Seán Power (Kildare South, Fianna Fail)

I thank Deputy Costello for raising this important matter on the Adjournment. I am happy to reply on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney.

Just over a week ago the Tánaiste launched A Strategy for Cancer Control in Ireland 2006, which was prepared by the National Cancer Forum. The forum expects that, mainly for demographic reasons, the number of patients with cancer will double over the next 15 years. One of the most significant strategic issues facing cancer services is the variation in survival rates within Ireland and our relatively poorer cancer survival rates for many common cancers when compared with other European countries. In part, this can be attributed to the fragmentation of cancer services, whereby too many hospitals are involved in the provision of treatment for cancer.

The strategy makes recommendations in relation to organisation, governance, quality assurance and accreditation across the continuum of cancer care from health promotion, prevention and screening through to treatment services, supportive and palliative care and research. There is a strong emphasis in the strategy on health promotion,addressing inequalitiesand quality assurance. Cancer patients should receive multi-disciplinary care from cancer specialists in radiology, pathology, surgery, medical and radiation oncology and oncology nursing, all working together as an integrated team.

Since the implementation of the first national cancer strategy commenced in 1997, approximately €920 million has been invested in the development of cancer services. These screening and treatment services are available free at point of service subject to the basic public charges and are provided on a whole-population basis. A total of 34,000 more people were treated for cancer in public hospitals in 2004 compared to 1998, an increase of 60%. The Vote for the Health Service Executive in 2006 includes a sum of €9 million to continue to meet the additional service pressures in cancer care, improve the quality of care, facilitate better access to radiation oncology services and continue the preparation for the national cervical screening programme.

While cancer services have improved, the prevention and reduction of incidences of this disease has become a priority. Current research suggests that approximately 30% of cancer deaths are potentially avoidable by the modification of diet, making diet second only to tobacco as a preventable cause of cancer. Disadvantage and poor lifestyle habits are often linked and it is acknowledged that those in the lower socio-economic groups are more likely to develop diseases such as cardiovascular disease, diabetes and cancer than their more affluent and educated counterparts. These health inequalities must be addressed or the burden of care which will be required will be enormous. Through modifying lifestyle behaviours in the population, significant gains will be made both for the individual in that they will achieve a better quality of life and for the health services through substantial savings in future health care costs.

The Department of Health and Children conducted a review of the impact of the National Health Promotion Strategy 2000-2005. It found that high levels of implementation at both national and regional level were reported in regard to being smoke free, being more active and eating well.

Tobacco use is the single largest causative factor, accounting for 30% of all cancer deaths in developed countries. Many advances have been made with regard to smoking and smoking control in Ireland in recent years, including a ban on advertising. However, on 29 March 2004 the workplace ban on smoking was introduced in all places of work, including licensed premises. With a 94% compliance rate and a reduction in smoking rates, the health benefits of this legislation will become apparent in the future.

For more than 11 years the health promotion unit of the Department of Health and Children co-ordinated an annual healthy eating campaign, which aimed to promote awareness of specific healthy eating messages and to provide practical information to the general public. These campaigns have enhanced public awareness on healthy eating guidelines on fruit and vegetables, fibre, low fat and being a healthy weight.

The World Health Organisation states that regular physical activity is a significant element in cancer prevention and control. There is consistent evidence that some form of regular physical activity is associated with a reduction in the risk of colon cancer. The protective effect of physical activity on cancer risk improves with increasing levels of activity. Twelve physical activity co-ordinators have been appointed in the HSE and structures have been put in place to provide advice and support in a number of settings including schools, workplaces and communities, targeting in particular the young and older people.

The reorganisation of the Department of Health and Children and the devolvement of executive functions to the Health Service Executive present an opportunity to address, in a more fundamental way, the broader determinants of health, such as lack of education or low socio-economic status, and to reduce health inequalities. There now needs to be sustained focus on the wider social and economic determinants of health to move beyond the lifestyle risk factors. This will require collaboration and collective action across Departments in association with the private sector and other statutory and non-statutory agencies. This Government will not be found wanting in continuing to improve the health status of the population and in particular those who are most vulnerable.

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