Joe Costello (Dublin Central, Labour)
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I welcome the Minister of State, Deputy Power, to the House. The issue I raise is the need for the Minister for Health and Children to address the high incidence of cancer in disadvantaged urban areas. As the Minister of State is aware, Ireland has among the highest cancer incidences and mortality rates in western Europe and in the western world. Each year, approximately 28,000 new cancer cases are diagnosed and 11,000 die from the disease on this island of 5.5 million people.

Statistics I recently obtained from the National Cancer Registry clearly demonstrate that the incidence of cancer is higher in Dublin city than in surrounding counties and that there are major differences within Dublin city. Certain areas such as Ballybough, west Cabra, Arran Quay, my own constituency of Dublin Central, Ballymun in Dublin North-West and Merchant's Quay in Dublin South-Central have cancer rates over 50% higher than the national average, or what is called the standardised incidence ratio, SIR. Such a high variation from the norm cannot be due to chance and clearly indicates that there are real and substantially greater cancer risks in certain parts of the city over other parts.

A 50% variation from the norm is a very serious matter for the residents of the areas affected. Material deprivation and high smoking levels are suggested by the National Cancer Registry as major factors contributing to higher cancer levels, but it is clear these are not the only factors as other traditionally deprived areas in the city of Dublin have only average rates of cancer. As lung cancer is by far the commonest cause of death from cancer, it is likely that fumes from motor vehicles are a significant factor. However, there may be other local but unknown causes and it is not sufficient for the health authorities simply to speculate about the causes of such a huge variation in the incidence of cancer in the city of Dublin. They must research and determine the causes.

I call on the Health Service Executive to conduct an urgent investigation into the five district electoral divisions in Dublin city where the incidence of cancer exceeds the standardised incidence ratio by 50% or more. By way of information for the Minister of State, Ballybough A, the district electoral division, is 150%, which is 50% above the norm. Ballymun C is 1.68%, which is 68% above the norm. That is very high. Cabra west A is 57% above the norm, while Merchant's Quay A at 1.64% is 64% above the norm. Those are very high incidence rates. Other areas are 20%, 30% and 40% but the fact that five separate electoral areas have levels over 50% above the norm is a massive variation.

The fact that the city of Dublin has a much higher incidence of cancers than the rest of the country demands that the HSE examine this matter. It is not much use saying we have the statistics and from those we speculate that it may be due to smoking or deprivation. What does that mean? There are many areas in Dublin city where these levels are the norm. They are the norm in the area of the north docks, for example, yet an area like Ballybough is over 56% above the norm, Cabra is 60% above the norm and Ballymun is 60% above the norm. That is very serious statistics. Cancer is one of the biggest killers in this country and we do not know the reason for the clusters of cancer in these inner city areas — Ballybough, Merchant's Quay, Arran Quay, Ballymun and Cabra west.

I would be pleased if the Minister of State accepted my proposal that the Health Service Executive should conduct an urgent investigation into these clusters of cancer in the city of Dublin.

Seán Power (Kildare South, Fianna Fail)
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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.