Dr Jane Wilde does not sound like a senior medical figure. When you speak to her on the phone, the slightly clipped accent is gentle and unassuming. There are plenty of "wells" and "what do you thinks" throughout the conversation.
When me meet, the impression of a good listener is confirmed. A tall, thin, bespectacled lady, hers is not the world of power dressing or the sweeping statement. Her style is much more low-key and unobtrusive than that.
As director of the Institute of Public Health, Dr Wilde heads one of the first institutions to emerge from the North/South provisions of the Good Friday Agreement. Its establishment in 1998 was an acknowledgement that the health concerns of both the Republic and the North of Ireland share a great deal of common ground.
People on this island, North and South, are less healthy and die younger than anywhere else in Western Europe. In addition, the less well-off have the worst health and die even younger. For instance:
In 1995, Northern Ireland had the highest rate of female deaths from coronary heart disease in Europe at 160 deaths per 100,000. The Republic came a close second. These figures are over four times that of the country with the lowest rate, France.
Ireland as a whole has the highest male death rate from heart disease in the EU at 320 deaths per 100,000.
Swedish men will outlive Irish men by four years (the average age of death here is 73, compared with 77 in Sweden).
A UNICEF survey shows that 30 per cent of children in the UK and Ireland are living in poverty.
People whose annual income is less than £10,000 have disability rates four times as high as those whose income is more than £29,000.
These facts underpin the work of the institute, which aims "to improve health in Ireland by working to combat health inequalities and influence public policies in favour of health".
Traditional medical care can prolong survival after some serious diseases, but it is social and economic conditions that affect whether people become ill in the first place. To make health gains across a whole population, it is vital to address the various social determinants of health, such as environment, work conditions, unemployment, social cohesion, alcohol and diet.
Working to improve the social determinants of health is a long way from taking the traditional medical path. Dr Wilde recalls how, at the beginning of her career in public health in the 1970s, she was carrying out research in her native Belfast, looking at infant mortality in the first year of life. When it came to mapping the location of the babies' deaths, she saw clearly for the first time the overwhelming importance of social conditions for good health.
"It broke my heart to see most of the deaths clustered in the same streets and areas of Belfast," she says. Finding that the mortality rate among children of poorer parents was 50 per cent higher confirmed for her the unfairness of health distribution.
Ten years later, she learnt another key lesson when she found that her medical experience left her poorly equipped when it came to addressing the high levels of ill-health prevalent in west Belfast.
The people of Moyard, rather than traditional medicine, taught her how to identify community issues affecting health. Instead of importing a pre-designed questionnaire, the local community insisted on putting one together for themselves, which they administered. The response rate was huge because of the community's ownership of, and access to, the information.
"I helped with some background advice, but it was an important lesson that information on health belongs to people and not doctors," Dr Wilde says. "The role of health services is to empower people rather than just provide a service on a take-it-or-leave-it basis.
"I also realised that to improve health in a fundamental way, you have to work across many sectors, such as education, housing, the environment and even people's basic economic well-being."
She talks about the negative impact poor housing has on health. For mothers with young children, a high-rise, dangerous, over-crowded environment with no play space leads to depression and isolation. Purely because of where they live, their children are prone to more infections and accidents. "We need to influence public policies in favour of health," she says, pointing to a recent Northern Ireland Executive report which acknowledges the importance of housing on health.
Education is also central to change, Dr Wilde believes. It builds confidence and opens up employment pathways, which in turn lead to the increased income that brings better health.
In 1990, Dr Wilde set up the Health Promotion Agency in the North and became its first director. She feels that the agency has helped to create a broader understanding of health, particularly among young people.
She feels that 1995, the year she left the agency, was something of a watershed for her. She left partly because it was time for "someone else" and also "to create some rethink time". She maintained some consultancy work, but it was a meeting in April 1996, called to discuss plans for the future governance of Northern Ireland, which shaped her next challenge.
Within a month, she was standing as a Women's Coalition candidate in elections for the Northern Ireland Forum. Although she was not elected herself, two of the coalition's candidates, Monica McWilliams and Pearl Sagar, were successful.
Dr Wilde immediately joined the Women's Coalition backroomteam, where she was involved in promoting the notion of a civic forum to other political parties, trade unions and business people. "I gained a broader sense of civic engagement and saw the importance of a representative democracy," she says.
During this time away from medicine, she realised the fundamental importance of human rights, equity and inclusion as conditions necessary for good public health.
As the new North/South arrangements began to emerge, Dr Wilde could see the possibility of bringing about practical changes in public health. She was delighted to be offered the post as director of the Institute of Public Health in October 1998 and keen to exploit the huge potential of a shared approach.
The institute, in consultation with the two departments of health and other organisations, is concentrating on the large health inequalities common to both jurisdictions. Reducing the high rates of cardio-vascular disease and cancer among the less well-off is a key target.
There is also the issue of our poor public health relative to other countries in Europe. One of her main hopes is to turn this situation around by getting both governments to put health at the centre of economic policy.
So what can we expect to emerge from the Institute of Public Health over the coming months? For the first time, mortality from different diseases across the whole island will be recorded. The figures will be broken down by occupation, geography and gender, and Dr Wilde expects the results to show differences based on where people live. The figures should also confirm that the mortality rate from particular diseases is twice as high for low earners as it is for those on high incomes.
The institute will also be participating in a Europe-wide programme aimed at collecting public health information on a standardised basis. There has always been an information deficit here and Dr Wilde sees this initiative as a useful method of judging what we are doing in public health and what impact our efforts are having.
Dr Wilde's strengths were obvious during her time with the Women's Coalition: she is a skilled facilitator and a good listener, who has shed the prescriptive persona of the medic and become someone who helps other people make things happen. This is good news for the Institute of Public Health and even better news for the socially disadvantaged people of this island.