Standard of Healthy Living on the Island of Ireland

Pre-requisites for health are equity, minimum income, nutrition, peace, water, sanitation, housing, education, work, political will and public support (WHO, 1986). It has long been known that social disadvantage harms health (Black, 1980, Ettner, 1996). Many researchers have documented that those in lower socio-economic groups are more at risk of developing major chronic diseases such as cardiovascular diseases (Beaglehole and Yach, 2003, WHO, 2003a), diabetes (Wilder et al., 2005), and some cancers (Brunner et al., 1993, Strong et al., 2005), and are at a higher risk of having multiple risk factors associated with these diseases (Lynch et al., 1997). The living standards that many people enjoy and the behavioural choices they make are heavily determined by their access to resources such as income, wealth, goods and services (O’Flynn and Murphy, 2001). The most prominent explanation between disadvantage and health is that lack of resources restricts access to the fundamental conditions of health such as adequate housing (Macintyre et al., 2003, Macintyre et al., 2005), good nutrition (Nelson et al., 2002) and opportunities to participate in society (McDonough et al., 2005). Each of these issues are very much influenced by material and structural factors inherent to and determined by fiscal, social and health policy (Graham and Kelly, 2004, Milio, 1986).

Acute Gastroenteritis in Ireland, North and South - A Study of General Practitioners

The principal aim of this study was to describe general practitioners management of patients with acute infectious gastroenteritis

Acute gastroenteritis in Ireland, north and south: a telephone survey

The telephone survey of almost 10,000 households was carried out over 12 months and found that in any four-week period 4.5% of the population will have an episode of acute gastroenteritis.

Foodborne infections & gastrointestinal disease on the island Of Ireland in 2002

A safefood consultation paper, ‘Towards the Enhancement of Foodborne Disease Surveillance’ indicated that the guiding principles for the development of surveillance in Northern Ireland and the Republic of Ireland should be the integration of data collection systems and analysis of combined data. The current surveillance systems have developed independently from each other and clinical, food and animal surveillance systems remain un-integrated in both jurisdictions. A more complete and efficient food safety system could be achieved through co-ordination and linkages across the disease surveillance systems and jurisdictions. For that reason, stronger links are being developed between safefood, surveillance agencies, government departments and public health professionals. This report is an examination and review of the clinical surveillance data collected in both jurisdictions. The work was undertaken as part of safefood’s support for the European Programme for Intervention Epidemiology Training (EPIET), which trains EU medical practitioners, public health nurses, microbiologists or veterinarians in all aspects of foodborne disease surveillance.

North/South Ireland food consumption survey

This Summary Report describes the methods used and the main findings with regard to food and beverage consumption, nutrient intakes, and anthropometric, physical activity and attitudinal data from the North/South Ireland Food Consumption Survey (NSIFCS). This survey investigated habitual food and beverage consumption, lifestyle, health indicators and attitudes to food and health in a representative sample (n=1379) of the 18-64 year old adult population in the Republic of Ireland and Northern Ireland during 1997-1999.

Infectious Intestinal Diseases on the Island of Ireland

It is increasingly recognised that the burden of infectious intestinal diseases (IID) in a population is an important indicator of food safety. This report has examined four bacterial infections that frequently cause IID on the island of Ireland (IOI). Over the decade covered by this report, levels of Salmonella have declined substantially while levels of Campylobacter remain a real problem for Food Safety professionals on the IOI. Although much less common, the verocytotoxigenic Escherichia coli O157 (VTEC O157) and Listeria infections present an on-going challenge because of their severity and associated long-term sequelae. Northern Ireland (NI) has a higher reported crude incidence rate of three of the included pathogens (Salmonella, Campylobacter and Listeria) than the Republic of Ireland (ROI), while VTEC 0157 was the exception. This may reflect differences in health seeking behaviour and reporting between the two jurisdictions and/or actual differences in incidence rates.

Food Behaviours: Healthy Eating on the island of Ireland

In the past, safefood’s consumer focused reviews (CFRs) have focused on key food chains including chicken, finfish, fruit and vegetables, milk, beef and pork. The reviews aimed to address consumer concerns surrounding food safety, production methods and nutritional issues related to key foods, with a view to communicating directly to consumers on those issues. More recently, there has been a shift in emphasis by safefood to address broader issues of consumer concern, such as food origin. The aim of the current CFR is different from previous reports. Instead of addressing key consumer food concerns, it focuses on understanding consumer food behaviour. Its primary aim is to inform the research, policies and practices of all those working towards changing consumer food safety and dietary behaviour on the island of Ireland and to ensure that communication with consumers is both evidence-based and effective.

Examining Nutrition Surveillance on the island of Ireland

The food we eat is a key determinant of our health and the monitoring of nutritional status is an essential element of monitoring public health. On the island of Ireland (IOI) there has been a wealth of nutrition data collected contributing to the nutrition surveillance picture, although no formal nutrition surveillance system currently exists in either jurisdiction. This report outlines recent and current activities contributing to nutrition surveillance on IOI and makes recommendations for the future. This is with a view to maximising the use of resources and harnessing and maintaining expertise in this important domain using a joint programming approach.

Measuring Food Poverty in Ireland

safefood has published a briefing document 'Measuring Food Poverty in Ireland - the indicator and its implications'. This briefing was based on researchcommissioned by the Department of Social Protection, as part of the Department’s research programme to monitor poverty trends with the ESRI. Their report ’Constructing a Food Poverty Indicator for Ireland using the Survey on Income and Living Conditions’ (Carney, C; Maitre, B; Department of Social Protection) uses data from the annual CSO Survey on Income and Living Conditions (SILC), providing a first step in measuring the experience of food poverty in Ireland by combining three food deprivation items to quantify the level of food poverty today.

Telephone Survey of Infectious Intestinal Disease in the Republic of Ireland

Infectious intestinal disease is a disease of the digestive system caused by infectious agents. Most infectious intestinal disease (IID) is self-limiting, requiring no clinical intervention, but it causes a substantial burden to the population through healthcare usage and absenteeism. Understanding the magnitude, distribution and demographic factors associated with IID is key to its mitigation. The cases and outbreaks of human disease detected via surveillance represent but a small proportion of the true burden of disease in the population, and special studies are needed periodically in order to be able to extrapolate true population experience from what is reported via surveillance. One way to identify the true extent of IID is to estimate illness in the community, and not just at the point where the individual has made contact with the health services.

A Carbon Tax for Ireland

The Programme for Government 2007-2012 states that '[a]ppropriate fiscal instruments, including a carbon levy, will be phased in on a revenue-neutral basis over the lifetime of this Government.' The terms of reference of the Commission on Taxation repeats the commitment to introduce measures to further lower carbon emissions and to phase in on a revenue neutral basis appropriate fiscal measures including a carbon levy over the lifetime of the Government and invites the Commission to [i]nvestigate fiscal measures to protect and enhance the environment including the introduction of a carbon tax. This paper presents thoughts and considerations about such a carbon tax. It discusses selected design issues, and presents a preliminary impact assessment for what the authors think is a reasonable design. More specifically, It addresses ten questions: 1. Why impose a carbon tax? 2. What level should the tax be? 3. Who should be taxed? 4. What is the expected revenue? 5. What to do with the revenue? 6. What are the macro-economic implications? 7. What are the effects on emissions? 8. What are the effects on income distribution? 9. How to tax internationally traded goods and services? 10. What about fuel tourism? On some of these questions, it presents arguments and evidence. Other questions call for further research. Aspects of some questions can only be answered by the Dail �ireann.This resource was contributed by The National Documentation Centre on Drug Use.

A Grounded Theory Model of the Counselling Referral Process in Primary Care Methadone Treatment in Ireland.

In terms of the treatment of illicit drug abuse, methadone maintenance is a well researched and widely applied systematic response. The approach to primary care methadone treatment in Ireland is based on the methadone protocol. Primary care plays a central role in the delivery of methadone treatment. Beginning with a view that a system evolves within the constraints and influencing factors of its context, the aim of this thesis is to model the process that has developed by which patients on primary care methadone treatment are referred to counselling. It investigates the role primary care practitioners perceive they have in relation to managing the psychosocial aspects of the methadone patient's treatment regime. It analyzes individual medical practitioner counselling referral mechanisms to determine what common processes operate across different practitioners. It identifies the factors that influence the use of counselling on primary care methadone programmes and structures these in a cause/effect model. This research used interviews and documentary analysis to acquire grounded data. The sample consisted primarily of medical practitioners involved in the delivery of methadone programmes. Others closely involved in the implementation of drug treatment in the primary care context made up the balance of interviewees. The study used a grounded theory methodology to induce the process that was latent in the grounded data. Concepts emerging were grouped under the headings of referral factors, decision making factors and factors related to the unique positioning of primary care at the interface between medicine and society. The core finding was that, in primary care in Ireland, there is no psychological model to complement the pharmacological intervention of methadone substitution. The findings from this study offer insight into the factors at work and their impacts, in the context of the use of counselling in primary care methadone treatment. The study suggests a possible direction for further evolution of opiate abuse treatment in Ireland which would transform it from a harm reduction to a holistic patient centric paradigm.This resource was contributed by The National Documentation Centre on Drug Use.

A Review of Harm Reduction Approaches in Ireland and Evidence from the International Literature

This report examines international literature on harm reduction and also presents primary research in health services in Ireland on approaches to harm reduction. The aim of harm reduction efforts is to minimise the risks stemming from shared use of drug-use paraphernalia, such as needle exchange programmes. One of the criticisms of Irish drug services is that the restricted opening hours and limited number of exchange services may contribute to continued sharing of needles among drug users. The report points out that other non-injecting paraphernalia such as spoons are also associated with the risk of contracting diseases, yet services do not as yet focus on them. The report notes that specific risk factors that contribute to risky drug practices include youth, a shorter injecting history, confinement to prison, homelessness and being involved in a sexual relationship with another intravenous drug user. The report suggests that harm reduction practices can be introduced into a prison population without a subsequent increase in drug consumption rates. The provision of consumption rooms and the prescription of heroin are also discussed, with the report noting that legislation would have to altered to implement these new strategies.This resource was contributed by The National Documentation Centre on Drug Use.

A Study to Examine the Attitudes of General Practitioners Towards Drug Users in the North East Region of Ireland

The research examines general practitioners attitudes and how these effect the management of drug misusers within their practice. The methodology is quantitative in approach. The instrument used is a structured postal questionnaire. Participants include all general practitioners within the North East region of Ireland. Anonymity and confidentiality of all respondents are guaranteed. Data was collected over a six week period, under the following headings - attitudes and beliefs, factors influencing treatment, treatment options, training and demographics. Attitudes and beliefs towards drug users were measured using a five point Likert scale ranging from strongly agrees to strongly disagree. The data was analysed with the aid of a computer package, SPSS allowing descriptive statistics to be presented. Results indicate that the majority of respondents are male. There appears to be sympathy towards drug users and that treatment approaches should be holistic. However, there appears to be a major lack of confidence in treating and managing drug misusers. Patient, social and practice factors all influence the decision to the drug misuser. Treatment options are varied, ranging from methadone maintenance to referral for residential treatment. However, a number of respondents offer no treatment for drug misusers. General practitioners do not feel adequately trained in treating and/or managing this client group. Results indicate that improved communication, ongoing education and more research is needed in this area.This resource was contributed by The National Documentation Centre on Drug Use.

Drug Misuse in Dublin, July 1982

In this report for the Medico Social Research Board the author provides an overview of the drug problem in Dublin's inner city. On 12-14 July 1982 the author visited the Sean Mac Dermott street area of the inner city, the Eastern Health Board, Coolmine Community, Jervis Street Drug Advisory and Treatment Centre and the Garda drug squad. From these interviews, the author concludes that Dublin's inner city has a serious problem with drug use, in particular the injecting of heroin. Heroin addicts steal on a regular basis to fund their habit, and frequently inject themselves in public spaces of local authority flat complexes. Despite the best efforts of the support services (Social workers, doctors, Gardai and clergy) there is a high prevalence of injecting heroin use. There has also been abuse of prescription services. Addicts frequently seek opiates from a small number of doctors who are willing to prescribe. Drug education is severely lacking or inappropriate, according to the author, and the Garda drug squad is severely over stretched. While cannabis use is said to be prevalent in Dublin's two universities, drug use has been most problematic in the deprived parts of the city. The author presents the drug epidemic, which has developed over the last two years, in moral terms, and wonders if Christian society, in particular the Catholic Church, and the health authorities can do anything to stop the crisis from worsening. Recommendations include; conducting epidemiological surveys to determine the true extent of the problem, cross disciplinary co-operation, greater drug awareness through education, and more rehabilitation units.This resource was contributed by The National Documentation Centre on Drug Use.