Attitudes to health in Ireland have changed. We are healthier than at any previous stage in Irish history, but does this mean we are healthy? "No we're not, if you take ordinary indicators like death from heart disease or cancers, we are worse than the average European," says Cecily Kelleher, Professor of Health Promotion at NUI Galway. "However, there are signs that attitudes to health in Ireland have, as you say, changed. Many people now take an active interest in their health and understand they can control many of the factors that influence it. The problem is that the poor in Ireland are less healthy then the better off and may have less control over their health."
Next Monday sees the publication of the first large-scale population survey of diet and nutrition since 1990. The Survey of Lifestyle, Attitudes and Nutrition (SLAN) report is the culmination of three years of preparation and survey work undertaken by Kelleher and her colleagues on more than 7,000 Irish adults throughout the Republic. Appointed in 1990 to NUI Galway's Chair of Health Promotion - the first in Ireland, and only the third in Europe - Kelleher set up the multi-disciplinary Department of Health Promotion within the faculties of medicine, arts and science and added an affiliated research centre ("more a concept than a place") the following year, implementing a series of multi-disciplinary research projects, such as her colleague Dr Margaret Barry's five-year initiative on mental health problems in rural communities, which is about to be concluded. Another forthcoming survey undertaken with UCC examines attitudes to dental health.
Kelleher does not create the impression of being a zealot. "I'm not. A crucial part of our work is facilitating genuine participation by people in decisions made about their health. We recognise that many people now want such a role. To me lifestyle is a signal. Vast volumes of research have identified the need to focus public health policy on the promotion of good health and research into the social and political determinants of health status." Looking ahead to Monday's national report which follows a report released last March, on lifestyles of adults and young people, she says: "I believe it will consolidate our long-held understanding that lifestyle patterns, including those related to diet, vary according to social circumstances."
Calm and logical, Kelleher is a striking-looking, impressive character, evoking Mary Robinson albeit with a more natural personality. She is likeable and very quick-witted. Her small face is dominated by expressive dark blue eyes and a good sense of humour. Her slightly old-world demeanour offers an interesting contrast to her up-to-the-minute command of her subject. She presents her views clearly and there is nothing pedantic or patronising about her approach. She quickly tailors her delivery according to the level of understanding of her audience and is a good speaker, articulate without being formidable. While she clearly believes that many aspects of ill-health can be prevented, she is not trying to claim that all ill-health can be eradicated - she is much too practical for that - but says "it is possible to control it".
"There is this belief that the average person is interested in lifestyle matters, so I am regularly asked by journalists what we should do about cancer or heart disease or stress. The crucial point is that there are two aspects of lifestyle. Firstly, what is within the power of the individual to change, and secondly, what takes political action. For instance, let's look at smoking: the average smoker may well be under stress and therefore, might be helped to cope with that stress and hence give up smoking. But the fact is that many smokers live in disadvantaged social circumstances and the only way to address that is to do something about poverty."
Recently awarded with colleagues a five-year prestigious competitive grant worth £300,000 (or less than half of the sum handed over to the rock Messiah project) to investigate this issue of poverty and ill-health in Ireland, the Health Research Board Unit will be the first of its kind in this country, Kelleher, a member of the newly established Food Safety Authority, has also been nominated by the Health Research Board to represent Ireland on a European Science Foundation-funded project examining social variations in health across Europe.
The first meeting took place about two weeks ago in London, and she is optimistic. "It is well known that there are major social variations between countries in patterns of heart disease across Europe. The Irish lead the European Union in these rates. For instance, our rates for women as well as men are double the European average. This new project should help to show why these differences are so stark." She points out that, as expected, in terms of risk factors for heart disease, smoking is a prime example.
"The only people currently reaching the target advocated by the Department of Health and Children are those who are older and more affluent. We have two separate problems. More working-class people of both sexes continue to smoke. And young people, particularly women, are continuing to take up the habit. To tackle smoking requires concerted public policy action. Schools and personal development programmes should be targeted to recognise that smoking among women is a feminist issue. In other words, smoking among young girls is a badge of assertiveness and image, as well as a rejection of authority. There is plenty of scope for health education programmes to explore these issues effectively, exploiting particularly young people's real concerns about pollution and the environment. What is needed is the resources to do this. In general, smoking cessation programmes for older, habitual smokers can work if offered through the workplace or through their GP. The real core, however, of these social realities are class differences such as poverty and inequality of which smoking is just a signal."
Stress appears to have emerged as a leading modern disease. Why has it developed such a high profile? "Stress has become a major issue because over the last 25 years we have learnt more and more about the social circumstances of people's lives and the psychology of how they think. There has been a vast amount of information published which is accessible to everyone. At the heart of so-called stress is the issue of control. This applies whether you are a worker in a dead-end job who sees no way out, or a smoker who simply cannot kick the habit. The challenge for stress management programmes is to achieve a balance of personal coping skills with the practical one, that of changing an unpleasant personal environment."
Born in Limerick in 1957, Kelleher describes herself as being "reared on a self-inflicted diet of American movies and Russian novels". She is the daughter of two doctors. Her father, Daniel, the youngest of six, came from a farming family in west Cork. "He broke off his studies to return home during the Emergency," she says, while her mother, Sheila, came from Dingle in Co Kerry. "My mother was one of five sisters who all studied medicine and four of whom qualified." There is a family tradition, including cousins and several uncles. "I always knew I would go to university. I was privileged and bright. But I was interested in many things, particularly literature and thought about being a writer. And as many writers could also be doctors, I felt if Somerset Maugham, A.J. Cronin and Chekhov could do it . . . but as it turned out, if I'd really wanted to be a writer I might have been better off doing an English degree. Most of the writing I do now is medical research reports."
The elder of two sisters, she went to Kate O'Brien's old school, Laurel Hill, and was in the A stream and so was educated largely through Irish. Later she went to boarding school at the Sacred Heart in Roscrea, now a community school. "I didn't want to go to boarding school but my parents had got this idea that boarding school was a good thing, and as my sister Hilary was going, off I went." Kelleher grew up in Castletroy, a suburb of Limerick, and then quite rural, about two miles from the city centre. "Even in my time there were still, architecturally, traces of Frank McCourt's Limerick, the old Georgian buildings and so on, but now of course much of that has been restored." Her father ran the independent Limerick Blood Transfusion Service and she has good memories about setting off with him visiting blood donation clinics, or bleeds, in west Limerick, north Clare and north Tipperary. "It was the mid-west region, and there were all these places with exotic names like Ulla, Kilkishin or Knocknagoshel." Her mother often accompanied them on these missions. Both parents influenced her; she seems to have inherited the best of Cork and Kerry from them. Above all she learnt from them that medicine is about people, the individual.
"My father was very keen on rugby and politics. We had great debates into the night. I was very close to him." He died in 1981, half way through her intern year, and her mother died recently also. "She was a great character, very witty. She was pragmatic, very able but highly human and treated all people as individuals."
As a schoolgirl, Kelleher would arrive at the casualty department of Barrington's Hospital where her mother worked - it was the chance of a lift home as much as curiosity which brought her there. Barrington's is gone now. "Casualty is very different from the way it is presented on television where it largely seen through the love life of the characters. Real-life casualty moves more slowly, in real-life time." There, in the casualty department, Kelleher observed medicine in practice. It seems to have been busy but civilised. "Mother would suspend all action at 4 p.m. for tea."
At 17, Cecily Kelleher went to university, choosing UCD rather than UCC. "I wanted to go to Dublin. I thought university was going to be like it was in novels and that we would sit around discussing life and love and all the big questions." She smiles wryly. "It wasn't like that."
Laughing at the idea of medicine being glamorous, though conceding its elite aura, she chose it "because I thought I could do something useful", adding she was very aware of the social aspects of university life and became involved with college literary forum, the Literary and Historical Society (L & H). In 1977, she was invited to became the society's record secretary, the first woman, by the then auditor, Frank Callanan, now a barrister and author of biographies on Tim Pat Healy and Parnell. "He is one of the few who fulfilled my expectation of what the people one met in university should be like." The L & H, however, was not for her. "While I have always enjoyed one-to-one debate, that does not necessarily translate into what is a bear-pit for later transplantation to the Law Library."
Halfway through the year, "the pathology exam announced itself". The next year she went to Tanzania and worked in clinics where she was forcefully struck by the fact that so much of the disease there was preventable. Referring to the ongoing AIDS crisis in Africa, she says: "The epidemic pattern of AIDS in Africa is so different from that in the US where effective treatment regimes are improving quality of life for AIDS sufferers. In Africa there are no such resources; the social and health-care infrastructure is hopelessly under funded, not least because such countries are crippled by their debt to the World Bank. This is a clear example of an inequity which politicians could address."
On qualifying, she worked at Lourdes Hospital in Drogheda ("there is nothing like hospital work as a way of getting to know your colleagues") and then moved on to UCC in late 1982, when she worked as research fellow in the department of medicine and trained in clinical epidemiology.
There she also completed her doctorate in diabetes and hypertension. Between 1987 and 1990 she worked in Harrow, in Greater London, co-ordinating a major heart disease primary prevention trial of low-dose aspirin and warfarin for the British Medical Research Council. It was a huge screening involving 55,000 men, with a follow-up of 5,000 of these on treatment. "The study successfully showed that heart disease can be prevented," she says, the results were published in the Lancet.
Living just outside Galway suits her very well at present. "The boys, Daniel (11) and Alexander (7) have a good quality of life. Commuting is not a problem, I can get home." She is married to independent film producer/director Anthony Sellers who is currently working on the pre-production of The Biographer's Method.
On her appointment nine years ago, Kelleher was profiled in this newspaper, and on the question of her multi-disciplinary research objectives, she has certainly delivered. Possibly the most important input of her research work to date is that presented to the national strategy on heart disease, Building Healthier Hearts, which was published by the Government in July. She agrees she has to fill many roles, from consultative public health physician, to administrator, to diplomat, to university lecturer and public speaker, and above all, communicator. "I would want to achieve a balance between academic credibility with medically qualified colleagues, with other colleagues in the social and behavioural sciences, and yet I am conscious that to the person in the street the message must be human and understanding. Sometimes I feel like Horatio on the bridge trying to achieve a dialogue between all these disparate groups."
With an immediate staff of 23, she says: "I enjoy working with men and women, I like people who like working hard. I feel we are doing important work which gives highly practical example of health promotion in action in different situations involving real people." We can all improve our health she says, "what I want to ensure is that change is truly within our control".
Copies of the SLAN report will be available from the Department of Heath and Children, or from the Department of Health Promotion UCG (price £10)
