Billy Kelleher (Cork North Central, Fianna Fail)

I welcome the opportunity to speak and congratulate the Technical Group on tabling a welcome motion, which highlights the issues in the House. The Minister referred to a collaborative approach in dealing with public health and everybody would concur with that in this context of promoting stroke awareness, particularly with regard to the Irish Heart Foundation campaign. It has been a strong advocate for many years in encouraging people into healthier lifestyles and promoting awareness in the general public of the issues surrounding stroke, the need for quick emergency interventions and awareness in the broader community, diagnosis and early treatment. The Irish Heart Foundation should be congratulated for promoting awareness through the FAST advertising campaign, which highlights face, arm, speech and time. Deputy Mary Mitchell O'Connor has indicated that this has brought a new awareness to the population and helps to ensure people gain quick access to medical procedures, meaning stroke can be prevented or damage can be limited.

There is a broader issue. In the Department of Health, like in other Departments, current financial constraints mean immediate issues are prioritised. There is a long-term issue that must nonetheless be addressed in society, namely the overall health of the nation. We can speak about short-term issues, such as the need for rehabilitative programmes for people who have had strokes and need continuing care or community based interventions for rehabilitation, including speech and occupational therapists. We can also discuss the supports required for the short term that will provide proper rehabilitative care and support for people who have had strokes that have left a detrimental effect on their ability to live completely independently. These are urgent and pressing issues.

Equally, there is another obligation. The Minister outlined his personal involvement in this issue, which encourages me and others, who for a long time have been trying to promote the idea of a healthy nation that is conscious of the need to be interested in promoting all facets of health. We can see alarming statistics on the obesity epidemic in the United States. In that nation statistics showed in the 1950s and 1960s there was a creeping movement in the waistline of the American people. This was initially broken into various socioeconomic and ethnic groupings but the problem has broadened across the entire United States. The problem is now evident in the United Kingdom, which also has an issue with obesity. In the last ten or 15 years the problem has arisen on our shores, with a creeping increase in obesity rates that will kill our population if we do not stop it now and proceed with major interventions to promote healthy living.

The national cardiovascular health policy made a recommendation that the Department of Health should prioritise actions to promote the behaviour and profiles underpinning cardiovascular health, with specific targets to pursue actively and achieve within ten years. It indicated the prioritised areas as maintaining a healthy body weight, healthy eating and physical activity, reducing salt intake, refraining from or quitting smoking and consuming alcohol responsibly. The actions would include fostering intersectoral support for initiation of activities promoting health and prohibition of activities that will maintain or foster unhealthy behaviours. Details of how to achieve the targets are contained in a range of Government policies and reducing inequalities in cardiovascular health across society must be an underlying principle in achieving improvements in health behaviour.

The lead organisation in that policy is the Department of Health, and it is critical that the Department encourages all other Departments in their efforts. When the recommendations were made it was the Department of Health and Children but we now have two separate Departments, with one for health and one for children and youth affairs. It is important that there be cross-departmental support and activity to ensure there is a conscious idea that to have a healthy nation we must deal with the underlying problem of obesity. That issue is growing continuously and if we do not take it seriously in the years ahead, there will be problems down the road. The Minister and I are aware of it but we need society to build on this.

I spoke in the debate on a Bill that would have allowed for publication on products of images of the horrific impact that smoking can have on one's health. I am amazed that there is a large cohort of people, particularly young girls, taking up smoking. It is a worrying trend and we must be aggressive in campaigning against and highlighting the problem at every level. We can consider the statistics. Each year, 5,200 people die prematurely from disease caused by tobacco use. When we talk about road fatalities and the carnage on our roads, we reflect on the efforts we have made, such as the establishment of the Road Safety Authority and the improvements in policing and implementation. The cultural shift in our views on drink driving has saved thousands of lives. Such changes have been universally supported in this House and embraced by the community outside.

The nagging view that smoking is cool continues to hang around in our society, particularly among younger people. It is something we have to target. Surveys have shown clearly that younger girls are most likely to take up smoking. This is happening for many reasons. Tobacco companies are engaging in subliminal advertising. Various methods and means are being used to subliminally transmit the message that if one smokes, one will suppress one's food intake and, by extension, one will be slimmer and one will look more like Kate Moss. It is a simplistic approach, but it resonates with young girls. It is having a detrimental effect on their health and, potentially, on the health of the nation in years to come. We owe it to the generations that will come after us to counteract this. We now have the knowledge. It was different when we were young. I started smoking when I was young. We did not have such an awareness of the impact of smoking and its dangers for people. We know it all now. The complete cohort of statistics, research and medical evidence demonstrates that individuals have nothing to gain from taking up smoking and everything to gain from giving up smoking. I implore the Minister to make a strong effort in this area. His Department is the lead Department. As a general practitioner, the Minister has practical experience of this issue. He spoke about his personal experience earlier in the debate.

The issue of encouraging people to be active is another key area. As a nation, we like sport, but unfortunately many of us like sport from the armchair. We have to start getting out there, not necessarily by participating in competitive sport but by engaging in various activities such as walking and general exercise. As a nation, we have to become more conscious of the need to be proactive in promoting our own health. The idea of healthy living being part and parcel of everyday life has been embraced in Australia, for example. When most Australian people get up in the morning, they go for a walk or a jog or do some other form of exercise. The idea is to live a reasonably clean and healthy life, to enjoy oneself and to treat oneself to excess occasionally. In general, the people of Australia have embraced the whole idea of healthy living. I appreciate that the Australian climate means they enjoy more sun. When one goes to Australia, one can sense that Australians have embraced the idea of challenging the problems of obesity, alcohol intake and the use of tobacco. The statistics show that Australia is beginning to climb up the league tables for longevity, life expectancy, body mass index and the general health of the nation. That is happening because certain policies are being pursued and the public is embracing the need to ensure health promotion is part and parcel of every aspect of life.

A Government Deputy suggested that an advocacy group or czar should be appointed to address obesity. I agree that something of that nature will have to be considered. Perhaps we should establish an agency - we do not like quangos in here - that can transcend Departments and bring them together. As I have said, the Department of Education and Skills is involved in ensuring these matters are covered on the school curriculum. The Department of Transport, Tourism and Sport is involved in another area. The Department of Health is the lead Department in this context. Each of those Departments has a critically important role to play. Equally, the local authorities have to provide amenities and facilities, for example by ensuring paths are safe and properly lit. That allows people to organise community walks in their own areas. Simple things can help to ensure we diminish the impact that stroke can have on the individual and, collectively, on the community. As has been pointed out, stroke has an enormous cost to individuals, families and communities. Much of the damage that is done by a stroke is hard to reverse. A large amount of intervention is needed from occupational therapists, speech therapists, language therapists and people with many other skill sets. We must make every effort to ensure those who suffer strokes get the best rehabilitative treatment and assistance possible. Equally, we must look over the horizon at the longer term to ensure fewer people enter the "at risk" category every year.

As a general practitioner, the Minister will be aware that technology is evolving. We should give greater consideration to developing our approach to risk assessment by profiling and testing people. We are familiar with the advertising campaigns that are always being promoted by individual organisations. The Irish Cancer Society's prostate cancer campaign, for example, encourages men to get themselves checked out. We all come in here and encourage each other to get ourselves checked out. Although all of these individual campaigns are worthwhile, I suggest there should be an emphasis on getting people to take an individual MOT test. I think it could lead to substantial cost savings in the short to medium term, but it is particularly worth encouraging because of its longer-term impact on life, on individuals and on society collectively.

I do not know where the need for a proper occasional evaluation and assessment of an individual's health will fit into the plans for universal health insurance and free primary care from general practitioners. I do not want to get into a confrontational political debate on these matters. Such an assessment could be funded or encouraged by the State. If it is not provided for free, some inducement could be offered to people to pay to get themselves checked out. As I have said, the technology that is now available to analyse potential risk is phenomenal. Advances in software technology mean that people who are in the high-risk category can use various types of equipment to analyse their blood on a regular basis to show how near they are to developing various illnesses. The technology that is now available should be embraced.

I will support the Minister when he has a good idea and I will oppose him when he has a bad idea. I applaud his passion and his commitment to promoting a healthy lifestyle, taking on the vested interests of those who encourage young people to kill themselves by taking up smoking, tackling the issue of alcohol abuse and promoting healthy living. I know there is very little to be gained in the short term from promoting something that does not bring an immediate return. Deputy Martin will tell the Minister that. The benefits of health promotion are incremental and come in stages. Perhaps, in years to come, someone will stand up in this Chamber and say "In fairness to the former Minister, James Reilly, when he was in the Department of Health, he stood up to vested interests and promoted healthy living, and for that we are grateful". That might take years to happen, but I will do it sooner if I continue to sense that the Minister has a genuine and positive commitment to promoting health and lifestyle changes, standing up to the vested interests that encourage people to take up smoking and abuse alcohol and inspiring people to change their diets and participate in healthy lifestyles. If the Minister acts on that commitment over the next few years, I am quite confident that the incidence of stroke, heart attack and other cardiovascular diseases and diabetes, etc., will diminish significantly. In such circumstances, future generations will say the Minister did a good job by starting the national cardiovascular health policy and promoting one's health as one's wealth.

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