynx/trachea/bronchus/lung it found that death was over four times higher for the poorest as compared with the richest.
For lymph/haematopoietic tissue cancer the highest social group had a mortality rate of 8.6 per 100,000, as compared with 22.0 for the lowest group, more than 2½ times greater.
For prostate cancer, the disparity as between social groups was not marked and for women's breast cancer no socio-economic data was published because of the difficulty in categorising women in social groups (why, I don't know) but it just is not believable that there is not the same gradient of inequality between the social groups.
My understanding is that the position has not changed significantly in the decade that this report relates to.
So how is it that these startling figures were not brought to the attention of Prof Keane, whose mission, according to himself, is to reduce the incidence of cancer and cancer mortality and to improve the quality of life of people living with cancer?
Or did he too ignore them?