Speech by the Minister for Heath and Children Mr Micheál Martin TD at the launch of “Health Inequalities and Poverty” at the SVP Shelter for Homeless Men, Backlane, Christchurch


I am delighted to be here today to launch “Health Inequalities and Poverty”; which raises crucial issues which need to be addressed if we are to deal efficiently with the challenge to the health sector to provide equity in health care for everyone in Irish Society today.

The National Anti-Poverty Strategy

The Chief Medical Officer, Dr Jim Kiely, chose health inequalities as the theme for his 1999 Annual Report. That Report drew attention to the fact that “inequalities in health status between socio-economic groups in this country have been demonstrated and are persisting”. The report went on to state that the factors involved in the relationship between ill health and socio-economic background are complex and hard to unravel. However, we know that poverty can lead to ill health and in turn ill health can lead to poverty.

It is for this reason that, when the Government gave a commitment in the Programme for Prosperity and Fairness to review the National Anti-Poverty Strategy (NAPS) across all relevant Government Departments, it included a commitment to develop NAPS targets in the health area and an associated monitoring and implementation framework. That exercise is now being carried out in consultation with the Social Partners under the auspices of a Working Group on NAPS and Health established by my Department.

Arising from a Government commitment to the development of an anti-poverty strategy at the UN World Summit in Copenhagen in 1995; the National Anti-Poverty Strategy was published in 1997. Ireland was the first EU Member State to develop anti-poverty targets and we are at a considerably more advance stage of development in this regard than most of our EU counterparts. The Irish situation is also characterised by a more advanced social partnership model than exists elsewhere in Europe, a model in which the Community and Voluntary Pillar are playing a critical role.

Key concerns arising for my Department from the outset of the strategy included drug addiction, family support services, care for people with disabilities, travellers health and homelessness. There has, therefore, been a significant health component in the NAPS process from its inception.


The public call for submissions made by the Working Group in the national newspapers at the end of February has had a good response. Throughout April the NAPS and Health consultation is taking place through the Health Boards, the Community and Voluntary Pillar and the County Development Boards.

With the assistance of the Institute of Public Health we are trying to ensure that the consultation process is as inclusive as possible so that people who are poor or socially excluded have a genuine opportunity to tell us what they think would improve their health situation. I would like to acknowledge the assistance which the Community and Voluntary Pillar and the Combat Poverty Agency are giving the Institute of Public Health in accessing these groups.

To avoid duplication this consultation is being co-ordinated with that for the National Health Strategy, with the same liaison officers co-ordinating both processes at Health Board level. The results of the NAPS and Health consultation will be one of the important elements feeding into the new National Health Strategy.

National Health Strategy

As I have already indicated a new Health Strategy is now being prepared to address the major issues still facing the health system. Building on “Shaping a Healthier Future” the new strategy will outline proposed development in the health system for the next five to seven years and set out radical ambitions for improving our nations health status. The overall objective of the strategy will be to provide a timely, safe and quality patient centred service on the basis of need. Lead responsibility for the development of the Strategy has been taken by a Steering Group, chaired by the Secretary General of my Department, comprising the Department’s Management Advisory Committee and a number of Health Board Chief Executive Officers. The Steering Group is being supported by a Project Team representative of the Department and Health Boards as well as being advised by a National Health Strategy Consultative Forum that is representative of key stakeholders including health professionals, healthcare management, consumers of health services and members of existing partnership structures. The first meeting of the Consultative Forum, put back from 5 March because of the foot-and-mouth crisis, will now take place on 23 April. Your own organisation has been invited and indeed has already been active by the able representation of Audrey Dean on the Eligibility Sub-group, one of eight recently set up subgroups of the Forum. These are working in parallel with Departmental and health board working groups examining the key issues of:

  • eligibility
  • funding
  • delivery of services; including human resources
  • E-health
  • quality
  • health promotion and population health
  • the future ahead for the health care system and
  • the interface between the statutory and voluntary sectors

Health Promotion

While there have been many initiatives to redress health inequalities, we know that much still remains to be done in this area, including the examination of variations in the health status of different groups in society and how these might be addressed. These objectives were addressed in the 1998 National Health and Lifestyle Surveys “Slán” (Survey of Lifestyle, Attitudes and Nutrition) and “HBSC” (Health Behaviour in School-Aged Children). These surveys looked more specifically at the relationship between social class and well being and clearly showed that lifestyle and behavioural factors are an important influence on health and inequalities in health as are the social and economic environment and the influences of school and society.

A person’s lifestyle decisions, in particular those decisions on diet, exercise and smoking to mention just three, also have an important effect on health. Good eating habits learned in childhood can last a lifetime. The reality is that the achievement of physical and mental well-being is not the responsibility of the individual alone. Some people are unable to pursue good health because they have limited skills, information and income. A range of social, economic and environmental factors together with issues of equity, equality and access impact on the physical and mental well-being of individuals.

The challenge for health promotion is how to respond to the evidence presented from social, economic and environmental factors, lifestyle practices and illness patterns to bring about health and social gain in a comprehensive and equitable manner. In recognition of this I believe that we need to give much greater emphasis to intersectoral co-operation for health and to assessing the impact on health of the policies of other sectors.

Waiting Lists and Hospital Consultants

Another area of major concern highlighted by St. Vincent De Paul is hospital waiting lists and the availability of hospital consultants in Accident and Emergency Departments. The Waiting Lists Initiative received £34.5 Million from my Department last year and will receive the same this year in support of the objective of no adult waiting for a procedure for more than 12 months and no child more than 6 months. Whilst there are difficulties it must always be remembered that the waiting lists represent only just over 3% of total hospital activity. In addition the number of cases treated in public hospitals has been markedly increasing in complexity on top of 3-4% increases in volume per year over the last couple of years.

Very significant achievements have been recorded in important specialties, for example in the year from December 1999 the waiting list for cardiac surgery has been more than halved.

I am also pleased to say that funding has been secured to appoint an additional 29 A&E consultants. Additional consultants are being recruited with 11 New posts currently being offered and interviews scheduled to ensure the recruitment of a further 10 consultants in the near future.

The recent report of the Forum on Medical Manpower sets out proposals for the construction of consultant posts not only in the context of changed work patterns but also in the context of a consultant delivered service. A quantification of the resource implications will now be undertaken to provided detailed and accurate data for consideration by Government.


The plight of homelessness has many varied causes and its victims range across all age groups. Homelessness is a complex issue requiring a multi sectoral approach including Government Departments, Local Authorities, Health Boards and Voluntary Agencies. This Government is committed to the concept of social inclusion and to dealing with the issue of homelessness. To that end the Government is now working to implement ‘Homelessness – An Integrated Strategy” which was published in May 2000 and seeks to develop an integrated response to the many issues that affect homeless people. The implementation of the Strategy on Homelessness will involve closer working between all agencies concerned.

The Strategy on Homelessness emphasises that in addition to addressing the issues of those already homeless, it is essential that action is taken to identify and assist those at risk of becoming homeless. Those leaving institutional care (whether custodial or health related) are identified as one of the principal groups at risk of becoming homeless. My Department is involved in developing a further strategy aimed at preventing homelessness among those at risk which will be published shortly. I am satisfied that this strategy will help to prevent homelessness in the future.

Support for Older People

Another area which the Government has been prioritising is support for older people. The older population in this country have been instrumental in building and strengthening the Irish economy to the healthy level we enjoy today. It is the policy of my Department to maintain older people in dignity and independence at home in accordance with their wishes, as expressed in many research studies. I also want to restore to independence at home those older people who become ill or dependent and encourage and support the care of older people in their own community by family, neighbours and voluntary bodies. I also aim to provide a high quality of hospital and residential care for older people when they can no longer be maintained in dignity and independence at home.

To date, I have increased the revenue funding for the development of services for older people from £10m in 1997 to an £46m in 2000. This has resulted in approximately 880 additional staff being appointed to services for older people between 1997 and 2000. This funding has also allowed for over 400 additional beds in 10 new community nursing units and over 1000 day places per week in 10 new day care centres.

Health Spending

The recent increases in funding resources, including the capital funding for new facilities under the National Development Plan, mean that over the last four years Government spending on health care has doubled. In 1996 current expenditure in the public system was £2.5billion and for 2001 it will be over £5.3billion. In addition the spending of £2billion over the 7 years of the NDP represents almost 3 times the capital budget over the previous 7 years.

For 2000 it is estimated that health spending is 6.75% of GDP. With a further major increase in 2001 the percentage of GDP taken up by total health spending in the public sector is estimated to be 5.8%. This is the highest figure as a proportion of national wealth since 1995. In addition a further 1.25 to1.5% could be added for private spending.

This will take us closer to the EU average in terms of GDP spent on health care and this is a trend I intend to see continuing.

Nursing Vacancies

Whilst the number of vacancies in the ERHA remains high I have taken various initiatives to address this situation. The initial response to these initiatives has been good. Information to hand now shows that there is a clear net inflow of nurses into the system. The full impact of these initiatives will become evident over the next few months with further improvements expected.

The Consultative Process

The overall consultative process allows individual members of the public the opportunity to communicate their views on the current system and proposal for change. An advertisement inviting the public to give us their views on our health care system and what should be included in the Strategy was published ten days ago. I invite those present here today to avail themselves of this opportunity of making their views known if they haven’t already done so via the NAPS process. In addition, I have asked that a market research be carried out on views of the public on health care. It is envisaged that the new Strategy will be completed by mid year.

Despite the problems which need to be addressed we must recognise the excellent health care being delivered by the many thousands of dedicated health care professionals. This remains something we can take pride in and build on when tackling the reform agenda which will lead, via the new health strategy, to the improvements which we all wish to see delivered.

As well as in the work on NAPS, most of the issues of concern to Saint Vincent De Paul are being addressed in the context of the new Strategy being developed, the review of bed capacity and the medical manpower report. The extensive consultation in NAPS and the Strategy will undoubtedly pick up on all these issues including a full examination of the need for overall reform of the system.


I acknowledge the important role which the Saint Vincent de Paul Society has played in our society for many years in drawing to the attention of the public and the administrators and politicians some of the inequities which persist in our society. The Society has had a special focus on health in recent times. Their conference last November on Health Inequalities and Poverty provided a valuable opportunity for debate on this issue. The publication we are launching here today is another milestone in this work. I want therefore to express my gratitude to the Society for inviting me to launch this policy document and congratulate you on this challenging contribution to the issues of health inequalities an poverty.