Speech by Mr. Micheál Martin TD – Meeting The Challenges Of Cultural Diversity In The Irish Healthcare Sector

It gives me great pleasure to accept the invitation to address this conference on “Meeting the Challenges of Cultural Diversity in the Irish Healthcare Sector” which is being organised by the Irish Health Services Management Institute in partnership with the National Consultative Committee on Racism and Interculturalism. The conference provides an important opportunity to develop our knowledge and understanding of the issues surrounding cultural diversity in the health sector from the twin perspectives of patients and staff. Cultural diversity has over recent years become an increasingly visible aspect of Irish society bringing with it both opportunities and challenges. It holds out great possibilities for the enrichment of all who live in Ireland but it also challenges us to adapt creatively to the changes required to realise this potential and to ensure that the experience is a positive one for all concerned but particularly for those in the minority ethnic groups. In the last number of years in particular, the focus has tended to be on people coming to this country either as refugees, asylum seekers or economic migrants. Government figures estimate that as many as 340,000 immigrants are expected in the next six years. However ethnic and cultural diversity are not new phenomena in Ireland. Travellers have a long history as an indigenous minority group in Ireland with a strong culture and identity of their own. The changing experience and dynamics of their relationship with the wider society and its institutions over time can, I think, provide some valuable lessons for us as we seek to address the more numerous and complex issues of cultural diversity which have arisen for us in the last decade. Turning more specifically to the health sector which is the focus of this conference, culture and identity have particular relevance to health service policy and provision in that The first requirement is that we in the health service acknowledge cultural diversity and the differences in behaviours and in the less obvious areas of values and beliefs that this often implies. Only by acknowledging these differences in a respectful way and informing ourselves of them can we address them. Our equality legislation – The Employment Equality Act, 1998 and the Equal Status Act, 2000 – prohibits discrimination on nine grounds including race and membership of the Traveller community. The Equal Status Act prohibits discrimination on an individual basis in relation to the nine grounds while for groups it provides for the promotion of equality of opportunity. The Act applies to the provision of services including health services. I will speak first about cultural diversity in relation to the patient. In this respect it is worth mentioning that the recognition of cultural diversity and appropriate responses to it were issues which were strongly emphasised in the public consultation process which we held earlier this year in the context of developing National Anti-Poverty targets for the health sector and also our new national health strategy. Awareness and sensitivity training for staff is a key requirement for adapting to a culturally diverse patient population. The focus of this training should be the development of the knowledge and skills to provide services sensitive to cultural diversity. Such training can often be most effectively delivered in partnership with members of the minority groups themselves. I am aware that the Traveller community, for example, is involved in in-service training for health care workers. I am also aware that the National Consultative Committee on Racism and Interculturalism has been involved in training with the Eastern Regional Health Authority. We need to have more such initiatives. A step beyond the sensitivity training for existing staff is the training of members of the minority communities themselves as workers in our health services. Again the Traveller community has set an example in this area with its Primary Health Care Project for Travellers. The Primary Health Care for Travellers Project was established in 1994 as a joint partnership initiative with the Eastern Health Board and Pavee Point, with ongoing technical assistance being provided from the Department of Community Health and General Practice, Trinity College, Dublin. This project was the first of its kind in the country and has facilitated The project included a training course which concentrated on skills development, capacity building and the empowerment of Travellers. This confidence and skill allowed the Community Health Workers to go out and conduct a baseline survey to identify and articulate Travellers’ health needs. This was the first time that Travellers were involved in this process; in the past their needs were assumed. The results of the survey were fed back to the community and they prioritised their needs and suggested changes to the health services which would facilitate their access and utilisation. Ongoing monitoring and data collection demonstrates a big improvement in levels of satisfaction and uptake and ulitisation of health services by Travellers in the pilot area. This Primary Health Care for Travellers initiative is being replicated in three other areas around the country and funding has been approved for a further 9 new projects. This pilot project was the recipient of a WHO 50th anniversary commemorative award in 1998. The project is developing as a model of good practice which could inspire further initiatives of this type for other minority groups. Access to information has been identified in numerous consultative processes as a key factor in enabling people to take a proactive approach to managing their own health and that of their families and in facilitating their access to health services. Honouring our commitment to equity in these areas requires that information is provided in culturally appropriate formats. The National Health Promotion Strategy 2000-2005, for example, recognises that there exists within our society many groups with different requirements which need to be identified and accommodated when planning and implementing health promotion interventions. These groups include Travellers, refugees and asylum seekers, people with intellectual, physical or sensory disability and the gay and lesbian community. The Strategy acknowledges the challenge involved in being sensitive to the potential differences in patterns of poor health among these different groups. The Strategic aim is to promote the physical, mental and social well-being of individuals from these groups. The objective of the Strategy on these issues are: While our long term aim may be to mainstream responses so that our health services is truly multicultural, we must recognise the need at this point in time for very specific focused responses particularly for groups with poor health status such as Travellers and also for refugees and asylum seekers. In the case of refugees and asylum seekers examples of targeted services are screening for communicable diseases – offered on a voluntary basis – and psychological support services for those who have suffered trauma before coming here. The two approaches of targeting and mainstreaming are not mutually exclusive. A combination of both is required at this point in time but the balance between them must be kept under constant review in the light of changing needs. A major requirement if we are to meet the challenge of cultural diversity is an appropriate data and research base. I think it is important that we build up our information and research data base in partnership with the minority groups themselves. We must establish what the health needs of diverse groups are; we must monitor uptake of services and how well we are responding to needs and we must monitor outcomes and health status. We must also examine the impact of the policies in other sectors on the health of minority groups. The National Health Information Strategy, currently being developed, and the recently published National Strategy for Health Research – Making Knowledge Work for Health provide important frameworks within which we can improve our data and research base. A culturally diverse health sector workforce – challenges and opportunities The Irish health service can benefit greatly from successful international recruitment. There has been a strong non-national representation amongst the medical profession for more than 30 years. More recently there have been significant increases in other categories of health service workers from overseas. The Department recognises the enormous value that overseas recruitment brings over a wide range of services and supports the development of effective and appropriate recruitment strategies in partnership with health service employers. These changes have made cultural diversity an important issue for all health service organisations. Diversity in the workplace is primarily about creating a culture that seeks, respects, values and harnesses difference. This includes all the differences that when added together make each person unique. So instead of the focus being on particular groups, diversity is about all of us. Change is not about helping “them” to join “us” but about critically looking at “us” and rooting out all aspects of our culture that inappropriately exclude people and prevent us from being inclusive in the way we relate to employees, potential employees and clients of the health service. International recruitment benefits consumers, Irish employees and the overseas personnel alike. Regardless of whether they are employed by the health service, members of minority groups will be clients of our service and consequently we need to be flexible in order to accommodate different cultural needs. For staff, we recognise that coming from other cultures can be a difficult transition. Consequently health service employers have made strong efforts to assist them during this period. Many organisations provide induction courses, religious facilities (such as prayer rooms) and help in finding suitable accommodation. The Health Service Employers Agency (HSEA) is developing an equal opportunities/diversity strategy and action plans as well as training programmes to support their implementation, to ensure that all health service employment policies and practices promote the equality/diversity agenda to continue the development of a culturally diverse health service. The management of this new environment is extremely important for the health service as it offers an opportunity to go beyond set legal requirements and to strive for an acceptance and nurturing of cultural differences. Workforce cultural diversity affords us the opportunity to learn from the working practices and perspectives of others by allowing personnel to present their ideas and experience through teamwork, partnership structures and other appropriate fora, leading to further improvement in the services we provide. It is important to ensure that both personnel units and line managers communicate directly with their staff and demonstrate by their actions that they intend to create an inclusive work place which doesn´t demand that minority staff fit. Contented, valued employees who feel that there is a place for them in the organisation will deliver a high quality health service. Your conference here today has two laudable aims – to heighten awareness and assist health care staff to work effectively with their colleagues from different cultural backgrounds and to gain a greater understanding of the diverse needs of patients from minority ethnic backgrounds. There is a synergy in these aims and in the tasks to which they give rise in the management of our health service. The creative adaptations required for one have the potential to feed into the other. I would like to commend both organisations which are hosting this conference for their initiative in making this event happen, particularly at this time – Racism in the Workplace Week. I look forward very much to hearing the outcome of your deliberations. Thank you.

Consumer Focused Review of the Pork Supply Chain

Pig meat production was valued at €290 (£198) million at farm gate in Republic of Ireland (ROI) in 2007. In Northern Ireland (NI) in 2006, pig meat was estimated to account for almost seven percent of gross turnover in the food and drinks processing sector at £190 (€280) million. Whilst researching for this report it emerged that comparable figures for the value of the pig meat industry on ROI and NI are not available. This report showed that pig production on the IOI has changed from a small-scale enterprise carried out by a large number of mixed farmers to a modern industry comprised of a small number of specialist producers operating large-scale units. Most products for retailers are prepared and packed in specialised cutting and processing units which may or may not be integrated in the slaughter plant. For some pork products, various additives such as salt, herbs and flavour enhancers are added. Pork products are then stored and transported, frozen or chilled to wholesale, retail and catering facilities for ultimate sale to consumers.

Consumer Focused Review of Men's Food Behaviour

Increasing attention has been paid to the burden of ill-health experienced by men in many Western countries. In Europe and internationally, the Republic of Ireland has been leading the way by developing a national policy for men’s health. In most countries around the world, women now have a longer life expectancy than men. Similarly, on the island of Ireland, in spite of recent increases in men’s life expectancy, men continue to have higher death rates at all ages and from all leading causes of death. In Northern Ireland, in 2010, men’s life expectancy at birth was 77.08 years (81.53 years for women), while in the Republic of Ireland, figures published in 2009 revealed that men’s life expectancy at birth was 76.8 years (compared to 81.6 years for women). Key health issues for men include circulatory diseases, cancers and respiratory diseases. In relation to food and health, obesity has been highlighted as a major concern in relation to men’s health. While physiological difference between men and women explain some of the variation in the rate and/or onset of disease (e.g., protective effects of oestrogen in relation to the onset of cardiovascular diseases), other factors, such as socio-cultural influences, which are the main focus of this report, also play an important role. It is acknowledged that men and women experience different influences and motivations with respect to their knowledge and attitudes of and behaviours towards food and health. The purpose of this report is therefore not to compare men with women or to encourage men to model themselves on women in relation to their food and health behaviour. Rather, the goal is to provide recommendations to improve communications, resources, interventions, education and services targeted at boys and men in relation to food.

Whole-person care: from rhetoric to reality. Achieving parity between mental and physical health.

The report presents evidence on a range of factors affecting disparity between mental and physical health, and includes case studies and examples of good practice to illustrate some of the key issues and solutions. It should be seen as the first stage of an on-going process over the next 5"10 years that will deliver parity for mental health and make whole-person care a reality. It builds on the Implementation Framework for the Mental Health Strategy in providing further analysis of why parity does not currently exist, and the actions required to bring it about. A parity approach should enable NHS and local authority health and social care services to provide a holistic, whole person response to each individual, whatever their needs, and should ensure that all publicly funded services, including those provided by private organisations, give people's mental health equal status to their physical health needs. Central to this approach is the fact that there is a strong relationship between mental health and physical health, and that this influence works in both directions. Poor mental health is associated with a greater risk of physical health problems, and poor physical health is associated with a greater risk of mental health problems. Mental health affects physical health and vice versa. The report makes a series of key recommendations for the UK government, policy-makers and health professionals. Recommendations include: The government and the NHS Commissioning Board should work together to give people equivalent levels of access to treatment for mental health problems as for physical health problems, agreed standards for waiting times, and agreed standards for emergency/crisis mental healthcare. Action to promote good mental health and to address mental health problems needs to start at the earliest stage of a person's life and continue throughout the life course. Preventing premature mortality " there must be a major focus on improving the physical health of people with mental health problems. Public health programmes must include a focus on the mental health dimension of issues commonly considered as physical health concerns, such as smoking, obesity and substance misuse. Commissioners need to regard liaison doctors (who work across physical and mental healthcare) as an absolute necessity rather than an optional luxury. NHS and social care commissioners should commission liaison psychiatry and liaison physician services to drive a whole-person, integrated approach to healthcare in acute, secure, primary care and community settings, for all ages. Mental health services and mental health research must receive funding that reflects the prevalence of mental health problems and their cost to society. Mental illness is responsible for the largest proportion of the disease burden in the UK (22.8%), larger than that of cardiovascular disease (16.2%) or cancer (15.9%). However, only 11% of the NHS budget was spent on NHS services to treat mental health problems for all ages during 2010/11. Culture, attitudes and stigma " zero-tolerance policies in relation to discriminatory attitudes or behaviours should be introduced in all health settings to help combat the stigma that is still attached to mental illness within medicine. Political and managerial leadership is required at all levels. There should be a mechanism at national level for driving a parity approach to relevant policy areas across government; all local councils should have a lead councillor for mental health; all providers of specialist mental health services should have a board-level lead for physical health and all providers of physical healthcare services should have a board-level lead for mental health. The General Medical Council (GMC) and Nursing and Midwifery Council (NMC) should consider how medical and nursing study and training could give greater emphasis to mental health. Mental and physical health should be integrated within undergraduate medical education.This resource was contributed by The National Documentation Centre on Drug Use.

In-depth assessment delivers the verdict on the Government�۪s promise of a more equal society

An independent and detailed expert analysis of a decade of reforms (published 25 February) takes up the challenge made by Peter Mandelson in 1997 to “judge us after ten years of success in office. For one of the fruits of that success will be that Britain has become a more equal society.����”Commissioned by the Joseph Rowntree Foundation, the study, by a team led by LSE’s Centre for Analysis of Social Exclusion, shows sharp contrasts between different policy areas. Notable success stories include reductions in child and pensioner poverty, improved education outcomes for the poorest children and schools, and narrowing economic and other divides between deprived and other areas.But health inequalities continued to widen, gaps in incomes between the very top and very bottom grew, and poverty increased for working-age people without children.����In several policy areas there was a marked contrast between the first half of the New Labour period and the second half, when progress has slowed or even stalled.John Hills, one of the leaders of study, said, “Whether Britain has moved towards becoming a ‘more equal society’ depends on what you look at, and when. Where clear initiatives were taken, results followed. But as the growth of living standards slowed, even well before the recession, and public finances tightened, momentum seems to have been lost in several key areas.”Kitty Stewart added, “The government can take heart from achievements such as the reduction in child poverty up to 2004.����Recent data show that by then, child well-being in the UK had begun to move up the European league table from its dismal showing at the start of the decade that formed the basis of UNICEF’s damning 2007 report. But even with improved figures, Britain was still left with one of the highest rates of child poverty out of the 15 original EU members, and the latest figures show it had increased again by 2006/7.”����The study concludes that the decade from 1997 was favourable to an egalitarian agenda in several ways: the economy grew continuously; the government had large majorities and aspired to create more equality; and public attitudes surveys suggested pent-up demand for more public expenditure. But that environment now looks very uncertain, not just in the near future, but also in the longer term.����Fiscal pressures from an ageing society could further constrain resources available for redistribution, and public attitudes towards the benefit system have hardened while support for redistribution has declined.Hills added, “The 1980s and 1990s showed that hoping that rapid growth in living standards at the top would ‘trickle down’ to those at the bottom did not work.����The period since 1997 has shown that gains are possible through determined interventions, but they require intensive and continuous effort to be sustained.”JRF Chief Executive Julia Unwin added, “We know the potential impact the deepening recession will have on those already living in poverty. This book provides an important, timely and comprehensive assessment of where we are and what remains to be done.”

Alzheimer's Disease Facts and Figures

Includes a Special Report on Race, Ethnicity and Alzheimer’s Disease2010 Alzheimer’s Disease Facts and Figures provides a statistical resource for United States data����related to Alzheimer’s disease, the most common type of dementia, as well as other dementias. Background and context for interpretation of the data are contained in the Overview. This includes definitions of the types of dementia and a summary of current knowledge about Alzheimer’s disease. Additional sections address prevalence, mortality, caregiving and use and costs of care and services. The Special Report for 2010 focuses on race, ethnicity and Alzheimer’s disease.

2011 Alzheimer's Disease Facts and Figures

2011 Alzheimer’s Disease Facts and Figures provides a statistical resource for U.S. data related to Alzheimer’s disease, the most common type of dementia, as well as other dementias. http://www.alzheimersanddementia.com/article/S1552-5260%2811%2900036-7/pdf ��

2014 Alzheimer's Disease Facts and Figures

2014 Alzheimer’s Disease Facts and Figures is a statistical resource for U.S. data related to Alzheimer’sdisease, the most common type of dementia, as well as other dementias. It also contains a special reporton women and Alzheimer's. Download the report here.

The Health and Well-Being of Children and Young People in South East England 2005 (report)

A compendium of facts and figures on the health status and the determinants of the health of children and young people in South East England

Surveillance of influenza in Northern Ireland

The influenza season started later than normal, clinical indices began to increase marginally in mid-February, much later than previous seasons, and activity remained very low throughout, with community syndromic indicators not reaching the baseline warning threshold during the season. The peak GP influenza-like illness consultation rates in 2011/12 were the lowest since surveillance began in Northern Ireland in 2000. No one age-group appeared predominantly affected, with low levels of activity in all age groups, however, GP consultation rates increased in both children and adults.Influenza A (H3) was the predominant strain of the virus circulating, with small numbers of the influenza B strain circulating later in the season. Unlike the 2010/11 season when Influenza A (H1N1)2009 strain dominated in Northern Ireland, there were no detections of this subtype in 2011/12; virological activity generally corresponded to clinical activity.There were however, patients with confirmed influenza admitted to Intensive care units, across Northern Ireland during the season. Numbers were low, the average age of these patients increased compared with the previous season and one fatality was reported in this group.The proportion of over 65 year olds who received the 2011/12 seasonal influenza vaccine was 77.0%, and in those in a clinical risk group aged under 65 years was 81.7%, both of these vaccination uptake figures were a slight increase on the previous year. Influenza vaccine uptake in frontline healthcare workers also increased marginally this season to 20.8%, as did the proportion of pregnant women vaccinated during the season.

Director of Public Health annual report 2011 and core tables 2010

Too many children and young people are living in circumstances that make it difficult for them to thrive. That is the key message from the third Annual Report of the Director of Public Health (DPH) for Northern Ireland, which was published on 14th June 2012. This significant report highlights the many public health challenges that affect people in Northern Ireland.As Director of Public Health, Dr Carolyn Harper's report describes the main public health challenges across Northern Ireland, and details work being undertaken by the Public Health Agency (PHA) and its partners over the past year to improve the health and wellbeing of people here.A Core Tables report for 2010, available below, produced by the PHA in support of the Director of Public Health's Annual Report for 2011-2012, including information such as estimated home population figures and projections, births information, fertility rates, death rates, information on mortality, life expectancy, immunisation rates and screening uptake rates.

Director of Public Health annual report 2012 and core tables 2011

Improving the health and wellbeing of the elderly is the theme of the fourth Director of Public Health annual report, launched on 12 June 2013. Northern Ireland's elderly population is growing and older people are living longer than ever before, which emphasises the importance of providing health and social care that allows them to live a productive life.This report highlights the many areas of public health work aimed at giving elderly people in Northern Ireland the best opportunity to live active and healthy lives in a safe and secure environment. An in-depth overview also provides statistics on many aspects of life as an elderly person here - life expectancy, mortality, mental wellbeing, lifestyle, social determinants of health etc. Further, more detailed, data is included in an accompanying report available�as a separate document.��The core tables for 2011, also available to download below, include information such as estimated home population figures and projections, birth rates, fertility rates, death rates, information on mortality, life expectancy, immunisation rates and screening uptake rates.The presentation slides from key speakers from the launch event on 12 June 2013 and all parallel sessions are also appended below.�Please note:�The PHA cannot be held responsible for any breach of copyright that may exist within individual presentations.Anyone wishing to get a copy of the presentation by Ron McDowell�in the 'Identifying those at risk' category should contact him directly at mcdowell-R3@email.ulster.ac.uk