Ms Martina Queally:

Senator Burke's point is well made. The obesity issue is a very serious one facing the country. The public health nursing role is crucial to that because many of the issues around obesity arise very early on and, indeed, prevention is much better than cure. While there is not a formal screening programme, elements of screening are done by the public health nursing service - in terms of developmental screening - and weight measurement is one of the important parameters of that screening. At each developmental screening from birth, the child's weight will be monitored. Initially, the concerns would be failure to thrive or insufficient weight gain but as time goes on and as the child grows, it is monitored. Issues such as breast-feeding, which public health nurses promote, are crucial to maintaining correct weight. We now know from some of the evidence that babies who are breast-fed are less likely to become obese. Weaning practices are very important in terms of weight management later on, as are early childhood nutrition and family nutrition. All these education issues are within the remit of public health nursing, so they are crucially important. Sometimes it is very easy to identify the things we do not prevent but if we are preventing things well, it is harder to measure. The public health nursing role is critical to that.

There is also the new clinical care programme around obesity. The public health nursing role in that clinical care programme is crucial. Their work as part of the primary care team, as Mr. John Hennessy said earlier, is critical because there are other elements to that. Many of the dietitians in health promotion are moving across to the primary care teams. We have some very successful programmes, such healthy food made easy, of which Deputy Byrne has been very supportive over the years, with health promotion and public health nursing. That is a community-based nutrition and advice education programme, which has been very successful and has shown very good outcomes.

Equally, our interventions with the broader population, such as schools, are very important because children must maintain participation and activity in order to maintain a certain weight. Nutrition is one element but obviously physical activity is another. Issues, such as playground markings or local sports partnerships, which the Government has supported, are crucial to maintaining a healthy active young population which grows into a healthy active adult one. It is critical that public health nurses are part of that broader primary care team and work in that integrated way with community partners and internally with health professionals.