Sir, - It is timely that you should raise the issue of health inequalities (Editorial, April 15th), particularly when the Minister of Health and Children is seeking submissions towards developing a new health strategy. The persistent variable of poverty and ill health cannot be articulated often enough. Also, it is necessary to debate the structures of the health service and in particular the human resources that facilitate or militate against a fair and equal system. Within our current system of healthcare there exists a hierarchy, not just within disciplines, with doctors very well placed at the top, but also within the approaches to healthcare where the dominant focus is on hospital and curative services. While the appointment of 1,000 consultants is to be welcomed, so also is there a need for investment in services such as public health nursing, both in terms of numbers and resources.
Public health nurses because of their specialist education and training in community healthcare can provide care for individuals and families in the community, but only if they have adequate resources and funds. It is worth noting that a recommended public health nurse population ration 1:2616 (Survey of Workload of Public Health Nurses, 1975), has never been achieved. Instead, most public health nurses serve a population of 5,000 or more. This is at a time of early hospital discharges, a growing elderly population, and a rise in the birth rate and changes in the complexity of healthcare needs of an increasingly multicultural society. - Yours etc.,
Jean Clarke, School of Nursing and Midwifery, University College Dublin,