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Summary by Dr Patricia Walls

The Irish have the highest death rates in the UK according to a conference attended by Caroline Flint MP, Minister for Public Health.

'The Irish Die Young', held on 31 January at the London King's Fund, exposed the urgent need for services to respond to significantly higher rates of heart disease among the Irish than most other ethnic groups. The conference also highlighted the ongoing failure to specifically deal with Irish health within local delivery plans and wider government targets.

Not only do people born in Ireland die much younger than other people in England, those born in England with Irish-born parents and grandparents die earlier too. According to Dr Gabriel Scally, South West Regional Director of Public Health, who chaired the conference, this is a " quite remarkable situation".

Professor Roger Boyle, National Director for Heart Disease, Department of Health added that "there is clearly a big issue and a big public health issue about the Irish population".

The conference's focus was on coronary heart disease (CHD). Between 1989-1992 CHD standardised mortality ratios for people aged 20-44 years were 49% higher for Irish males and 20% higher for Irish females. Among Irish people aged 45-59 years, CHD deaths showed an excess of 32% for Irish males and 41% for Irish females.

Professor Boyle stated that "we need to now be much more proactive in terms of identifying those people in our society where special attention needs to be placed. And clearly Irish people living in this country are one group".

Dr Mike Knapton, Director of Care and Prevention, British Heart Foundation, pointed out that the Irish have the highest prevalence of cardiovascular disease (CVD) in men and women of all ethnic groups. Although he found that prevalence rates of heart disease among the Irish was not as high as among Indian and Pakistani populations, although still high, the Irish compensated for this by having an excess prevalence of Stroke - and unexpectedly this was even higher than the well-known prevalence found among Black Caribbeans. "CVD is a disease of deprivation and we at the BHF are committed to tackling inequalities in CVD and therefore, the Irish issue is an issue for us," he explained.

There was widespread acknowledgement by speakers from the Department of Health and Trusts that prior to the conference many service planners and providers, including themselves, had been largely unaware of the health needs of the Irish or the extent of their health disadvantage.


Ignorance about the poor health of the Irish was "endemic across the whole of the NHS," said Professor Boyle. "We need to raise awareness amongst the professional community to address this." Averil Dongworth, Chief Executive Barnet and Chase Farm Hospitals NHS Trust, agreed that raising awareness was vital, especially amongst GPs who currently lack information on Irish health issues.

Married to the lack of awareness was the admission that the health service was not addressing Irish needs in service planning. However, many of the speakers felt that dealing with the Irish was necessary given their impoverished health profile. Professor Boyle felt that health professionals need to "find a way of factoring in Irishness as a risk factor, just as we've done for South Asian people and for the Afro-Caribbeans".


Speakers drew parallels with other ethnic minority communities' experience of gaining recognition at health service level as a model for how the Irish community might move forward to work in partnership with a range of organisations to raise awareness, access treatment and prevent further community ill health.

Mina Bhavsar, Head of Service Improvement, Leicester City PCT, talked about the lessons the Irish might learn through the success of Project Dil which reduced CHD risk within the South Asian community and which was developed as a model for other interventions. She stressed the importance of focusing on the similarities in terms of the challenges and solutions between the South Asian and Irish communities, rather than on differences. Ms Bhavsar argued that change would only come when Irish ill health was given national acknowledgement.


Bridget Riches, Director, National Programme Delivery, Health Improvement Directorate, said she would raise Irish health with her Programme Leads in the Department of Health and would inform them that "there are voices out there that need to be listened to, just as strong for the Irish population as there are for other minority groups".

Various speakers presented solutions aimed at improving Irish health in the UK, and dealing with coronary heart disease in particular. These ranged from dealing with a range of lifestyle factors which make the Irish at particular risk of significantly worse health, such as heavy smoking levels, high alcohol intake and poor diet. Caroline Flint MP emphasised that the prevention and treatment should be regarded as equally important within health delivery and reiterated her Department's aim to better target communities and groups, whether in terms of ethnicity, gender or area, by using a range of approaches. She added that communities themselves "can be part of the solution, rather than being seen as just the problem".

There was widespread support for this among delegates and examples given of current Irish sector activity aimed at promoting health and empowering disadvantaged communities to access services and live healthier lives. However, barriers were identified by delegates in dealing with the extent of the health problems among the Irish community.

For example, Irish community groups are mainly funded by the Irish government, not the UK government, and lack the ability to build their capacity due to under-funding, while also facing a British health sector which is oblivious of the extent of their health problems.

Local planners, more often than not, fail to support Irish organisations trying to improve the health of their communities. Some have obviously made strides to develop valued local services for very disadvantaged Irish people in areas of high population, such as Brent and Camden, but the conference concluded that the Irish need to be included at all stages in service planning, in partnership with local providers.


A number of prevention and treatment options were suggested to help reduce Irish CHD rates such as working with the community to help it both access treatment and to reduce high risk behaviours.

Including the Irish in universal interventions as well as specific targeting was considered the only way to make a difference, according to Professor Boyle, who also suggested that the Department's current aim to develop a new strategy for Stroke needed to link in with work on inequalities and include "targeting of people at risk, of which people of Irish origin clearly need to be included".

Giving data on levels of hypertension among the Irish which may link to Stroke prevalence, Dr Knapton added: "There is clearly something in the health service that we could do about focusing activity and identifying the Irish in our practice lists and attending to them a bit more assiduously."

Speakers emphasised that reducing inequalities is currently at the top of government priorities and Irish people need to be included as a key group in plans to reduce ethnic inequalities. Averil Dongworth insisted that local communities needed to understand the profile of their populations and find ways of targeting those in need, that it was important to get the Irish into the "psyche of the Trust, both in primary care and in secondary care" and that the Irish should ensure they are involved this year in the Healthcare Commission's Race Equality Service Review.

Bridget Riches stressed the importance of addressing the needs of local populations through targeting in partnership, using the mechanism of Local Area Agreements. She emphasised that local communities need to tailor national strategies for use at local level.

Delegates from a range of statutory and voluntary health and social care organisations expressed concern that the Irish are usually hidden, forgotten and unheard within policy and practice. Dr Mary Tilki, Chair of the Federation of Irish Societies, felt that the message of the day was "with a few exceptions, the health needs of the Irish are not being met" and certainly not in relation to coronary heart disease.

Dr Tilki said that it must not be forgotten that Irish health was about equality and human rights. She emphasised that Irish people pay taxes in this country and have a right to good health and healthcare. She stated that even from a pragmatic point of view, dealing with Irish health needs, particularly in areas of high Irish population, would help authorities to meet their health improvement targets and would incur economic benefits for commissioners.

Being Irish in England increases the risk of suicide, cancer, accidents, respiratory disease, heart disease and stroke. It increases the risk of permanent sickness and disability, limiting long term illness and being admitted to psychiatric care. It also increases the risk of homelessness and premature death.

Nothing has substantially changed since nearly two centuries ago the Surgeon of the Poor Law Infirmary in Birmingham stated about the Irish: "The acute diseases of which they become the subjects are fatal in a much larger proportion than among the English." 676 000 people living in England today were born in Ireland. In London alone, 11% people have Irish parents and 19% have Irish grandparents. These figures suggest the scale of a health problem that can no longer be forgotten about.

The Delegates

Conference Aims, Speakers and Agenda