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ANNEX 1 Summary of presentation by Mr Michael Bloomfield on the Departmental consultation document 'Investing for Health'
The Health of Our People Life expectancy in NI is among the worst in Europe. Average life expectancy for females is 79.71 years, behind France at 82.9, Spain at 81.96 and Sweden at 81.83. The European average is 80.98. Male life expectancy here of 73.9 years is nearly three years behind Sweden, and again behind France at 74.84 and Spain at 74.49. The European average for males is 74.41. Heart disease and cancer are the two top killers, accounting for almost 60% of deaths in those under age 75. Deaths from coronary heart disease (CHD) are higher in NI than elsewhere in Europe. In 1996 there were 147 deaths from CHD per 100,000 among women here compared with a European average of 77. In men it was 307 deaths per 100,000 here compared with a European average of 164.
Working for a healthier people is one of the Executive's priorities. It is committed to publishing a cross-cutting public health strategy by September 2001 that maximises the efforts to improve health and well-being and reduce health inequalities across all sectors.
In July the Executive agreed that the HSSPS Minister should take forward a public health strategy. The Minister re-established the Ministerial Group on Public Health comprising senior officials from all Departments. The approach is in line with international policy frameworks such as WHO's Health 21.
It aims to improve the health of our people and reduce inequalities in living and working conditions which cause ill health.
There is clear evidence that poverty is the biggest risk factor for health. Most affluent men live 6.5 years longer than the most deprived. Most affluent women live 4 years longer than the most deprived. Life expectancy of travellers is almost 20 years less than the settled community. Those electoral wards here with the highest death rates are also those with the highest levels of deprivation.
Investing for Health aims to improve the state of our health and reduce inequalities through addressing general economic, cultural and environmental conditions, living and working conditions, food production and access to services. It will also promote social and community networks.
Democratic accountability and ownership. All Ministers and Departments will be participating. There will be inclusive consultation and engagement. It will focus on the social, economic and environmental determinants of health, and recognise the inequalities that exist here and aim to reduce them.
A public consultation process was launched in November 2000. The Department is working in partnership with the Community Development and Health Network to engage the community and voluntary sector in particular. Seven groups have been identified to participate in themed workshops, including carers, ethnic minorities, people with literacy difficulties, and the homeless. The consultation process will end on 31 May 2001.
There is a focus on the most disadvantaged in society as these people suffer the worst health of all. However, beyond this, the document suggests three priority groups for action: the very young, children and young people, and older people. It is also proposed to promote action in a number of settings where people spend most of their time: homes, schools, workplaces, and communities.
The following topics have been chosen as they contribute to the main causes of death and illness: Smoking
The Ministerial Group on Public Health will co-ordinate the efforts across Departments, each of which will ensure that health factors are given due consideration in their areas of responsibility. Health Impact Assessments are proposed for all Departments' policies and programmes. It is proposed that the HSS Boards should lead local Investing for Health partnerships drawing together the key statutory, voluntary and community organisations in their areas. These partnerships will produce Health and Well-Being Investment Plans to tackle inequalities and develop high quality, efficient, effective and responsive services. For this to succeed it must attract widespread support across the community. It is important to mobilise the efforts of society, which is why there is a commitment to working together North and South, East and West, and internationally, to learn from and contribute to what is happening elsewhere. There is also a need to have the best possible information about what works and to have proper arrangements in place for monitoring inequalities in health and for evaluating the effectiveness of measures taken to reduce them. Summary of Question-and-Answer Session Q. While the new strategy to improve public health is both impressive and laudable, I am concerned as to how effectively it can be co-ordinated given the number of bodies involved, including the Boards, Trusts and the Health Promotion Agency. Where is the overall co-ordination strategy? [The Chairman] A. We fully recognise the importance of all Departments and Agencies working together with public health at the top of the agenda. There needs to be a drive from the top, and your Committee can play a crucial role in ensuring that effective co-ordination takes place. Q. You mentioned that it is estimated that 70% of the factors that affect our health are outside the responsibility of the Health Service, an assertion with which I would not agree entirely. Rather, I would see this Committee as complementing the Department's lead role in addressing those factors that affect public health. Can you comment? Also, going back to the question of co-ordination of the strategy, can you clarify the chain of accountability. For example, are the Boards and Trusts directly answerable to Dr Campbell, the Chief Medical Officer, at the top of the management structure? [Mr Gallagher] A. We have examined literature from elsewhere, including the World Health Organisation, and the 70% refers to the fact that the root causes of illness derive from factors such as poor housing and working conditions, social exclusion, low education, and unemployment, all of which fall outside the direct control of the Department. We do, however, fully accept your point about the central role of the Department here and the importance of leadership and advocacy. There needs to be accountability for leading in the right way, and, while working with the Boards and Trusts should not be a problem, it might be more difficult with other Departments. The Ministerial Group on Public Health, chaired by the Minister, will work to ensure the cross-departmental approach, and is answerable to the Executive. Q. I am concerned about where the funding will come from to meet the aims of this wide-ranging strategy: will it cut across all Departments? Where do the Executive's Programme for Government and the Department's Priorities for Action fit in with Investing for Health? Will the policies of all Departments be Health Impact Assessed? Will the Department have control over the policies of the local councils? Can they be directed to provide certain facilities? [Ms Ramsey] A. We would like to see more funding earmarked across all Government Departments for public health. But while there is a clear need to invest for the future in terms of public health, we recognise that this can be difficult in the face of current priorities. The current Priorities for Action were set up prior to the consultation on this Investing for Health document, which, we hope, will help inform future Priorities for Action and Health and Well-Being Plans. We want all Departments to give health priority when co-ordinating expenditure plans, so maximising their contribution to public health. It will be difficult to have all Departmental policies health impact assessed from year 1, but the Regional Transport Strategy is currently being piloted. In terms of the local councils, we can try to maximise their contribution by working through the Ministerial Group when we need to talk to them. Q. Funding seems to be the main issue - our hospitals are under severe pressure - so the importance of having effective contributions from all the Departments must be stressed. It is also vital that local community groups should be brought on board with the strategy. The work of the Health Action Zones, for example, has been very positive. [Mr Berry] A. We fully agree, but equally crucial is the matter of determining how the Departments can use their resources better. This Department has a budget in excess of £2 billion per year, which if used to the optimum effect would make a significant impact. Q. Where does Investing for Health fit in with the overall health strategy and all the other consultation documents, and how will it be implemented? There is concern that the Boards cannot be persuaded to update equipment or appoint dermatologists, for example. Will the document be influenced by the results of the reviews of Primary Care services and the Acute Hospitals? [Rev R Coulter] A. We see this as a visionary document that takes precedence; it should determine the public health strategy for all the Departments. It is taking place alongside the important reviews you mentioned, which had to proceed urgently because of the difficulty in sustaining some of the hospitals. The document speaks closely to primary care and will be able to provide an input to the Primary Care Review. It is important, however, to bear in mind that some of the implications of the strategy will only be seen 10 to 20 years down the line. The Boards have an important role in providing an overarching vision and identifying the priority needs of the local population. We are more aware than ever of the need for a local response. Q. Can you provide some detail on the methodology proposed for the Health Equity Impact Assessments? Who would have an input to these assessments? While your priorities are laudable, I was disappointed not to see reference to mental health, including eating disorders. Suicide is another big issue. Also, I was surprised to see so few targets in comparison with GB. Were you awaiting the outcome of the consultation process before firming up timetables? [Ms McWilliams] A. We are working with other Departments and Agencies on Health Impact Assessments, and are also looking at good practices in England. We hope that they will want to do it rather having to make it a statutory requirement. Work is ongoing on eating disorders, which, it is hoped, will inform the final report. It is important to see Investing for Health as an open document, which is posing a number of questions. Its aim is not to pre-determine the priorities but to seek a response from people before examining targets in that context. A Cross-Departmental and multi-sectoral group has been established to give thought to what the targets may be. We would expect there to be a relatively small number of high level objectives from which would flow various action strategies. The targets should be relevant to all Departments.
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