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ANNEX A

Q. The Labour Government places great emphasis on Targeting Social Need (TSN): what advice would the panel give the Committee in relation to TSN?

A .It is vital first to acknowledge the inequalities that poverty creates; it is an accepted concept that the poorest are confronted with the severest health challenges. Specific programmes must therefore be developed to focus directly on this group, which needs most intervention.

Q. What is the Agency doing to reduce the number of fatalities from heart disease? What measures is it taking to increase public awareness of the dangers of smoking and its link with lung cancer?

A. The Agency has been instrumental in helping to co-ordinate the 'Change of Heart' campaign and later separating out and working on the different factors involved. Apart from its policy, research and training functions, it has also developed a range of awareness programmes directed at schools and work places that highlight the importance of physical activity.

Smoking is recognised as a major problem, especially with young women, though it is reducing among the economically advantaged. The Government produced a White Paper in 1999 that has led to a range of activities targeted at the young. The decision to end tobacco advertising is clearly a very welcome development.

What work is being done by way of preventative medicine - for example, breast screening in relation to reducing breast cancer? Has any thought been given to using leisure centres more creatively in this field?

While the Agency is not significantly involved in the area of breast screening, it concurs with the generally held view that the programme is achieving most of its objectives. The Agency is, though, working closely with professionals on research into the prevention of diseases. It has also run a health promotion training programme for GPs, and the short-term evaluation of the results, which have been published, shows a positive change in the GPs' behaviour. The Agency is keen to stress that its role is part of a bigger picture, and it cannot operate as a health policing service; co-ordination and co-operation among all the various statutory and voluntary groups is crucial if energy is not to be dissipated.

The Agency envisages an increased role for District Councils in relation to the use of leisure centres; indeed, there is a physical activity strategy specifically directed towards the Councils and their recreation officers.

The Agency's literature seems very glossy and could include more figures about the state of people's health: any comment? How does the Agency get its message across best to those who need it? Can the Agency justify its existence when so many other related bodies exist? Should all these bodies be co-ordinated under one umbrella organisation? How can the Agency show that it is providing value for money?

The Agency gives a lot of thought to the presentation, design and development of its literature and training packages with a view to producing relevant and comprehensive information to reach effectively its target audience. It works closely with further education colleges and schools to cascade its message. The aim is to use appropriate language to ensure that people will read it, and a balance must be struck between cost and presentation to optimise impact.

The Agency feels that it has a clearly defined regional role that is not duplicated elsewhere and it therefore believes it should continue as a separate body. It is happy to be held financially accountable and confidently holds up its work for scrutiny. It does, though, accept the need for a more integrated infrastructure to help develop a health promotion service, which it sees as a low spend priority needing to be moved up front on the health agenda.

The Agency has clear objectives against which to measure itself, though it acknowledges that behavioural changes which prevent diseases can take a long time to develop, especially when many organisations promote agendas working directly against health promotion - for example, the tobacco and fashion industries. On a positive note, the Agency's recent drug awareness campaign has shown a slight increase in the number of 15-year-olds showing a negative attitude towards drugs.

There is a big problem with teenage suicides and pregnancies: is there a role for the Agency in trying to tackle these problems via an input to the education system? Is there scope for practical co-operation in relation to research and advertisements on an all-Ireland and British Isles basis? What are the Health Action Zones and has the Agency a monitoring role in this area? Does the Agency have a role in relation to testicular cancer?

The Agency recognises the major problem of teenage pregnancies and suicides and has been working with some 200 community groups to produce a framework for mental health promotion and suicide prevention to inform Departmental strategy. The Agency cannot directly affect the teenage pregnancy rate here, but the Department has now remitted a Teenage Parenthood Working Group to examine the issues, and, of course, sex education is part of the schools' curriculum. It is felt that there will need to be a real change in society's attitude to sex in order to bring about a significant reduction in the figures.

The Agency has tried where possible to develop common programmes with the Republic's Department of Health and Children, especially where there are clear economies of scale, though the problems are not always the same - for example, the levels of heroin abuse. It is now closely identifying common areas for work through the all-Ireland Institute of Public Health.

The Health Action Zones are a Government sponsored initiative at Board and Trust level to bring together all agencies involved with health; the Agency has a role in the evaluation of the zones.

The Agency has no role in relation to testicular cancer.

Health and Social Services Minutes 12 January 2000