Health, like life, is rarely simple. The journey from birth to death is a matter of chance at times, even when we try to take responsibility into our own hands. The chances for some of us worsen considerably when health policy fails to realise its own prejudices and act on them. This, says Medb Ruane, is a key lesson from the many facts in the National Cancer Registry's first five-year analysis.
Micheál Martin claims that 62 new consultants, more money and a vote for his policies may turn the statistics round. But if healthcare is to be more than a matter of wishful-thinking-syndrome, the Minister must recognise the need to change attitudes, and fast. The report goes so far beyond the adage linking health to socio-economic status that it raises basic questions of fairness at almost every level. Whatever the prejudice, its effects are there.
The levels of discrimination suggest that women are at risk because they don't behave like men; that men would survive cancer longer if they behaved more like women; and that anyone living in the west of Ireland can breathe a sigh of relief about their lower risk of cancer, but worry that the facilities are not there to treat them if they buck the odds.
Everyone past middle-age is justified in assuming that if they get cancer, their chance of surviving is compromised not only because they are getting older but because treatment is oriented towards the young.
Nowhere is evidence that policy-makers have made connections between health and other social and environmental factors, such as Sellafield, bad water and toxic earth. Nowhere are signs that cancer-prevention campaigns have worked across the board: the rates here suggest a level of gender bias that may actually increase people's risk because of poor targeting.
Why is anti-smoking advertising geared so that men respond, while women's lung cancer rates are now running 66 per cent higher than the EU average?
Why should anyone assume that campaigns designed to make women check their breasts for lumps will work exactly the same way in encouraging men to check their testicles?
The bias affects women so badly that it is tantamount to a national health emergency that they are smoking their lives away at such rates. Their rates have actually increased during the very same years as increased Government health campaigns.
Yet the same old campaigns and same old warnings continue, to everyone's cost. The methods work best for middle-class men, and everyone else is assumed to follow that model. Nicotine addiction is still being processed within a strict socio-economic mindset, which tends to let governments off the hook.
Instead, the women who are smoking come from all backgrounds and many are, unfortunately, very young. Unless women are being deliberately obtuse about health advice - which still begs the question why? - it should be clear that the anti-smoking campaigns and laws as now constituted are failing to communicate with them.
ESTABLISHING a cancer registry was one of the campaign calls made by the late Dr Patricia Sheehan and her colleagues during the protests against building a nuclear plant at Carnsore, Co Wexford. Their observations suggested to them that clusters of cancers might well be linked to the winds blowing across the sea from Sellafield.
Other campaigners since then have identified the toxic disposition of Ireland's green, green fields at many levels, not least illegal dumping, chemical waste, and bad management of industrial and agricultural waste. Yet the Irish tendency to ignore EU directives until the last possible moment increases the chances that bad practices will impact negatively on health.
Last month, the European Environment Commissioner, Ms Margot Wallström, warned the Government about the dangers of nitrate poisoning arising from its failure to implement the EU nitrates directive. Ms Wallstrom was speaking at the launch of the Environmental Protection Agency's report where it was revealed that 38 per cent of ground water in Ireland is now polluted as a direct result of activities such as slurry spreading, which in turn relate to delays in implementing other EU agricultural and environmental directives.
Such delays may impact on the next round of statistics in five years' time. While no government can be expected to protect every citizen from the interconnectedness of things, each citizen must have a right to expect its government to act across policy areas as effectively as it can.
Had prostate cancer campaigns been launched in advance of the timeframe in the current cancer statistics, we could reasonably expect more men would have survived the disease than did in the period 1994-98.
Just as reasonably, Government can recognise the state of emergency among women caused by nicotine addiction, and target them on the basis of their particular behaviour and habits.
Prejudices are rarely simple either. Good healthcare is a right, but bodies aren't machines to be made good as new by a bit of tinkering, no matter how old they are or how much wear and tear they've had. There is a balance to be struck between increasing cultural expectations about what healthcare can achieve, and how governments deliver healthcare across their span of work.
Judging by the current statistics, Ireland has a way to go before it gets that balance right.