IPH response to Building an Active Travel Future for Northern Ireland

IPH responded to the Department for Regional Development consultation Building an Active Travel Future for Northern Ireland, March 2012 The draft Active Travel strategy seeks to set out how to increase active travel by demonstrating that walking and cycling are safe, healthy, flexible, inexpensive and social means of travel and by setting out ways in which opportunities for active travel can be significantly improved.IPH welcomes the new Active Travel Strategy and highlights the need for a truly integrated approach to the strategy which has the potential to positively influence health in areas such as obesity, mental health and cardiovascular health.  IPH suggest a health impact assessment is undertaken on each of the Active Travel Demonstration projects to fully maximise the potential health outcomes of developing the required infrastructure for active travel.

IPH response to 'Towards a Childcare Strategy' (Northern Ireland)

The remit of the Institute of Public Health in Ireland (IPH) is to promote cooperation for public health between Northern Ireland and the Republic of Ireland in the areas of research and information, capacity building and policy advice. Our approach is to support Departments of Health and their agencies in both jurisdictions, and maximise the benefits of all-island cooperation to achieve practical benefits for people in Northern Ireland and the Republic of Ireland. Giving every child the best start in life is recognised by governments worldwide as the most effective way to improve life chances and health outcomes.  This is one of IPH’s key strategic action areas in our Business Plan and we endorse the need for early intervention, particularly in tackling health inequalities and improving the health and wellbeing of children in the most disadvantaged communities.  International evidence is increasingly pointing towards investment in the early years as a critical component of any sensible approach to improving population health and tackling health inequalities across the life course (WHO, 2008 and Marmot, 2010).  It is also apparent that Northern Ireland public policy is now reorienting towards achieving better and fairer outcomes in the early years, as demonstrated through the recent draft public health strategy (DHSSPS, 2012a) and the draft early years strategy (Department of Education, 2012).

The trouble with suicide. Mental health, suicide and the Northern Ireland conflict: a review of the evidence.

Section 1: The Social Basis of Mental Well-being Section 2: Mental Illness, Conflicts and Disasters Section 3: Northern Ireland, Conflict and Mental Health Section 4: Mental Health and Suicide Section 5: Suicide: Patterns and Trends Section 6: The Social Characteristics of Suicides in Northern Ireland Section 7: Explaining Suicide Trends Section 8: Suicide and Transition to Peace Section 9: ConclusionThis resource was contributed by The National Documentation Centre on Drug Use.

Public Policy and Ageing in Northern Ireland: Identifying Levers for Change

Public Policy and Ageing in Northern Ireland: Identifying Levers for Change Judith Cross, Policy Officer with the Centre for Ageing Research Development in Ireland (CARDI)��������Introduction Identifying a broad range of key public policy initiatives as they relate to age can facilitate discussion and create new knowledge within and across government to maximise the opportunities afforded by an ageing population. This article looks at how examining the current public policy frameworks in Northern Ireland can present opportunities for those working in this field for the benefit of older people. Good policy formulation needs to be evidence-based, flexible, innovative and look beyond institutional boundaries. Bringing together architects and occupational therapists, for example, has the potential to create better and more effective ways relevant to health, housing, social services and government departments. Traditional assumptions of social policy towards older people have tended to be medically focused with an emphasis on care and dependency. This in turn has consequences for the design and delivery of services for older people. It is important that these assumptions are challenged as changes in thinking and attitudes can lead to a redefinition of ageing, resulting in policies and practices that benefit older people now and in the future. Older people, their voices and experiences, need to be central to these developments. The Centre for Ageing Research and Development in Ireland The Centre for Ageing Research and Development in Ireland (CARDI) (1) is a not for profit organisation developed by leaders from the ageing field across Ireland (North and South) including age sector focused researchers and academics, statutory and voluntary, and is co-chaired by Professor Robert Stout and Professor Davis Coakley. CARDI has been established to provide a mechanism for greater collaboration among age researchers, for wider dissemination of ageing research information and to advance a research agenda relevant to the needs of older people in Ireland, North and South. Operating at a strategic level and in an advisory capacity, CARDI�۪s work focuses on promoting research co-operation across sectors and disciplines and concentrates on influencing the strategic direction of research into older people and ageing in Ireland. It has been strategically positioned around the following four areas: Identifying and establishing ageing research priorities relevant to policy and practice in Ireland, North and South;Promoting greater collaboration and co-operation on ageing research in order to build an ageing research community in Ireland, North and South;Stimulating research in priority areas that can inform policy and practice relating to ageing and older people in Ireland, North and South;Communicating strategic research issues on ageing to raise the profile of ageing research in Ireland, North and South, and its role in informing policy and practice. Context of Ageing in Ireland Ireland �۪s population is ageing. One million people aged 60 and over now live on the island of Ireland. By 2031, it is expected that Northern Ireland�۪s percentage of older people will increase to 28% and the Republic of Ireland�۪s to 23%. The largest increase will be in the older old; the number aged 80+ is expected to triple by the same date. However while life expectancy has increased, it is not clear that life without disability and ill health has increased to the same extent. A growing number of older people may face the combined effects of a decline in physical and mental function, isolation and poverty. Policymakers, service providers and older people alike recognise the need to create a high quality of life for our ageing population. This challenge can be meet by addressing the problems relating to healthy ageing, reducing inequalities in later life and creating services that are shaped by, and appropriate for, older people. Devolution and Structures of Government in Northern Ireland The Agreement (2) reached in the Multi-Party Negotiations in Belfast 1998 established the Northern Ireland Assembly which has full legislative authority for all transferred matters. The majority of social and economic public policy such as; agriculture, arts, education, health, environment and planning is determined by the Northern Ireland Assembly at Stormont. There are 11 Government Departments covering the main areas of responsibility with 108 elected Members of the Legislative Assembly (MLA�۪s). The powers of the Northern Ireland Assembly do not cover ��� reserved�۪ matters or ��� excepted�۪ matters . These are the responsibility of Westminster and include issues such as, tax, social security, policing, justice, defence, immigration and foreign affairs. Northern Ireland has 18 elected Members of Parliament (MP�۪s) to the House of Commons. Public Policy Context in Northern Ireland The economic, social and political consequence of an ageing population is a challenge for policy makers across government. Considering the complex and diverse causal factors that contribute to ageing in Northern Ireland, there are a number of areas of government policy at regional, national and international levels that are likely to impact in this area. International The Madrid International Plan of Action on Ageing (3) and the Research Agenda on Ageing for the 21st Century (4) provide important mechanisms for furthering research into ageing. The United Kingdom has signed up to these. The Madrid International Plan of Action on Ageing commits member states to a systematic review of the Plan of Action through Regional Implementation Strategies. The United Kingdom�۪s Regional Implementation Strategy covers Northern Ireland. National At National level, pension and social security are high on the agenda. The Pensions Act (5) became law in 2007 and links pensions increases with earnings as opposed to prices from 2012. Additional credits for people raising children and caring for older people to boost their pensions were introduced. Some protections are included for those who lost occupational pensions as a result of underfunded schemes being wound up before April 2005. In relation to State Pensions and benefits, this Act will bring changes to state pensions in future. The Act now places the Pension Credit element which is up-rated in line with or above earnings, on a permanent, statutory footing. Regional At regional level there are a number of age related public policy initiatives that have the potential to impact positively on the lives of older people in Northern Ireland. Some are specific to ageing such as the Ageing in an Inclusive Society (6) and others by their nature are cross-cutting such as Lifetime Opportunities: Governments Anti-Poverty Strategy for Northern Ireland (7). The main public policy framework in Northern Ireland is the Programme for Government: Building a Better Future, 2008-2011(PfG) (8) . The PfG, is the overarching high level policy framework for Northern Ireland and provides useful principles for ageing research and public policy in Northern Ireland. The PfG vision is to build a peaceful, fair and prosperous society in Northern Ireland, with respect for the rule of law. A number of Public Service Agreements (PSA) aligned to the PfG confirm key actions that will be taken to support the priorities that the Government aim to achieve over the next three years. For example objective 2 of PSA 7: Making Peoples�۪ Lives Better: Drive a programme across Government to reduce poverty and address inequality and disadvantage, refers to taking forward strategic action to promote social inclusion for older people; and to deliver a strong independent voice for older people. The Office of the First Minister and deputy First Minister (OFMDFM) have recently appointed an Interim Older People�۪s Advocate, Dame Joan Harbison to provide a focus for older peoples issues across Government. Ageing in an Inclusive Society is the cross-departmental strategy for older people in Northern Ireland and was launched in March 2005. It sets out the approach to be taken across Government to promote and support the inclusion of older people. The vision coupled with six strategic objectives form the basis of the action plans accompanying the strategy. The vision is: ���To ensure that age related policies and practices create an enabling environment, which offers everyone the opportunity to make informed choices so that they may pursue healthy, active and positive ageing.�۝ (Ageing in an Inclusive Society, Office of the First Minister and Deputy First Minister, 2005) Action planning and maintaining momentum across government in relation to this strategy has proved to be slower than anticipated. It is proposed to refresh this Strategy in line with Opportunity Age ��� meeting the challenges of ageing in the 21st Century (9). There are a number of policy levers elsewhere which can also be used to promote the positive aspects of an ageing society. The Investing for Health (10) and A Healthier Future:A 20 Year Vision for Health and Well-being in Northern Ireland (11), seek to ensure that the overall vision for health and wellbeing is achievable and provides a useful framework for ageing policy and research in the health area. These health initiatives have the potential to positively impact on the quality of life of older people and provide a useful framework for improving current policy and practice. In addition to public policy initiatives, the anti-discrimination frameworks in terms of employment in Northern Ireland cover age as well as a range of other grounds. Goods facilitates and services are currently excluded from the Employment Equality (age) Regulations (NI) 2006 (12). Supplementing the anti-discrimination measures, Section 75 of the Northern Ireland Act 1998 (13), unique to Northern Ireland, places a statutory obligation on public authorities in fulfilling their functions to promote equality of opportunity across nine grounds, one of which is age(14). This positive duty has the potential to make a real difference to the lives of older people in Northern Ireland. Those affected by policy decisions must be consulted and their interests taken into account. This provides an opportunity for older people and their representatives to participate in public policy-making, right from the start of the process. Policy and Research Interface ���Ageing research is vital as decisions in relation to policy and practice and resource allocation will be made on the best available information�۝. (CARDI�۪s Strategic Plan 2008-2011) As outlined earlier, CARDI has been established to bridge the gap to ensure that research reaches those involved in making policy decisions. CARDI is stimulating the ageing research agenda in Ireland through a specific research fund that has a policy and practice focus. My work is presently focusing on helping to build a greater awareness of the key policy levers and providing opportunities for those within research and policy to develop closer links. The development of this shared understanding by establishing these links between researchers and policy makers is seen as the best predictor for research utilization. It is important to acknowledge and recognise that researchers and policy makers operate in different institutional, political and cultural contexts. Research however needs to ���resonate�۪ with the contextual factors in which policy makers operate. Conclusions Those working within the public policy field recognise all too often that the development of government policies and initiatives in respect of age does not guarantee that they will result in changes in actual provision of services, despite Government recommendations and commitments. The identification of public policy initiatives as they relate to age has the potential to highlight persistent and entrenched difficulties that social policy has previously failed to address. Furthermore, the identification of these difficulties can maximise the opportunities for progressing these across government. A focus on developing effective and meaningful targets to ensure measurable outcomes in public policy for older people can assist in this. Access to sound, credible and up-to-date evidence will be vital in this respect. As well as a commitment to working across departmental boundaries to effect change. Further details: If you would like to discuss this paper or for further information about CARDI please contact: Judith Cross, Policy Officer, Centre for Ageing Research and Development in Ireland CARDI). t: +44 (0) 28 9069 0066; m: +353 (0) 867 904 171; e: judith@cardi.ie ; or visit our website at: www.cardi.ie References 1) Centre for Ageing Research and Development in Ireland (2008) Strategic Plan 2008-2011. Belfast. CARDI 2) The Agreement: Agreement Reached in the Multi-Party Negotiations. Belfast 1998 3) Madrid International Plan of Action on Ageing. http://www.un.org/ageing/ 4) UN Programme on Ageing (2007) Research Agenda on Ageing for the 21st Century: 2007 Update. New York. New York. UN Programme on Ageing and the International Association of Gerontology and Geriatrics. 5) The Pensions Act 2007 Chapter 22 6) Office of the First Minister and deputy First Minister (2005). Ageing in an Inclusive Society. Belfast. OFMDFM Central Anti-Poverty Unit. 7) Office of the First Minister and deputy First Minister (2005). Lifetime Opportunities: Government�۪s Anti-Poverty and Social Inclusion Strategy for Northern Ireland. Belfast. OFMDFM Central Anti-Poverty Unit. 8) Northern Ireland Executive (2008) Building a Better Future: Programme for Government 2008-2011. Belfast. OFMDFM Economic Policy Unit. 9) Department for Work and Pensions, (2005) Opportunity Age: Meeting the Challenges of Ageing in the 21 st Century. London. DWP. 10) Department of Health, Social Services and Public Safety (DHSS&PS) (2002) Investing for Health. Belfast. DHSS&PS. 11) Department of Health, Social Services and Public Safety (DHSS&PS) (2005) A Healthier Future:A 20 Year Vision for Health and Well-being in Northern Ireland Belfast. DHSS&PS. �� 12) The Employment Equality (Age) Regulations (Northern Ireland) 2006 SR2006 No.261 13) The Northern Ireland Act 1998, Part VII, S75 14) The nine grounds covered under S75 of the Northern Ireland Act are: gender, religion, race, sexual orientation, those with dependents, disability, political opinion, marital status and age.

Health Impact Assessment: A baseline report for Ireland and Northern Ireland

Report of the findings of the Institute's Health Impact Assessment (HIA) work programme in 2001, in order to (a) record the baseline of HIA awareness, activity and thinking in Ireland and Northern Ireland and (b) identify the issues around its implementation.

IPH response to A Healthier Future: A 20 year vision for health and wellbeing in Northern Ireland

The Institute of Public Health in Ireland aims to promote cooperation for public health between Northern Ireland and Ireland, to tackle inequalities in health and influence public polices in favour of health. In its work, the Institute emphasises a holistic model of health which recognises the interplay of a wide range of health determinants, including economic, social and environmental factors as well as health and social services.

Ireland and Northern Ireland's Population Health Observatory (INIsPHO)

Ireland and Northern Ireland's Population Health Observatory (INIsPHO) is housed in  The Institute of Public Health in Ireland (IPH) and is part of the Association of Public Health Observatories (APHO). The Observatory supports those working to improve health and reduce health inequalities by producing, disseminating and supporting the use of relevant health knowledge and strengthening the research and information infrastructure on the island of Ireland.

Food poverty in rural Northern Ireland

“Decent Food for All” (DFfA) was a three-year integrated, partnership-based programme committed to reducing food poverty and addressing inequalities in physical and financial access to safe healthy food in the Armagh and Dungannon area of Northern Ireland. DFfA is led by the Armagh and Dungannon Health Action Zone (ADHAZ) and involves the delivery of a range of programmes and workshops which provide practical community based focused help and advice on food issues and nutrition. A comprehensive research and evaluation programme entitled ‘All-island learning from the Decent Food for All programme’ runs throughout the lifetime of the programme, which ensures effective evaluation, and the sharing of best practices and experiences. The research and evaluation program is coordinated by the Institute of Public Health in Ireland (IPH) with cooperation from ADHAZ. Funding for the research is provided by the Food Safety Promotion Board. To take into account background changes not directly attributable to the DFfA Programme a matched comparison area was selected in the Newry/Mourne area of Co. Down. An accurate measure of the changes that have occurred over the period of the DFfA programme is required. Valid estimates of change are based on measures before and after the programme. Pre-test and post-test community surveys provide a wide range of measures. This fact-book highlights the findings from the pre-test community survey.The aims of the pre-test survey were to:- Provide pre-test measures of the Key Performance Indicators underpinning the Key Expected Outcomes of the DFfA programme;- Identify factors influencing these pre-test measures; and- Contribute to the development of the programmes in DFfA.

IPH response to Phase 2 of the New Strategic Direction for Alcohol and Drugs 2011-2016 (Northern Ireland)

The IPH response to the New Strategic Direction for Alcohol and Drugs questionnaire which has been designed to help stakeholders respond to New Strategic Direction for Alcohol and Drugs Phase 2 (2011-2016) consultation document.

IPH response to DHSSPS Consultation on a ten year breastfeeding strategy for Northern Ireland 2012-2022

The Department of Health, Social Services and Public Safety invited submissions on the development of a new ten-year Breastfeeding Strategy for Northern Ireland 2012-2022 between May and September 2012. The draft Breastfeeding Strategy 2012 – 2022 proposes further action in relation to breastfeeding and aims to protect, promote, support and normalise breastfeeding within the population of Northern Ireland. Key points from IPH response IPH welcomes the commitment by the Department of Health, Social Services and Public Safety to develop a comprehensive long-term strategy to support women in Northern Ireland to breastfeed. The timeframe provides scope for developing clear long-term targets and actions and the embedding of breastfeeding culture into allied services, policies and programmes throughout Northern Ireland. The draft strategy’s recognition of the potential of breastfeeding as a means for tackling health inequalities forms a central theme of the IPH submission IPH welcomes the success achieved to date in improving breastfeeding. However, it is clear that the overall breastfeeding rate in Northern Ireland still lags behind the rest of the UK. Inequalities in breastfeeding rates remain an ongoing concern. IPH emphasises the importance of integrating the actions of the breastfeeding strategy with the strategic direction of overall public health policy in particular the forthcoming Fit and Well policy framework and early years strategies. IPH welcomes the inclusion of stipulations regarding weaning practices as an important component of the vision and one which, if achieved, will maximize the benefits from improving breastfeeding rates and duration.

IPH response to the DSD consultation on regulations to prohibit or restrict irresponsible promotions of alcohol in Northern Ireland

IPH responded to the Department for Social Development consultation on the banning of certain promotions that may encourage irresponsible and excessive drinking. The consultation relates to regulations Article 57A(2)(d) of the 1996 Licensing Order “involving the supply of unlimited amounts of intoxicating liquor for a fixed charge (including any charge for entry to the premises)” and Article 31A(2)(d) of the Registration of Clubs Order “restricting the price at which the holder of a licence or the licence holder’s servant or agent may sell on licensed premises a package containing two or more intoxicating liquor products”. IPH welcomes this consultation and supports the Department’s proposals to restrict promotions that involve the supply of unlimited amounts of intoxicating liquor for a fixed charge. IPH welcomes this tangible action linked to the renewed commitment to tackling alcohol-related harms on the island of Ireland set out in the Steering Group Report on a National Substance Strategy (Dept of Health, 2012) and in the New Strategic Direction on Alcohol and Drugs (DHSSPS, 2011). IPH considers that irresponsible alcohol promotions can contribute to this burden of physical and mental ill-health, accidental and non-accidental injury and other harms associated with excessive alcohol consumption in Northern Ireland. As previously stated in the IPH submissions on the introduction of powers to prohibit or restrict irresponsible alcohol promotions (Dec, 2010), IPH considers that the issues of promotion and price are inter-related. The effectiveness of the proposed restrictions could be reinforced by the expeditious introduction of minimum unit pricing of alcohol on an all-island basis.

IPH response to the Joint Committee on Health and Children and members of the Northern Ireland Assembly on “Cross-border cooperation on healthcare”

The Institute of Public Health in Ireland were asked to submit a paper on 'Cross-border cooperation on healthcare' for a joint meeting between the Oireachtas Joint Committee on Health and Children and the Northern Ireland Assembly Health Committee which took place in Leinster House on 1 March 2012. Key points from the submission included: o    The Institute of Public Health in Ireland (IPH) is an all-island organisation which promotes cooperation between the Republic of Ireland and Northern Ireland with the aim of improving population health on the island and tackling health inequalities. IPH work is focused on addressing the causes of ill health rather than the design and delivery of treatment services. o    North/South cooperation on health was mandated under the Belfast Agreement in 1998 in five domains, including health promotion. IPH has supported the North South Ministerial Council (NSMC) in respect of the health promotion strand since inception. o    The Department of Health and Department of Health, Social Services and Public Safety North-South Feasibility Study (December 2011) states that mutual benefits are most evident from cooperation in the areas of (i) anticipating trends and illnesses in a collective manner (ii) public health issues (iii) specialised services where the population or activity required to sustain the service cannot be met by either jurisdiction alone and (iv) in relation to those areas adjacent to the border. o    The European Directive on Cross-Border Healthcare will be implemented in the next few years which will have implications in relation to patients travelling for healthcare across the Republic of Ireland/Northern Ireland border. o    IPH is supporting the development of new public health strategies in the Republic of Ireland and Northern Ireland which are both due for publication this year. o    There are tangible benefits from cross-border cooperation in the health sector, both in public health and in health service planning and delivery and there are many examples of successful initiatives. However, developments are not occurring in the context of an agreed plan or overall strategic context and tend to be project-based and concentrated in border counties. o    Successful cross-border cooperation requires high level support and integration into departmental policy cycles. The provision of data on an all-island basis supports cross-border cooperation as does the operation of sustainable all-island organisations which can support research, evaluations and programmes. o    In the future, cross-border cooperation in health will be more effective if developed with a strategic planning process intrinsically linked to Departmental priorities. o    North-South cooperation in the areas of alcohol, obesity, tobacco health surveys and rare diseases will be particularly beneficial.

IPH Response to draft Northern Ireland Programme for Government 2011-15

On 17 November 2011, the First Minister and deputy First Minister published the draft Programme for Government 2011-2015 for consultation. IPH recognise that health is influenced by a wide range of social determinants, including economic, biological, environmental and cultural factors such as housing, the environment, income, employment and access to education and health services . Improvements to health can be achieved through a well-designed PfG which addresses the economy, creates safer communities and delivers efficient public services.  IPH welcome this opportunity to submit our views to the Northern Ireland Executive on the Draft Programme for Government 2011-15. Key points from the IPH response include: • Northern Ireland has a poor population health status in key areas when compared to other regions in the United Kingdom and in the Republic of Ireland. IPH support and particularly welcome allocation of an increased proportion of the Northern Ireland budget to public health. • IPH endorses the perspective in the PfG that good population health makes a central contribution to economic and social development.   However we would welcome greater acknowledgement of the links between social deprivation and health outcomes.  • IPH welcomes the adoption of a social determinants of health approach to improving population health and tackling health inequalities which is in line with current health policy and recent policy developments across the United Kingdom and internationally (See report of the Commission on the Social Determinants of Health (CSDH))

IPH response to Review of Maternity Services in Northern Ireland

IPH responded to the Department of Health, Social Services and Public Safety consultation on a draft maternity strategy for Northern Ireland. The strategy contains a number of proposals, which, if implemented, will significantly change how maternity services are delivered in the future. The draft strategy aims to provide women, professionals, commissioners and policy makers with a clear pathway for maternity services from preconceptual care through to postnatal care.  It places an emphasis on early direct contact with a midwife and a better understanding of the role of the midwife and obstetricians. It sets out clear recommendations for tackling public health issues such as obesity, smoking and alcohol abuse in pregnancy; providing more choice; providing care closer to home and ensuring safe, high quality care tailored to meet the needs of the woman.

IPH response to a Draft Policy Framework for supporting people in Northern Ireland living with long term (or chronic) conditions

The Department of Health, Social Services and Public Safety recently consulted on a draft Policy Framework for supporting people in Northern Ireland living with long term (or chronic) conditions