IPH response to the Environmental Protection Agency Consultation on Stategic Environmental Assessment (SEA) Process Checklist

The Institute of Public Health in Ireland is an all-island body which aims to improve health in Ireland by working to combat health inequalities and influence public policies in favour of health. The Institute promotes co-operation in research, training, information and policy in order to contribute to policies which tackle inequalities in health. Over the past six years the Institute has worked closely with the Department of Health and Children and the Department of Health, Social Services and Public Safety in Northern Ireland to build capacity for Health Impact Assessment. The Institute takes the view that health is determined by policies, plans and programmes in many sectors outside the health sector as well as being dependent on access to and availability of first class health services. The importance of other sectors is encapsulated in a social determinants of health perspective which recognises that health is largely shaped and influenced by the physical, social, economic and cultural environments in which people live, work and play. Figure 1 illustrates these multi-dimensional impacts on health and also serves to highlight the clear and inextricable links between health and sustainable development. Factors that impact on long-term sustainability will thus also impact on health.

Response to Northern Ireland Housing Executive Review of Housing and Health

The Institute of Public Health in Ireland welcomes the opportunity to comment on the Northern Ireland Housing Executive (NIHE), Review of Housing and Health – Towards a Shared Agenda policy.   The Institute aims to improve health in Ireland, North and South by working to combat health inequalities and influence public policies in favour of health. The Institute recognises the potential health impacts linked with housing and welcome the proactive approach NIHE is adopting. By identifying the wider determinants of health, the NIHE acknowledges that as a statutory organization they have a major role to play in contributing to improved health for Northern Ireland.   There are many causal pathways linking housing to health and due to the nature of social housing, a number of vulnerable groups, for example those on a low income or the Travelling Community are subject to NIHE policies.  Overall the policy outlines a number of key recommendations.  The Institute advise that the Implementation Plan which will incorporate the recommendations should outline targets which can be measurable, for example, under Objective 1 which identifies the reduction of fuel poverty.  We recommend that key targets are outlined to show what action the NIHE has set in accordance to measure a reduction in fuel poverty.

Cancer Services - A Position Paper for the Professions Allied to Medicine (PDF 175 KB)

A Position Paper for the Professions Allied to Medicine Patients with cancer are living longer due to early diagnosis and better treatment. In recent years there has been increasing attention to issues related to the quality of life of patients with cancer and a recognition of the potential for habilitation and rehabilitation. As a result, PAMs as members of the multi-disciplinary team are now more actively involved with patients diagnosed with cancer during all phases of their disease. Each person’s life possesses a unique blend of psychological, social, economic and physical factors and comprehensive care requires the needs of the whole person to be addressed. This requires patients and carers having timely access to the most appropriate range of professional skills that will allow individual patients and their carers to retain control of their lives and associated circumstances for as long as possible. It also requires professions, in all locations, to work in a collaborative patient centred manner that affords the best outcome for patients. The need has been highlighted for a multi-professional approach to the delivery of cancer services in “Investing for the Future” and “A Framework for the Multi-professional Contribution to Cancer Care in Northern Ireland”. This need has also been highlighted in the PAM Strategy document. åÊ

Inhabitants' and professionals' social representations of health determinants in a disadvantaged urban area in France: a qualitative analysis = représentations sociales des déterminants de santé dans une zone urbaine défavorisée en France : analyse qualitative auprès d'habitants et de professionnels

Background and objective. - Access to care in French disadvantaged urban areas remains an issue despite the implementation of local healthcare structures. To understand this contradiction, we investigated social representations held by inhabitants of such areas, as well as those of social and healthcare professionals, regarding events or behaviours that can impact low-income individuals' health. Method. - In the context of a health diagnosis, 288 inhabitants living in five disadvantaged districts of Aix-les-Bains, as well as 28 professionals working in these districts, completed an open-ended questionnaire. The two groups of respondents were asked to describe what could have an impact on health status from the inhabitants' point of view. The textual responses were analyzed using the Alceste method. Results. - We observed a number of differences in the way the inhabitants and professionals represented determinants of health in disadvantaged urban areas: the former proposed a representation mixing personal responsibility with physiological, social, familial, and professional aspects, whereas the latter associated health issues with marginalization (financial, drug, or alcohol problems) and personal responsibility. Both inhabitants and professionals mentioned control over events and lifestyle as determinants of health. Discussion. - The results are discussed regarding the consequences of these different representations on the beneficiary - healthcare-provider relationship in terms of communication and trust.

Work and health : remodelling perspectives of working life research, as proposed by Järvholm et al. (2009)

Järvholm and Co-workers (2009) proposed a conceptual model for research on working life. Models are powerful communication and decision tools. This model is strongly unidirectional and does not cover the mentioned interactions in the arguments.With help of a genealogy of work and of health it is shown that work and health are interactive and have to be analysed on the background of society.Key words: research model, work, health, occupational health, society, interaction, discussion paperRemodellierung der von Järvholm et al. (2009) vorgeschlagenen Forschungsperspektiven in Arbeit und GesundheitJärvholm und Kollegen stellten 2009 ein konzeptionelles Modell für die Forschung im Bereich Arbeit und Gesundheit vor. Modelle stellen kraftvolle Kommunikations- und Entscheidungsinstrumente dar. Die Einflussfaktoren im Modell verlaufen jedoch nur in einer Richtung und bilden die interaktiven Argumente im Text nicht ab. Mit Hilfe einer Genealogie der Begriffe Arbeit und Gesundheit wird aufgezeigt, dass Arbeit und Gesundheit sich gegenseitig beeinflussen und nur vor dem Hintergrund der jeweiligen gesellschaftlichen Kontextfaktoren zu analysieren sind.Introduction : After an interesting introduction about the objectives of research on working life, Järvholm and Co-workers (2009) manage to define a conceptual model for working life research out of a small survey of Occupational Safety and Health (OSH) definitions. The strong point of their model is the entity 'working life' including personal development, as well as career paths and aging. Yet, the model Järvholm et al. (2009) propose is strangely unidirectional; the arrows point from the population to working life, from there to health and to disease, as well as to productivity and economic resources. The diagram only shows one feed-back loop: between economic resources and health. We all know that having a chronic disease condition influences work and working capacity. Economic resources have a strong influence on work, too. Having personal economic resources will influence the kind of work someone accepts and facilitate access to continuous professional education. A third observation is that society is not present in the model, although this is less the case in the arguments. In fact, there is an incomprehensible gap between the arguments brought forth by Järvholm and co-workers and their reductionist model.Switzerland has a very low coverage of occupational health specialists. Switzerland is a long way from fulfilling the WHO's recommendations on workers' access to OSH services as described in its Global plan of action. The Institute for Work and Health (IST) in Lausanne is the only organisation which covers the major domains of OSH research that are occupational medicine, occupational hygiene, ergonomic and psychosocial research. As the country's sole occupational health institution we are forced to reflect the objectives of working life research so as not to waste the scare resources available.I will set out below a much shortened genealogy of work and of health, with the aim of extending Järvholm et al's (2009) analyses on the perspectives of working life research in two directions. Firstly towards the interactive nature of work and health and the integration of society, and secondly towards the question of what working life means or where working life could be situated.Work, as we know it today - paid work regulated by a contract as the basis for sustaining life and as a base for social rights - was born in modern era. Therefore I will start my genealogy in the pre-modern era, focus on the important changes that occurred during industrial revolution and the modern era and end in 2010 taking into account the enormous transformations of the past 20-30 years. I will put aside some 810 years of advances in science and technology that have expanded the world's limits and human understanding, and restrict my genealogy to work and to health/body implicating also the societal realm. [Author]

Department of Health Annual Report 2011

Annual Report 2011 Undoubtedly, 2011 was a year of significant change in the health services. The general election brought a new Government and a new direction and policies in healthcare with a commitment to introduce Universal Health Insurance. The health system is being reformed so as to guarantee equal access to healthcare for all, achieved through a single-tier system enabling access based on need and not on ability to pay. Click here to download PDF 353kb  

Managing health and increasing well-being

The Building the Community-Pharmacy Partnership has worked to improve local health outcomes by encouraging members of the community to develop skills relating to managing their own health, and providing accessible information on the availability of services of which they can avail of. The aim is to facilitate local people to gain knowledge on various health issues through books, videos, leaflets and enable the most vulnerable and in need to access additional support through the pharmacy to complementary therapy. Outcome: A room in the pharmacy has been renovated and offers access to other support services. Funding has allowed the pharmacist to equip the room with videos, leaflets, books etc. There has been an increase in partnership working between the community group, pharmacist and more contact has been made with primary care. Further funding has allowed for the development of a subsidised support referral service for counselling and complementary therapies. As well as this, the pharmacist has worked with local groups to provide information sessions on lifestyle and on health issues identified by the local groups

Putting a health inequalities focus on the Northern Ireland cardiovascular service framework

The PHA, supported by the Institute of Public Health in Ireland (IPH) and other agencies and individuals, has completed a health impact assessment (HIA) on the Cardiovascular Service Framework (CVSFW) for Northern Ireland.The CVSFW is the first in a series of service frameworks developed in Northern Ireland to guide HSC provision from prevention and health improvement over early intervention in communities and general practice into hospital and other institutional settings towards rehabilitation, palliative care and end of life.The CVSFW is relevant to everyone who has a part in HSC services for health improvement, hypertension, hyperlipidaemia, diabetes, heart disease, cerebrovascular disease (stroke), peripheral vascular disease and renal disease. This includes patients, carers, families, communities, voluntary and statutory service providers, policy makers and researchers. There are many determinants which impact on cardiovascular disease. Individual lifestyles are major contributors and smoking remains one of the biggest risk factors for the disease alongside sedentary lifestyles and alcohol consumption. Circumstances experienced during the early years influence health and wellbeing into adulthood. Breastfeeding can help protect against obesity, while physical activity and eating habits developed from a young age often form lifelong patterns of behaviour. Living and working conditions also impact on health. Type of job, level of control and employment conditions are major factors. Educational achievement and income are also powerful influences on health. The environment where we live can provide access to open and green space, which plays an important part in physical activity patterns alongside available transport infrastructure. As well as physical health impacts, all of these factors also influence mental health and emotional wellbeing.

Traveller Focus Week - improving health and wellbeing

Members of the Traveller community and their support organisations joined the Public Health Agency and the Health and Social Care Board at an event in Dungannon to mark Traveller Focus Week (5 - 11 December) by sharing the progress made, and celebrating good practice in meeting the health and wellbeing needs of Travellers.These needs were identified in the 'All Ireland Traveller Health Study' by University College Dublin in June 2010. It estimated that there are 3,905 Travellers living in 1,562 families in Northern Ireland, and the stark findings include that when compared with the life expectancy of the general population, male Travellers lose 15 years of life and females lose 11 years.The report made a number of recommendations, including:prioritising mother and children's health; enhanced preventative work for respiratory and cardiovascular disease, as well as better risk detection and management of the disease; development of primary care interventions which involve Travellers engaging with other Travellers in health improvement;engagement of men and young men in improving health and wellbeing and access to healthcare.Speaking at the event, Mary Black, Assistant Director of Public Health (Health and Social Wellbeing Improvement) PHA, said: "The Public Health Agency works in partnership to promote health and wellbeing and reduce health inequalities."This event with the Travellers Health and Wellbeing Forum was an important opportunity to look at progress against agreed priorities and share good practice across Northen Ireland and the successful work of the Forum. One such example is the recruitment of Travellers into employment as health workers developed by the Belfast Health and Social Care Trust and part-funded by the PHA. Other areas are also considering work placements and all of this developing practice will help inform future partnerships with employers and help break down the real prejudice that can be experienced by Travellers."We also heard about the progress Travellers have made in their own right, and their views about how the Travelling community is fully engaged and participates in the future development of the Forum and programmes that aim to improve health and wellbeing and contribute to a more equal society."Mark Donahue, Equality Officer, An Munia Tober (a Traveller support organisation), added "The event was a great success in terms of highlighting the main health issues for Travellers, which came out of the All Ireland Traveller Health Study. I was heartened to see a great turn out by the Traveller community from all over Northern Ireland and also by the interest and commitment of so many public agencies and other organisations to work together to improve Traveller health."The event, at 'Breakthru' in Dungannon, also brought together representatives from the five health and social care trusts, Cooperation and Working Together (CAWT), Housing and key voluntary sector organisations, all involved in delivering the recommendations from the 'All Ireland Traveller Health Study'.

Shaping the future: applying therapy research to practice

In these challenging financial times the use of research as a basis for effective health and social care cannot be overstated. 'Shaping the Future', a joint Public Health Agency and University of Ulster workshop (27 January) takes a fresh look at research within the Allied Health Professions (AHPs) to improve the care and experiences of people across Northern Ireland.The AHPs provide a wide range of services including physiotherapy, occupational therapy, radiography, podiatry, speech and language therapy and orthoptics.The nature of their work enables AHPs to carry out research that can rapidly benefit patient care and experience. 'Shaping the Future' will look at priorities for new AHP research and consider how existing research can be more effectively shared and used in health and social care development, rather than perhaps being limited to the academic world.Speaking at the event, Professor Bernie Hannigan, Director of Health and Social Care Research and Development (HSC R&D), aDivision of the PHA, said: "A sound base of evidence from research is vital for effective health and social care practice. I welcome this study as an important resource that will help generate new evidence and highlight the potential for existing evidence to be applied in practice. The evidence base points to beneficial innovations that use the most up-to-date knowledge and keep the service user at the centre of care practices. At this event, health and social care policy makers, commissioners, academics and researchers will be able to consider how they can do and use research to ensure our AHP services deliver the best outcomes for patients and are sufficiently cost-effective to be sustained."A recent study funded by HSC R&D was carried out by the University of Ulster working closely with leading AHPs, key stakeholders and service users* from throughout Northern Irealnd. Presenting the results of this study at the 'Shaping the Future' event will help to identify ways to gather evidence and contribute to innovative projects and programmes.Professor Suzanne McDonough, of the Health and Rehabilitation Sciences Research Centre at the University of Ulster, said: "In our study we used the Delphi technique, which is a structured process using a series of questionnaires, to gather information and gain consensus from AHP groups, stakeholders and service users."The results identified seven major priority areas for research. These ranged from: the need for more practice evaluation particularly in the areas of mental health, cancer, obesity; diabetes; chronic disease management (especially stroke and brain injury); the role of AHPs in health promotion; service delivery issues such as access to services and waiting times. This study provides an important road map for AHP research priorities. It is the first step in the process of identifying what research still needs to be undertaken, what research already exists but needs to be translated, and some of the processes that need to be in place to ensure that research is an integral part of the day-to-day practice of AHPs and of service delivery."

REACH - Rethinking Eating and Activity for Children's Health

The aims of the REACH programme were to: - Provide a quality whole-family healthy lifestyle programme that is accessible and equitable to support children aged 4-7 and 8-11years who are above the healthy weight range in maintaining or achieving a healthy weight; - Target areas of poor health and high prevalence of childhood obesity; Contribute towards the prevention and reduction of obesity prevalence in South Gloucestershire; - Be a resource for other health professionals and services in South Gloucestershire. As this was a pilot of a child weight management programme being developed from scratch the objectives of REACH were to: Provide a high quality service which meets the needs of the local health community; - Improve childrens diet and nutritional intake and promote a healthy weight; Encourage exercise and physical activity participation; - Develop a range of skills with participants in order to increase their confidence and self esteem; - Be participant centred but also use a whole family approach to deliver healthy lifestyle messages; - Develop appropriate referral protocols, resources and course plans; - Advertise and promote the programme locally liaising with communications and the Public Health Team in NHS South Gloucestershire, GPs and staff working in the community such as School Health Nurses (SHNs); - Successfully recruit families on to the programme; Enable eligible new participants referred to the service to take part; - Encourage participants to complete the programme; - Deliver a service that helps to address health inequalities; - Monitor participants weight and lifestyle changes as part of a follow up programme; - Provide continuous professional development of service staff; - Ensure individuals and families are signposted and supported to access other services such as after school clubs, local sports clubs and leisure centres; - Provide equitable access to the service and ensure equitable outcomes are achieved by the service; Ensure continuous quality improvement;

A key to the door - Homeless Agency action plan 2007-2010, Issue 22, Summer 2007

The Homeless Agency recently launched its action plan to eliminate long-term homelessness and the need to sleep rough in Dublin by 2010. This article will discuss the elements of the plan that relate to homeless individuals with addiction problems in the context of the wider policy framework on drugs and homelessness. The plan contains three strategic aims, relating to prevention, local access to quality homeless services and long-term housing options with support when required. The plan contains 10 core actions (high priority) that cover more than one strategic aim and 74 additional actions (lower priority). Individuals with mental health problems, addictions (alcohol and drugs) and dual diagnosis (addiction and mental health) needs have been identified as needing healthcare and other interventions as part of the strategic aim to prevent homelessness and reduce the risk of becoming homeless. As part of the development of the action plan, a total of 105 men, women and children, both current and past users of homeless services, were interviewed. The principal immediate causes of their becoming homeless were identified by those interviewed as family breakdown, and alcohol, heroin and mental health problems. Several studies have shown the prominent role played by drug use in exposing individuals and families to homelessness in Ireland.This resource was contributed by The National Documentation Centre on Drug Use.

Implementing A vision for change: moving towards a modern, quality and responsive mental health service. Carlow / Kilkenny / South Tipperary.

The key element of the HSE South’s Programme is to enhance and develop community mental health services in Carlow, Kilkenny and South Tipperary, to enable the service user to remain in the community to the greatest extent possible. HSE South has prioritised the implementation of the change programme and has allocated more than €20m capital funding and over €1.75m revenue funding to support this comprehensive development programme. Speaking at the briefings Mr. Pat Healy, Regional Director of Operations, HSE South said, “When this plan is delivered, clients will have access to the highest standards of services in all three counties, which should significantly improve these clients’ treatment programmes and quality of life. The National Service Users Executive are supporting the change programme, which is of immense importance to HSE South. The programme heralds the enhancement and development of community mental health services, the closure of old long stay institutions, the separation of North and South Tipperary acute inpatient mental health services and development of appropriate acute inpatient services, for the extended catchment area, in line with the national strategy for mental health “A Vision for Change”. The programme also acts on recommendations of the Mental Health Commission.”This resource was contributed by The National Documentation Centre on Drug Use.

Garden to Plate

North Tipperary Food Partnership aims to improve access to healthy food and build community and skills through food growing initiatives. `The Garden to Plate` project was set up as part of Nenagh Community Allotments, a voluntary group who lease a site privately containing up to 20 allotments and a communal green house. The North Tipperary VEC Community Education and Back to Education Initiative Projects rent two allotments from NCA offering a certified learning opportunity and generating a space for the wider benefits of learning. The adults engaged are mainly men both recently and long term unemployed with a range of skills and experiences. A small study has been conducted with participants to identify feedback on skills and knowledge gained including those related to health and nutrition. A report is available. North Tipperary Leader Services, VEC Initiative Type Community Food Growing Projects Location Tipperary Funding North Tipperary Leader Services, VEC Partner Agencies NTLS/VEC/HSE/NCA/Council

Hiding the evidence: The State and spatial inequalities in health in Ireland

The Irish State has consistently reduced its production of publicly accessible disease / mortality maps over the last fifty years. State health statistics, and the small number of disease / mortality maps that have been produced in official publications, show a declining level of detail and are routinely out of date. Following a review of the production of disease / mortality maps in Ireland by the State and allied health agencies, two reasons are suggested for this decline. The first explanation relates to spatial inequalities in healthcare provision and to the absence of a health funding formulae in Ireland. The second explanation focuses on the potential politicisation of spatial inequalities in health status. Researchers in these fields are urged to disseminate information widely on spatial inequalities in healthcare provision, healthcare access and health status, both within and outside of the academic literature. Researchers in these fields are also urged to adopt an advocacy role on these issues, or to develop strategic alliances with such advocates.����