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Health Protection Inequalities - Time for an All Ireland Approach

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Health Protection Inequalities - Time for an All Ireland Approach

  1. 1. Health Protection Inequalities - Time for an All Ireland Approach Dr Lorraine Doherty Assistant Director Public Health Public Health Agency, NI 18 February 2016
  2. 2. Health Protection Practice Communicable Disease – Surveillance, Prevention and Control Chemicals, Radiation and Poisons Environmental Health, Emergency Planning and Response
  3. 3. Tackling HP Inequalities All Ireland Approach  NI and ROI - both wider policies, strategies on tackling health inequalities.  To date - no in-depth consideration of the issues around inequalities in respect of infectious diseases or in other health protection areas.  Working group (PHA and HSE/HPSC) -scoping paper, sponsored by Institute of Public Health
  4. 4. Infectious Diseases & Inequality  Infectious diseases disproportionally affect the most socioeconomically deprived communities.  Not restricted to a few ‘signature infections, such as TB or HIV, but also a wide array of other infectious diseases.  Elevated infectious disease rates in vulnerable populations pose a health threat, not only to them, but to society at large.
  5. 5. Ireland - Tuberculosis notification rate by county of residence; 2011 Vulnerable Populations – Infectious Diseases  Homeless, people who inject drugs, people in prison, those who are unemployed, young children.  Migrant populations, e.g. the Roma population.  Migrant populations from countries with a high prevalence of infectious diseases are disproportionately affected by HIV, STIs, TB, Hepatitis B and C, and a range of other infections.
  6. 6. New HIV diagnoses in Northern Ireland, by year of diagnosis, by country where infection was acquired, 2000–2013 By heterosexual route of infection
  7. 7. MSM HIV New HIV diagnoses in Northern Ireland, by year of diagnosis, by country where infection was acquired, 2000–2013, MSM Route of Transmission
  8. 8. Number of tuberculosis notifications In Ireland and rate by country of birth and year of notification
  9. 9. MRSA – link to Socioeconomic Deprivation  Study in London.  All MRSA cases in 4 month period in a three borough catchment area mapped to area SE and demographic data. Cases classified as Healthcare Associated (HA) or Community Associated (CA) based on WGS.  Conclusions – HA-MRSA originate from hospital reservoir. CA- MRSA – higher risk in areas with overcrowding, homelessness, low income, and recent immigration to UK.
  10. 10. Children/Young People at Risk of not being fully Immunised  Missed previous vaccinations (whether as a result of parental choice or otherwise)  Looked after children  Physical or learning disabilities  Children of teenage or lone parents  Not registered with a GP  Younger children from large families  Children who are hospitalised or have a chronic illness  Those from some minority ethnic groups  Those from non-English speaking families  Vulnerable children, such as those whose families are travellers, asylum seekers or are homeless.
  11. 11. Irish Travellers  Higher risk of vaccine preventable diseases.  Risk factors – living conditions, health risk behaviours, low immunisation uptake, poor access to services, misinformation.
  12. 12. Roma Migrants  Largest ethnic minority in Europe  Over 25% of Roma children are not fully vaccinated  May live in poverty, have low socioeconomic status, thus are more vulnerable to diseases such as TB, measles, and Hepatitis.  Discrimination, marginalisation may affect access to healthcare Homeless: A Romanian family after being forced from their Belfast home Read more: Homeless: A Romanian family after being driven out of their Belfast Home
  13. 13. Refugees  Arriving in Ireland from war torn countries, prolonged deprivation as a consequence of conflict.  High rates of tuberculosis, malaria, hepatitis, intestinal parasites, and nutritional deficiencies. Mental Health issues.  Social isolation, unemployment, difficulties accessing services. 
  14. 14. Climate Change
  15. 15. Health Impacts Climate Change Extremes of weather –  Heat-waves → Heat related mortality, affects elderly and other vulnerables  Flooding → already problem in UK & Ireland. Effect on health and welfare; disruption of services, lack of clean water, infectious diseases, mental health issues.
  16. 16. Global warming and Vector Borne Disease  Direct impact on vector distributions which may carry disease.  Direct impact on human behaviour leading to changing patterns of exposure. Examples  Altered incidence of arthropod borne diseases transmitted by ticks (e.g. Lyme disease), by mosquitoes (e.g. chikungunya, Zika, Dengue).  Increased risk of mosquito populations establishing in UK and Europe.
  17. 17. Zika Virus Disease and Inequality ‘Zika’s spread in Brazil is a crisis of inequality as much as health’ ‘it’s no coincidence that most Zika-related microcephaly cases were found in the north- east of the country: of course, the weather there is hot, which is prime breeding ground for the Aedis aegypti, but it is also where most of Brazil’s poverty is concentrated’. Nicole Froio
  18. 18. Politics, Economy and Ecology  Biological environment is shaped by and shapes society and economy.  Africa – long history of strife, deals done with multinationals, industry; impact on environment, e.g. deforestation - animals closer to humans – zoonoses.  Similarly – pandemic 2009, influenza strains, SARS, Mers- CoV. Ebola 2014-15 Deforestation at border between Guinea & Liberia. Bats in closer contact with humans.
  19. 19. Impact of Financial Crisis  The economic crisis will adversely impact employment and increase migration.  Economic hardship - associated with higher risk of infectious diseases by virtue of increases in poverty, migration, homelessness, unemployment, and malnutrition.  Restricted access to health care.  Health services cuts and restructuring leading to reduced capacity to respond to infectious diseases.  Preventive services are most vulnerable to disinvestment (e.g. immunisation services in vulnerable populations), as well as surveillance programmes, hospital infection control activities and capacity of systems to respond to outbreaks.
  20. 20. ECDC – AID Framework Action: Building the information base, and ensuring the dissemination of key findings through collaboration with key stakeholders, specifically action: enhance member states capacity to act on health inequalities among vulnerable groups. Information: Advanced evidence through studies and investigations, and by leveraging the existing data sources such as the European surveillance systems. Dissemination: Communicate best practices and expand networks to key actors and stakeholders in the field.
  21. 21. North-South – Areas for Action  Strengthen surveillance and monitoring of health inequalities in infectious diseases/health protection issues.  Developing data linkages, e.g. between infectious disease datasets and indices of deprivation, postcode etc. – e.g. TB and ‘One Health Approach’.  Strengthening prevention in specific areas - while considering population-at-risk, entire population and vulnerable populations.  Linking tackling health protection inequalities to the wider work on tackling health inequalities, e.g. migrant health, homeless.  Strengthening collaboration with existing organisations who work to address health needs of diverse and disadvantaged communities.
  22. 22. Forward Action  North- South Forum on Health Protection Inequalities – Leadership, joint work programme – advocacy composite logic model.  Raising awareness of health protection inequalities amongst politicians, policy makers, health services, public and across other government sectors.  Actively disseminating and sharing information on health protection inequalities.
  23. 23. Acknowledgements Health Protection, PHANI - Cathriona Kearns, Michael Devine, Neil Irvine IPH - Elizabeth Mitchell, Owen Metcalfe HPSC - Darina O’Flanagan, Derval Igoe, Suzanne Cotter, Joan O’Donnell, Paul Mc Keown, Lelia Thornton HSE - Kevin Kelleher

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