OPINION:Times may be grim and the economy ailing but the cheery news is Irish people are living much longer than before, writes Mary Harney
WE CELEBRATED the 90th anniversary of the meeting of the first Dáil recently. Anyone born in that first year in Ireland was expected to live to the age of about 55 – that is, until about 1974.
As we know, many people born in 1919 have lived much longer than that. In fact, since the foundation of the State, we have added 25 years to life expectancy.
This is an extraordinary change, and the contribution to it over the last 10 years or so has been very significant.
It is common to hear the sentiment expressed that "your health is your wealth". Yet in many debates – both in Ireland and internationally – health is labelled as a cost, the level of spending on which is of growing concern. So last Friday's Irish Timesfront-page article, highlighting new life expectancy figures from the Central Statistics Office is a timely reminder of the need to also consider health outcomes – such as life expectancy – in evaluating health expenditure.
A common objective in past national health strategies has been to improve life expectancy so as to reach the EU average. For many years, this gap remained and even widened.
However, in the space of just 10 years, Ireland has moved from being one year below average EU life expectancy to more than one year above it. It is not just that the improvements are unprecedented for Ireland, they are unprecedented in Europe.
For many decades on his 65th birthday, an Irish man could expect to live about another 13 years. Now, in the last 10 years, a typical 65-year-old Irish man has, on average, gained three years in life expectancy and can expect to live until 81.5 years.
Ten years ago, an Irish woman of 65 years was expected to live until age 82. Now, on average, she is expected to live until just short of her 85th birthday.
The Irish Times rightly noted the narrowing in the difference in life expectancy between men and women. Good health involves quality of life as well as longevity.
Better medical care means more people alive with chronic conditions which in the past would have resulted in earlier mortality.
A longer life in good health is what we would wish for most. It is interesting then that when Irish people are asked to rate their level of health, we place ourselves higher than any other country in Europe. After decades lagging behind others, we have achieved the long sought after goal of longer life in better health.
How has the improvement in life expectancy come about? The simplistic answer is that it has been achieved by reducing death rates. Between 1999 and 2007, the death rate, taking account of the changing age structure of the population, has fallen by over one-quarter. This is far ahead of the rest of the EU where mortality fell by 12 per cent.
Circulatory diseases represent the largest cause of death in Ireland, accounting for almost 40 per cent of all deaths each year. It is now clear that, in 1999, when the National Cardiovascular Health Strategy was published, we were on the cusp of a period of remarkable improvement in heart health. Mortality from circulatory diseases has fallen by 38 per cent since 1999. The corresponding figure for the EU is 23 per cent.
Preventative knowledge regarding heart disease is now much better and, combined with medication, can control cardiac risk factors such as blood pressure and cholesterol. There is wider appreciation of the importance of behavioural factors including smoking, diet, alcohol consumption and exercise.
There is mixed progress being made in reducing these cardiac risk factors among the population, including through public policy interventions such as the smoking ban. However, if we are to build on recent improvements in heart health and other preventable illness, much more effort will be needed to address worrying trends in lifestyle among Irish young people and adults.
Health technology, although costly, has transformed the prognosis for heart disease. Most of us know from our own families and acquaintances that death in the aftermath of heart attack has been reduced greatly and quality of life has improved.
In the 1950s, someone recovering from a heart attack was prescribed a long period of bed rest (now known to be ineffective) and little more. Today, drugs such as aspirin or heparin are used to thin the blood, beta-blockers to reduce the workload of the heart, and thrombolytic drugs to dissolve the clot. Following cardiac catherisation, the patient may undergo an angioplasty or coronary artery bypass surgery. Stents, only developed in the 1990s, are often implanted to keep the artery open.
As the case of heart health illustrates, the specific causes of improvements in life expectancy are numerous and difficult to assign precisely. They include lifestyle changes, higher standards of living, better housing and environment and improvements in healthcare.
Some studies suggest that investment in health services and implementation of public health policy may account for as much as 50 per cent of measurable gains in health.
Another way to measure this effect is to look specifically at causes of death considered to be particularly amenable to health service intervention. Profs Ellen Nolte and Martin McKee published an analysis in 2008 showing that Ireland had the highest decrease in mortality in respect of such amenable causes.
The health service has contributed significantly to the remarkable improvements in the health of the Irish population.
Economic prosperity has made it possible to invest in improving our health service – and that investment has, in turn, produced measurable dividends in health status. It seems likely that these trends in overall population health status have fed through into a healthier and more productive labour force.
Health services that promote healthy lifestyles, encourage preventative care and ensure early intervention in disease processes, reduce future demands on the health system.
Like all areas of public expenditure, the health services must continually strive to obtain better outcomes from limited resources. But, clearly, health services also act as a real contributor to economic growth and productivity. All this highlights the many interdependencies between health status, economic growth, and investment in capital and social infrastructure.
Mary Harney is Minister for Health and Children