Sociology 1: sociology of health and illness 2
Some life expectancy figures (1994)
mortality rate among those diagnosed in
Ireland, compared to 33% in Australia
and 35% in France. This raises questions
about the quality of healthcare here for
women with breast cancer.
country
Men
Women
Ireland
73
79
Sweden
76
81
Netherlands
75
80
Why are health outcomes different in
Ireland to other western countries, particularly those in the EU?
Japan
77
84
Reasons include:
France
74
82
Lifestyle factors
Ireland is not unique (very similar in
UK, Austria, Germany), but the only EU
countries with lower figures are Portugal, Finland and Denmark.
Life expectancy, and other comparative
measures of mortality, are key measures
of health. Morbidity (rate of illness) is
another one.
Each can be difficult to define and
measure: eg what is ‘suicide’ or ‘flu’?
States of health in Ireland
How healthy are the Irish, and how
much of our ill-health can be attributed
to failures of the health services?
There are many indicators: both of ‘lifestyles’ and health outcomes.
For example: in Ireland one in three
adults smokes; one in four drinks too
much; one in three is overweight; and
one in 10 is obese.
We know that Irish people die younger
than men and women in many other
countries. Indeed those who reach 65 in
Ireland have the lowest remaining life
expectancy in the EU. Ireland has the
highest rate in the EU of premature mortality from coronary heart disease for
both men and women. Among women,
we have the second-highest death rate
from cancer in the EU.
OECD figures show that while Ireland,
Australia and France have a similar incidence of breast cancer, there is a 45%
Recent social change and prosperity has
seen greater access to alcohol, cigarettes
and drugs as well as a deterioration in
diet & increase in obesity. There is more
frequent use of convenience foods, a
more sedentary lifestyle (including reliance on electronic media) and it is suggested that overwork is negatively affecting the nation’s health.
Poorly delivered health services
Ireland is moving towards a US style
system where many (45%) have private
health insurance, the disadvantaged
(30%) are covered by a second-rate
health system, and many (25%) in the
middle have no health coverage at all.
People on just £9k per annum are excluded from medical card system. By
contrast in Denmark free hospital and
general practitioner care is available to
all, financed primarily by local taxes:
there private hospitals have been opposed as inequitable. In Ireland it has
been said that the ability to pay, rather
than medical need, is the dominant characteristic of the health system.
Three quarters of the £4bn that funds the
health services in Ireland comes from
central government, mainly from general
taxation. Private health insurance contributes only £350m, less than 9% of all
health spending: yet totally distorts access to services.
Our public health sector is commonly
described to be in ‘crisis’: long waiting
Sociology 1: sociology of health and illness 2
lists for public patients are the most visible and persistent symptom of this situation. Low health spending (Ireland
spends less of its income on health than
most other EU countries and has the
fewest hospital beds per capita in the
EU); doctors’ resistance to change and
politicians’ refusal to rationalise small
rural hospitals (out of date and duplicate
services) all contribute to this situation.
There are strong correlations between
class inequality and ill health
Last year Ireland spent just over 6% of
GDP on health, compared to an average
of 8% for both the EU and the OECD.
Ireland has been one of the few countries
to recently reduce its spending on
health: from 1980-1996 only three EU
member-states reduced health spending
as a proportion of GDP: by far the biggest reduction – 20% - was in Ireland.
That ESRI also found that occupational
hazards were a factor in the poorer
health of certain sectors of society, as
was the quality and access to health care.
Furthermore much of the spending on
‘health’ is on aspects – such as childcare
and social services – that would not be
defined as heath services elsewhere.
Social inequality
Inequality in health care leads directly to
greater levels of mortality for some
groups.
For example those whose annual income
is below £10,000 have disability rates
four times as high as those whose income is more than £29,000.
The mortality rate of infants of poorer
parents is 50% higher than those higher
up the socio-economic scale. Ireland has
the highest male death rate from heart
disease in the EU, at 320 deaths per
100,000. Of these, the death rate is doubled for men who are low-earners and
who live in socially deprived areas.
Internationally, there is a long known
connection between social inequality
and health [for example in the UK thius
was detailed in the comprehensive Black
report of 1982 (see Macionis & Plummer p561)
In Ireland in 1990 the ESRI found significant mortality differences between
different socio-economic groups, and the
gradients may be even steeper than in
Britain, which itself was found to have a
more marked gradient than many other
countries.
The Combat Poverty Agency have
pointed out that ‘poor people get sick
more often and die younger than the
well-off . . . The scale of income difference, the bigger the gap in inequality,
the more life expectancy drops.’
According to Professor Brian Nolan of
the ESRI:
alleviating poverty and reducing inequalities in income, wealth and education may
be the most effective way of narrowing
differentials in health and life expectancy
The wide ranging Kilkenny Health
Study has also shown clear links between social inequality and health.
But there is still much debate about how
the links operate. Factors that have been
identified include:
 diet (types of food, nutrition)
 smoking (levels related to social class)
 alcohol
 housing/environment eg: for mothers
with young children, a high-rise, dangerous, overcrowded environment with
no play space leads to depression and
isolation. because of where they live,
the children are more prone to infections and accidents.
 accidents (vehicle, home & work)
 work itself (wear and tear)
Sociology 1: sociology of health and illness 2
 stress (of work, poverty, making ends
meet)
 depression
 services (lack of, quality) eg Patients
are three times more likely to find a
general practitioner in a well-off area
than in a socially deprived area, according to Dr Tom O'Dowd, Professor of
General Practice and Community
Health at Trinity College Dublin. Waiting lists can mean years before services
provided. Public patients far more likely to be discharged early from hospital
 ill health as cause of poverty: eg disability and unemployment
The health position of Travellers is particularly bad: Traveller women die 12
years earlier than settled women and
their children are three times more likely
to die in their first year than the majority
population. This may be due to:



living conditions
attitudes of GPs
lack of education
Public and private medicine
Where Ireland’s health system differs
most from other countries’ is in the specific combination of public and private
care: four fifths of consultants are engaged in both public and private practice. The same consultants treat both categories of patient, very often in the same
hospitals.
A number of official reports have expressed deep concerns that doctors favour those who will bring them more income. As it has been said by one health
board administrator: ‘If a publican paid
her barman by the hour for covering the
bar and by the drink for covering the
lounge, it would be hard to get served in
the bar’.
It has also been said that ‘some hospitals
or consultants may find it attractive to
maintain a public waiting list because a
proportion of those waiting may opt to
be treated privately’.
Private patients are buying up subsidised
space in public hospitals and thereby
jumping queues
Perry Share
April 2001