Achieving a healthy Ireland will take more than words, money or promises

Our village is in mourning. Mary, our postmistress, passed away suddenly last week. To describe her as the lynchpin of the community would be an understatement. As her eldest son said in his eulogy, she was part social worker, part counsellor and part older persons’ guardian. In her early years, when her job included looking after the manual telephone exchange, she was an essential part of the local GP’s communication system. If he was attending to a patient at one end of the practice and an urgent call came in, Mary saw to it that the call was relayed to him via the nearest house with a telephone. Those were the days before telephone answering machines; mobile phones were not even a glimmer in Steve Jobs’ eye.

Two days after we buried her, the Government published an important framework document, aimed at improving the health and wellbeing of Irish people. Healthy Ireland has been developed in response to rising levels of chronic illness, lifestyle trends that threaten health and persistent health inequalities. “Healthy Ireland is based on evidence and experience from around the world which shows that to create positive change in population health and wellbeing, a whole of government approach and the involvement of local communities as well as all of society is required,” the document states.

With the launch attended by An Taoiseach and no less than four senior Ministers, the Government’s commitment to the plan cannot be questioned. A key to the initiative is the recognition that the achievement of a healthier Ireland is not just the responsibility of the Department of Health and those working in the health services but is something that needs the whole of Government and wider society working together.

Responding to the announcement, the Director of the Institute of Public Health, Owen Metcalfe, emphasised the importance of collaboration: "We welcome the co-ordinated approach that is being taken to oversee the implementation of the strategy through the Cabinet Committee on Social Policy – headed up by An Taoiseach – and the Health and Wellbeing Programme in the Department of Health," he said.

Mary was the eyes and ears of our community. So much of the informal care she gave was unplanned. No one paid her to do it. No one organised it. But by enabling the chronically ill and older people to survive in our community, her care was truly preventive.

The Inverse Care Law, first suggested by Welsh GP Dr Julian Tudor Hart in 1971, states: "The availability of good medical care tends to vary inversely with the need of the population served." It has been proven to apply to the uptake of childhood immunisation, waiting times for cardiac surgery and many other health measurements. However, according to research published in the British Journal of General Practice , the opposite is the case for informal carers of sick people in their communities. The distribution of work by unqualified people providing unpaid care to their relatives or friends is almost exactly matched to need. In other words, a Positive Care Law exists in the community, one that is created and sustained by human forces – family, neighbours, community ties that have somehow resisted the socially divisive and dehumanising force of the market.

Mary was employed by An Post to provide the services of a local post office. They did not pay her to offer informal care. But the organisation will come under pressure not to replace her and to close our post office as a cost-saving measure. If it does, then Healthy Ireland will have fallen at its first hurdle. It promises to use existing resources, ensuring “they are directed toward community based programmes for those most at risk, experiencing the greatest disparities and with the greatest opportunity for impact.”

Taoiseach, in memory of Mary and other unpaid carers, let's strengthen, not destroy, those elements of Healthy Ireland that are already in place.

mhouston@irishtimes.com
muirishouston.com