Growing obesity levels pose significant risk, spending review warns

The growing levels of obesity among the Irish population will represent a significant expenditure risk for the State into the future, a new Government spending review has warned.

The report, released by the Department of Public Expenditure on Friday, says obesity is associated with many forms of cancers, stroke, type-2 diabetes, sleep apnoea and heart disease.

These carried direct and indirect costs that were of “increasing health and budgetary concern”, it says.

"The World Health Organisation forecast that by 2030, 47 per cent of the adult population over 20 years of age in Ireland will be obese. It appears that this is and will remain a significant burden on the Irish healthcare system and indeed a strong driver of healthcare expenditure."

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The report also says that, despite major investment in the health service over recent years and a recorded growth in life expectancy, breast cancer mortality rates in Ireland are among the highest in the European Union and are above the OECD35 average.

The review further warns that early evidence suggests “that mental health needs associated with the global health emergency and lockdowns will be vast”. It says this area is likely to be “a focus of expenditure and policy in the medium term to deal with the indirect health consequences of Covid-19”.

The spending review says that between 2011 and 2020, total voted expenditure on healthcare rose from €14.52 billion to €20.8 billion. Between 2015 and 2020 total health expenditure increased by 44 per cent.

It says growth “was significantly driven by increased expenditure in the acute hospital setting through increased staff numbers, wider growth in pharmaceutical expenditure and most recently due to additional Covid-19 response items, such as personal protective equipment for service providers, the GP Covid-19 contract, testing and tracing as well as other related costs”.

Significant driver

The report says the most significant driver of the increase in health expenditure over the past decade has been the Health Service Executive pay bill. It says pay accounts for almost 50 per cent of voted health expenditure “and indeed some elements of the non-pay budget, such as grants, also go towards pay”.

It says from 2010 to 2020, the health pay bill increased by €1.1 billion, or 17 per cent. It says this was due to a combination of pay restoration and agreements “and of a considerable expansion of the HSE workforce between 2014 and 2020, with approximately 22,000 additional WTEs [whole-time equivalent workers] hired by the HSE over this period”.

The review says the largest element of growth in total non-pay related health expenditure has been on pharmaceuticals on which €2.269 billion was spent across hospital and community schemes in 2020.

The review says Ireland’s life expectancy at birth has increased 2.3 per cent over the decade and surpassed the EU15 average, to reach 82.3 years in 2019.

However the review also states: “This growth in life expectancy suggests that investment into healthcare in recent decades has translated into tangible benefits for the population. However, given the amount invested in healthcare each year and Ireland’s relatively young population, it may be the case that our performance in terms of health metrics is not as strong as it may appear on the surface.”

The review also says that while five-year survival rates in Ireland for all cancers have improved, they are still below that of the OECD average in terms of breast cancer at 82 per cent compared with 85 per cent.