Speech for Minister Reilly to the 3rd China Health Forum (2012) in Beijing on 17th – 18th August 2012
Minister Chen, distinguished guests, ladies and gentlemen. I am very honoured to have been invited here to speak to you today on this important health issue. I would like in the first instance to thank Minister Chen for his invitation and to congratulate him on what is clearly a very well organised and smoothly running event.
While Ireland is a relatively small country with a population of 4.6 million people we still face the same issues, challenges and complexities as other larger countries.
There is now a global awareness of the impact health has on the productivity and economic well-being of nations. In that context, it is worrying that non-communicable diseases now account for nearly two out of three deaths per annum worldwide and every year non-communicable diseases kill 9 million people under 60. These diseases are the leading cause of death and morbidity in developed countries. They represent a major emerging health threat.
The pattern in Ireland is similar to that in Europe where approximately 80% of the overall disease burden is attributed to chronic disease. It is estimated that three quarters of people over 75 have at least one chronic condition and over a third of men over 60 years of age have two or more NCDs.
Mental health conditions are one of the leading causes of morbidity affecting approximately one in four people in their lifetime. There are significant health inequalities in chronic disease rates and the lifestyle factors that lead to these conditions are also unevenly distributed across society, in particular, smoking, alcohol consumption, diet and physical activity.
Patients with chronic conditions are heavy users of the health services. In Ireland it is estimated that three quarters of healthcare expenditure relates to non-communicable diseases. In practical terms, this translates to 80% of General Practitioner consultations and 60% of hospital bed days. Non-communicable disease accounts for two thirds of emergency medical admissions to hospitals.
The economic burden is considerable. Not only for the health system but also in terms of families and society as a result of reduced income, early retirement, an increased reliance on social care and welfare support and diminished productivity and absenteeism. According to the World Health Organisation, a 10-15% increase in chronic diseases will reduce a country’s GDP by an order of 1% over the next decade.
The trend analysis from recent Irish hospital utilisation data clearly indicate significant increases, ranging from 20 to 70%, for certain chronic conditions over the past decade. In addition primary care prescribing is also showing significant increases.
Our forecasting indicates that chronic conditions will generally increase by around 40% between 2007 and 2020 as a result of the ageing population and the impact of lifestyle factors.
The pressures faced by the Irish Healthcare system by this burden cannot be sustained from a cost or hospital capacity perspective in future years under current structures. A new model of structured integrated care involving primary care with an emphasis on prevention will be required. We need to shift our health systems away from a medical curative model of healthcare and encourage patients to actively participate in the management of their condition.
When I took over as Minister of Health in Ireland last year it was clear that reform was needed Reform that would:
- improve health services for our people
- help us deal with future cost pressures on our health system.
The first step in this planned reform is the provision of Universal Primary Care.
In our Programme for Government we committed to introducing free GP care at the point of use to the whole population. Initially, free GP cover will be extended to persons with defined long-term illnesses. We want to get to the position where up to 95 per cent of people’s day-to-day health and social care needs can be met in the primary care setting. As they should be.
New Primary Care Centres throughout the country will put patients in contact with integrated multi-disciplinary teams of general practitioners, nurses, physiotherapists, occupational therapists, etc.
Shared premises encourage interaction across all health care professionals. That is why we are committed to developing a network of new primary care centres.
Enhancing and expanding our capacity in the primary care sector is critical if we are to deliver a proactive, joined-up approach to the management of our nation’s health. This is particularly important in light of the very significant challenges due to the increase in the incidence of non-communicable diseases.
Primary Care Teams allow structured approaches to chronic disease management, enhanced multidisciplinary team working, improved diagnostic capabilities in Primary Care and the integration of services between primary and secondary care.
We are developing chronic disease programmes to improve patient access to hospitals when required and to manage patient care in an integrated way in order deliver better health outcomes, enhanced clinical decision making and more effective use of resources.
These programmes include: Diabetes; Heart Failure; Asthma; COPD and Stroke – all of our hospitals that receive stroke patients now have a stroke unit compared to less than 20% a year ago. This means that 24 hour thrombolyosis is available to those patients who are suitable. We estimate that this will save many lives and reduce morbidity considerably.
Our underlying principle is that the patient must come first and that all we do should focus on this key point. If we do not improve outcomes for patients then our efforts are in vain. A supporting principle of this is that the patient should be treated at the lowest level of complexity that is safe, timely, effective and as close to home as possible.
This means that much work that is currently done by specialists should be done by GPs. In turn work by GPs can be done by nurses and indeed much work done by nurses can be done by allied health care professionals and workers – in other words the right patient treated by the right person in the right place at the right time – thus maximizing the use of all the skills in our health services.
While the first step in this journey is the provision of universal primary care. A major shift towards prevention is imperative.
Many non-communicable diseases have a number of modifiable risk factors. Eating a healthy diet, being active, not smoking and limiting alcohol use will help prevent the risk factors.
Prevention is crucial: approximately two thirds of the predicted disease burden is caused by risk factors that can – and must – be prevented.
We can do it. We’ve already done it.
Ireland, for example, was a world leader in banning smoking in the workplace. It happened despite what seemed insurmountable opposition. Our workplaces – including theatres and public houses – changed, and in due course, some of our non-communicable disease statistics will change, too, as a result, not of a medical change, but an environmental one.
Now, we need to draw on the lessons from this success when we tackle alcohol misuse, poor diet and lack of physical exercise.
At the end of this process, we must have a public health policy that supports and fortifies our capacity for early disease detection, risk assessment, mitigation and control.
Increasingly, it is apparent – and not just in the health area – that changing behaviours changes attitudes, and that action to change behavior, rather than starting with attitude, may be more speedily productive. Let’s be clear – worldwide campaigns to reduce tobacco consumption and the effects of indirect smoke have been markedly less effective than banning smoking in the workplace has. Similarly, on our roads, direct punitive action against drink driving, using mobile phones and failing to wear a seat belt has quite simply changed the behavior of the majority in a way that consciousness-raising could not.
Smoking is a major risk factor for strokes and Ireland has a good reputation as regards tobacco control legislation. However, we must continue to build on the work that has already been done in order to tackle this problem which results in approximately 5,200 deaths every year.
An Irish Tobacco Policy Review, currently underway, will cover areas such as smoking in cars in the presence of children and improving the quality and effectiveness of our smoking cessation services and the possible need for further legislation on tobacco control measures. I am considering how best to progress this in relation to beaches, public parks and educational campuses.
It is essential that we denormalise smoking in our society and I anticipate that the report of the Tobacco Review Group will go some way to assisting us in this regard.
Similar bodies are working on the issue of obesity, which as you know, is now a global epidemic.
All of this adds up to radical change in the way we look at health and healthcare. Up to now, we’ve focused on specialist treatment. Now, we’re shifting to self care and patient empowerment. We have the evidence that patient empowerment improves health outcomes. Knowledge of the disease and its treatment not only improves quality of life but reduces dependency on the health services.
It is important that we share our experiences of best practices in this area and learn from those of other nations. I had the opportunity earlier this year to discuss these developments in an EU context and also to give Ireland’s support to the European reflection process on innovative approaches for non-communicable diseases and in particular the important role of patient empowerment as a key element in managing chronic diseases.
I think it is clear that there is a global commitment to tackle non-communicable diseases. It is most important that we all continue to engage internationally.
I participated last year in the high level UN meeting on the Prevention and Control of Non-Communicable Diseases. The aim of the meeting was to set a new international agenda on Non-Communicable Diseases and for countries to adopt a concise, action-oriented outcome document that will shape the global agendas for generations to come.
This was only the second time in the history of the UN that the General Assembly with the participation of Heads of State and Government had met in relation to health, reflecting the seriousness of this emerging health issue which has a major socio-economic impact on all of us. Specific aspects of the Political Declaration arising from the high level meeting are currently being progressed by the World Health Organisation.
Platforms such as this Forum are also pivotal to widening the discussion and sharing experiences which can only enhance our capacity to deal with this issue. Indeed one cannot fail to be impressed by the astonishing progress China has made over the last few years. In particular I refer to Tianjin City which I visited 2 days ago. I saw at first hand a new state of the art hospital for the treatment of cardiovascular disease and a community hospital with multiple facilities to treat people in the community. The speed with which these hospitals have been built is something we are unfamiliar with in my country but which we must try to emulate.
When I spoke in Europe and the UN it became very obvious that in both North America in Europe we face the same problems as indeed you face here in China. Despite the fact that we face serious economic challenges and have had to cut 15% of our health budget over the last few years we have managed through reform to reduce the number of patients waiting for both inpatient and emergency services.
The message is clear – great challenges bring even greater opportunity. I have no doubt that together through co operation, collaboration and sharing information we can achieve our mutual goal of giving all our citizens the health service they need and deserve.
Can I thank again Minister Chen and the Chinese Government for hosting this important and well run event.