Action needed on higher level of ill-health among poor – North and South
People at risk of poverty are much more likely to have higher levels of chronic illness according to a recent report produced by the Institute of Public Health in Ireland (IPH) and Combat Poverty.  Poorer people’s health outcomes are very influenced by social factors, such as poor housing, nutrition and education (known as the social determinants of health) which explains the higher level of ill-health found among poor and socially excluded groups in Ireland, North and South. 
In the Republic of Ireland 38% of those at risk of poverty suffer from a chronic illness compared to 23% of the general population.  In Northern Ireland 47% of unskilled workers suffer from long-standing illness compared to 30% of professionals and managers. 

This report was welcomed by the World Health Organisations’ Commission on the Social determinants of Health.  Speaking on the fact that poorer people have poorer health across the world the Commission’s Director General Dr Margaret Chan said that “the toxic combination of bad policies, economics and politics is, in large measure responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible.  In its own report, entitled Closing the Gap in a Generation: Health Equity through action on the Social Determinants of Health the Commission concluded: “Social injustice is killing people on a grand scale." 

Health inequity really is a matter of life and death.  Leadership is required in Ireland and in countries across the world to ensure that all those involved, in the health sector and outside the health sector, recognise their impact on health and act appropriately. 

In this context primary health care has a huge part to play.  Ireland’s healthcare system has struggled to provide an effective and efficient response to the health needs of its population.  Despite a huge increase in investment in recent years great problems persist.  One key initiative that would make a substantial positive impact on reducing these problems would be the development of primary care teams across the country.

Primary care teams draw the health professionals in an area together into a team that provides a one-stop shop where people can go locally rather than heading directly to the accident and emergency unit in the nearest hospital.   Up to 80 per cent of those who go to accident and emergency units should not be there.

The National Social Partnership Agreement Towards 2016 contains a commitment to engage in ongoing investment to ensure integrated, accessible services for people within their own community with a target of 300 primary care teams by end-2008, 400 by 2009 and 500 by 2011. However, progress towards this target has been unacceptably slow.   CORI Justice and CORI Health have constantly drawn attention to this particular commitment and its potential to have a very positive impact on Ireland’s healthcare services. 

We welcome the commitment in Budget 2009 to initiate a programme for the development and construction by the private sector over the next two years of 200 primary care centres. However, we strongly urge Government and the HSE to ensure that these centres are progressed on the basis of local needs assessment including fair coverage of both rural and urban areas.

We also urge Government and the HSE to take the necessary action to ensure that development of the 200 primary care teams for these centres is initiated as soon as possible. Finally we urge all involved to ensure that the target of 500 teams is reached by the target date of end-2011.