The year began with "hard-hitting anti-smoking adverts from the HSE". Dr Stephanie O'Keefe, HSE national director of Health and Wellbeing, hopes the ads "inspire other people to quit smoking and help them avoid the pain of illness and premature separation from their loved ones". Dr Fenton Howell, National Tobacco Control advisor said they will "help a lot of smokers make a quit attempt".
Well, I have news for them. These ads won’t have much, if any, influence on smokers or smoking behaviour. Children will not be less obese because of the “Let’s beat childhood obesity” campaign from Safefood/HSE which will continue throughout 2014 and aims to remind parents about the “negative health impacts of excess weight in childhood and how this can impact on a child’s quality of life”. Scare tactics and negative media messages do not change behaviour. Mass media appeals, whether scary or otherwise, are a waste of professionals’ time and taxpayers’ money.
The Department of Health and Children and the HSE know this already which is why Healthy Ireland – A Framework for Improved Health and Wellbeing 2013-2025 (Hi) was launched in March 2013.
This excellent strategy focuses almost exclusively on a whole systems approach with all sectors of society working together to influence the determinants of health: educational attainment, poverty and the overall environment. Unfortunately, the HSE’s National Service Plan 2014 for the Health and Wellbeing Division will deliver nearly the complete opposite to the actions required by Hi.
Focus on disease prevention
While the HSE recognises the need to "reconfigure and realign work practice, programmes and teams to deliver against the actions in Healthy Ireland", the Health and Wellbeing Division intends to ensure reforms "result in a greater focus on disease prevention and self-care".
What happened to the Hi aspiration that “the health sector must assume both a stewardship and advocacy role to support other sectors in pursuing health and wellbeing goals”? Where are the coordinated inter-sectoral plans? Instead the HSE will “develop a ‘health services’ implementation plan for Hi”.
Furthermore, the Health and Wellbeing Division intends to target high-risk groups and “ensure that people have the knowledge and supports to live healthier and more fulfilling lives”.
Disadvantaged groups are about three times more likely to smoke, be obese, have an unhealthy diet, and be physically inactive because of their social conditions, not because they are ignorant about health matters. They have enough difficulties to contend with in their daily lives without being the targets of campaigns.
Why such a difference between government strategy and what is actually delivered by the HSE? Targeting needs to be the other way around.
In his 2011 inaugural speech President Michael D Higgins urged Irish people to "be the arrow not the target". In terms of health and wellbeing this means that the health sector, the education system, local authorities and other public sector organisations need to be targeted by disadvantaged groups.
Families in disadvantaged areas need to target their schools to ensure poorer children have an equal chance of getting to college.
Medical card holders need to target the health system to ensure waiting times and treatments are identical to those with private health insurance. Disadvantaged groups need to target local authorities to ensure poorer people live in safe areas with good houses, plenty of play areas, shops, cafes and other necessary amenities.
Empowering people
This reverse type of targeting is consistent with Hi's goal of empowering people and communities. "Building awareness of and action on the social determinants will assist communities to organise and mobilise." Hi wants to increase participation, create activity-friendly environments, and social connectedness.
In fairness to the HSE’s Health and Wellbeing Division, some actions planned for 2014 are very worthwhile. The health promoting cities, campuses and schools projects, and brief intervention training for health professionals, should continue. The HSE should stop all the lifestyle health education programmes and start empowering communities to be arrows not targets. There are not enough resources to do both.
The budget for the division is €232 million, just 1.8 per cent of the overall HSE allocation instead of the 10 per cent recommended by the World Health Organization. Most of the Health and Wellbeing budget is spent on immunisation, screening programmes and food safety, all of which are vitally important.
Yes, we need information campaigns. These should be about the importance of citizen engagement, educational attainment, how the environment affects health, and what can be done about these determinants. Not scare tactics or negative health messages.
Dr Jacky Jones is a former HSE regional manager of health promotion
drjackyjones@gmail.com