Catherine Conlon: New priorities needed to change our unhealthy, unequal, and dissatisfied world

The constant emphasis on economic progress as a measure of a country’s wellbeing has failed us, given the high levels of physical and mental ill-health in rich countries.
Catherine Conlon: New priorities needed to change our unhealthy, unequal, and dissatisfied world

Students of four national schools in Clonakilty town gathered for the Big Cycle To School. Picture: Dermot Sullivan

The Healthy Ireland (HI) survey is an interview-administered survey of health and health behaviours of people living in Ireland, commissioned by the Department of Health, and carried out by Ipsos.

In this sixth wave of the survey since its inception in 2015, the starkest findings centre around mental health and suicide.

One in 10 people under 35 reported trying to take their own life over the last two years. Over two thirds of those who responded (67%) knew someone who has died by suicide, with 14% knowing someone close to them who has died in this way. 

Almost one in 10 (9%) of those with a long-standing health problem report trying to take their own life.

Low income

Michael Marmot in the Health Gap (2015) highlights the huge impact trying to survive on a low income has on both mental and physical health: "Trouble paying bills pressure at work, when you are worried about a sick child, demands from the landlord that cannot be ignored, then the heating fails, and the partner gets laid off and becomes morose." 

All contribute to the lack of control that builds up to an ongoing chronic stress that compounds chronic ill health.

Budget 2023 highlighted the urgency to address the needs of low-income groups in terms of changes in taxation and social transfers that target cost of living, as well as key areas such as childcare, education, and health. These services are critical for narrowing the health gap between low-income groups and the better-off.

Budget supports that will assist low-income groups include welfare and State pension increases, once-off fuel allowance payments, increases in the living alone allowance, significant tax credits for renters, a higher point of entry for paying the top rate of tax, a doubling of welfare and pension payments, and an extra child benefit payment.

Cutting childcare bills by 25% is a first step in facilitating families in all income brackets to being able to retain a reasonable take-home salary after paying for childcare. For the first time, more than half the population will be eligible for a GP visit card or GMS card, and inpatient fees are to be abolished.

Grants for carers and people with disabilities will also help to support these groups and keep people who are in need of services in the community and out of hospital.

These supports are a critical first step in addressing the wide gap in mental health between high- and low-income groups in our communities.

Obesity

In terms of weight, the HI survey reports that 56% of the population aged 15 and over report that they are overweight (35%) or obese (21%). These figures are self-reported as opposed to being measured in person as in previous rounds of the survey, where results tend to be more accurate.

These findings are comparable to rates across Europe. A World Health Organization (WHO) report earlier this year confirmed that obesity in Europe has reached ‘epidemic proportions’, causing at least 200,000 cancer cases and 1.2m deaths per year. Almost a third of children and 59% of adults in Europe are now overweight or living with obesity.

"We live in a world where we have easy access to cheap and delicious food and where it’s really easy to be sedentary all day," said Julianne Williams — co-author of the report and WHO’s technical officer for noncommunicable diseases.

We know our children are being barraged with advertising, increasingly in the digital world, even when they’re on video games, they’re seeing ads for foods high in fat, sugar, and salt." 

She added that Europe’s low breastfeeding rates were another risk factor associated with higher levels of obesity.

Where you live, work and play can have a huge impact on the risk of developing obesity. 

Safefood research in 2020 showed that low-income households need to spend up to a third (35%) of their income to buy the minimum essentials for a healthy food basket. The cost of food for a teenager was almost double that for a preschool child.

We know a key driver of overweight and obesity is the profit-driven flooding of the market with cheap, energy-dense, nutrient-poor food and drinks. Legislation preventing the placing of confectionary and other unhealthy products at the end of aisles and checkouts, as well as a ban on promotions such as 'buy one, get one free', would reduce pester-power for parents out shopping with young children.

Benjamin, 11, with his mother Susan Jane White and Ciaran Cottrell, 13, as they voiced support for the addition of a ban on junk food marketing to children. Picture: Sasko Lazarov/Photocall Ireland
Benjamin, 11, with his mother Susan Jane White and Ciaran Cottrell, 13, as they voiced support for the addition of a ban on junk food marketing to children. Picture: Sasko Lazarov/Photocall Ireland

If we know what the problem is, why are we dithering to solve it?

In June 2020, the newly elected Government committed to addressing obesity in Ireland with the Public Health (Obesity) Act, including restricting the marketing of unhealthy foods to children. 

This legislation is likely to be fiercely opposed by the food industry as has happened in the UK. But it has the potential to have an impact and is overdue, with the capacity to give parents and children an opportunity to have a "fair chance to make the healthy choice". 

For too long Government has bowed to the free market economy of low taxes and light regulation. The political will to confront the food industry with much-needed legislation that addresses the rights of children to a healthy diet is long overdue.

Alcohol

The HI survey reports ongoing high levels of binge drinking (six or more drinks in one session) in Irish society. Last year 22% of those who drink over a six-month period were considered binge drinkers. That figure has risen to almost a third (32%).

In recent years, alcohol has become more readily available, and advertising more sophisticated. All of this has had an impact on consumption rates. Irish teenagers have one of the highest rates of binge drinking in Europe, and liver disease is rising — particularly among women.

What is missing from much of the conversation around alcohol consumption is the huge harm inflicted on the fabric of society by alcohol companies in the pursuit of profit and wider market share.

This year saw the introduction of a minimum unit price (MUP) for alcohol in Ireland, following a long campaign and evidence from Scotland and more recently Wales, of its effect in reducing consumption among some of the heaviest drinking households. 

The research concluded that MUP "is an effective policy option to reduce off-trade purchases of alcohol and should be widely considered". It will be interesting to watch this space in terms of binge-drinking habits of Irish adults in future rounds of the Healthy Ireland survey.

Economic growth

In modern times, gross domestic product (GDP) has become a measure of a country’s wellbeing. If the economy is growing, then things must be good. If it is shrinking, then not so much. Using GDP to measure how well we are doing is increasingly at odds with reality.

The Covid pandemic highlighted a distorted view of the world with the constant emphasis on economic progress as measured by GDP. This model has failed us, leaving behind an unhealthy, unequal, and dissatisfied world on the verge of environmental meltdown.

High levels of physical and mental ill-health in the wealthiest countries in the world will not improve until we challenge the hugely damaging impact of profit-driven economies on chronic disease and mental health.

Dr Catherine Conlon is a public health doctor in Cork and former director human health and wellbeing, safefood.

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