Alex White (Dublin South, Labour) | Oireachtas source

I am very pleased to have the opportunity to respond to the report of the Seanad Public Consultation Committee in respect of lifestyle and its relationship to cancers.

As the report points out, Ireland lies second in the world in terms of cancer incidence. Within Ireland, it is estimated that one in three people will develop cancer during their lifetime. Bearing this in mind, it is worth remembering that finding and diagnosing cancer at an early stage can result in better outcomes for patients. Screening programmes, early detection and more effective treatment options have led to improved outcomes and survival rates for cancer patients.

Ireland now has three quality assured cancer screening programmes run by the National Cancer Screening Service, NCSS. They are as follows: BreastCheck with its national breast screening programme; CervicalCheck with its national cervical screening programme; and BowelScreen with its newly launched national bowel screening programme.

The HSE's national cancer control programme, HSE-NCCP, continues to reorganise cancer services to achieve better results for patients. The programme is working to ensure that designated cancer centres for individual tumour types have adequate case volumes, expertise and concentration of multi-disciplinary specialist skills.

As a Minister in the Department of Health, I would like to see more emphasis on disease prevention rather than intervention. Healthy lifestyle choices are a key element of creating good health, particularly where cancer is concerned. The European code against cancer has highlighted the fact that the risk of cancer can be minimised by adopting a healthy lifestyle.

Lifestyle trends that threaten health were one of the main motivations which prompted the development of Healthy Ireland - A Framework for Improved Health and Wellbeing 2013-2025. The Healthy Ireland framework was launched in March and provides a framework for action to improve the health and well-being of the citizens of this country. In line with the recommendations made in the report under discussion here today, it takes a whole of government approach to the issue of health and well-being. It also encourages all sectors of society to get involved in making Ireland a healthier place to live, work and play.

One of the most significant lifestyle choices threatening health is smoking. As Members will be aware, 5,200 people die in Ireland every year due to smoking and 44% of these are deaths from cancer. Tobacco use is the leading cause of preventable death in Ireland.

Many successful tobacco control initiatives have been introduced in Ireland. Examples include the workplace smoking ban, the ban on the display of tobacco products at point of sale, and the introduction of graphic warnings. In the coming weeks, the Minister for Health will be launching a new tobacco policy for Ireland. The recommendations outlined in the Seanad's report being discussed here today will help inform that policy.

It is internationally recognised that the countries which have developed and enhanced their tobacco control legislation, policies and services are those which are successful in reducing smoking rates. The new tobacco policy will set out what we need to do in order to move to a tobacco-free Ireland. The Minister has indicated many times that his priority, while not forgetting current smokers, is to prevent children from starting to smoke. The bans on tobacco advertising, packs of ten cigarettes and point-of-sale display have assisted in reducing the number of ten to 17 year olds who smoke from nearly 19% in 2002 to 12% in 2010. The trends are clear. The rates are reducing. The initiatives introduced since that last tobacco policy in 2000 have assisted in this reduction. This new policy, over a decade later, sets out the framework for achieving further reductions over the coming years.

Alcohol is also key when considering lifestyle choices which impact on health. Alcohol plays a complex role in Irish society. While it is associated with many aspects of Irish social and cultural life, it is also responsible for a wide range of health and social harms in society and places a significant burden on the resources of the State in dealing with the consequences of its use and misuse. A recent report from the Royal College of Physicians of Ireland, entitled Reducing Alcohol Health Harm, highlighted the links between alcohol and cancer. Alcohol is classified as a group 1 carcinogen and it is one of the most significant causes of cancer in Ireland, being a risk factor in seven types of cancer. Alcohol increases the risk of more than 60 medical conditions; even at low-risk levels of consumption it increases the risk of developing many major diseases, including numerous cancers and gastrointestinal conditions.

The college reported that between 2000 and 2004, alcohol was estimated to cause 4.4% of deaths in Ireland. The rate of hospital discharges for alcoholic liver diseases increased by 247% for 15 to 34 year olds and by 224% for 35 to 49 year olds between 1995 and 2007.

Research from the National Cancer Control Programme found that approximately 5% of newly-diagnosed cancers and cancer deaths are attributable to alcohol, with around 900 cases and 500 deaths each year. The greatest impact was on organs of the upper aerodigestive tract. Cancer risk due to alcohol is deemed to be the same, regardless of the type of alcohol consumed, and even drinking within the recommended limits carries an increased risk. So what are we going to do about the misuse of alcohol?

My Department has submitted proposals to the Government based on the recommendations of the national substance misuse strategy report launched last year. These proposals cover all of the areas mentioned in the report, including: legislation on minimum unit pricing; the advertising of alcohol; sponsorship; labelling of alcohol products; and prevention and intervention activities on alcohol.

Minimum unit pricing is a mechanism whereby a statutory floor in price levels is imposed for alcohol products that must be legally observed by retailers. The primary function of this measure is to reduce at-risk levels of alcohol consumption, especially by those who drink in a harmful and hazardous way, and it would also have a greater impact on discouraging children from drinking. The primary aim of minimum unit pricing is to target harmful and hazardous drinkers and reduce their consumption. Another aim is an overall reduction in consumption across the entire community. The means of attaining both aims is increasing the price of alcohol that is cheap relative to its strength. This is because research has shown that harmful and hazardous drinkers tend to purchase disproportionate amounts of cheap alcohol, no matter what the income level of the drinker. Therefore, there is evidence that increasing the price of such cheap alcohol using minimum unit pricing should lead to a reduction in the consumption of alcohol by such harmful drinkers.

We have consulted and negotiated extensively with other colleagues in the Government. Of course we have to weigh up all of the different arguments before deciding how to proceed. Governments across Europe and elsewhere have already taken measures, while others are actively considering measures along the lines that we are addressing.

The Cabinet committee on social policy has considered these proposals and it is my intention to submit a finalised package of proposals to the Government shortly for consideration and approval.

Obesity, discussion on which must necessarily encompass lifestyle factors such as diet and levels of physical activity, is also a significant risk factor for cancer. The prevalence of overweight and obesity has increased at an alarming speed in recent decades, so much so that the World Health Organization, WHO, refers to it as a global epidemic. The high levels of obesity in all age groups of the Irish population are of increasing concern, but of particular concern are the rising levels of obesity in young children. The situation in Ireland mirrors the global obesity epidemic, with 61% of Irish adults now overweight or obese and an alarming figure of one in four children overweight or obese at three years of age.

Unfortunately, Irish children are consuming large amounts of energy-dense foods, often outside the home, while many are not engaging in sufficient physical activity to prevent excess weight gain. Most worrying is the fact that childhood obesity has reached epidemic proportions in Europe, with body weight now the most prevalent childhood disease. Some 26% of nine year old Irish children are overweight or obese. The WHO Europe Childhood Obesity Surveillance Initiative, COSI, in which Ireland participated in 2009, found that 23% of seven year olds were overweight or obese.

Obesity in adulthood drives the development and worsens the outcome of chronic diseases including cancer, type 2 diabetes and dementia. Between 70% and 80% of health care costs in Europe are spent on chronic diseases. Most of these health budgets are spent on treatment. Chronic disease management is a key challenge for future health care provision in Ireland. This challenge is not merely a financial one, but also an organisational one that requires a health system with a greater focus on prevention, co-ordination, continuity, integration and information flows that follow the patient. Approximately 80% of the overall disease burden in Europe is due to chronic diseases and the pattern in Ireland is similar.

Chronic conditions will generally increase by approximately 40% during the next ten years due to our aging population and the impact of lifestyle factors. This trend is not sustainable from a cost or hospital capacity perspective. A new model of structured integrated care involving primary care with an emphasis on prevention will be required. We need to shift our health systems away from a medical curative model of health care and encourage patients to participate actively in the management of their own conditions. There is evidence that patient empowerment improves health outcomes. Knowledge of the disease and its treatment not only improves quality of life but reduces dependency on health services.

In working to prevent chronic disease, it is of fundamental importance that we promote measures to increase physical activity generally, but especially among children, and that we continue to warn of the dangers of excessive consumption of foods high in fat, sugar and salt. Eating healthy food and being physically active are two of the most important steps that we can take to improve our health.

It is widely acknowledged that no single initiative will reverse the growing obesity trend, but a combination of measures should make a difference. For this reason, the special action group on obesity is concentrating on a specific range of measures, including actions such as calorie posting in restaurants, healthy eating guidelines, measures to restrict the availability of top shelf food and drinks, nutritional labelling, marketing of food and drink to children, the supply of healthy food products in vending machines, the detection and treatment of obesity and the promotion of physical activity. Many of these initiatives are at an advanced stage and the group will continue to liaise with Departments and organisations in a cross-sectoral approach to progress this area further and to help halt the rise in overweight and obesity. The healthy eating guide and food pyramid for the general public alongside the Food Safety Authority of Ireland, FSAI, guide for professionals are positive steps in the achieving this aim.

There is significant evidence that physical activity promotes well being and physical and mental health, prevents disease, improves quality of life and has economic, social and cultural benefits. However, the majority of Irish people do not meet the levels of physical activity indicated in the national physical activity guidelines. One of the commitments in the healthy Ireland framework is to develop a plan to promote increased physical activity levels across the population. The ambitious initial key performance indicator is to increase the proportion of the population across each life stage undertaking regular physical activity by 20%. A working group, which will be co-chaired by the Departments of Health and Transport, Tourism and Sport, has been established to develop this plan. It will provide a strong focus for modifying unhealthy life habits and promoting awareness of the benefits of physical activity, not just for health, but also in a wider socioeconomic context. It is hoped to have a draft plan completed by the end of 2013.

I commend the work the Seanad Public Consultation Committee has done in the area, and thank the committee for this opportunity to respond to the issues outlined in its report.

Improving our own health is a responsibility we all share. I firmly believe that we must harness all the resources available to us to work together to ensure that people can lead balanced and healthy lives. Although cancer is a serious threat to the lives and health of the population in Ireland I believe that our health policies are already addressing some of the key risk factors and I hope that future trends will reflect the progress that has been made.