Analysis: "Any state that is based on economics alone is a prison home. What a state needs is imagination." The words of WB Yeats come to mind when reading the first report of the Public Health Alliance of Ireland (PHAI) into inequalities in health.
Despite the massive growth in the economy, it appears from the statistics in today's report that the poor and those on the margins of society have been left behind. Across a whole spectrum of conditions, people in the lowest socio-economic groups have the highest death rates.
Whether looking at cardiovascular disease, cancer or infant mortality, if you are unemployed or work at a manual job, you are more likely to die prematurely than if you are a professional. And in case any The Irish Times readers are tempted to take solace from the comfort of the middle classes, it is well documented that the wider the gap between socio-economic groups in terms of health indices, the poorer the health of that nation as a whole.
While money is not the answer to all of life's problems, being poor limits your chances. If you are brought up in a mainly working class area, the housing you occupy is likely to indirectly affect your health. The educational opportunities available to you are limited, which again negatively affects your attitude to health. Even your transport options, because they are limited, go against your future health status.
In a revealing case study in its report, the PHAI spells out bluntly how low income severely limits your health choices.
For a single person living alone who earns just above the €138 weekly ceiling for a medical card, one €40 fee for a visit to a GP can consume 28.5 per cent of weekly income. Add €20 for antibiotics and the effect of an illness is to consume 43 per cent of weekly income. For a couple with two children earning just above the €250 weekly ceiling, one visit costs 15.6 per cent of income, one visit plus €20 of medication consumes nearly a quarter of their weekly income.
The case study is damning enough even though it does not consider the importance of prevention. Let's say the episode of ill health that has cost you 43 per cent of your weekly income also uncovers a diagnosis of asthma. Will you be able to afford the inhalers prescribed by the doctor? Probably not and almost certainly you will have to do without the more expensive "preventer" inhaler - the one that might prevent future visits to the doctor.
What if you are diagnosed with high blood pressure and coronary heart disease? Will you be able to change diet from high fat, high salt preserved food to a more expensive meal made of healthier alternatives? And while you understand the doctor's advice to exercise more, it's a bit difficult to achieve given the motorway that hems in your estate, not to mention the rising levels of violent crime in the area.
With the Government receiving a weekend reminder from the electorate that it needs to change tack, the PHAI report is well timed. Politicians can and must tackle the inequalities in healthcare laid bare by today's analysis.