How healthy are the Irish, and how much of our ill-health can be attributed to failures of the health services? One in three adults smokes; one in four drinks too much; one in three is overweight; and one in 10 is obese.
Irish people die younger than men and women in many other countries. People who reach 65 in Ireland have the lowest remaining life expectancy in the EU.
Irish men have an average life expectancy of 73, compared to 74 in France and 77 in Japan. Irish women can expect to live to 78, compared to an average of 82 in France and 84 in Japan. Ireland has the highest rate in the EU of premature mortality from coronary heart disease for both men and women. Among women, we have the second-highest death rate from cancer in the EU.
Has all this anything to do with our health services or is it genetically preordained? The report to the Government of the cardiovascular health strategy group last year drew startling comparisons between Ireland and Finland. During the 1960s Finnish male death rates from coronary heart disease were higher than in Ireland; they are now lower. Death rates for women were similar to Ireland; they are now nearly half the Irish rate.
In his annual report last year the Department of Health's chief medical officer, Dr Jim Kiely, highlighted the strategy group's finding that death rates at the same age from coronary heart disease varied significantly around the State. There was regional inequity in access to services which he described as "clearly unacceptable". The strategy group, he commented, had also found evidence of "inconsistent implementation of internationally recognised best practice" in treatment of patients.
OECD figures show that while Ireland, Australia and France have a similar incidence of breast cancer, there is a 45 per cent mortality rate among those diagnosed in Ireland, compared to 33 per cent in Australia and 35 per cent in France. This must raise questions about the quality of healthcare here for women with breast cancer.
Death rates from many common conditions vary in hospitals around the State, leading to the suggestion that there are uneven standards of care. The unpublished draft report of the Medical Manpower Forum records that analysis of mortality from common diseases and procedures such as chronic bronchitis, myocardial infarction, mastectomy, fracture of the hip, appendectomy and diabetes found "considerable variation with regard to the mortality from these conditions in Irish hospitals".
Thus the state of the health service, its organisation and the quality of its medical care are relevant to early Irish deaths. This is not a healthy State, nor is it particularly well served by its health service despite the World Health Organisation ranking Ireland 19th for overall health system performance in its most recent review of nearly 200 countries.
Dr Kiely's report focused particularly on health inequalities - poorer health and earlier deaths among the less well off. "Inadequate medical care" was a contributory factor to these inequalities. "There is evidence that the less well off in society have poorer access to health services," he wrote.
Research by Prof Brian Nolan of the ESRI, based on 1980s figures, found that for Irish men aged 55 to 64 higher professionals had a death rate of 13 per 1,000 compared to 22 for the semi-skilled and 32 for the unskilled manual groups. Only 10 per cent of higher professionals reported chronic physical illness, compared to 25 per cent of unskilled manual workers. Clinical studies tended to support these self-reports, he found.
Prof Nolan pointed out that such contrasts were found in many countries with differing health systems, suggesting they are produced by deep-seated factors. "The impact of poverty and deprivation on health are an important part of the explanation."
He added: "Alleviating poverty and reducing inequalities in income, wealth and education may be the most effective way of narrowing differentials in health and life expectancy." He argued, however, that since inequalities in access to healthcare contributed to health inequalities, more equitable access must be part of any strategy to reduce health inequalities.
The cardiovascular health strategy group commented that factors leading to coronary heart disease began with the formation of the cardiovascular system in the foetus. Lifestyle choices such as smoking, diet and exercise were also important in determining risk of developing the disease.
However, while individuals had responsibility for their own health behaviours, "social inequalities play an important part in the development of the disease". Yet those social groups at most risk from disease are also those most likely to have difficulty in accessing health care.
Dr Philip Crowley, a community development worker in Newcastle upon Tyne, told a recent seminar on health inequalities of his experience there of the "inverse-care law". The West End area of Newcastle had the highest rate of premature death from heart disease and the lowest rate of access to hospital treatments for heart disease.