I recently had a week wandering around Ireland (perhaps not relevant beyond the blogosphere), including exploring local bookshops (getting more familiar to followers of research sites and think tanks), and found Sarah Burke’s recent Irish Apartheid: Healthcare Inequality in Ireland (Dublin: New Island, 2009). She analyzes four main points:
- the Irish government does not have a comprehensive public health strategy and pays little attention to upstream preventative strategies and health promotion; instead the focus is on acute health services with little consideration paid to the roots of ill health in broader social inequality;
- health and social services have been relatively under-funded and do not provide universal care for those who need it most. In times of economic crisis, the need for basic universal services is even greater;
- the two-tier healthcare system has been attenuated, with those able to pay or afford private health insurance able to get far quicker access to crucial diagnoses and treatment. She highlights a much publicized case in which a woman who, without access to private care, did not get her cancer diagnosed and treated early enough and died
- while it has gone largely unnoticed, government policy, funding and regulations have quietly supported the steady growth of the private system at the expense of the public.
These issues are not so dissimilar to trends and challenges faced in Canada and other wealthy countries. Learning from other countries can often serve as an important caution for directions not to take.
Burke also describes the many research, advocacy and community groups who have been addressing these problems, and sets out policy directions to build a fairer public health system and reduce health inequality in Ireland.
- building public support and political momentum for a truly public and universal healthcare system;
- directly addressing inequitable access and investing in better availability of primary care and specialist services;
- directly addressing the systemic roots of ill health in poverty, inequality and wider social conditions, and creating a comprehensive population health strategy;
- enhancing services and support for people with chronic heart, mental health and other conditions – areas where Ireland compares especially poorly to other European countries;
- building a comprehensive continuum of primary care and community-based and continuing services;
- challenging the incentives to providers, the privileged position of private care within public hospitals and the government’s support for increased privatization of services;
Just as the terribly unequal two-tier system in Ireland shows graphically where not to go, these types of initiatives can also provide hopeful lessons for those working towards health equity here and in other countries.