Healthy Ireland - A Framework for Improved Health and Wellbeing

Objectives

Healthy Ireland is a whole-of-government and whole-of-society framework intended to enable everyone in Ireland to achieve their full potential for physical and mental health and wellbeing, with wellbeing valued, supported and recognised as a shared responsibility. It treats health as a resource for everyday life and focuses on prevention, equity and the social, environmental and economic conditions that shape health.[1][2][3]

• Increase the proportion of people who are healthy throughout all stages of life.[4][5]
• Reduce health inequalities, including differences associated with socio-economic status, education, poverty, housing, disability, disadvantage and social exclusion.[4][6][7]
• Protect people from threats to health and wellbeing through an all-hazards, risk-based approach encompassing infectious disease, food safety, environmental hazards, air and water quality, tobacco and emergency preparedness.[4][7][8]
• Create conditions in which individuals, communities and every sector can contribute to a healthier Ireland.[4][9]
• Address health determinants and lifestyle risks across the life course, including diet, tobacco use, alcohol consumption, physical inactivity, unhealthy weight, mental wellbeing and self-harm.[1][10]
• Prioritise early intervention, children and families, healthy ageing, prevention, early detection and support at key life transitions from before birth to older age.[5][11]
• Apply 64 integrated actions across 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.[4][3]

The framework is underpinned by equity, fairness, proportionality, openness and accountability, solidarity and sustainability.[3][12]It seeks to redirect attention and resources towards evidence-based prevention and health promotion, partly in response to the growing burden and projected cost of chronic disease, while supporting quality of life, participation, productivity and sustainable health services.[13][14]

Its Outcomes Framework is intended to cover health status, health inequalities, access to services, lifestyle-related risks and wider determinants, including measures disaggregated by life stage, socio-economic characteristics and geography.[15][16][7]Illustrative targets include improving healthy weight, fruit and vegetable consumption and physical activity, reducing smoking and alcohol consumption, reducing consistent poverty, and limiting salt intake.[10][7]

Implementation

Delivery is designed as an integrated, partnership-based model that combines national leadership, cross-sectoral policy action, health-service reform, local implementation, community participation, evidence generation and systematic measurement.[1][3][17]The Cabinet Committee on Social Policy, chaired by An Taoiseach, provides high-level oversight; the Department of Health Health and Wellbeing Programme leads strategic planning, co-ordination, tracking and monitoring; and the multi-stakeholder Healthy Ireland Council serves as a national advisory forum.[4][3]

• Develop high-level and detailed implementation plans for priority areas, with timelines, consultation across sectors and a directly responsible individual identified for each action.[4][18]
• Integrate health into environmental, social and economic policy through a Health in All Policies approach, supported by inter-ministerial committees, cross-sector action teams, legislative frameworks and Health Impact Assessment.[19][20]
• Coordinate Government Departments, the Health Service Executive, statutory agencies, local authorities, civil society, voluntary and community organisations, employers, businesses, academia, professional bodies, schools and families.[3][21][22]
• Support local action through partnerships involving local authorities, community groups, schools, primary care teams, sporting partnerships and local health partners, including community health and wellbeing assessments and information-sharing.[23][24]
• Empower individuals and communities through information, skills, motivation, health literacy, participation in decision-making and the removal or reduction of practical and legislative barriers to healthier choices.[19][6][22]
• Consolidate, reconfigure or develop strategies, guidelines and programmes as necessary, while integrating health and wellbeing goals into health-system governance and cross-directorate working.[9][25]
• Strengthen prevention, self-care, quality improvement and safe care close to home, alongside population health protection and rapid response arrangements for current and emerging threats.[26][8][27]
• Build workforce capacity through a health and wellbeing human-resource and development plan, baseline assessments and multidisciplinary teams for priority policy areas.[25]

Research and evidence are intended to inform objectives, funding strategies, communications, interventions and service delivery.[28]The framework calls for a Healthy Ireland research plan, audits of research capacity, collaboration with funders and academic institutions, stronger community profiling, better qualitative and quantitative reporting, and mechanisms for knowledge transfer into policy and practice.[28][29]

Monitoring and accountability are centred on an Outcomes Framework, planned for completion by the end of 2013, with standard indicators, baseline measures, targets where appropriate and an agreed measurement and evaluation model.[15][16]Partners are expected to demonstrate improvement against relevant indicators, while the Health and Wellbeing Programme is to establish standards and reporting requirements and report implementation progress through the Cabinet Committee on Social Policy.[15][17][18]Annual health and wellbeing updates and reports were envisaged, alongside periodic revision of the Outcomes Framework as data systems and priorities change.[15][16]

Operational data improvements include reviewing national and international indicator sets, strengthening data collection and quality controls, developing a National Immunisation Register and a basic child health dataset, and aiming to publish annual county-level health and wellbeing profiles.[15][16]The supplied material does not provide a comprehensive programme budget or funding allocation; the Health and Wellbeing Programme is intended to operate within existing resources.[3]

Monitoring & Evaluation

Healthy Ireland uses an outcomes-driven monitoring and accountability model centred on an Outcomes Framework, implementation plans, research and evidence development, and cross-government oversight. Monitoring, reporting and evaluation are one of the framework’s six themes, alongside governance, partnerships, community empowerment, health reform, and research and evidence.[4][3]

• Establish an Outcomes Framework with standard indicators, baseline measures, targets where appropriate, defined indicator levels, and an agreed measurement and evaluation model.[15]
• Measure progress across the four goals: healthy life across all stages, reduced health inequalities, protection from threats to health and wellbeing, and an enabling societal environment for health.[30][31]
• Track indicators covering health status, healthy weight, diet, tobacco, alcohol, physical activity, self-harm, mental wellbeing, health inequalities, access to services, wider determinants, and setting-specific conditions in schools, workplaces and hospitals.[16][10][7]
• Disaggregate reporting by life-course stage, socio-economic group, geography and relevant equality characteristics to identify disparities and support local planning.[16][7]
• Set and monitor quantified targets, including healthy-weight, diet, smoking, physical-activity, alcohol-consumption, poverty, salt-intake and immunisation measures.[10][7][17]
• Maintain statutory detection, surveillance and control arrangements for infectious diseases, while monitoring food safety, air and water quality, tobacco control and other public-health threats.[7]
• Develop a research plan, strengthen data systems and quality controls, audit research capacity, and improve qualitative and quantitative reporting by funded organisations to inform policy, programme assessment and future action.[28][29]
• Require partners to demonstrate improvement against indicators, establish baseline measures for cross-government collaboration, and periodically revise the Outcomes Framework as information systems, statutory requirements and policy priorities change.[15][16]

The Health and Wellbeing Programme in the Department of Health is to support, co-ordinate and track implementation, with actions reported to the Cabinet Committee on Social Policy.[9][3]The Cabinet Committee, chaired by An Taoiseach, is responsible for oversight, monitoring and resolution of common Government policies, targets and action plans related to health and wellbeing.[3]The Healthy Ireland Council provides a multi-stakeholder national advisory forum, while implementation plans are expected to identify a directly responsible individual for each action.[4][3]

Annual updates and an annual report on health and wellbeing activity are envisaged, with the Minister for Health presenting reports to the Cabinet Committee on Social Policy.[15]The framework also proposes a dissemination and data-reporting plan, with a longer-term aim of publishing annual county-level health and wellbeing profiles.[15][16]Local monitoring is supported through health and wellbeing assessments and integrated Social Impact Assessment tools for local authorities.[24]

Although the framework specifies broad domains, illustrative targets and governance routes, the supplied material does not provide a complete indicator catalogue, all target values, detailed evaluation designs, full reporting schedules or a single comprehensive surveillance methodology.[4][15][7]

Costing & Financing

Healthy Ireland presents prevention, health promotion and action on wider determinants as investments intended to reduce avoidable illness, improve productivity and lessen the risk of future healthcare costs becoming unaffordable.[13][14]It promotes evidence-based and cost-effective interventions, and proposes redirecting existing resources, accelerating existing initiatives and using partnerships to support delivery.[4][2]

• Establish the Health and Wellbeing Programme within existing resources.[3]
• Direct resources towards robust evidence-based initiatives, research capacity, knowledge transfer and evaluation where possible.[28][29]
• Maintain budget oversight, budget-control mechanisms and funding-allocation models as implementation-support requirements.[18]
• Address the economic burden associated with obesity, alcohol-related harms, mental health problems and tobacco-related disease.[32]
• Recognise that tobacco-related disease is estimated to consume 6% to 15% of the health budget, equivalent to approximately €1 billion to €2 billion annually.[13]

Public healthcare spending reached €15.5 billion annually in 2009 after more than doubling in real terms since 2000, and was reported as being directed mainly towards diagnostic and treatment services.[32]Estimated annual economic costs include €1.13 billion for obesity, €3.7 billion in alcohol-related harms to State resources, and €11 billion for mental health problems.[32]Smoking-attributable diseases were estimated to generate €280 million in hospital costs in 2008, in addition to productivity losses.[32][13]

No programme-wide budget, detailed costing methodology, financing allocation, named funding source, resource-mobilisation plan or quantified funding gap is specified for Healthy Ireland or its Outcomes Framework in the supplied material.[4][15][18]