Billy Kelleher (Cork North Central, Fianna Fail)
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Yesterday, at the Irish Cancer Society's annual Charles Cully Lecture the worryingly high rate of cancer incidence and death in poor communities across Ireland was highlighted in a discussion on health and wealth, the cancer gap. Death rates in some areas, notably some of the poorest parts of the Dublin region, are more than twice as high as rates in more affluent areas. Cancer death rates in Dublin between 2009 and 2011 combined varied from 381 per 100,000 in Blakestown north west; 310 per 100,000 in Blanchardstown north; 265 per 100,000 in Ballymun east; 141 per 100,000 in Foxrock and Cabinteely south west; 138 per 100,000 in Malahide east; and 128 per 100,000 in Castleknock south east. It is clear that the more deprived the area, the higher the risk of a person developing cancer and dying from the disease. People in areas of most disadvantage are twice as likely to die from cancer as those in the most affluent areas.

As well as this, often the poorest in society have the greatest difficulties in accessing health care. As well as dying younger, they develop multiple illnesses at an earlier age. In some deprived Dublin areas, there are not enough primary care resources, for instance, in north Dublin there is one general practitioner, GP, for every 2,500 people. Nationally, this figure is 1:1600.

The cancer strategies implemented by governments over the past 20 years have been successful in many ways. I know that the Minister for Health, Deputy Leo Varadkar, has appointed a team of three international experts to evaluate Ireland's current national cancer strategy and to provide advice for the next one. In doing so, he said that the main challenges facing Ireland during the ten year period of a new strategy are likely to be minimising the increase in cancer numbers, bringing services for cancer treatment to a par with the top international performers and maximising holistic recovery among cancer patients.

I ask the Minister to bear in mind that the Irish Cancer Society has suggested that the next strategy should give specific priority to the need to combat cancer in the poorest sections of our society.

I represent the constituency of Cork North-Central, which has some areas of high socio-economic deprivation. The basic elements of housing, education and other support services are under stress and pressure and there is no point in saying otherwise. That is just an observation, as opposed to a political point. This aspect of the issue of health, which is a key concern of mine, has been highlighted by the Irish Cancer Society. Given his background and the constituency he represents, I know the Minister of State will be aware of this as well. Regardless of what we do in terms of resources, the least we should do is ensure the cancer strategy that is applied in the years ahead contains a strong commitment to social justice in the context of providing adequate health care in the areas under discussion. A strong strategy is needed to address the underlying causes of the poor health outcomes of many people in such areas.

Aodhán Ó Ríordáin (Dublin North Central, Labour)
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I genuinely appreciate the opportunity to discuss this crucial issue with the Deputy. In effect, the life expectancy of certain people in certain parts of Ireland is lessened. We need to take this serious issue on board. I will present the reply from the Department of Health to the House on behalf of the Minister and we can expand on it. As we have been making progress with cancer control over recent years, we have focused on improving the quality and equity of cancer services through reorganisation and expansion. We have moved from a fragmented system of care to one that consolidates cancer treatment in larger centres, with multidisciplinary care and decision-making.

The national cancer control programme has reorganised cancer surgery into eight designated cancer centres and ensured these centres have sufficient activity to provide and maintain ongoing surgical expertise. The programme has also established symptomatic breast disease clinics and rapid access clinics for lung and prostate cancer at the designated centres. These clinics are available to all patients, regardless of income. The HSE also provides free screening for breast, cervical and bowel cancer. The Government recently announced the extension of the BreastCheck screening programme, which offers women between the ages of 50 and 64 a free mammogram every two years, to women between the ages of 65 and 69.

The World Health Organization estimates that more than 30% of cancer deaths could be prevented by modifying or avoiding key risk factors. Tobacco use is considered to be the single most important risk factor for cancer. The Department of Health and the HSE are promoting healthier lifestyles to reduce the risk of many chronic diseases, including cancer. Policies include the achievement of a tobacco-free Ireland by 2025.

The National Cancer Registry, which publishes data on cancer incidence, treatment and survival in Ireland, has presented figures to demonstrate that regional variations in survival patterns are not statistically different. Long-term survival from cancer has greatly increased in the past decade. Survival at five years from diagnosis among men increased from 42% in the 1994-99 period to 60% in the 2005-09 period. The increase among women over the same period was from 52% to 62%. It is estimated that the five-year survival rate for people diagnosed with breast cancer between 2005 and 2009 was 84.9%, which represented an increase on the rate of 75.1% for people diagnosed between 1994 and 1999. It is expected that survival rates will increase further due to the combined approach of prevention screening, early detection and improved treatment.

The issue of health inequalities, as well as prevention, will be examined as part of the development next year of the next cancer strategy, which will run from 2016. Of course much of this is about the treatment of illnesses in certain areas. I feel quite strongly about the issue of life expectancy. The Government has adopted an area-based approach to tackling child poverty and disadvantage, using models like Young Ballymun, the Tallaght child development initiative and the Preparing for Life programme in Darndale. These models focus on parental empowerment, for example. Issues of maternal depression are becoming quite acute in certain disadvantaged areas. If mothers become isolated from the rest of the community, it can lead to destructive patterns of behaviour.

When one focuses on the geographical dimension to the blackspots of disadvantage in this State, it is clear that the potential exists for different agencies to work together collectively. Often in disadvantaged areas, many people who are doing fantastic work are not in communication with each other. Models like Young Ballymun, the Tallaght child development initiative and the Preparing for Life programme in Darndale have broken down many of those entrenched positions. We are rolling out more of those area-based approaches. They might form part of the solution to tackling the issue that has quite rightly been raised by Deputy Kelleher today.

Billy Kelleher (Cork North Central, Fianna Fail)
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I thank the Minister of State, who is quite right when he says this issue should be broadened out. We should have a broader debate on health outcomes and supports for people in areas of socio-economic deprivation. There is no doubt that the location where a person lives is a determining factor in many health outcomes. Rates of obesity, dietary concerns and cancer, for example, vary by geographical area. The Minister of State referred to maternal depression. I do not believe it is beyond our capacity as a nation to recognise first and foremost that it is simply wrong for people's health outcomes to be predetermined by where they live. We should do everything in our power to address that issue. As the Minister of State suggested, when one scopes through this issue, one can identify the areas where resources should be put in place in the context of cancer and in the context of providing a platform whereby people have the supports and services around them.

Education is necessary to ensure people are aware of what is required to provide for their own health. There is no point in putting this in any other way. In many places in this country, basic skills like cooking, managing diets and handling household budgets are being lost. While we do not want to stereotype people, there is an inherent need for us to address these problems at a basic level. We need to ensure supports are in place to assist people who are vulnerable. They need to be helped to manage their own affairs and empowered to look after themselves and their families. While I hate burdening schools all the time by suggesting they are the answer, I think this issue starts in our schools. They need supports to allow people in communities to feel a sense of empowerment and look after their own destinies in areas like health and education. I refer to things that many of us take for granted on a daily basis. Yesterday's interesting Charles Cully lecture about the issues of health and well-being associated with the cancer gap is well worth reading. It highlights the huge inadequacies and inequalities that exist in our society.

Aodhán Ó Ríordáin (Dublin North Central, Labour)
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I appreciate the raising of this equality issue by the Deputy. I agree with what he has said about the schools system. Children do not live in schools. They are influenced by many things outside the school system. They start school at the age of four or five when so many things have already happened to them and influenced their lives. They key to this is empowering the parents in terms of diet and lifestyle in the home. If one comes from an area that is steeped in disillusionment, one can be sucked into a pattern of addiction in which one is attracted by vices like alcohol and substance abuse. Obviously, that has knock-on effects on the wider community. It is about empowerment and prevention. As the Deputy quite rightly said, it is also about providing services and resources to those who are suffering from cancer-related illnesses.

A wider societal approach is necessary here. As I have said previously, if we take an area-based approach, if we ask agencies to interlock with each other and - fundamentally - if we empower people, particularly young mothers, to think differently about diet, oral language and literacy skills and lifestyle and to take a fresh approach to parenting, it can be a starting point that leads to a long-term change in the life expectancy of people in certain disadvantaged areas. A report like this is a wake-up call for everybody. It is refreshing to have a discussion like this in the House because it is the real stuff of equality. It is an area in which policies and politicians can make a real difference. I appreciate the raising of this topic by the Deputy. I will personally raise it with the Minister when he returns. I think that, collectively, we can make some real differences in this area. It is not just a health issue. Many different strands are involved in it. Unfortunately, in government and in policy formation we sometimes tend to compartmentalise these areas far too much.

However, we are in broad agreement as to the strategy we should take. We should have a continuing discussion on this matter.