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Read MoreOpening Statement by Health Promotion Alliance Ireland to the Oireachtas Joint Committee on Health on public health and the commercial determinants of health, 14th February 2024
Delivered by Janis Morrissey, Director of Health Promotion, Irish Heart Foundation, and Chair of the Health Promotion Alliance Ireland (HPAI) who was joined by HPAI members Dr Sheila Gilheany, CEO, Alcohol Action Ireland, and Dr Liz O’Sullivan, Lecturer in Nutrition TU Dublin.
Thank you Cathaoirleach for this opportunity today.
Health Promotion Alliance Ireland is here to talk about chronic disease prevention. We have had another winter of waiting lists and trolley queues. The health service is increasingly challenged by the burden of chronic diseases, such as cancer, cardiovascular disease, dementia and respiratory conditions. These conditions place a significant strain on the healthcare system and on the economy. Chronic diseases account for 76% of all deaths annually, 40% of admissions and 75% of bed days[i].
Our population is aging and growing. Our healthcare system will never be able to cope with the demand. We do not do health well in Ireland. In fact, we have an illness service, not a health service.
Yet, a major solution is staring us in the face.
These chronic diseases are largely preventable. They are mostly caused by five common risk factors: poor diet, alcohol consumption, physical inactivity, smoking and obesity. We know what needs to be done. Yet, little meaningful action has been taken to address the drivers of these leading causes of death and disability.
The Healthy Ireland framework was a whole of government plan with a goal of ‘addressing the wider determinants of health’ but this vision has not been realised. Sláintecare stated it would have ‘a strong emphasis on prevention and public health’. When published, it seemed like a godsend to finally shift us from dealing with the latest trolley crisis and the symptoms of ill health to tackling their causes. Why has this been neglected? How often is chronic disease prevention discussed in this Committee?
Everyone from the Taoiseach to the Secretary General in the Department of Health has spoken of disease prevention but too often when Government or officials talk about health promotion, they mean an awareness campaign, which is simply not enough.
Prevention does not just mean campaigns or early detection of disease. It also means stopping these preventable diseases developing in the first place. This is called primary prevention. To address the causes of chronic disease a major shift to primary prevention is required.
We are all products of our environment – the circumstances in which we are born, live and age so we need to invest in policy measures to tackle the environmental drivers of chronic disease rather than solely focussing on those already ill.
Primary prevention issues are largely ones of political choice. Decisions around areas like smoking and obesogenic environments are made here in this building. We need to change the narrative away from waiting lists, away from campaigns that focus on individual behaviours and shift our thinking entirely.
This approach to preventing chronic disease would save thousands of lives each year and protect our stretched health service. It includes preventive strategies addressing the core determinants of health, i.e. the social, economic, environmental and commercial conditions in which risk of chronic disease emerges, such as restrictions on the marketing of unhealthy food to children.
A focus on primary prevention is recognised by the WHO as a ‘best buy’, being highly cost-effective, evidence-based, and yielding a significant return on investment. For example, multiple alcohol control measures in Norway based on these ‘best buys’ resulted in a 37% reduction in alcohol consumption per head of population compared with Ireland.
To address the lack of focus on primary prevention, the Irish Heart Foundation has established Health Promotion Alliance Ireland, an all-island coalition with a shared interest in advocating for major policy change to promote the primary prevention of chronic disease. It comprises over twenty leading organisations including my colleagues here today from Alcohol Action Ireland and TU Dublin as well as prominent medical and health bodies.
The vision of the Alliance is ‘a future without preventable chronic disease’. We can play a constructive role in supporting efforts and building political consensus to reduce the burden of chronic disease on the health service.
One goal of the Alliance is to highlight the impact of harmful tactics by vested interests that are used to delay adoption of health policy. There has been an increased global focus on this area in the last decade and it is termed the ‘commercial determinants of health’.
We have witnessed an over-reliance on individual responsibility to improve health. Smoking, physical inactivity, alcohol consumption and poor diet are often characterised as ‘lifestyle risk factors’ for disease. We need to move beyond this “lazy language of lifestyle”. It frames health at an individual level – effectively blaming individuals for making irrational decisions that are detrimental to their health.
While individuals may have a level of responsibility for their health, the language of lifestyle perpetuates a disproportionate focus on the need for individuals to change their ‘unhealthy lifestyle’ as opposed to system-level change to support healthier choices. This talk of educating people on healthy lifestyles is straight from the industry playbook and feeds into commercial interests.
How can you expect someone to eat a healthy diet just because they occasionally hear a radio ad when they are constantly subjected to a well-resourced onslaught of targeted marketing of readily available, cheap ultra-processed food? How can people have a choice when the odds are stacked against them?
All government departments influence the nation’s health. While health promotion has a junior ministry, health should be an integral part of all relevant policy areas. Much of the action that is needed to address the commercial determinants of health falls outside of the Department of Health entirely, but the Department deals with the negative consequences of corporate influence on other department’s policies.
In Ireland, we will shortly mark 20 years since the introduction of the workplace smoking ban. This ambitious initiative improved everybody’s health and proved the Government’s ability to stand up to the big tobacco lobby. We welcome the Minister’s recent actions on tobacco and e-cigarettes which will have a massive lasting impact on public health. Now Government needs to repeat this brave action with other sectors, who all use the same corporate playbook to oppose any progressive health policy.
Preventing chronic disease is a political choice. Waiting lists will continue to soar unless there is greater political will to implement chronic disease prevention policies which are more effective, more equitable and more cost-efficient than targeting individuals.
Health Promotion Alliance Ireland calls on the Committee to take two actions:
Membership Health Promotion Alliance Ireland
Further reading
[i] Department of Health. Better health, improving health care. Dublin, Department of Health; 2016 cited in: Integrated Care Programme for the Prevention and Management of Chronic Disease. National Framework for the Integrated Prevention and Management of Chronic Disease in Ireland 2020-2025. https://www.hse.ie/eng/about/who/cspd/icp/chronic-disease/documents/national-framework-integrated-care.pdf
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