In Tiger economy, money is antidote to premature death

The first report on all-Ireland mortality since the early 1920s is significant

The first report on all-Ireland mortality since the early 1920s is significant. As the first major report published by the Institute of Public Health, a body set up under the Good Friday agreement, it represents tangible evidence of the benefits of cross-Border co-operation.

That your address and job influence your health status has been identified in many studies; this report, for the first time in an Irish context, lays bare these inherent social inequalities as measured by death rate.

Despite differences in the measurement of social class in the two jurisdictions, and the barely believable fact that women's socio-economic status is still that of their partners, the figures convey a stark message.

If you were a member of the lowest socio-economic group during the 10 years studied, whether in the North or the Republic, you were 100 per cent more likely to die of cancer than higher socio-economic groups; 120 per cent more likely to suffer heart attacks and strokes; and 200 per cent more vulnerable to lung disease and other respiratory complaints.

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The elimination of these inequalities alone would result in a reduction, every year, of 6,000 premature deaths on the island. Quite apart from the personal loss for the individual and the devastating effect on families left behind, the benefits to the health service of such a reduction in mortality and morbidity would be immense.

The most recent edition of the British Medical Journal contains a UK study of the impact of material deprivation on death from diabetes. It confirms "death by post code"; death rates closely tracked socio-economic deprivation, rising steadily from 1.3 times the UK average in districts with the most affluent post codes to 2.3 times in the poorest.

While mortality may be a crude measure of health service delivery, in many ways it is the ultimate barometer of how easy it is for different sections of society to access a level of service which will make a difference to their health.

There is some evidence that the health services are increasing inequalities by creating barriers to the access of care.

Does the health service have a role in tackling health inequalities? Will change make a difference? The evidence suggests it has and it can.

It was recently estimated that half the reduction in coronary disease mortality and morbidity in Europe over the past 10 years could be attributed to improvements such as the targeting of high-risk groups and the creation of programmes aimed at overcoming barriers to services.

Plans for a new health strategy, currently being formulated, must include measures which specifically address the social inequalities which successive reports have highlighted.

While broader societal changes, involving job creation, improving the environment in which the socially deprived live and increasing income will help prevent further damage, the immediate focus must be on limiting the effects of existing health inequalities.

Such change requires huge efforts and resources. As a newly appointed doctor in a deprived area of Dublin over a decade ago, my experience is of the immense effort required to implement effective preventive healthcare programmes in such areas. Huge levels of unrecognised illness and disease will be uncovered, and the level of secondary prevention needed to address such "hidden illness" will be substantial.

The extent of health inequalities is a poor reflection of our economic success. This report and others have marked out the starting line for change; the task of implementing meaningful improvement lies ahead.