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27 September 2001 Edition

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Health study highlights inequalities

BY MICHAEL PIERSE

The creation of a new, unhealthy underclass of single Dublin males, a sharp divide between health in urban and rural areas and insufficient data on the health of poor people and women are among the findings of a new report compiled by the Department of Community Health and General Practice at Trinity College Dublin.

Joe Barry, the Senior Lecturer at the Trinity Department says that the report, titled `Inequalities in Health in Ireland - Hard Facts', is ``not new news - but it can't be said often enough''.

The expertise of GPs, public health specialists, statisticians and other specialists was invoked by the Trinity team, who compiled the report with Health Board sponsorship. The inequalities in healthcare in the 26-County area were identified by comparing different occupational groups and geographic locations. The resulting report forms part of a growing body of work pointing to increasing gaps in living standards between lower and higher socio-economic groupings in the 26 Counties.

Four key elements of health and healthcare were examined: mortality, pre-natal, mental health and acute hospitals. ``The report shows poor people have worse health in all of these areas,'' Barry says.

In particular, unskilled, manual male workers are identified as far more likely to suffer from health ineqality. They are twice as likely to die prematurely as higher professionals and eight times more likely to die as a result of accidents than higher professional men. This news is likely to intensify calls from trade unions (as reported elsewhere in today's An Phoblacht) for better safety standards in workplaces, most notably building sites.

Unskilled, manual male workers are almost four times as likely to be admitted to hospital for the first time for schizophrenia than higher professional workers.

People in the unskilled, manual socio-economic group have worse health than professional groups for all ages and in all the categories of health problems studied. Unemployed women are more than twice as likely to give birth to low-weight babies as women in the higher professional socio-economic groups.

A sharp divide between the health of urban and rural dwellers has also been identified. Premature death seems to be worse in medium-sized towns than in cities and rural areas, with medium-sized towns also showing high levels of heart disease and cancer.

Insufficient health data is identified as a major problem by the report. This is evident in several areas, and common to one sex. The recording of data on women is significantly hampered by their arcane classification (in medical data) by their husband's occupation, rather than their own. Aptly described by Dr Muiris Houston in Tuesday's Irish Times as ``Taliban-like in its inequality'', this classification makes comparison impossible between women with different occupations impossible.

Another difficulty, criticised by the report, is the growing number of ``unknowns'' - people who are not classified by any socio-economic category and who have the worst health of all groups. Almost half of the deaths in this group occurred in Dublin. This criticism suggests a need for an updated system of data recording on death certificates provided by doctors. ``We have made recommendations for better data collection,'' Barry says.

With an election figuring somewhere in political events over the next few months, establishment parties have taken a renewed interest in the health issue. Consistent opinion polls have rated the issue as Number One on the list of public concerns and the publication of policy proposals by the PDs this week, combined with the impending publication of a Dublin government health strategy document in coming weeks, are only some of the media spectaculars that will emerge during the pre-election period.

Whether and how they propose to tackle the issues identified in the Trinity report remains to be seen.
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