2nd November 2001
World Diabetes Day approaches and I had better get at the BMI again before I join the members of the Type 2 group. Minister Mary O'Rourke is doing her best to help me - the traffic is still so slow in Dublin it is wiser to walk everywhere. Cycling is out as the grim deaths under trucks continue. The last time I cycled down to Roy Fox's vegetable shop in Donnybrook I thought my end was in sight even though I was in what is jokingly called a cycle lane - it is just a slope into the gutter.
Being a fan of Dr. Jane Wilde, the director of the Institute of Public Health in Ireland and indeed of all the Institutes works, I got down to reading the report "Inequalities in Mortality" 1989 - 1998, a Report on All-Ireland Mortality Data.
To begin with, we in the Republic have a 6% higher mortality rate for all causes combined than in Northern Ireland. After adjusting for age the mortality rates from all causes, the main causes of death being circulatory and respiratory diseases, were higher in both parts of the island than they were for the combined EU countries. But, cheer up, we "compared favourably" with the EU average for deaths due to injuries, poisoning, infection and parasitic diseases. Even for deaths due to digestive diseases we are alright.
The report compares North-South death rates and the death rates of both parts separately and for the island as a whole with the EU average. The survey is fascinating. One is much more likely to be murdered in Northern Ireland if one is from a lower socio economic group and killed in a traffic accident for the same inferior station in life in the South. But soon I began to see that there was one patently obvious difference between the two jurisdictions - the statistics in Northern Ireland were far less likely to have a high number described as "unknown" than in the Republic.
For example, I will go back to diabetes. The death rates in both parts of the island was above the EU average. But in Northern Ireland a clear occupational class gradient in mortality could be seen with only a very small number of those who died classified as "occupation unknown". There were nearly ten times as many in the Republic classified as "occupation unknown" and no clear socio economic grading could be identified.
Sometimes both jurisdictions were affected. In the section on breast cancer the authors wrote "Occupational class differences in mortality from malignant neoplasms of the female breast were not assessed because of general problems associated with occupation coding for women".
We keep on saying that the rich are getting a better deal from the health service than the poor but some money is going to have to be put into getting the figures together to show this is so. There are huge lacunae in some areas. I suspect it is due to poor reporting and not to the Central Statistics office workings.
Worse followed when I read another report "Inequalities in Health in Ireland - Hard Facts", from the Department of Social, Community and Family Affairs. Amazingly data from the Perinatal Reporting System has not been published for eight years. In simple terms the last time the Perinatal Mortality Rate was published was 1993. This is unbelievable. The Perinatal Mortality Rate is recognised internationally as the accepted measure of the quality of maternity services and despite all the changes in the profile of women giving birth in the recent past we cannot really say what is going on in the Maternity services of the country.
The rise in the number of single mothers is so great that about one child in four is born to a single mother. Because we take the baby's father's occupation as the one to be used for socioeconomic grouping we have a huge number of mothers whose socio economic grouping is unknown. We do know that professional and salaried persons have a much lower perinatal mortality rate but all those "unknowns" are not helping us get accurate information about other groups. Also, why are farmers still classed together? There is a big difference in the lifestyle of a large farmer in Meath to a small holder in Leitrim.
In the foreword to this report by Joe Barry, Hamish Sinclair, Alan Kelly, Ros O'Loughlin, Deirdre Handy and Tom O'Dowd, Dr. Jim Kiely, the Chief Medical Officer of the Department of Health recognises the "genuine difficulties presented by incomplete and inadequate data" and says that despite that it is clear the international mortality rates for people in lower socioeconomic groups is higher for all causes. But suppose we were different (not that I seriously think we are) it would be impossible for us to find out.
A new health strategy is about to be launched after a very long gestation. It appears to me it will be based on very shaky statistics. Having the facts is usually essential to making good judgements but I suppose if one can say the facts weren't available it could give one a good excuse for policy failures if they occur in the long run.
Senator Mary Henry, MD
