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“Definite link between poverty and ill-health”: SJI

By editor - 07 April, 2015

Dr Sean Healy and Michelle Murphy of Social Justice Ireland.

Dr Sean Healy and Michelle Murphy of Social Justice Ireland.

“The Government should roll out its proposed 90 Primary Care Networks before the end of 2015 if it is serious about providing a viable healthcare system across the whole country,” Fr Seán Healy, Director of Social Justice Ireland, has said.

The SMA priest was commenting on the publication of the Social Justice Ireland 2015 Socio-Economic Review on Tuesday.

“These networks are a very good example of what should be prioritised as resources become available from Ireland’s economic recovery. They would benefit the entire community and in particular older people, children and people with disability,” he said.

Fr Healy added that they would go some way towards mitigating the income and service losses endured by Ireland’s most vulnerable since the crash of 2008.

The 343-page Socio-Economic Review, titled ‘Towards a Just Society: Securing Economic Development, Social Equity and Sustainability’ argues that “…decent services in areas such as health and education and essential infrastructure in areas such as social housing and disabilities should be prioritised by Government.”

The review goes on to state that, “There is a definite link between poverty and ill-health. People’s health is influenced by factors such as poor housing, food security, unhealthy early childhood conditions and poor educational status”.

National evidence shows that there is a widening health and social gap amongst Irish children by the time they are five years old.

A recent international study confirmed that Irish adolescents from the lowest socioeconomic groups are more likely to suffer from poor health, and Ireland ranked 33 out of the 34 countries studied on the difference in body mass index between poor adolescents and their better off peers.

We must invest in preventative measures and universal primary care to narrow the health and social gap and to ensure that our healthcare system does not worsen inequality.

Social Justice Ireland believes that healthcare is a social right that every person should enjoy and that people should be assured that care is guaranteed in their times of illness or vulnerability.

According to the independent think tank and justice advocacy organisation, “This is going to become more challenging in the years ahead as Ireland’s population ages. However, there are significant areas of concern that must be addressed in the years ahead to ensure that every person has access to essential healthcare at all stages of the life cycle.”

The development of 90 Primary Care Networks across the country, each with about 4 or 5 primary care teams (PCTs), could have a substantial positive impact on reducing problems the healthcare system currently faces and which, among other things, are putting huge pressure on accident and emergency services in acute hospitals.

PCTs would, in effect, be one-stop shops providing a wide range of health services at local level. They should be the basic building block of local public healthcare provision.

According to SJI, Ireland has a very underdeveloped system of primary care. This results in significant pressure on the acute hospital system and a two-tier system of access to public hospital care which means that private patients have speedier access to care.

The Government target on public waiting lists is that the waiting time for treatment or out-patient appointment should be no longer than 15 months by the end of 2015.

“This is extremely unambitious and completely unacceptable,” SJI warned. “Very long waiting times have a disproportionate impact on those patients reliant on the public health service. Access to health care at any age should not be determined by the content of one’s wallet.”

There is no evidence that funding has been provided to address the ageing of the population. In fact Ireland’s spending on over 65s will have fallen by approximately 32 percent between 2009 and 2016.

There will be nearly one million people aged over 65 by 2031 an increase of more than 86% or an extra 20,000 people per annum.

The old age dependency ratio (the ratio of those aged 65 years and over to those 15-64) was 17.3 in 2011 but is projected to rise to 30 by 2031.

These numbers highlight the need for long-term planning and investment to ensure that our health service can provide the care and services that will be required at all stages of the lifecycle into the future.

Central to this must be increased support for community-based services to support older people in their own homes/communities and the provision of capital investment to replace or refurbish community nursing facilities.

In this Socio-Economic Review, Social Justice Ireland spells out its vision of Ireland as a just society in which human rights are respected, human dignity is protected, human development is facilitated and the environment is respected and protected.

It argues that Ireland’s core values should be human dignity, equality, human rights, solidarity, sustainability and the pursuit of the common good.

Having these as guiding values would, according to Social Justice Ireland, ensure that Ireland became a nation in which all women, men and children have what they require to live life with dignity and to fulfil their potential: including sufficient income; access to the services they need and active inclusion in a genuinely participatory society.

The Review goes on to identify five key areas for policy development that must be addressed if Ireland is to become a just society.

  1. a) The first is macroeconomic stability, which requires a stabilisation of Ireland’s debt levels, fiscal and financial stability and sustainable economic growth, and a substantial increase in investment. How that investment might be sourced is also addressed.
    b) The second is the need for a just taxation system, which would require an increase in the overall tax-take towards the European average; such an increase should be implemented equitably and in a way that reduces income inequality while ensuring that the corporate sector pays a fair share.
    c) The third area is decent services, the securing of social services and social infrastructure, the prioritisation of employment, and a commitment to to securing seven basic social, economic and cultural rights.
    d) The fourth area is that of good governance, which requires the promotion of deliberative democracy, new processes in policy evaluation and a deliberative process of social dialogue in a society that promotes the common good.
    e) Fifth, policies must be adopted that create a sustainable future, through the introduction of measures to protect the environment, promote balanced regional development, and develop new economic and social indicators to measure performance, alongside traditional national accounting measures suchas GNP, GDP and GNI.


Chapter 3 – Income Distribution
• Adopt targets aimed at reducing poverty among particular vulnerable groups such as children, lone parents, jobless households and those in social rented housing.
• Examine and support viable, alternative policy options aimed at giving priority to protecting vulnerable sectors of society.
• Carry out in-depth social impact assessments prior to implementing proposed policy initiatives that impact on the income and public services that many low income households depend on. This should include the poverty-proofing of all public policy initiatives.
“The incidence of being at risk of poverty amongst those in employment is particularly alarming. Many people in this group do not benefit from Budget changes in welfare or tax”.
“The persistence of high rates of poverty and income inequality in Ireland requires greater attention than they currently receive. Tackling these problems effectively is a multifaceted task. It requires action on many fronts, ranging from income, healthcare and education to accommodation and employment”.

Chapter 4 – Taxation
• Increase the overall tax take towards 34.9 per cent of GDP (i.e. a level below the high tax threshold identified by Eurostat).
• Broaden the tax base and make the tax system fairer.
• Secure a fair share of corporate profits for the State.
“Taxation plays a key role in shaping Irish society through funding public services, supporting economic activity and redistributing resources to enhance the fairness of society. Government decisions to raise or reduce overall taxation revenue needs to be linked to the demands on its resources”.
“New future taxation needs such as the on-going servicing of our national debt, providing for the liability for future public sector pensions are in addition to those that already exist for funding local government, repairing and modernising our water infrastructure, paying for the health and pension needs of an ageing population, paying EU contributions and funding any pollution reducing environmental initiatives that are required by European and International agreements. Collectively, they mean that Ireland’s overall level of taxation will have to rise significantly in the years to come – a reality Irish society and the political system need to begin to seriously address”.

Chapter 5 – Work, Unemployment and Job Creation
• Launch a major investment programme focused on creating employment and prioritise initiatives that strengthen social infrastructure, including a comprehensive school building programme and a much larger social housing programme.
• Expand funded programmes supporting the community to meet the growing pressures arising as a result of the recent economic downturn.
• Put in place a new programme targeting those who are very long-term unemployed (i.e. 5+ years).
• Seek at all times to ensure that new jobs have reasonable pay rates and adequately resource the labour inspectorate.
“By the end of 2014 the number of underemployed people, defined as those employed part-time but wishing to work additional hours, stood at 115,500 people – almost 5.5 per cent of the labour force”.
“The experience of the 1980s showed the dangers and long-lasting implications of an unemployment crisis characterised by high long-term unemployment rates. While Government should not ignore any group in its overdue attempts to address the unemployment crisis, major emphasis should be placed on those who are most likely to become trapped in long term unemployment – in particular those with the lowest education levels”.
“As recovery emerges, it is important that policy focuses on those furthest from the labour market being able to rejoin the numbers employed and assist those within employment but struggling as the working poor.

Chapter 6 – Public Services
• Develop an integrated public transport network ensuring that commuters can access local, regional and national transport services.
• Ensure adequate support and funding of public library services including the provision of open-access information technology.
• Ensure the roll out of rural broadband to all households and premises across the State.
“Access to adequate public transport is a key component of modern society. In the wake of the economic collapse, many households remain on the commuter belt of urban centres in properties with negative equity mortgages that were originally intended to be ‘starter homes’ for young professionals. These families need proper access to local and regional amenities, including schools and hospitals, as well as a cost-effective way to maintain social networks with family and friends”.
“Libraries are obvious centres with potential to support lifelong learning, easy access to information and easy access to modern means of communication. To play this potential role, continued support for, and expansion of, the library service is essential”.

Chapter 7 – Housing and Accommodation
• Fully resource the Social Housing Strategy and expand its scale to effectively eliminate the 90,000+ households currently on the waiting list.
• Ensure adequate resources are allocated within the various stakeholders involved in Construction 2020 providing the datasets to ensure that construction policy is made on the basis of accurate and up to date data.
• Implement specific policies aimed at protecting the rights of tenants to a secure home while addressing the issue of accidental landlords.
“The social housing crisis response requires an adequate supply of social housing, with rents controlled through a central housing body with capacity to manage the maintenance of properties, resolve tenant disputes and secure finance for the ongoing provision of housing into the future. Social Justice Ireland believes that NAMA could be such a housing body, having built a cache of experience in housing since its inception and having sufficient staff numbers to actively undertake the role required”.
“There are to be a number of immediate issues in the private rented sector: the supply of adequate, affordable accommodation, security of tenure and rent for tenants, the instability of accidental landlords and, with increasing numbers of renters in the market, regulation of the sector. Neither Construction 2020 nor Social Housing Strategy 2020 go far enough to address these problems which will serve to undermine any progress made by the implementation of these policies”.

Chapter 8 – Healthcare
• Roll out the nine Community Healthcare Organisations and 90 Primary Care Networks intended, inter alia, to support Primary Care Teams as envisaged in the 2015 HSE Service Plan.
• Recognise the considerable health inequalities present within the Irish healthcare system, develop strategies and provide sufficient resources to tackle these.
• Give far greater priority to community care and restructure the healthcare budget accordingly to deliver on the commitment to enable groups like older people to live in their own homes for as long as possible. Care should be taken to ensure that the increased allocation does not go to the GMS or the drug subsidy scheme.
“In Ireland out-of-pocket spending on medical expenses as a share of household consumption is above the European (EU28) average and it increased by over 2 percentage points between 2007 and 2012. Out-of-pocket expenses – such as prescription charges – in healthcare tend to operate as a much bigger barrier for poorer people who may defer visits or treatment as a result”.
“Social Justice Ireland is seriously concerned that there is no evidence that funding has been provided to address the ageing of the population that will result in a steady increase in older people and people with disabilities accessing services. For example, those over 65 are increasing in number annually by approximately 20,000. Those over 80 years, who have the greatest healthcare needs, are growing by some 4% annually”.
“Research and development in all areas of mental health are needed to ensure a quality service is delivered. Providing good mental health services should not be viewed as a cost but rather as an investment in the future. Public awareness needs to continue to be raised to ensure a clearer understanding of mental illness so that the rights of those with mental illness are recognised”.

Chapter 9 – Education
• Invest in universal, quality early childhood education.
• Set an ambitious adult literacy target and ensure adequate funding is provided for adult literacy programmes.
• Increase resources available to lifelong learning and alternative pathways to education.
“By 2026 the secondary school aged population is projected to increase by between 31 and 34 per cent. This projected increase will require long-term planning in terms of both capital and current expenditure between now and 2026. It will require a significant increase in expenditure during the period”.
“A coherent Early Childhood Education and Care strategy requires adequate resources and policy coordination between the Department of Education and Skills and the Department of Children and Youth Affairs. A commitment to ensuring equal opportunities to all children at the start of their lives should be at the core of all Government policy and not just confined to a number of key departments”.
“Considerable investment is required to ensure that the higher education sector in Ireland can continue to cope with the projected increased demand. The sector will require long-term, sustainable Government funding to ensure that it can deliver what is expected of it in terms of human capital and engaging with society”.

Chapter 10 – People and Participation
• Immediately increase the weekly allowance allocated to asylum-seekers on ‘direct provision’ to at least €65 per week for an adult and €38 for a child and give priority to recognising the right of all refugees and asylum-seekers to work.
• Adequately resource the PPN structures for citizen engagement at local level and ensure capacity building is an integral part of the process.
• Ensure that there is real and effective monitoring and impact assessment of policy implementation using an evidence-based approach. Involve a wide range of perspectives in this process, thus ensuring inclusion of all sectors in a new deliberative process of social dialogue.
“Over 3,000 people have been in direct provision centres for two or more years and 1,600 have been in direct provision for five or more years. The system of direct provision relies heavily on private operators. In 2014 €43.7 million went to 25 commercially owned centres”.
“Ireland urgently needs to set a course for the future that will secure macroeconomic stability, a just tax system, strengthened social services and infrastructure, good governance and a real commitment to sustainability. A social dialogue process that includes all the stakeholders in Irish society would go a long way towards achieving such a future”.

Chapter 11 – Sustainability
• Communicate a common understanding of sustainable development across all Government departments, policy makers, stakeholders and civil society. This should underpin all public policy decisions.
• Account for the economic value of biodiversity in all environmental policy decisions.
• Develop Shadow/Satellite national accounts to move towards a more sustainable, resource efficient model of development.
“It is clear that in order to live within the means of the planet whilst producing the kind of society in which we want to live a sustainable development framework should be at the centre of national and international policy making”.
“A sustainable economy requires us to acknowledge the limitations of finite natural resources and the duty we have to preserve these for future generations. It requires that natural capital and ecosystems are assigned value in our national accounting systems and that resource productivity is increased”.

Chapter 12 – Rural Development
• Prioritise rolling out high speed broadband to rural areas.
• Develop a new national rural strategy. This strategy should be part of a new national spatial strategy.
• Publish a rural and regional economic development policy statement and incorporate it into national economic and employment strategies.
“Rural development and the challenges facing rural areas in terms of generating sustainable employment are either absent or barely referenced in key national policies such as the Medium Term Economic Strategy and the National Skills Strategy. Employment and enterprise policy should have a rural specific element designed to support local enterprises, rural specific jobs and be cognisant of the need to create full-time, high quality jobs with career progression opportunities”.
“The removal of resources from rural areas will make it difficult to maintain viable communities. Government is failing to deal with the new challenges an ageing population brings to rural areas in relation to health services, social services and accessibility for older and less mobile people”.
“The provision of quality broadband to rural areas must be a priority in the future if rural development is to be facilitated in a meaningful manner. State intervention must be prioritised in order to prevent the two-tier digital divide developing between urban and rural areas growing any wider”.

Chapter 13 – Global South
• Renew Government’s commitment to meet the United Nations target of contributing 0.7 per cent of GNP to Overseas Development Assistance. Recognising that the deadline of 2015 will be missed, Social Justice Ireland proposes that the new date should be 2020 and a clear pathway should be set out to achieve this.

  • Take a far more proactive stance at government level on ensuring that Irish and EU policies towards countries in the South are just. Ensure that Irish businesses operating in developing countries – in particular Irish Aid country partners – are subject to proper scrutiny and engage in sustainable development practices.
  • Continue to support the international campaign for the liberation of the poorest nations from the burden of the backlog of unpayable debt and take steps to ensure that further progress is made on this issue.
    “As the Millennium Development Goals timeline come to an end, a major focus of governments and NGOs is now on the nature of the post-2015 development agenda. This year will be crucial in assessing progress thus far and defining what next in the efforts to combat conflict, disease, inequality and poverty”.
    “The Irish Government should work within the EU and UN for a broad-based, inclusive agreement at Paris later this year, one that reflects the Global nature of Climate Change and the responsibility of richest nations to contribute most to combat the dangerous effects of increased emissions”.

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