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Pike, Brigid (2013) Healthy Ireland – implementation matters. Drugnet Ireland, Issue 46, Summer 2013, pp. 15-16.

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On 28 March 2013 the government launched Healthy Ireland: a framework for improved health and wellbeing 2013–2025.1 Healthy Ireland sets out a framework of actions to improve health and wellbeing and reduce the health risks posed to future generations. The government has developed the policy in response to rising levels of chronic illness, lifestyle trends that threaten health and persistent health inequalities

 
The economic justification for the policy is clear. It is estimated that in Ireland the economic cost per year associated with obesity, smoking, alcohol use and mental health issues is around €18 billion. (The economic cost of the illicit drugs market in Ireland has never been calculated.)
 
Obesity: Two in every three adults in Ireland are overweight or obese, and 20% of children in all socio-economic groups are overweight.
Smoking: Around 1 million people in Ireland smoke tobacco products, and 12% of children aged between 11 and 17 years are current smokers. Smoking rates are highest (56%) among women aged 18–29 years from poor communities, compared to 28% of young women from higher social classes. One in every two smokers will die of a tobacco-related disease; 5,200 preventable deaths occur each year from tobacco.
Alcohol: The alcohol consumption rate for Ireland is one of the highest in Europe, at 11.9 litres per capita. Alcohol is responsible for approximately 90 deaths every month, and is a factor in half of all suicides.
Drugs: Use of illegal drugs in the last year is reported at 7% of adults aged between 15 and 64 years, and drug use was the direct or indirect cause of 534 deaths in 2008.
Mental health: Mental health is a growing health, social and economic issue and it is expected that depressive mental illnesses will be the leading cause of chronic disease in high-income countries, including Ireland, by 2030. Currently, in Ireland, the mortality rate from suicide in the 15–24-year age group is the fourth highest in the EU. One in 20 participants in an Irish longitudinal study on ageing (TILDA) reported a doctor’s diagnosis of depression, with a similar number reporting a diagnosis of anxiety. Levels of depression and admission to psychiatric hospital are higher among less affluent socio-economic groups.
 
Evidence and experience from around the world show that in order to make a positive change in population health and wellbeing a whole-of-government approach is needed, as well as involving local communities and society as a whole. Healthy Irelandlists 64 broad inter-sectoral actions, with initial partners including government departments, statutory agencies, civil society organisations, the community and voluntary sector, the private sector, and employee representative organisations.
 
The authors of the policy framework recognise that ensuring effective implementation of the policy, making sure it does not get left on a shelf, is the biggest challenge.2 The framework of actions emphasises five activities – leadership, measurement, partnership, empowerment, and resource management – designed to ensure the policy remains on the front burner.
 
Leadership: The Cabinet Committee on Social Policy, chaired by An Taoiseach, will oversee implementation. It will oversee and monitor targets and action plans to improve health and wellbeing and will address the cross-cutting policy issues that arise. A national Healthy Ireland Council will be established to represent all stakeholders. This Council will build a network of advocates at national and local level to actively promote and pursue the goals of Healthy Ireland.
Measurement: Rigorous planning, reporting and evaluation will be assured through an Outcomes Framework with key indicators and measurable targets. Indicators will be set to measure improvements in population health. These will include health status, weight, diet and activity levels. It will also include indicators to measure health inequalities and the broader determinants of health, such as the proportion of young people completing second level education, access to green spaces and other environmental influences; and indicators that measure how we are protecting the health of the population, e.g. uptake of immunisation programmes.
Partnership: Responsibility for action on health determinants and health behaviours will be distributed across the State, private sector and employers, communities, families and individuals. Local structures will be identified and supported to work on common implementation agendas. It is at this level that individuals, community and voluntary groups and projects, sporting partnerships, local schools, businesses, primary care teams, community gardaí etc. will be able to work together.
Empowering people and communities: To achieve the goal of a ‘healthy Ireland’, it is essential to empower people and communities to improve and take responsibility for their own health and wellbeing. Actions to empower individuals and communities will need to be balanced with a broader range of provisions influencing the choices people have, e.g., regulatory and legislative options to adapt or change the decision-making environment or to provide for quality and safety standards. Social interaction and social connectedness and involvement in community life are also keystones to empowering people at the individual level and building strong communities for health and wellbeing, and will be addressed.
Resource management: Healthy Ireland will be implemented using existing resources; existing programmes and priorities will be reviewed to ensure they are directed toward community-based programmes for those most at risk or experiencing the greatest disparities, and to ensure selection of those programmes with the greatest opportunity for impact.
 
 
How Healthy Ireland will work in with the National Drugs Strategy remains to be seen. With regard to alcohol, citing the 2012 report of the Steering Group on a National Substance Misuse Strategy, Healthy Ireland identifies a decrease in alcohol consumption across the population as an indicator and sets a target of reducing the amount of alcohol consumed by people over the age of 15 years to an annual per capita consumption of 9.2 litres of pure alcohol. No date is set for this target.
 
 
1. Department of Health (2013) Healthy Ireland: a framework for improved health and wellbeing 2013–2025. Dublin: Department of Health. Available at www.drugsandalcohol.ie/19628
2. The challenge of effective implementation has been recognised and written about elsewhere. For example, see Pike B (2010) How effectively is policy being implemented? Drugnet Ireland, (33): 15–16  (www.drugsandalcohol.ie/13029), and Burke K, Morris, K and McGarrigle L (2012) An introductory guide to implementation: terms, concepts and frameworks. Dublin: Centre for Effective Services. Available at www.effectiveservices.org/knowledge-exchange/ces-publications
Item Type
Article
Publication Type
Irish-related, Open Access, Article
Drug Type
Alcohol, Tobacco / Nicotine
Intervention Type
Harm reduction, Policy
Issue Title
Issue 46, Summer 2013
Date
July 2013
Page Range
pp. 15-16
Publisher
Health Research Board
Volume
Issue 46, Summer 2013
EndNote
Accession Number
HRB (Electronic Only)

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