Gaining health : analysis of policy development in European ...

Ireland
Anna Ritsatakis
1. Country profile
Ireland lies in the Atlantic Ocean, separated from Great
Britain by the Irish Sea. The President is head of state, with
a largely consultative role. Local government is composed
of 29 county councils, 5 county borough corporations, 5
borough corporations and some smaller entities.
In 1973, Ireland joined the EU. Irish is the first official language
and English the second.
1.1. Socioeconomic development
Entering the 1980s with high inflation, substantial external
debt and deteriorating public finances (1), this small open
economy achieved a remarkable turnaround in the following
decade. Unemployment dropped from around 18% in
the late 1980s to 4.4% in 2005, half the average rate for
the EU countries prior to 2004. GNP per capita rose from
US$ 18 230 in 1980 to US$ 26 960 in 2003.
Ireland’s economy is now one of the world’s most globalized
and has experienced annual growth rates above the
averages for developed countries. Growth rates averaging
10% were experienced in the period 1997–2000, while current
rates are of the order of 4–5%.
1.2. The people and their health
The population of Ireland has increased from 2.9 million in
1970 to 4.2 million. Some sources forecast an increase to
over 5 million in the next 10 years. With decreasing fertility
rates, the proportion of children aged 0–14 years in the
population fell from 31.3% in 1970 to 20.7% in 2005. The
proportion of people aged 65 years or more has remained
stable at around 11%, but the numbers of people living to a
very old age is expected to increase rapidly and, given the
widening gender gap in life expectancy, these will be mainly
women.
Life expectancy at birth increased between 1970 and
2005 from 68.5 to 77.3 for men and from 73.2 to 81.8 for
women. Until about 2000, this was the result of a rather
mixed picture. While the SDR for cerebrovascular disease
dropped rapidly, by 2000 it was still above the EU average.
Mortality from all cancers and particularly from lung cancer
in males aged 0–64 years dropped substantially between
1980 and 1990, but remained above the EU average in
2000. Since then, death rates from these diseases have
fallen below the average in pre-2004 EU countries.
Improvements in death rates for diseases affecting women
have been less evident. The SDR for cancer of the cervix
remains double the pre-2004 EU average (4.6 compared
to 2.3 in 2004) and the mortality rate for breast cancer in
women also remains above the pre-2004 EU average (30.8
compared to 25.7 in 2004).
Deaths from selected alcohol- and smoking-related causes
dropped very significantly from 1980, though the latter
remained well above the EU average in 2004 (252.6 compared
to 205.4 per 100 000 population).
The All-Ireland Study on Mortality 1989–1998 (2) showed
that there was a three-fold difference in SDRs between
men in the lowest and highest socioeconomic groups during
this period. The strong impact of occupational class was
evident for nearly all the major causes of death. While occupation
is recorded on death certificates, mortality data are
not routinely available by socioeconomic group and there
are inadequacies in the available data. More recent data for
2002, although not strictly comparable with the 1989–1998
data, indicate persistence in health inequalities, particularly
in areas such as heart disease, cancer, accidents and injuries,
and low birth weight.
Chapter 4
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Case studies: policy development in countries for tackling noncommunicable diseases