Thank you very much and good morning everybody.
It’s an absolute pleasure to be here.
And on my behalf and on behalf of Laura we would really like to welcome you
and to thank you for coming to today’s event.
I would urge all of you to go and feel what it’s like to turn on a TV with your legs.
There’s a bike in the room behind us and by putting a lot of effort
into its rotation it’s supposed to demonstrate how much energy
goes into producing electricity and it’s a good thing to do.
So if my heart is still palpitating that’s actually why.
So I’m here to talk to you this morning about
the HSE’s strategy to improve health and wellbeing of our population,
of our service users, of our patients, of our staff
and indeed the communities in which we work.
And the approach that we are taking is very much informed by government policy
in relation to the Healthy Ireland Framework.
And initially I want to touch off
on the broader global context within which this framework,
I think, is best situated.
If we look at the Rio declaration in Principal 1
it states that human beings are at the centre of concerns for sustainable development.
They are entitled to a healthy and productive life in harmony with nature.
And we know that the goals of sustainable development can’t be achieved
if we have significant levels of debilitating illness.
And we certainly can’t maintain population health improvement
without ecologically sustainable development.
And there is an increasing focus globally
and indeed within other jurisdictions
in relation to the impact that the environment has upon health.
Estimates coming from the World Health Organisation,
that 23% of all global deaths are linked to the environment,
and two thirds of those due to non-communicable diseases,
such as stroke, heart disease and unintentional injuries and cancers.
And if we look at the sustainable development goals,
and we specifically look at Goal 3
which is to ensure that health and wellbeing is there for all at every stage of life.
So that’s looking from reproductive health, maternal health, child healthy,
communicable and non-communicable diseases,
looking at safe, effective access to medicines and to vaccines for people.
It talks about better investment in terms of health systems, in terms of universal healthcare.
It talks about strengthening capacity, of course,
very importantly from an environmental protection point of view
to risk and risk reduction and management, and indeed increased health financing.
And we know, of course, that unhealthy environmental conditions
increase the risk of both non-communicable and infectious diseases.
And that is very much reflected strongly, I think,
in the integrated nature of those sustainable development goals.
We know, and there are estimates, with regard to the number of people
who die globally from infectious diseases,
whether that’s from faecal contamination in water,
whether it’s from inadequate hand-washing facilities and hand hygiene,
or indeed whether it’s from household or ambient air
pollution across different jurisdictions.
And indeed, if you look at recent EPA publications
you will see that we still have some way to go
with regard to addressing traditional environmental threats to health.
At the same time we also need to address emerging environmental threats.
And sustainable development Goal 13 calls for urgent action
to combat climate change and its impacts.
It actually states that climate change presents the single biggest threat
to development and its widespread, unprecedented impacts
will disproportionately burden the poorest and the most vulnerable.
Urgent action to combat climate change and minimise its disruptions
is integral to the successful implementation of the sustainable development goals.
So health has become more of a central concern in development,
both as a contributor to and indeed as an indicator of sustainable development.
And while health is a value in its own right, it’s also key to productivity.
And from our perspective in relation to looking at health and wellbeing,
there’s actually a really interesting emergent literature
in the whole area of wellbeing,
where we can see that improved levels of individual wellbeing,
and in particular community wellbeing,
is related to lower levels of crime within those communities,
lower levels of violence, higher levels of employment,
higher levels of education and higher levels of economic output and social cohesion.
And indeed some jurisdictions are looking at,
certainly supported by academic evidence,
at the value of looking at population measures of wellbeing
as better indicators of social and economic output
when you compare it to measures like GNP.
But, of course, the piece that’s underpinning Healthy Ireland,
that links it to the broader global sustainable development goals,
is that many of the key determinants of health and disease,
as well as its solutions, lie outside of the actual direct control of the health sector itself.
So it lies in the environment.
It lies in relation to water and sanitation, agriculture,
trade, housing, education, employment, energy, cross-border travel,
which of course means that
we really need to take a much more systemic approach
to how we concentrate our efforts around improving health,
addressing health inequalities and addressing risks to health within the population.
And indeed there’s a huge amount of initiatives and endeavours happening
that take on board those issues, trying to drive improved community health.
And you will be familiar with a lot of those.
In Ireland here we have a significant amount of work
being led by our local authorities with regard to having age-friendly cities and counties.
Yesterday there was a launch of the next phase of our healthy cities and counties.
And you will see another stand out in the room behind you this morning explaining about that.
And within the health service we are playing a key role
and an important role in working to support our partners
and in acknowledging the leadership that they are providing
in relation to improving the health and improving the living conditions of the citizens
within those geographic boundaries and within the country as a whole.
And as I say, addressing the underlying determinants of health is key,
of course, to ensuring longer term sustainable development.
The Healthy Ireland Framework really is a rallying call.
It provides a mandate. There’s a level of authority behind it.
Progress in relation to its implementation is reported into a Cabinet committee on social policy.
The Department of Health is responsible for co-ordinating and driving
the implementation of it across other government departments.
Its goals are about improving the health of the population,
reducing health inequalities, protecting the public from threats to health and wellbeing
and creating an environment whereby every sector of society can play its part.
And I suppose for us within the health service, why is this really important?
Or why do I think it’s important to think of the bigger picture
in relation to population health improvement and health inequalities?
Within the health service in Ireland we know that we are going to see an increase
in demand of between 20% and 30% over the next 10 years.
We know that rising demand in the health service that we can see now
and that we can project into the future is attributed to
increasing levels of the numbers of people within the population,
and the population is ageing.
It’s ageing faster in Ireland than it is anywhere else in Europe.
And that unfortunately, whilst we are living longer, we are not living longer in good health.
We have a significant issue with regard to increases in chronic diseases
which are attributed to those five or six things there on the bullet points on the list.
And we know that in order to address those risk factors
we need to go back to what we have been talking about
with regard to the broader social determinants.
And within the healthcare system,
what we know is that by having a larger population
that is ageing that we need to ensure the prevention,
that early detection, that self-care and self-management
for chronic diseases underpins our work.
And that we need to be as concerned about health as we are about hospitals,
as Duncan Selby mentioned in the UK some time ago.
And indeed the fact that we are living longer brings with it
such fantastic opportunities, but we need to make sure that the trends
correct themselves so that actually those opportunities can be realised.
From a health service perspective it means that we need to look at care
for people as they age outside of hospitals,
within communities and within people’s homes,
and looking at the opportunities that are there
through technology and so on and so forth.
And you can see there we have much better data.
There’s a lot to be done with regard to improving health system data,
but we have much better data coming from longitudinal studies in Ireland.
We have a longitudinal study in ageing, a longitudinal study in children,
and we know, for example, from the TILDA study
that 80% of adults in Ireland over the age of 50 are overweight or obese.
And indeed the clinical, the social, the psychological
and the financial implications of rising levels of obesity
are still to be determined,
but we certainly know that there’s a lot that we need to be doing about it.
So we talked about the broader risk factors,
so I’m putting this here, this spaghetti kind of diagram.
It comes originally from the Foresight Report in the UK,
looking at the determinants of obesity.
And we know that we cannot address rising levels of obesity
by purely looking at the individual. There are systemic risks.
There are systemic issues ranging from food production to food distribution,
to farming, to parks, to playgrounds, to education, to housing,
similar to the list that I mentioned previously.
And in order to address that the kind of global direction
and the European direction through Health 2020 Framework is about health in all policies.
Some jurisdictions are legislating for that,
and it’s interesting to see the impacts that that’s having
in terms of policies across government.
But again from a health perspective
what we are trying to ensure is that framework has sticking power.
That it can transition across the political cycle
and that we can build much greater energy through partnerships,
like the partnerships that we have with the EPA
and that is evidenced today in the work that we are doing together
to ensure that we can deliver on the broader agenda.
That means that within the health service we actually have to walk the walk and talk the talk.
So we are actively trying to do what I mentioned earlier,
which is embed prevention, early detection, self-care, self-management,
into our clinical models of care.
And in fact looking at our own health and wellbeing,
our own environments from a green point of view,
but also from a staff health and wellbeing point of view.
It’s fair to say with regard to the Healthy Ireland Framework
that there are some elements of it that are very specific to the health service also,
particularly with regard to health protection.
So protecting the public from threats to health and wellbeing,
and ensuring that we have effective strategies and interventions
to protect the public from threats to health and wellbeing
is an important part of that agenda.
That’s an example of some of the things that we are trying to do.
And as much as we are looking at convergence at the national level,
and I would say there’s a lot there to discuss,
maybe for another day, with regard to convergence,
globally across these kind of like issues.
Certainly within Ireland we have burgeoning strategies
coming from different government departments,
whether it’s on ageing or dementia, whether it’s on transport,
whether it’s on technology, whether it’s on better outcomes
brighter futures for our children.
And what we are trying to do within the health service
for the piece that we are responsible for
is to put in place strong implementation capability
for translating those strategies into tangible actions
across the health service, having leads in place and ensuring
that we have good research and good communications capacity
to bring those strategies to life.
And the Healthy Ireland Framework is very much alive and kicking
within the health service right now, which is really good,
in terms of building partners, building a network of leaders
and advocates for this agenda, which is very challenging.
Obviously I’m very proud to work in the health service,
and I work with absolutely amazing colleagues
who deliver great care, from a patient perspective,
but a great environment as well to try and do things differently.
We know, as Margaret Chan once said,
that the threats to global health and the profile
in terms of what health looks like across different jurisdictions
and indeed within them from a health and equalities perspective
means that a business-as-usual approach is no longer tenable.
And Healthy Ireland is really about saying
that actually we are not doing the business-as-usual approach,
we want to do something different.
We acknowledge that that’s challenging
but we certainly feel that within the health sector
we have got a whole load of champions and people who are pioneering this agenda.
And we know that it won’t deliver unless we make it stick,
and unless we ensure that the approaches that we are taking are built into our systems.
So how do we take this big huge document within the health service?
Well what we did was, we identified three priority actions,
one around health service reform - everything that we do to reform the health service
has to take cognisance of that particular approach
- reducing the burden of chronic disease – we have over 100,000 staff in the health service.
We have millions and millions of contacts every day.
We have connections into people’s homes, into people’s communities
– we can make every contact count.
And improving staff health and wellbeing,
and we have an implementation infrastructure to deliver that
through our nine community healthcare organisations
and we have new leads of health and wellbeing, some of whom are here today
- and you are very welcome - through our hospital groups,
through our national services and divisions.
And Jane Carlin is here today, who is the Head of Health Business Services,
is responsible for all the estates and facilities, procurement,
all of those functions play a critically important part
in terms of making the Healthy Ireland Framework come to life in the health service.
And of course our partners, reaching out both from a citizen point of view,
and indeed from a private sector and public sector point of view.
The foundations underpinning it are around structure reform.
Any changes to structure reform, like the creation of those new community healthcare organisations,
we have a Head of Health and Wellbeing at the senior management team.
Financial reforms – how do we incentivise this behaviour over time?
How do we ensure that hospitals that have lower rates of healthcare,
associated infections, are rewarded differently to others?
Through service reform, through our partnerships,
through integrated care programmes and models of care,
if we want to embed prevention, early detection and self-care,
then we need to prescribe them in an evidence-based way,
working with our clinical leaders to design those pathways,
and obviously acknowledging information being critical to it.
So that’s currently how we are conceiving this big picture,
Healthy Ireland Framework, in terms of the health service
and our role to create much stronger advocates
for this agenda over time.
So as much as we are trying to create networks in health
and networks with our partners,
I think that the next phase of this
for exploration really,
we are only really just thinking about it,
is how do we actually network the networks.
And I think that today that’s what elements of that is actually about.
We have a long history of collaboration with our goal of protecting the public
from threats to health and wellbeing with the Environmental Protection Agency.
And tangible elements of this collaboration include
the HSE’s participation on the EPA’s health advisory committee,
and the publication of a range of joint papers.
However, last year both organisations recommitted themselves to this goal
by signing a Memorandum of Understanding
which has led to even closer ties, including the co-funding of research,
again examples of which can be seen in the room behind us today.
And I think that both myself and Laura and our teams
feel very strongly that we probably do need to move away
from that business-as-usual approach,
making sure that we are both fulfilling our statutory responsibilities,
and collaborating, but maybe collaborating at a higher level
to deliver a greater good,
and maybe mobilising more support across our partners,
and the public sector and the private sector taking that community approach.
There’s no doubt that the challenges to creating a truly healthy population are significant,
trying to do it within a health sector where you don’t get any credit,
I would think probably you would all agree,
positively reinforcing your work on a daily or a weekly
or even an annual basis, if you look at the papers
in relation to the health service in Ireland.
But there is great work happening
and there’s great work happening through the leadership within local authorities in Ireland
- some fantastic people working and wanting to support this agenda.
But we do need to work much more smartly if we are to deliver it.
I think there’s a lot to be gained from looking across those policies,
from a convergence point of view,
lots of local authorities in Ireland, particularly some of the smaller ones,
don’t have the capacity to be able to take on board
an age-friendly agenda plus a healthy city and counties agenda,
plus a suicide prevention agenda.
And when we look at it, the actual high-level outcomes and objectives
that we should all be working to from a measurement point of view are actually the same.
I would like to finish with a quote from Martin Luther King which is:
“All of life is interrelated.
We are all caught in an inescapable network of mutuality,
tied to a single garment of destiny.
Whatever affects one directly affects all indirectly.”
And I think that if we think about that from the perspective of
the bodies that we are born with, the air that we breathe,
the families that we have,
the communities that we are in, the environment that we live in,
I think that it’s quite a profound statement,
and a nice one to finish on.
So thank you all for listening.
0:00:00 / 0:00:00
Dr. Stephanie O’Keeffe, National Director, Health & Wellbeing
Healthy Ireland – strategic approach within the HSE