Healthy Ireland - A Framework for Improved Health and Wellbeing

Objectives

Healthy Ireland is a whole-of-government and whole-of-society framework to enable everyone in Ireland to achieve their full physical and mental health and wellbeing potential, creating a healthier, fairer and more prosperous society in which wellbeing is valued and supported throughout life.[1][2][3]It seeks measurable improvements in population health by addressing the social, economic, environmental and behavioural determinants of health, while reducing avoidable health inequalities.[2][4]

• Increase the proportion of people who are healthy at every life stage by promoting protective factors, supporting healthy behaviours, preventing disease, enabling early detection and improving resilience.[5][3]
• Reduce inequalities between socioeconomic groups, occupational classes, geographical areas and other population groups by addressing poverty, deprivation, unequal exposure to risks and the wider circumstances in which people are born, grow, live, work and age.[5][3][6]
• Protect the public from threats to health and wellbeing through prevention, preparedness, surveillance, response and recovery, including action on infectious disease, food safety and environmental hazards.[5][6][7]
• Create conditions in which individuals, families, communities, employers, public bodies and all sectors can contribute to better health through lifestyle, community, policy and legislative action.[5][8]
• Apply a life-course approach, prioritising pregnancy, early childhood, adolescence, adulthood and older age, with emphasis on early intervention, healthy ageing and key transition points.[3][9][10]

The framework comprises 64 integrated actions and programmes organised under six themes: governance and policy; partnerships and cross-sectoral work; empowering people and communities; health and health reform; research and evidence; and monitoring, reporting and evaluation.[2][4]Its operating principles include equity, fairness, proportionality, openness and accountability, solidarity and sustainability.[4][11]

• Promote healthier everyday choices through health-promoting, sustainable and activity-friendly environments, health literacy, social connectedness, public information and community participation.[12][13][14]
• Prevent and manage major non-communicable disease risks, including tobacco use, alcohol harm, unhealthy diet, physical inactivity, overweight and obesity, hypertension, high cholesterol, poor mental wellbeing and self-harm.[15][16][17]
• Strengthen people-centred health systems oriented towards prevention, quality improvement, supported self-care and care delivered as close to home as safely and cost-effectively possible.[18][17]
• Integrate health into environmental, social and economic policy, recognising the health effects of housing, transport, education, employment, urban development, agriculture and environmental protection.[19][20][7]
• Use evidence-based and cost-effective prevention to improve quality of life and productivity while avoiding potentially unaffordable future costs from chronic disease.[21][9]

Implementation

Healthy Ireland is delivered through integrated, co-ordinated action across government, the health system and society, rather than through the health service alone.[1][12]The Cabinet Committee on Social Policy oversees implementation, common government policy, targets and action plans, while the Health and Wellbeing Programme in the Department of Health co-ordinates, supports and tracks action projects.[4]

• Establish a multi-stakeholder Healthy Ireland Council as a national advisory forum supporting cross-sectoral implementation.[5][4]
• Develop a high-level implementation plan, followed by detailed plans for priority policy areas, and assign a directly responsible individual to each action.[5][22][23]
• Consult government departments, health services and other sectors in preparing plans, and link individual programmes and initiatives to the framework’s four high-level goals.[5][8]
• Engage Government Departments, the Health Service Executive, statutory agencies, local authorities, civil society, community and voluntary organisations, employers, private organisations, academia, professional bodies, media, families and individuals in shared delivery.[4][24]
• Support local structures through which communities, schools, businesses, primary care teams, sporting partnerships and local authorities can work on common health and wellbeing priorities.[24][25]

Implementation combines national leadership and accountability with local autonomy, partnership working and evidence-informed policy development.[14][26]Cross-sectoral mechanisms include inter-ministerial and interdepartmental committees, formal multi-sectoral committees, Health Impact Assessment, integrated Social Impact Assessment, collaborative networks and joined-up workforce development.[19][4][24]

• Strengthen community support infrastructure and prioritise evidence-based prevention and early-intervention programmes for children, families, disadvantaged communities and groups facing the greatest disparities.[27]
• Develop the capacity of individuals and communities through health knowledge, health literacy, resilience, informed choice and participation in decisions affecting health and wellbeing.[19][13]
• Integrate public-health and environmental considerations into national, regional and local decision-making, including Environmental Protection Agency processes and local cross-sectoral assessments.[25][7]
• Assess workforce capacity, develop a health and wellbeing human-resource plan and establish multidisciplinary national teams for priority areas.[26]
• Build research, data and knowledge-transfer capacity with the Health Research Board, government departments, agencies, academic institutions, training bodies and professional organisations.[28][29]

Accountability is intended to rest on an Outcomes Framework, regular monitoring, defined indicators, baselines and targets where appropriate, and annual reporting on health and wellbeing activity to the Cabinet Committee on Social Policy by the Minister for Health.[30][31]The framework is to be developed collaboratively, assess existing information systems, address data gaps and enable reporting across health and other sectors, including longer-term county-level profiles where feasible.[30][31]

• Measure health status, lifestyle risks, health inequalities, access to services, child health, wider determinants and public-health threats using standard indicators.[30][31]
• Disaggregate indicators where possible by life stage, setting, demographic, socioeconomic, educational and social-exclusion characteristics.[31]
• Monitor immunisation, infectious disease, environmental and food safety, and relevant International Health Regulations and World Health Organization requirements.[22]
• Review and revise the Outcomes Framework as information systems develop and policy, statutory or European Union requirements change.[31]
• Establish the Health and Wellbeing Programme within existing resources; the supplied text does not specify an overall programme budget, allocations or funding sources.[4]

Monitoring & Evaluation

Healthy Ireland establishes an outcomes-led monitoring and accountability system linking its four high-level goals, 64 actions and cross-sectoral implementation arrangements. It combines an Outcomes Framework, research and data development, regular measurement, action-level responsibility and reporting to central government oversight bodies.[5][4][30]

• Develop the Healthy Ireland Outcomes Framework by the end of 2013 to provide an objective assessment of impact, define baseline measures and establish indicators for each goal.[30]
• Set measurable targets where appropriate, require delivery partners to demonstrate improvement, and measure indicators regularly to assess progress over time.[12][30]
• Cover health status, healthy life expectancy, health inequalities, access to services, child health, lifestyle risks, wider determinants, public-health threats and participation across society.[32][30][31]
• Disaggregate indicators where feasible by life-course stage, setting, demographic, socioeconomic, education and social-exclusion characteristics, and produce county-level outcomes and profiles in the longer term.[31]
• Monitor health status and inequalities using measures such as morbidity, mortality, chronic disease, healthy weight, diet, smoking, alcohol use, wellbeing, physical activity, poverty and socioeconomic disparities.[15][6]
• Maintain statutory surveillance, detection, control and response for infectious diseases, alongside monitoring of immunisation, food safety, air and water quality, fluoridation, and International Health Regulations and World Health Organization requirements.[6][22]
• Use potential uptake targets of 95% for childhood immunisation and 80% for human papillomavirus immunisation where baselines are available.[22]
• Consider proposed targets including a 5% increase in healthy weight among adults and 6% among children by 2019, a 20% increase in adults consuming five or more daily portions of fruit and vegetables, a 1% annual reduction in smoking prevalence and youth initiation, alcohol consumption of 9.2 litres of pure alcohol per person aged over 15 annually, and a 20% increase in regular physical activity.[15]
• Recognise that proposed measures for self-harm, suicide, population wellbeing, child development at age five, school retention and self-reported happiness do not have specified targets.[15][6]
• Develop a research plan to improve access to current data, scientific knowledge, evaluation tools, research capacity, knowledge transfer and evidence use in policy and service delivery.[5][28][29]
• Improve data quality by identifying data-collection methods, applying controls and quality assessments, assessing existing national and international indicator systems, and addressing information gaps through strengthened partnerships.[29][30][31]
• Develop standard indicators and a robust measurement and evaluation model for cross-sectoral commitments, health and wellbeing targets, performance indicators, quality standards and progress audits.[28][29]
• Use Health Impact Assessment and integrated Social Impact Assessment to evaluate population-health and distributional implications of policies, programmes and projects.[19][4][33]
• Assign a directly responsible individual to each action, track integrated projects through the Department of Health Health and Wellbeing Programme, and report progress to the Cabinet Committee on Social Policy.[5][8][4]
• Produce annual updates and an annual report on health and wellbeing activity for presentation by the Minister for Health to the Cabinet Committee on Social Policy, supported by a dissemination and data-reporting plan across sectors.[30]
• Require public-sector organisations and workplaces to include commitments to health and wellbeing in corporate, strategic or business plans, and audit publicly funded departmental programmes intended to improve health and wellbeing.[24][27]

Some sections provide principles or descriptive statistics rather than operational detail. Outside the Outcomes Framework and specified surveillance arrangements, the material does not consistently specify indicator definitions, reporting intervals, quantitative targets, evaluation methodologies or accountability mechanisms.[32][4][16][18]

Costing & Financing

Healthy Ireland does not provide an overall costed implementation plan, programme budget, quantified allocation, funding source, funding gap or resource-mobilisation target in the supplied material. It instead emphasises prevention, cost-effectiveness, stronger budget oversight and more effective use of existing resources.[4][15][23]

• Establish the Health and Wellbeing Programme within existing resources, while using it to co-ordinate and monitor implementation.[4]
• Focus and redirect existing resources, accelerate current initiatives and use evidence, monitoring and evaluation to improve resource use.[12]
• Apply cost-effectiveness as a criterion for policies and programmes alongside robust evidence, international best practice, integration with service delivery and measurable impact.[5][12]
• Require budget oversight, budget-control mechanisms, governance arrangements and evidence-based funding-allocation models, without specifying monetary amounts.[23]
• Recognise prevention and early intervention as means to reduce future healthcare costs, improve productivity and achieve better value, with early-years intervention described as offering a greater rate of return than later intervention.[21][9][10]
• Identify chronic disease growth, new technologies and more effective treatments as pressures that could make future health costs costly or unaffordable unless health systems remain financially viable.[2][18]

The material quantifies major economic burdens: public healthcare spending reached 15.5 billion euro per annum in 2009; obesity was estimated to cost 1.13 billion euro annually; alcohol-related harms 3.7 billion euro annually; and mental health problems 11 billion euro annually.[34]Tobacco-related disease was estimated to consume 6% to 15% of the total health budget, equivalent to 1 billion euro to 2 billion euro annually, while smoking-attributable hospital costs were estimated at 280 million euro in 2008.[34]

These figures describe health and economic burdens rather than committed Healthy Ireland funding. No financing strategy, budget allocation, funding source or quantified funding gap is specified for the framework, research plan, Outcomes Framework or related implementation actions.[34][28][30]