Mary Wallace (Meath East, Fianna Fail)

I apologise to Senators for the delay in providing copies of the script. They were outside but they appear to have gone back to the other House. They will be here in a few moments.

I welcome the opportunity to speak in Seanad Éireann on the subject of health promotion priorities. It is widely accepted that the general increase in life expectancy, particularly in the developed world, reflects both the lifestyle changes that have taken place as well as the changes and advances in medical practices. Yet, the primary focus of health care systems is on treatment rather than prevention. We all know that people are living longer. It is important for each individual, and for society in general, to ensure that this longevity is matched with good health. Health and longevity are influenced by lifestyle, and by living and working conditions. Almost 60% of the disease burden in Europe is accounted for by seven leading risk factors, which we can influence. Those are, high blood pressure, tobacco, alcohol, high blood cholesterol, overweight, low fruit and vegetable intake, and physical inactivity. People's lifestyle and behaviours can be positively influenced in regard to those risk factors. Poor lifestyle habits and practices are reversible and the benefits of such changes are great.

Individuals are responsible for lifestyle choices, which determine health in later years. However, individuals face different incentive structures with respect to those lifestyle choices. The physical environment, social and fiscal policy, housing, education, the work environment and nutrition are all directly relevant to future health. Responsibility for achieving and maintaining good health is, therefore, multi-layered, involving the individual, the health sector, other sectors and broader society. Investment in health and in addressing the so-called "determinants of health" will have positive economic and social consequences for the country. In other words, promoting and encouraging people to make better and more informed lifestyle choices is good for Ireland.

I wish to refer to two surveys, one relating to adults and the other to children. The adult survey is the national health and lifestyle survey, Slán. In order for us to make informed decisions at Government level we are assisted by research data on which to base policy. The Slán 2007 survey was the third in a series, which was commissioned by the Department of Health and Children and carried out by the Centre for Health Promotion Studies, National University of Galway. It involved face-to-face interviews with more than 10,000 adults, in addition to a sub-study on body size of 967 younger adults, 18-44 years old, and a more detailed examination of approximately 1,250 adults over the age of 45.

The Slán study provides us with invaluable data for policy development and programme planning on a range of lifestyle related health behaviours in the Irish population such as smoking, alcohol consumption, diet and physical activity. More importantly, the Slán survey allows us to identify trends and monitor changes in population behaviours, thus better informing our priority setting decisions at national and regional levels. It is only through more and better information that we can better understand the health behaviours of the population and provide the necessary services and support.

The second survey I would like to mention is the health behaviour in school-aged children, HBSC, survey. This collaborative European study measured a number of health and lifestyle factors among children in all parts of Europe between the ages of ten and 18. Information from the survey is used to inform the development and implementation of health promotion policies. A number of positive findings were contained in the 2006 HBSC survey. It found that smoking levels among young people are continuing to decrease. It also reported an increase in the number of children who have never had an alcoholic drink. However, it outlined some worrying findings regarding the use of alcohol among people between the ages of 15 and 17. The HBSC study informed us that half of all children in that age category are current drinkers. Just over a third of them reported that they had been "really drunk" in the previous 30 days. Such information is needed if we are to identify areas in which a particular focus is needed in the interests of tackling these lifestyle behaviours. I propose to speak about the three issues of alcohol, smoking and overweight and obesity separately.

The Department of Health and Children believes that the level of alcohol consumption in a population is an important determinant of health and disease levels. Therefore, alcohol policy must take into account the total drinking population when defining the scope of public health action and targeting high-risk groups and individual high-risk drinkers. Policies aimed at reducing the harmful use of alcohol reach far beyond the realm of health. They relate to matters such as fiscal policy, trade, agriculture, education and employment. Numerous governmental agencies and organisations are responsible for implementing policy in such areas. The Strategic Task Force on Alcohol, which was established in January 2002, published two reports which set out approximately 100 recommendations across a wide range of sectors. The recommendations are consistent with the measures identified by the World Health Organisation as being effective in reducing alcohol consumption in a population.

I wish to mention four statistics relating to alcohol consumption in Ireland. Irish people aged 15 and over consume an average of 13.5 litres of pure alcohol per person each year, which is 50% above the EU average. A report published by the Health Research Board, which examined the health-related consequences of problematic alcohol use, found that alcohol consumption among the Irish population has increased by 17% in the past 11 years. There was a 147% increase in alcohol-related liver disease between 1995 and 2004, resulting in 1,775 deaths. The number of people in hospital with alcohol-related problems or injuries increased by almost 90% in the same period. Such statistics demonstrate the importance of addressing the problems associated with the role of alcohol in Irish society.

The Intoxicating Liquor Act 2008 was conceived and passed by the Seanad and the Dáil within six months earlier this year. It is a demonstration of the commitment of the Government and the Oireachtas to dealing with alcohol misuse, particularly from a public order perspective. The Act reduces the hours in which off-sales of alcohol can take place and puts in place tougher public order provisions allowing the Garda to seize alcohol from minors. It provides for a court procedure whereby a wine-only off-licence can be secured and specifies new grounds for objecting to the granting of an off-licence. It attaches new conditions to the granting of a special exemption and outlines the arrangements for the structural separation of alcohol in mixed trading outlets.

The introduction on 1 July last of new codes on the advertising and marketing of alcohol was an important development. In co-operation with representatives of the Irish drinks and advertising industries, the Department of Health and Children developed the strengthened codes on advertising and sponsorship. The new codes, which came into effect on 1 July, place an upper limit of 25% on the volume of all alcohol advertising. For the first time, alcohol advertising will be limited to no more than 25% of available space or time in all Irish media — television, radio, cinema, outdoor advertising and the print media. The new controls will also deal with alcohol advertising or sponsorship during the broadcasting of sports programmes. The Government has agreed to establish a working group to examine the extent of existing sports sponsorship by alcohol companies and the terms and lengths of such contracts. The working group will seek to direct how concerns around the extent of sports sponsorship by alcohol companies might be further addressed. The group will be established by the Department of Health and Children, following consultation with other relevant Departments.

In July 2005, a working group on alcohol was established under the terms of Sustaining Progress. The group used the social partnership structure to encourage stakeholders to achieve a targeted and measurable reduction in alcohol misuse. It operated in the context of the special initiative on alcohol and drug misuse under Sustaining Progress. The group included representatives of the social partners, relevant Departments, the Garda, the national drugs strategy team and the Health Service Executive. It examined the three issues of under age drinking, drink driving and high-risk drinking. The group's report, which was published in June 2006, included recommendations on issues like community mobilisation, workplace alcohol policies, advertising, labelling and education and awareness. An implementation group was established in November 2006 to monitor and report on the progress being made with the implementation of the recommendations. The report of the implementation group is expected to be published in the next few weeks.

Almost 7,000 people die each year in Ireland as a result of tobacco use. That number of deaths is far greater than the combined death toll from car accidents, fires, drug abuse and murder. Ireland has led the way in Europe and beyond in implementing legislation to address the tobacco epidemic. There is widespread agreement that the smoke-free at work legislation that was introduced in Ireland over four and a half years ago has been hugely successful. The primary purpose of that measure was to protect the health of workers and the public from exposure to toxic environmental tobacco smoke. Compliance levels of 95%, arising from almost 29,000 inspections last year, indicate that this critical public health initiative is receiving a high level of co-operation from employers and employees. Senators will agree that the real sign of the success of the legislation is the overwhelming support it has received from the public. This positive and progressive health and safety measure has brought immediate and long-term positive benefits to workers and the general public. Its successful introduction is a reflection of the widespread public support and goodwill that exists for a clean smoke-free environment in the workplace.

Price has been identified as an effective tobacco control measure, particularly in preventing young people's initiation and subsequent addiction to tobacco. The sale of cigarettes in packs of less than 20 and the sale of confectioneries that resemble cigarettes was banned in May 2007. The minimum price below which cigarettes cannot be sold was increased to €7.14 with effect from 1 September 2008. The recent budget day increase of 50 cent in the price of a packet of cigarettes has brought the price of the most popular brands to more than €8, making cigarette prices in Ireland the highest in the 27 EU member states and the second highest in Europe. The further provisions of the Public Health (Tobacco) Acts 2002 and 2004 will be commenced from 1 July 2009. I understand that some Senators have been contacted by representatives of retail premises about this issue. It is important to remind them that the Acts contain important provisions limiting the display and advertising of tobacco products in shops. For example, the Acts provide for a ban on all in-store and point-of-sale advertising of tobacco products, a ban on the display of tobacco products in retail premises, the introduction of a closed container or dispenser provision, tighter controls on the location and operation of tobacco vending machines and the introduction of a retail register. The aim of these provisions is to further denormalise tobacco and protect children and adults alike from the dangers of tobacco consumption.

The final main topic I propose to address is overweight and obesity. This issue can be linked to recent developments in tackling cardiovascular illnesses. Of all chronic diseases, obesity is the most preventable, however it is a complex condition. The prevalence of overweight and obesity has been described by the World Health Organisation as an epidemic. Ireland is no different from other countries in terms of obesity trends. Obesity is becoming one of the fastest growing health problems in Ireland. It is a complex condition that affects and threatens to overwhelm virtually all age and socio-economic groups. The statistics are frightening. One in eight Irish people is obese and every second person is overweight. As a result, half of the population is at an increased risk of developing a chronic health condition. Overweight and obesity contribute to a significant number of illnesses including high blood pressure, type two diabetes, excess cholesterol and, of course, cardiovascular disease, including stroke. It is estimated that obesity is responsible for around 2,000 premature deaths in Ireland each year. The indirect cost of obesity in Ireland is estimated at €400 million per annum.

With a co-ordinated multi-sectoral approach to tackling obesity, diabetes and cardiovascular disease, as identified by the task force on obesity, prevention is not only possible but essential. The task force report, entitled Obesity — the Policy Challenges, was launched in May 2005. Its recommendations relate to action across six broad sectors: high-level Government; education; social and community; health; food, including commodities, production and supply; and the physical environment. It highlights the need for cross-collaboration between all key stakeholders and real practical engagement by both the private and public sectors.

A key recommendation of the task force was the development of a national nutrition policy. My Department is finalising this policy, which will provide strategic direction on nutrition for the next ten years. While addressing the nutritional needs of the whole population, it will have a particular focus on young people and on food poverty. My Department has already produced a number of guidelines aimed at specific groups, including pre-schools and primary schools. Post-primary school guidelines and food and nutritional care in hospitals guidelines will be launched shortly.

Another key recommendation of the task force is that Departments, together with the private sector and consumer groups, should take multi-sectoral action on the marketing and advertising of products that contribute to weight gain, particularly those aimed at children. For this reason I very much welcome the new Broadcasting Bill going through the Oireachtas. It provides that the Broadcasting Authority of Ireland prepare codes governing the standards and practices to be observed by broadcasters. This will allow for revised codes on advertising and is a first step in a multi-sectoral approach towards addressing the problem of obesity.

We have made great inroads on the detection and treatment of cardiovascular disease in recent years. The Government has committed over €60 million since 2000 towards the implementation of the cardiovascular health strategy, building healthier hearts. This funding has supported a wide range of new services and initiatives. These have had a positive impact on the diagnosis and treatment of patients with heart disease.

An audit of progress on the implementation of the building healthier hearts strategy was published by the HSE in September 2007. The report, Ireland: Take Heart, showed a continuing decline in cardiovascular disease. However, a rise in obesity and low levels of physical activity have prevented Ireland from doing even better. Smoking is still an important issue, especially among younger women. The report also identifies where services fall short of what was recommended in building healthier hearts.

A cardiovascular health policy group was established in September 2007 to develop a new policy framework for the prevention, detection and treatment of cardiovascular disease, including stroke. The work of the group is nearing completion and it is expected to make recommendations shortly.

An integrated chronic disease policy framework was published earlier in the year. This policy focuses on the population measures to prevent chronic disease including diabetes and how inter-sectoral action can be taken to address the wider determinants of health. These actions will be taken through the Cabinet Committee on Social Inclusion with the support of the senior officials group on social inclusion. The integrated chronic disease policy framework also focuses on disease management programmes. This part of the policy focuses on how chronic disease should be managed. It includes the strengthening of primary care and the development of self-care programmes to empower people with chronic disease to take greater control in the management of their conditions.

The prevention of chronic diseases will benefit everyone, not just the individuals concerned, but society in general. We must ensure that the increases in longevity witnessed in the last few decades are matched with improvements in health. This will not happen unless there is real commitment to addressing the lifestyle factors which contribute to poor health. There is no doubt that the pace of life has increased and it is often difficult for people to live healthy lives. It is important that we help improve general awareness of lifestyle factors affecting health and also that we try to put in place the structures to make it easier for people to lead healthy lives. I will conclude with some wise words from the famous comedian George Burns, who lived to the ripe old age of 100: "If I had known I would live this long, I would have taken better care of myself".