Frances Fitzgerald (Fine Gael)

I thank the Minister of State for joining us here to discuss this area of health promotion priorities. This is the first debate in this session on this issue and it is very important. The Minister of State has covered a wide range of areas and we should return to particular areas, such as alcohol, smoking and obesity, in the Seanad because there are many reports covering different areas. We might discuss each area in detail for a session in the Seanad and examine how the recommendations are being implemented in the various areas. That would be very worthwhile.

Health discussions in this country almost always focus on the crisis situation. Prevention is better than cure, however, unfortunately, the promotion of healthy lifestyles does not get the kind of attention it needs to reduce mortality and morbidity. The absence of the required focus is a serious problem for the country. Much can be done to prevent people from having to go to hospital or developing many of these so-called lifestyle diseases.

When we saw the removal of the medical card from the over 70s this week I was very struck by the numbers of doctors, physicians and consultants who said the one effect of the universal medical card was that it helped people to stay at home by providing access to all the other services. A relatively small input of service to an elderly person can ensure he or she stays at home. A home help or a nurse calling, for example to do some bandaging at home, can make a difference and keep a person at home. This week the Government took a decision that is not in the interest of health promotion and prevention rather than cure. Withdrawing the medical card has put many people at risk and made it less likely that community care will happen for a person rather than his or her having to go into a hospital or nursing home.

We know there is no comparison between the cost of a nursing home and remaining in the community. I would make that political point about the decision making in this year's budget from a health promotion perspective. It was very short-sighted and I was struck by the doctors who have spoken on this during the week and the studies that show the difference those small interventions can make to an elderly person.

The Minister of State has covered a wide range of areas and I will not be able to address them all. I am very keen to see the report of the group examining the implementation of the recommendations of the strategic task force on alcohol. I hope we can discuss that here. One would wonder about young people who are so at risk from binges. With the affluence we have had in this country in the last ten years there is no doubt alcohol consumption is very high and the Minister of State has quoted some startling and frightening figures. The implications are serious and it must be a key area for us to address, particularly regarding young people. Getting education and information about the effects of alcohol to young people is an uphill struggle, given the kind of society we have. If one looks at the health implications for them, it is a matter of life and death.

One example is driving and accidents. We should seriously consider introducing a zero level for alcohol for provisional drivers. There have been improvements. Young people are now often nominating a driver when they go out. However, when one looks at the levels being consumed it is a very serious issue. We may need to take more specific action regarding young people. There is a problem across all ages with alcohol, it is a cultural issue and it is well known that we have ambivalent attitudes. We need more action on the implications of this, and probably need to take more action on the advertising side.

I welcome the changes brought in by the Government in recent months. I hope they will protect communities because many of them are very concerned about groups of young people out of control. These young people can be assaulted and murdered. It is a critical issue. As a society, we need to shift from merely addressing and dealing with health problems as they arise to encouraging and fostering an environment whereby the public is educated about health matters. We need to shift the focus.

The promotion of health, and healthy life, living and eating, needs a champion. This is seen worldwide when one looks at what is happening with health promotion. Someone in Government is needed to drive an agenda promoting healthy lifestyles and good choices. The office held by the Minister of State provides the scope to become this champion. The energy within Government is what is needed.

I turn now to the areas of obesity, drugs and smoking and cancer screening. Cancer screening is not within the area of responsibility of the Minister of State but I am interested in the links her Department can make to this, and I want to make suggestions about some of the screening we need to do which would be important to prevent illness. These arguments could be applied to any range of health issues we face and we need the Government to play a leadership role in promotion and education.

We need to focus on the ticking time bomb of obesity. In 2001, 57% of Irish people were overweight or obese. This year, only seven years on, that figure has risen to 64%. The problem is growing. More and more Irish people are becoming obese and this is leading to serious health difficulties. We need to address this. It leads to diabetes, cancer and — the most recent research shows — dementia. It has life-long implications. We need to do a lot about it.

In 2005 the Government established the National Taskforce on Obesity. There were 93 recommendations. I am concerned. Ten of these recommendations have been farmed out to industry, and some action has been taken on them. The Minister of State said some Departments are working on this. The problem is there are approximately 80 recommendations across a range of Departments, and I do not think we have seen action on these. We need a detailed update on these recommendations and a timeframe for implementation.

I am concerned that there is currently no implementation group in place. The Minister of State might confirm this in her reply. Getting implementation of this report is problematic if there is no implementation group. I may be wrong — perhaps the interdepartmental action may be the implementation group — but is an interdepartmental group charged with acting on these recommendations and has it met? I would like a reply to that. I am not sure that there is one, and the Minister of State might outline whether the implementation group will be departmental or broader in scope. I understand the first recommendation in the obesity report involved stakeholders.

There are groups like the Nutrition and Health Foundation, with which the Minister of State is meeting, who have done much work in this area and produced some terrific publications which deserve to be seen by a wider audience. We must have the interdepartmental group, with a timeframe and an implementation plan for this to move ahead. We need co-ordination and the Minister of State is the person who can do this. This addresses the areas of healthy eating, exercise, nutrition and how we get the message to people about the risks they are taking if they do not begin to act. Getting the message to younger people in schools is critical.

I raised the issue of vending machines earlier in the year, and there has been some progress. There are still issues arising on the range of healthy eating options available to young people in our schools and hospitals. It is extraordinary to go into hospitals and frequently see that one cannot buy fruit. Often, the vending machine is the only thing available to young people. We have work to do in this area and Government action can be taken to look at healthy eating in schools. The schools have a lot to do, and parents are under increasing pressure to prepare healthy lunches, but there is a role for the Government in taking action that can impact on the way young people get food in school or patients, and their family and friends, access food in hospital.

The Minister of State did not mention screening issues, and this may be because it is dealt with by a different part of the Department of Health and Children. Screening is a very important tool for prevention. A meeting of the Joint Committee on Health and Children this week had a superb briefing from the National Cancer Screening Service. It produced some very worrying statistics on the levels of breast cancer, colerectal cancer and cervical cancer. We have had much discussion on breast cancer screening. We want to see it provided across the country. It is depressing that it has taken eight years and we still do not have universal coverage. We should reduce the age at which people have screening and extend it at the upper end. Other countries have brought it up to 75 and we ought to be doing the same.

The numbers of people who are dying of colerectal cancer this per year is extraordinary and very disturbing. There are 1,900 new cases every year, and 900 people are dying. Irish men have the fourth highest mortality rate among men in the world for colerectal cancer. We need this screening to be brought in. Women are tuned into prevention and they are good at undertaking screening, but Irish men are not. As can be seen from the statistics, colerectal cancer screening must come in very soon. It should not take ten years to come in, as breast cancer screening did. We must find a faster way to proceed because lives are being saved. As it is a good preventative tool and resource it can alleviate pressure on the hospital system.

The Minister of State highlighted very effectively the challenge we still face regarding smoking. There was cross-party agreement to put €2 on the price of cigarettes. That would not be popular with smokers. Many voters will say that it is a time of recession, people who smoke want to smoke, and they do not want cigarettes to become more expensive, but it is the most effective means of addressing the issue. We had cross-party support for a €2 increase. Can the Minister of State tell us why this was not done? The Fianna Fáil Chair of the Joint Committee on Health and Children supported it. It is the most effective way to proceed if we are serious about health promotion and preventing disease and illness. The recommendation was put forward by ASH. There have been some very good initiatives regarding smoking.

I welcome this debate, which I requested. We must start focusing on health promotion and the prevention of serious illness in Ireland. Culturally, we are not doing enough. We need a champion and it is a great opportunity for the Minister of State to take on that role and to try to promote greater debate. I would like to see the Seanad playing a stronger role in this area.