Sir, - Maev-Ann Wren is to be congratulated on her excellent series of articles on the Irish Health Services. She highlighted the difficulties that public patients face in gaining access to health care and, in particular, the long waiting-lists for non-life-threatening ("elective") surgery.
She also highlighted the underfunding of health services in Ireland relative to other developed nations and the extent to which the private sector is subsidised by the public sector. It is astonishing that private health insurance secures preferential access for approximately 40 per cent of the population while contributing a mere 9 per cent to total health spending.
There is a danger, however, that in our fixation with health services we lose sight of the major determinants of the health of our population. We must not equate health with health care and imagine that health services alone make a substantial contribution to the health of the population. Poverty, social and educational exclusion - with the attendant problems of obesity, poor nutrition, lack of exercise, smoking and psychological distress - are the fundamental determinants of people's health.
To ensure continued improvement in people's health and reduce inequalities related to social class and income, we must tackle these fundamental determinants. In particular, we must prioritise work on poverty and on social and educational disadvantage in childhood. Not alone, therefore, do we need to spend more on our health services, we need to spend more protecting and promoting the health of our population.
In the UK, the Labour government has appointed a Minister for Public Health. Perhaps a similar appointment in this country might ensure that our health agenda is not totally dominated by discussion of hospital services. - Yours, etc.,
Prof Ivan J. Perry, Department of Epidemiology and Public Health, University College Cork.