The publication of "Inequalities in Health in Ireland - Hard Facts" by the Department of Community Health and General Practice at Trinity College Dublin is a significant addition to a growing set of data suggesting that the Republic is an iniquitous place to live - if you come from a deprived area.
The Trinity team brought together public health specialists, academic GPs, statisticians as well as other specialists in carrying out the Health Research Board sponsored project. It had two principal objectives: to look for evidence of inequities in health in the State over the past 20 years; and to make recommendations as to the collection of routine health data so that it can be used to meaningfully measure changes in health status and healthcare uptake amongst different social groups.
Health inequality is the difference in the prevalence of health problems between individuals of higher and lower socio-economic status. Health inequity exists when inequalities are avoidable, unnecessary and unfair.
There are several aspects of the research published today which make it unique. It has benefited from the expertise of the Trinity department's Small Area Health Research Unit which has developed techniques to examine health data at a more local level than is the norm.
The research is quite convincing in suggesting an urban rural divide in health outcomes. Medium sized towns, in particular, appear to have high rates of heart disease as well as cancer; this finding will inevitably trigger further research in an effort to define the reasons for it.
The report details a number of recommendations many of which are frank criticisms. "The Hospital Inpatient Enquiry (HIPE) is practically no use in making comment on socio-economic differences" is an observation which the majority of observers would concur. Even the Department of Health must wonder at the relevance of HIPE data in terms of the effort and money which goes into its collection.
The Victorian status of women in the way we classify socio-economic groups beggars belief. That most women are still classified by their husband's occupation rather than their own is Taliban-like in its inequality. The authors also recommend the inclusion of data on private healthcare in any new health information system.
Apart from suggesting that improving health information should be a priority for the forthcoming National Health Strategy, perhaps the most important recommendation in the report is the call to urgently investigate the true nature of the "unknowns".
Is this burgeoning category of people with alarmingly poor health the result of poor data or does it represent a real deterioration in health in a socially excluded section of society? With the National Health Strategy due for publication in a number of weeks today's report adds yet more urgency to the final deliberations of politicians and civil servants alike.