Community involvement is a key element in restructuring the health service and producing better health outcomes, a leading public health specialist has said.
In an Irish Times/Royal Academy of Medicine lecture at the Royal College of Physicians of Ireland last night, Dr Philip Crowley asked whether our health system meets the needs of ethnic minorities, Travellers, lesbian and gay groups and those with disabilities.
He said he was concerned that a system of inverse care existed here, where those with the greatest medical need were least likely to be offered appropriate care.
Dr Crowley's paper, "Doctors and communities in partnership: from Nicaragua to Dublin", outlined his experience working with the Nicaraguan community movement in the 1990s.
"The lessons I learnt are that the community is the key resource for development. It ensures that actions meet real needs," he said. Doctors could support, facilitate and advocate a community development approach to health, he told the largely medical attendance.
Based on his subsequent experience working with a community development initiative in Newcastle-upon-Tyne, Dr Crowley said the initiative - "Community Action in Health" - was led by a community committee independent of health service management. It achieved specific advances for the deaf community and Asian groups.
He said communities would mobilise around health if they could access decision-making. "Community development draws in community resources to improve health, with general practice an ideal setting for a partnership approach."
Recently returned and working with the Institute of Public Health and the Irish College of General Practitioners, Dr Crowley spoke of the potential here for community development through primary care. "With GPs having contact with 85 per cent of the population in any one year, they offer the opportunity for a community to access non-stigmatised health care."
He listed potential obstacles to progress as the high percentage of single-handed GPs in the State, a medical education dependence on the pharmaceutical industry and the dominance of the medical model, rather than a psycho-social one, in our approach to health care. "With the advent of the new primary-care strategy as well as a commitment to partnership and equity we have a timely opportunity to tackle some of the conditions in community life that create ill-health, in partnership with communities in the Republic," he said.