Strategic Measures Will Address our Serious Over-Consumption of Alcohol

October 24, 2013 § Leave a comment

Today I published a government-approved package of measures, which for the first time will comprehensively address our societal misuse of alcohol.

This is a landmark day. It is the first time alcohol misuse has been addressed as a public health issue. The Government has recognised the severe consequences of the misuse of alcohol – including deaths, injuries and social and financial problems – and has determined to take action to address this problem. The package of measures to be implemented is the result of intensive discussions across Government departments, and will include provision for minimum unit pricing for alcohol products and the regulation of advertising and marketing of alcohol.

To implement this range of measures, the Government approved the drafting of the first ever piece of public health legislation to address the problem – the Public Health (Alcohol) Bill.

The package of measures is based on the 2012 Substance Misuse Report. The Report correctly identified that the misuse of alcohol could only be addressed through a range of complementary measures rather than one particular measure. This range of measures is the result of intensive discussions across Government departments. I compliment the time and energy my government colleagues shared with me to advance this major public health initiative. I look forward to their continued support as we progress this much needed legislation.

Urgent yet considered action is required. The average Irish person over the age of 15 is consuming the equivalent of a bottle of vodka a week. Tragically we see the results of alcohol misuse every day in our A&E Departments and regrettably more widely in every community across Ireland. These measures will help address our problem of alcohol misuse and hopefully rebuild an environment where responsible consumption of alcohol is the norm.

Free GP Care an Essential Element of an Effective Health System

October 18, 2013 § Leave a comment

The government has decided to extend free GP access to all children aged 5 and under. It is a move that will benefit many young families. But it is much more than a budget ‘gain’ for one group or sector. Rather, it is the first step in achieving universal access to GP care without fees, and the ultimate transformation of our health services.

Health budgets worldwide are under enormous pressure because of rising costs, ageing populations, and the ever-increasing challenges associated with illnesses such as diabetes, cardiovascular and other chronic diseases. We need a radical shift in the way we manage our health system.

The best way of starting would be to facilitate easier access to GP services, so that health problems are identified before they get serious, and people get guidance on how to manage their lifestyle – to avoid becoming ill.

The evidence is clear that people delay or avoid visiting their GP where a fee is required, and this cost barrier is not confined to the less well-off. We should remove this barrier, and extend access to GP services without fees to the whole population.

There is a good reason why GP care without fees is the norm in Northern Ireland, Britain and across Europe: because it makes sense and it works. Far from being a “stunt” or a gimmick, it is an essential step towards the achievement of an effective and equitable health service for all our citizens.

It has been suggested by some that healthcare should be targeted, and not made universal. But for our health system to succeed we need to “target” the entire population. The old approach of waiting for people to become sick before we intervene is just not going to work for the future.

Others have questioned why we are starting with young children. Along with older citizens, young children constitute a public health priority. If we can provide the right interventions at early ages, we can make a huge difference for people in their middle and later years. The evidence for this quite simply is indisputable.

It has been suggested that this measure will favour the wealthy at the expense of people in greater need. This is not so. The vast majority of families to benefit from this initiative are average, working families on low or middle incomes – they are hardly millionaries.

Even if a small number of wealthy people no longer have to pay to bring their children to the doctor, it is right that we should have a universal service in primary care, just as we have for services like child health screening and surveillance programmes, or immunisation. Does anyone question the fact that wealthy parents do not pay for their children’s primary school education?

The controversy over discretionary medical cards points up a fundamental issue:  in a modern civilized society, the allocation of healthcare should not be based on discretion or a means test. It should be a basic right. And the funding of healthcare at all levels – whether through taxation or insurance – should ensure fairness by requring that citizens contribute to that funding in accordance with their income.

This government has to address two sets of challenges simultaneously. On the one hand, we must maintain the current inadequate system in a fair and prudent manner. On the other, we must pursue a radical reform programme to end our two-tier healthcare structure.

Full universal access to GP services is a critical first step, and an essential one if we are to have any chance of addressing the health needs of the Irish people in the years and decades ahead.

Alex White is Labour TD for Dublin South and Minister of State for Primary Care

Celebrating Scoil Mhuire’s Third Green Flag Success

October 8, 2013 § Leave a comment

Scoil Mhuire, Ballyboden I recently visited Scoil Mhuire in Ballyboden to help raise their third Green Flag, which the school was awarded for water conservation.

I was honoured to help the pupils and teachers of Scoil Mhuire raise their third Green Flag. It’s an amazing achievement. Congratulations to all of the children and their teachers for their incredible hard work and commitment to environmentalism.

The dedication of the school is very impressive. To think that Scoil Mhuire has already won a green flag for litter reduction and a second green flag for energy conservation. Now they have been awarded their third green flag which commends water conservation. There really is no stopping the success of Scoil Mhuire.

It is great to see the next generation taking responsibility for our environment and showing adults how it’s done.

Opening of Dublin Simon Community HIV respite/stabilisation service in Ushers Island

October 5, 2013 § Leave a comment

Dublin Simon HIV ServicesOn Friday I had the honour of launching the Dublin Simon Community’s new respite and stabilisation unit for people with HIV. Here are some of the remarks I made:

I am very pleased to be here today during ‘Simon Week’ to officially open Dublin Simon’s new HIV respite/stabilisation service in Ushers Island.

Dublin Simon has helped many people over the years to improve their lives from incredibly challenging circumstances – assisting people on a pathway out of homelessness, helping to rebuild their lives and become part of the wider community.

Today, I am honoured to launch the expansion of Dublin Simon’s services that will provide help to people living with HIV.

I am particularly pleased to be here as I am aware that this event marks the culmination of two years hard work. These services will ensure that HIV patients with addiction problems can access accommodation and support.

I understand that this new service is already providing a more amenable care pathway for HIV patients where they have a safe place to rest while managing their complex illnesses.  In this regard, it is great that each patient can avail of 24/7 qualified nursing staff, a visiting primary care GP Monday to Friday, access to on site counselling and a key worker to address their complex needs, be they related to their health, housing or family.

The launch of the Dublin Simon HIV Respite Stabilisation Unit will help to provide greater effective working relationships within the community and help to integrate clients into services that they require e.g. counselling and holistic therapies etc. These new arrangements will lead to better outcomes for patients and help to enhance their lives.

It is very positive to learn that since its opening the unit has already looked after 60 patients, including patients previously treated in the Rowan Ward.  This new service is not only supporting existing patients, but also managing to reach others who are in need.  The long list of services that refer their patients here is testament not only to the fact that this facility is needed, but also that it is held in high regard by the experts in this field.

I commend all those involved in the establishment of this important service and in the successful transfer of the patients from the Rowan Ward to this new setting.  It provides a very positive example on how the HSE and NGOs such as Dublin Simon can work together to address the needs of patients within the current constrained financial situation.

I commend Dublin Simon which has been doing outstanding work for over 40 years, helping some of the most vulnerable people in our society.  They have helped homeless men and women address their physical and mental health issues, as well as overcoming addiction on their journey out of homelessness.

I especially thank them for their dedication in responding to local needs and providing innovative local solutions such as this new facility.  I congratulate you all and wish you continued success in all you do.

Go raibh maith agat.

RTE Interview on Benzodiazepines with Maia Dunphy

October 4, 2013 § Leave a comment

Maia Dunphy Interview In Maia Dunphy’s RTE Documentary ‘What Women Want’ she explored  increased benzodiazepine use amongst women in Ireland. She interviewed me as part of her documentary which you can watch on RTE Player here. 

The National Drugs Prevalence Survey found that there had been a 40% increase in the number using sedatives and tranquillisers between 2007 and 2011. The misuse of drugs doesn’t just take place on our streets, but also in our homes, amongst our friends, colleagues and neighbours. I recognise the problem of the misuse of prescription drugs in Ireland. That’s why the Department of Health is currently reviewing the Misuse of Drugs regulations.

My intention is that additional controls on benzodiazepines and z drugs being traded illicitly will be introduced including:

  • import and export controls on benzodiazepines and z drugs
  • an offence of possession without entitlement (e.g. a prescription) which will assist the Gardai and customs.

Consideration is also being given to the introduction of additional and stricter prescription-writing requirements on benzodiazepines including:

  • A restriction of the period of validity of benzodiazepine prescriptions
  • A restriction of the quantity of benzodiazepines that may be dispensed.

I’d hope that these tighter controls would remind both prescribers and patients of the nature of these medicines and of their potential for misuse. With these restrictions, prescribers would need to use a specific prescription form, sign and date the prescription. They would also be required to set out detailed instructions of the drug including the instalments and intervals that the drug is to be dispensed.

Fluoridation as a Public Health Policy in Ireland

October 3, 2013 § Leave a comment

Water fluoridation and the use of appropriate fluorides is a major plank of public health policy in Ireland in the prevention and management of tooth decay. This policy has been subject to recent debate. Evidence-based research proves that water fluoridation is a safe and effective public health policy.

The Irish Expert Body on Fluorides and Health was established in April 2004. The Expert Body and its sub-committees have broad representation from areas such as dentistry, biochemistry, environmental health and public health medicine. The sub-committees of the Expert Body may also co-opt members as the need arises, for example in toxicology, and seeks the advice of experts in other specific fields when required.

I and my Department believe that it is important that policy makers and the public have access to independent, evidence-based, expert advice on this issue and are satisfied that the Expert Body provides such advice. The opinion of the Expert Body is supported by major international scientifically validated reviews. The effects of fluoride on health and related matters are kept under constant review.

You may find a detailed response to the questions posed by the editor of Hot Press on these matters of some interest: 

Hot Press Questions:

(1) What evidence does the Minister or Department have to prove that fluoride is safe for long-term daily consumption by humans? Note: since the Expert Body on Fluorides and Health is without expertise in toxicology, we do not regard safety assurances from this source as an answer to this question.

Water fluoridation is the adjustment of the natural concentration of fluoride in drinking water to the optimal recommended level for the prevention of dental caries (tooth decay).  The only known side effect of optimal levels of fluoride in water is enamel fluorosis, and this has been known since the 1930s. A number of other claims have been made in various media in relation to water fluoridation and potential health issues but none of these claims has been substantiated. 

Safety is determined from the available scientific evidence. This evidence has been examined in detail by panels of experts from many diverse fields of science including medicine, dentistry, biochemistry, toxicology, environmental sciences and engineering. 

Comprehensive and systematic reviews have been conducted in many countries including the United Kingdom (York Review 2000, Medical Research Council 2002), Australia (2007), Canada (2010) and most recently the European Union (2011). None of these reports has established any basis for considering that artificially fluoridated water poses any systemic health risks. 

The Forum on Fluoridation, established by the Minister for Health in 2000, and which had senior representation from a broad range of relevant sciences, considered the issue of water fluoridation. They found there was no evidence at that time of any negative health effects, stating that 
“The best available and most reliable scientific evidence indicates, that at the maximum permitted level of fluoride in drinking water at 1 part per million, human health is not adversely affected” (Forum on Fluoridation, 2002). 

The Irish Expert Body on Fluorides and Health was established in April 2004. The Expert Body and its sub-committees have broad representation from areas such as dentistry, biochemistry, environmental health and public health medicine. The sub-committees of the Expert Body may also co-opt members as the need arises, for example in toxicology, and seeks the advice of experts in other specific fields when required. The Minister of State and the Department believe that it is important that policy makers and the public have access to independent, evidence-based, expert advice on this issue and are satisfied that the Expert Body provides such advice.

(2) Has the Department carried out any research to ascertain the effects, other than in relation to tooth decay, of the fluoridation of the water supply in Ireland? If not, why not? And on what basis has the claim been made that the policy is having no adverse health impacts on Irish people’s health?

The only known side effect of water fluoridation is enamel fluorosis, which is a cosmetic or aesthetic condition which refers to the way teeth look; it is not considered to be an adverse health effect. 

The Department of Health, in addition to monitoring the impact of water fluoridation on dental decay, has also rigorously monitored enamel fluorosis and responded to evidence of change in fluorosis levels. In the National Survey of Children’s Oral Health (1984) it was found that lifetime residents of fluoridated communities had substantially lower levels of dental decay than lifetime residents of non-fluoridated areas. The levels of fluorosis found were at levels predicted on the basis of the initial studies in the United States in the 1940s on communities served by naturally fluoridated water. Some 18 years later in the 2002 study on Children’s Oral Health, again it was found that levels of dental decay were substantially lower in lifetime residents of fluoridated communities, but there had been an increase in the levels of enamel fluorosis. Since the levels of fluoride in water had not changed over this period, the most likely explanation for this change was the increased use of fluoridated toothpaste which had been introduced to Ireland in the early 1970s and became widely used in Ireland by the 1980s. The EU FLINT study, which involved seven European research groups, had reported that parents tended to commence toothbrushing of children at too young an age, that too much toothpaste was being placed on the toothbrush, and that young children had a tendency to swallow the toothpaste. As a result of these findings, The Forum on Fluoridation introduced two strategies to minimise fluorosis. The first of these was in relation to the appropriate use of fluoride toothpaste, and the second was to lower the level of fluoride in water from a range of 0.8 to 1.0 parts per million (mg/l), with a target of 0.9ppm, to a range of 0.6 to 0.8ppm with a target of 0.7ppm, in order to account for the extra availability of fluoride to the population. This second approach was consistent with evidence from Canada following research by Locker et al. 

Regarding general health, the Department of Health considers evidence on all health effects in relation to all health issues from across the globe. For example, we accept the evidence that smoking is harmful even when none of the studies linking smoking to ill health effects were conducted in Ireland. We do not need to repeat these studies here in order to establish that smoking is harmful for people living in Ireland. 

The same is true in the case of water fluoridation, which is one of the most widely studied public health policy initiatives in the world. The Department of Health uses information from across the globe in order to assess the health impact of water fluoridation. Public health workers in Ireland make use of official statistics published regularly by the World Health Organisation, the OECD, the European Union and others in order to monitor health trends. 

In Ireland, there was a study into cross-border rates of osteosarcoma (Comber et al, 2011) as a result of concerns raised in the United States regarding the plausibility of a link between this condition and fluoride exposure. This study did not show any difference in disease rates between fluoridated and non-fluoridated communities. Since the Comber et al study was published, definitive results from two major studies in the United States has shown no association between fluoride exposure and osteosarcoma (Kim et al 2011, and Levy et al 2012).

(3) Does the Department know what the average level of fluoride is in the urine, blood, bone and hair of people in the State?

The determination of the fluoride concentration in body fluids such as urine and blood is useful as an indication of recent fluoride intake only (see Question 4 below). Renal fluoride excretion varies, moreover, with urinary flow and pH. Therefore, the term “average level of fluoride” has little real meaning, as these values vary widely during the course of a single day. There is no clear-cut relationship between fluoride content in bone and extracellular fluids. 

One of the best biomarkers for fluoride absorption is the level of enamel fluorosis in the population. Irish researchers have rigorously monitored this condition for over 30 years.

(4) Have attempts been made to collect such values on a systematic or scientific basis? If not, why not?

No, because there is no reason to do this. The Department agrees with the views of the EU Scientific Committee on Health and Environmental Risk (SCHER) working group that: 
“At present, there are no reliable biomarkers to assess fluoride exposure. The Working Group and SCHER expressed concern over the use of urinary biomarkers as indicators of fluoride exposure because they are considered to be unreliable due to fluctuations in urinary flow and pH which influence fluoride output. Therefore data from the UK National Diet and Nutrition Survey of 2000-2003 providing evidence of 24-hour urinary fluoride output and water fluoride concentration have not been presented in the opinion. A paragraph to this effect has been added to the SCHER opinion, and development and validation of appropriate biomarkers recommended as a research need.” (SCHER Report explanatory note 2011). 

As stated in question 3 above, the meticulous monitoring of enamel fluorosis is widely regarded as a reliable and non-invasive method for ongoing monitoring of fluoride exposure. 

The measurement of the fluoride content of nail clippings is a promising technology which is currently in development (Whitford). 

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The Case for Retention of the Seanad Has Failed, Vote YES on Friday

October 3, 2013 § Leave a comment

On Friday people have an opportunity to improve our democracy, to reform our government and legislature, and to change the way our politics works.

For those three reasons it is vital that people use their ballot and get out in numbers and vote Yes for the abolition of the Seanad.

In doing so people will be voting for real reform. Not only by doing away with an outmoded second chamber that is no longer fit for purpose. But also by precipitating further reforms of the Dail to ensure that we have a more effective and better functioning parliament.

In the absence of a yes vote, the status quo will remain. We will still have a second chamber that is unrepresentative, undemocratic, and unnecessary. People must understand that a no vote will not lead to a reformed Seanad. Rather, it will mean that a chamber that has long outlived its sell-by-date will remain in place.

Throughout this campaign I have heard the arguments from the No side.

Largely they concentrate on the potential of the Seanad, rather than anything it has done to date.

I have seen various proposals for reform. But none of these offer a new purpose or vision for the Seanad that can’t be done in a properly functioning Dail.

I have listened to suggestions to change the way we elect people to the second chamber. But none of these address the elitism that is inherent in drawing exclusively from special interest groups.

The Seanad belongs to a different time and a different period in Irish history. It was established to ensure representation for a particular group – unionists – that would not otherwise have been heard.

That concern no longer exists, and there is no clearly identifiable ethnic, social, or other group that requires such representation.

The case for retention of the Seanad has failed. The people now have the opportunity to have their say, and I would urge as many as possible to come out and cast their vote in and support Friday’s referendum.

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