WE toast it, we abuse it, we crave it when we lose it — there are some things neither money nor Mastercard can buy, and good health is one of them.
Despite its being a priceless commodity, the level of dedication to maintaining good health varies widely.
While faulty genomes, family history, and genetic background are the inescapable curse of the unfortunate few, there are plenty among us who give little thought to the impact of negative lifestyle choices on our future wellbeing, even though our continued good health is largely ours for the choosing.
However, for many, socio-economic factors such as unemployment, low educational attainment and poverty can have a significant bearing on health.
For instance, a study of Irish childhood obesity published earlier this year found children growing up in low-income homes are twice as likely to become obese as those who are better off.
The potential knock-on effect of this is higher diabetes levels among the same socio-economic group due to the link between obesity and diabetes. In fact, the experts’ mantra is that obesity makes you more prone to a whole range of conditions including heart attack and stroke, high blood pressure, some cancers, osteoarthritis — the list goes on.
Further evidence of the effects on our health of our socio-economic background are highlighted in the comprehensive SLÁN study published in 2009 which found more affluent, better-educated women are more likely to go for cancer screening. Screening can lead to early detection and treatment and better outcomes.
The same study found smoking, the main cause of lung cancer, was more prevalent in the lower classes.
And so there are many variables that come into play when it comes to determining our health, detecting ill-health and the type of treatment we receive — but how about where we live?
If you look at some of the cancer statistics contained in this publication, you will see huge variations between some Irish counties in incidence and death rates for the four cancers we included.
For instance, the death rate from lung cancer in Galway is approximately 27 per 100,000 while the rate in Carlow is approximately 55 per 100,000. That’s an alarming 28 additional deaths per 100,000 in Co Carlow. Carlow also has the highest death rate from non-melanoma skin cancer.
The National Cancer Registry has examined geographical variations in cancer risk and cautions that they “do not mean that the spatial location itself causes cancer”, but rather they are “likely to reflect socio-economic differences in the population, geographical differences in exposure to risk factors and, for some cancer sites, variations in access to, or uptake of, screening or other cancer services”.
This NCR caveat should be born in mind when reading this publication — we are not saying your health is governed by where you live, but we are saying it may be impacted:
* If you live in an unemployment blackspot where household income is low;
* If you live in an area where access to health services is poor or where the level of service available is substandard;
* If you live in an area where population-based public health campaigns are non-existent or ineffective;
* If you live in an area where exposure to risk factors is high.
We don’t draw any conclusions. The purpose of this project is to set out in one publication county-by-county statistics under a variety of health indices and to give our readers food for thought.
Drawing on a multiplicity of sources (see right) and a variety of measurements, we break our analysis down into approximately 20 categories, looking at areas such as cancer, respiratory illness, diseases of the circulatory system, disability, obesity, diabetes, child mental health, infant mortality, breastfeeding rates, suicide rates, problem alcohol use.
We also look at the level of medical card coverage across the country and the level of access to GPs. Where the figures were available, we compare county rates to the national average: For example, nationally, 55.2% of infants were breastfed in 2011, but on an individual county level, the percentage breastfed ranged from as low as 37.8% in Limerick to as high as 62.1% in Dublin. Similarly, for suicide, the national average was 11.5 deaths per 100,000, but in Cork City, that soared to 17.6, while falling to 6.3 per 100,000 in parts of Dublin such as Dun Laoghaire and Fingal.
Where individual figures were not available as indicators of incidence rates, we use ranges. For instance, the number of hospital admissions for respiratory illness in 2011 ranged nationally from 1,500 to 3,500 per 100,000 population, as per figures from the Institute of Public Health.
These ranges are broken down further to give a better indication of how individual counties fare eg in Kerry and Roscommon, admissions rates for respiratory illness are lowest in the country at 1,500-1,750 per 100,000, compared to 3,250-3,500 per 100,000 in Co Sligo, at the top end of the scale.
Ranges are also used in measuring diabetes, obesity, death rates from diseases of the circulatory system, percentage of the population with a medical card and the number of GPs per 100,000. The results of our data mining threw up more questions than answers. Why, for instance, are obesity levels so high in the border counties?
Why does Longford have the highest percentage of low birthweight babies?
Why does Cork city have the highest suicide rate?
Why does Dublin have the highest breastfeeding rates?
And why does Co Carlow appear to be a lung cancer blackspot?
We offer some tentative, non-academic opinions as to what may lie behind some of these contrasts, solely for the purpose of stimulating debate and perhaps prompting a more robust and scientific analysis.
Sources of health data
1. Population: CSO, area profiles, Census 2011 (census.cso.ie/areaprofiles/)
2. General Health Rating: CSO, area profiles, Census 2011
3. Disability: CSO, area profiles, Census 2011
4. Child disability: State of The Nation’s Children — Ireland 2012, Department of Children and Youth Affairs (www.dcya.gov.ie/viewdoc.asp?fn=/documents/.../StateoftheNationReport...)
5. Respiratory Illness: The Health Well, Institute of Public Health (www.thehealthwell.info)
Original source: HIPE (Hospital InPatient Enquiry, 2011).
Each HIPE discharge record represents one episode of care. HIPE is managed by the Healthcare Pricing Office. HIPE does not collect private hospital data. (www.hpo.ie)
6. Cancer: National Cancer Registry, incidence rates for years 2009-2011 annual average, and mortality rates for 2011 (www.ncri.ie). Figures contain margin of error.
7. Death rates from disease of circulatory system 2012: Public Health Information System (PHIS) — Department of Health. (data provisional, as published in Health in Ireland: Key Trends 2013, Department of Health)
8. Obesity: The Health Well, Institute of Public Health. (www.thehealthwell.info)
Original source: SLÁN 2007, (Survey of Lifestyle, Attitudes and Nutrition in Ireland, respondents aged 18+)
9. Diabetes: The Health Well, Institute of Public Health. (www.thehealthwell.info)
Modelled estimate (2010) of number of adults who have been told by a doctor in the previous 12 months that they have diabetes (Type I and Type II)
10. Infant mortality: CSO Vital Statistics 2011
11. Percentage of low birth rate babies: National Perinatal Reporting System, 2011 (www.hpo.ie), as published in State of The Nation’s Children — Ireland 2012
12. Rate per 1,000 of hospital discharges of children: Census 2011; Hospital In-Patient Enquiry, 2011, as published in State of The Nation’s Children — Ireland 2012
13. Rate of admissions of children to psychiatric hospitals: Census 2011; National Psychiatric In-Patient Reporting system 2011 (www.hrb.ie), as published in State of The Nation’s Children — Ireland 2012
14. Number of general practitioners per 100,000 people: The Health Well, Institute of Public Health, 2011, based on information from the HSE’s Primary Care Reimbursement Service.
Included are 481 GPs not contracted to the GMS Scheme who are registered to provide services under the Primary Childhood Immunisation Scheme, the Health (Amendment) 1996 Act, Heartwatch, Methadone Treatment Scheme and National Cancer Screening Service.
15. Percentage of population with a medical card: Primary Care Reimbursement Service. (as published in Health in Ireland: Key Trends 2013, Department of Health. Excludes GP Visit Card.)
16. Problem alcohol use: Health Research Board (2014) Treated problem alcohol use in Ireland figures for 2012 from the National Drug Treatment Reporting System. Available at http://www.drugsandalcohol.ie/21518/
17. Suicide by Area of Residence 2007-2011: National Suicide Research Foundation (www.nsrf.ie)
18. University College Dublin Geary Institute discussion paper series: From Angela’s Ashes to the Celtic Tiger: Early Life Conditions and Adult Health in Ireland (unskilled manual workers and infant mortality rates).
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