Health Policy.

Thursday, 28 February 2008

Seanad Éireann Debate
Vol. 188 No. 18

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Senator Cecilia Keaveney: Information on Cecilia Keaveney Zoom on Cecilia Keaveney I thank the Cathaoirleach for allowing me to raise this matter on the Adjournment.

The programme for Government refers to the establishment of a freely available and personalised national programme for personal health checks to provide for the prevention and early detection of illnesses in respect of both men and women. The Government has been in office for more than six months and the proposed programme of personal health checks has not yet been discussed to any great extent. As far as I am con[1404]cerned, getting the ball rolling in respect of this programme should be a matter of priority.

This debate comes at a poignant time because the Irish Thoracic Society yesterday published its INHALE report, Ireland Needs Healthy Airways and Lungs — The Evidence. This report contains figures which indicate the death rate from respiratory diseases in Ireland is the second highest in Europe. Asthma is now the most common chronic childhood illness in this country. Respiratory diseases cost the health service €437 million in 2006 and more than one in five people visit their doctor at least once a year because of respiratory illness.

Dr. Neil Brennan, one of the authors of the Irish Thoracic Society’s report, said that whether it is lung cancer, asthma, chronic obstructive pulmonary disease, tuberculosis or cystic fibrosis, the picture is the same — death rates and prevalence are either rising or are higher than they should be and the resources to effectively prevent, diagnose and treat these diseases are inadequate. The Irish Heart Foundation has also released figures, in preparation for its national information campaign, Message from the Heart, which indicate that 36% of all deaths in Ireland are caused by heart disease.

The obesity rate among adults in Ireland is on the increase — it has reached 13% — according to the latest OECD indicator reports. Very few people are aware that obesity is related to chronic illnesses such as diabetes, asthma, cardiovascular disease and some forms of cancer. Under its budget for 2008, the Department of Health and Children’s current spend will be €344 million, €29 million of which will be spent on cancer, and the capital spend will be €52 million. In 2006, the VHI paid out €139 million in respect of cancer patients.

As of December 2007, 24% of the population in Ireland were listed as smokers. The higher percentage of these individuals is male. Although the percentage of those who smoke has decreased significantly in recent years, particularly following the introduction of the smoking ban, tobacco remains a prevalent killer in society. The highest percentage of smokers — 25.21% — in Ireland is to be found in Munster. Why is that the case? Are we not communicating effectively enough with members of the public in Munster?

I would like matters of this nature to be addressed in the context of personal health checks. As stated on the Order of Business earlier this week, we need all-island approaches in respect of health measures and public awareness campaigns. If personal health checks were introduced, we would obtain information that would enable us to identify the areas on which we should focus. For example, people in Munster obviously need a little more information regarding the dangers of smoking.

[1405]The number of illnesses caused by obesity, alcohol consumption and smoking is on the increase, as is the cost to the State in terms of being obliged to provide treatment. This is why the Government’s programme for personal health checks is vital. The programme needs to be initiated in order to curb costs. Personal health checks will result in early detection of illnesses, thus reducing the cost to the State.

Annual personal health checks will provide members of the public with information on all aspects of their health and lifestyles. Many people are unaware of how their diets can affect their health. Leading medics throughout the world constantly reiterate that simple exercise and a regular diet of fruit and vegetables can lower the risk of cancer. Lifestyle factors relate to choice but people need to be aware how their lifestyle choices affect their personal health. Personal health checks could provide this information as well as assisting in the early detection of illnesses.

According to Professor Crowe of Vanderbilt University, early detection through screening and annual check ups could increase the proper use of antiviral medicines, reduce the inappropriate use of antibiotics — thereby reducing antibiotic side-effects — and help reduce hospital waiting times and free up beds. Good health is necessary for individuals to flourish as citizens, workers, family members and consumers.

The basic message is straightforward. Last week, a company provided free check ups, on a voluntary basis, to Members who wished to avail of them. I was surprised by the number of people who stated that they did not want to have a check up because they did not want to discover how bad might be the state of their health. We want to roll out BreastCheck services on a nationwide basis but I am referring to the roll out of a more comprehensive health check. If person health checks are to be introduced, people should be made aware of the need to avail of them. I look forward to the Minister of State’s reply.

Minister of State at the Department of the Environment, Heritage and Local Government (Deputy Tony Killeen): Information on Tony Killeen Zoom on Tony Killeen I thank Senator Keaveney for raising the issue, which I am responding to on behalf of my colleague, Deputy Mary Harney, Minister for Health and Children.

The programme for Government contains a commitment to the development of a freely available and personalised national programme to provide for the prevention and early detection of illnesses for both men and women. The programme intends that guidelines should be developed for the personal health check based on best available national and international evidence of what works well, with structured call and recall arrangements during a person’s life and provision for appropriate clinical follow-up where required.

[1406]The Department of Health and Children is examining at present a range of issues which need to be addressed to decide how best to proceed on this commitment in the context of international best practice, our own national health policy and the many competing priorities for health service development.

By way of context, it is appropriate to acknowledge that chronic diseases represent a major challenge for the health services and society generally. They represent the major component of service activity and expenditure in the health care system as well as being the major contributor to mortality and ill health in this country. Given projections which predict a doubling of the elderly population over the next 30 years, this will give rise to a significant increase in chronic diseases, which will bring a significant challenge to our society and health care system as well as to individuals and their families.

The main causes of chronic disease are known and largely preventable. Lifestyle factors, including tobacco and alcohol usage, together with physical inactivity, poor diet and obesity are key risk factors along with high blood pressure and cholesterol for chronic disease. Effective interventions are known and it is estimated that 80% of cardiovascular disease and type 2 diabetes as well as 40% of cancer could be avoided if major risk factors were eliminated.

It is also very relevant that the challenge of chronic diseases and the lifestyle factors that contribute to them is especially acute among lower socioeconomic groups. The policy question that arises here, as elsewhere, is to how to use scarce resources to help those who need help the most. The context, therefore, in which the role of a personal health check is being worked on is one in which there will be a strategic and integrated approach to the prevention, detection and effective management of chronic illness. This is an area in which the Department of Health and Children at present is preparing a policy framework which will be completed in the coming months.

Among the issues to be considered for a personal health check programme are whether whole age cohorts of the population should be offered or encouraged to have a periodic health check or whether a more targeted approach is preferable. Also to be considered is the appropriate clinical content of a personal health check and the interval between checks according to individuals’ age, gender and relevant risk factors.

The appropriate degree of State involvement in any programme and the organisational issues which would arise will also be considered, along with direct and indirect cost issues. The Department of Health and Children therefore is considering these and other relevant issues to inform the best way to proceed.

[1407]Senator Cecilia Keaveney: Information on Cecilia Keaveney Zoom on Cecilia Keaveney I have a comment I would ask the Minister of State to relay to the Minister for Health and Children. I was a student in Jordanstown for a number of years and even now I will get called for cervical smear tests in the North every two years. If I do not follow up that appointment, I get a letter asking me to sign a disclaimer indicating I have voluntarily refused not to take up the offer.

I ask the Minister of State to request of the Minister for Health and Children, Deputy Harney, to liaise with the people in the Executive in the North to see how the structure there operates, given that availability of these facilities there is normal. Perhaps the Department could learn from the regular activity in the North in the cancer screening and other public health areas.

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