There is nothing new about health inequalities: different sections of the population have always had different health experiences. But a report from the National Cancer Registry Ireland (NCRI) provides additional information on how age, deprivation and geographic location impact on cancer risk and a person’s chances of treatment.
The NCRI report shows the incidence of cancer in the most deprived 20 per cent of the population is 10 per cent greater for men, and 4 per cent higher for women, when compared with the most well-off 20 per cent of Irish people. However the gap is even more striking for certain malignancies. The incidence of cervical cancer is 120 per cent higher in the most deprived section of the population compared to the most affluent, 60 per cent higher for lung cancer and 40 per cent higher for stomach cancer.
In addition it found a poorer survival of patients from the most deprived populations; for all cancers combined, patients from this group were about 40 per cent more likely to die from their cancer (within five years of diagnosis) than those from the least deprived group.
Older patients had a worse outcome for all cancer types examined; overall, patients aged 75 and older at diagnosis were about four times more likely to die from their cancer than those aged 45-54 years. They were also less likely to have undergone a range of cancer treatments compared with the rest of the population.
Some of these inequalities are unjust and avoidable. Some have complex aetiology, only part of which is amenable to corrective action. But many can be addressed through public policies.
Tasc, the social change think tank, has pointed out that health services matter because the prevention and treatment facilities provided can mitigate some health inequalities, as long as those services are accessible, universal and free at the point of delivery. However, if there are inequalities in access to public health services, existing health inequalities will be exacerbated.
Some years ago Tasc proposed a Cabinet Sub-Committee on Population Health with a mandate to drive the process of inter-departmental co-ordination of health and the addressing of health inequalities across all relevant Government departments. The idea remains a good one; it may be the only way to tackle the kind of glaring inequalities exposed by the NCRI report.
The issue of inequality and inequity in health must be a priority for the new all-party Oireachtas Committee on Health. With its long-term remit it can make recommendations that transcend the often reactionary annual budget cycle. And the Government must initiate an independent review of health inequalities with the aim of identifying the most effective evidence-based strategies for reducing health inequalities in the Republic.