Dr. Edward McKone:

I will start with two issues that were raised: the impact of socioeconomic factors on lung diseases, which is certainly worth elaborating on, and Senator Crown's question on staffing and manpower. As I mentioned, lung disease is much more common in persons from lower socioeconomic backgrounds. In the past that has been largely attributed to the belief that those who are poorer and from lower socioeconomic backgrounds tend to smoke more. There is a great deal of information which shows that although smoking is an important contributor, it certainly is not the biggest one. The most compelling data show, first, that diseases that are not related to cigarette smoking, in particular asthma and including cystic fibrosis, CF, are heavily influenced by socioeconomic factors. Survival around the world is much lower, for example, in North America, if one does not have private insurance. Inner-city asthma is a massive problem and it is not smoking related; it is due to asthma and other environmental factors. Therefore, we know that socioeconomic factors independently affect conditions like asthma and CF.

Irish data were collected for COPD on world spirometry day in June, when we offered free lung function testing to 750 people around the country. Half of these individuals were never previously diagnosed for lung disease. One in seven of the latter cohort had airflow obstructions suggesting asthma or COPD and one in five had abnormal lung functions. This highlights the prevalence of the condition. We also asked people to complete questionnaires on their smoking habits and educational backgrounds. Education level is one of the best determinants of socioeconomic background. It is better than asking people about their incomes or jobs. We found that lung function was on average lower in smokers, as one would expect, but also that socioeconomic factors had an independent effect on lung function. There was a significantly lower level of lung function among people who were not educated beyond junior certificate level.

Clearly, however, this is not simply an educational issue. Other factors include awareness and getting out the message that people should do something about these symptoms. Access to health care is also an issue. We have a good public health service but there are limitations and access can be disparate. Environmental factors must also be considered, including housing and jobs that entail exposure to dust and fumes. These factors cause lung disease in ways that are not related to smoking. Healthy air is also relevant. If one lives in the centre of a city in a poor environment with heavy traffic, one is exposed to pollutants. We would like to do more work on the multitude of factors involved. We spend considerable amounts of money on drugs but if we could find a way to bridge the outcomes among people from different socioeconomic classes, we could probably make a bigger impact than through expenditure on medication.

In regard to manpower, 50 public consultants work in the area of respiratory medicine in this country. The European Respiratory Society plans to publish a White Paper on the issue later this year. We tried to get access to the hard data but we do not have them yet. As Senator Crown noted, we fare badly compared with other European countries in terms of delivery of respiratory health care. That includes consultants, respiratory nurses, respiratory scientists, physiotherapists and primary care provision. There is currently one consultant per 80,000 in Ireland, compared with one per 50,000 in the UK. Indeed, the UK intends to further improve its ratio by employing additional consultants. We would need to appoint an additional 30 consultants to bring our ratio to the UK level. We also need to increase substantially the numbers of respiratory nursing staff, who are critical to carrying out breathing tests to identify lung disease. This issue is being addressed by the asthma programme and Professor McDonnell's COPD programme.