This HSE Public Health position paper on health inequalities was requested by the Chief Clinical Officer and the National Director of Public Health. It was developed by a working group comprised of representatives from across the domains of Public Health in the HSE at regional and national levels, working with colleagues from the Office of Wellbeing, Equality, Climate and the National Social Inclusion Office, led by the office of the Director of National Health Improvement - Public Health (see report Appendix A). The group was asked to develop a paper to inform future work within the HSE and contribute to the national Public Health strategy currently under development. To this end the paper considers specific roles and actions for the HSE, and Public Health in particular, in reducing health inequalities in Ireland.

P.12 In an Irish context groups who are socially marginalised or excluded have worse health outcomes. This includes but is not limited to Irish Travellers, Roma, vulnerable migrants, people with disabilities, people with severe and enduring mental illness, sex workers, people with addiction, people in contact with the justice system and people experiencing homelessness. There is compelling evidence of health inequalities for many other social groups, some referenced in report Table 1. Additionally, dimensions of inequality may interact resulting in compounding, intersectional effects. For example, single mothers are significantly more likely than partnered mothers to experience depression, anxiety, and to live in inadequate housing conditions, including exposure to damp..

P.21 Community work, or community development, can be defined as “social change to achieve equality, social justice and human rights”, and community development approaches to addressing the SDHs are well developed in Ireland (39). While community work addressing determinants of health and health behaviours may not always be expressed in the language of health inequalities, in the past there have been attempts to align local action with community health inequality networks (40). Local and regional actions can also focus on specific determinants, risk factors or settings, and reflect needs identified by the population. For example Local and Regional Drugs and Alcohol Task Forces target drug and alcohol misuse which causes harm across the life course. In care environments where substance misuse occurs, serious damage can affect children at every age and have lifelong impacts.