State of Health in the EU Ireland

[Pages:24]State of Health in the EU

Ireland

Country Health Profile 2019

The Country Health Profile series

Contents

The State of Health in the EU's Country Health Profiles

1. HIGHLIGHTS

3

provide a concise and policy-relevant overview of

2. HEALTH IN IRELAND

4

health and health systems in the EU/European Economic

3. RISK FACTORS

7

Area. They emphasise the particular characteristics and challenges in each country against a backdrop of cross-

4. THE HEALTH SYSTEM

9

country comparisons. The aim is to support policymakers

5. PERFORMANCE OF THE HEALTH SYSTEM

13

and influencers with a means for mutual learning and

5.1 Effectiveness

13

voluntary exchange.

5.2 Accessibility

16

The profiles are the joint work of the OECD and the

5.3 Resilience

18

European Observatory on Health Systems and Policies,

6. KEY FINDINGS

22

in cooperation with the European Commission. The team

is grateful for the valuable comments and suggestions

provided by the Health Systems and Policy Monitor

network, the OECD Health Committee and the EU Expert

Group on Health Information.

Data and information sources

The data and information in the Country Health Profiles are based mainly on national official statistics provided to Eurostat and the OECD, which were validated to ensure the highest standards of data comparability. The sources and methods underlying these data are available in the Eurostat Database and the OECD health database. Some additional data also come from the Institute for Health Metrics and Evaluation (IHME), the European Centre for Disease Prevention and Control (ECDC), the Health Behaviour in School-Aged Children (HBSC) surveys and the World Health Organization (WHO), as well as other national sources.

The calculated EU averages are weighted averages of the 28 Member States unless otherwise noted. These EU averages do not include Iceland and Norway.

This profile was completed in August 2019, based on data available in July 2019.

To download the Excel spreadsheet matching all the tables and graphs in this profile, just type the following URL into your Internet browser: health/Country-Health-Profiles-2019-Ireland.xls

Demographic and socioeconomic context in Ireland, 2017

Demographic factors Population size (mid-year estimates) Share of population over age 65 (%) Fertility rate? Socioeconomic factors GDP per capita (EUR PPP?) Relative poverty rate? (%) Unemployment rate (%)

Ireland

4 807 000

13.5

1.8

54 300 15.6 6.7

EU 511 876 000

19.4 1.6

30 000 16.9 7.6

1. Number of children born per woman aged 15-49. 2. Purchasing power parity (PPP) is defined as the rate of currency conversion that equalises the purchasing power of different currencies by eliminating the differences in price levels between countries. 3. Percentage of persons living with less than 60 % of median equivalised disposable income. Source: Eurostat Database.

Disclaimer: The opinions expressed and arguments employed herein are solely those of the authors and do not necessarily reflect the official views of the OECD or of its member countries, or of the European Observatory on Health Systems and Policies or any of its Partners. The views expressed herein can in no way be taken to reflect the official opinion of the European Union.

This document, as well as any data and map included herein, are without prejudice to the status of or sovereignty over any territory, to the delimitation of international frontiers and boundaries and to the name of any territory, city or area.

Additional disclaimers for WHO are visible at

? OECD and World Health Organization (acting as the host organisation for, and secretariat of, the European Observatory on Health Systems and Policies) 2019

2 State of Health in the EU ? Ireland ? Country Health Profile 2019

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1 Highlights

The health status of Irish people has improved substantially since 2000, with life expectancy registering huge gains and most people reporting being in good health. Despite this progress, there is consensus in Ireland that the health system is underperforming and that a fundamental transformation is needed to make it fit to meet future demands associated with an ageing society. Key areas to be tackled include introducing a universal health system, building up the health system to improve access and adequately meet health care needs, more consistent workforce planning and better budget management at all levels of the system.

IE EU

83

81

79

77

77 3 76 6

75 2000

Life expectancy at birth, years

82 2 80 9

2017

Health status

The life expectancy of the Irish population has increased by nearly six years since 2000, the strongest gains among western European countries, and is now above the EU average. The increase was driven by sharp reductions in mortality from cardiovascular diseases, due in part to reductions in some risk factors like smoking but also to improvements in treatments.

IE EU Smo n

B n e dr n n

Obes t % of adults

Risk%0fa1 ct%o0r1CEsUountr

17 %

In 2018, 17 % of adults in Ireland smoked tobacco every day, down from

27 % in 2002, and now slightly below the EU average. Nearly one-third of 32 % adults reported regular heavy alcohol intake in 2014, a rate well above

the EU average. The obesity rate increased to 18 % in 2015, up from 15 %

18 %

in 2007, and is now higher than the EU average.

IE EU

Publ c spend n

Out-of-poc et

12 %

VoluSnmt or nhe lth 17 13 %

nsur nce

Bn

e Odrthnerns

2 % 0 22

50

% of total health expenditure, 2017

Obes t

21

73 % 100

Effectiveness

Mortality from preventable and treatable causes in Ireland is lower than the EU average, signalling that public health policies and health care interventions are generally effective. Yet many other western European countries are more successful in avoiding premature deaths.

Prevent ble

138

mort l t

161

Tre t ble mort l t

80

93

IE

EU

Age-standardised mortality rate per 100 000 population, 2016

Health system

Health spending in Ireland has increased at a moderate rate in recent years. At EUR 3 406 per person in 2017, it is around one-fifth higher than the EU average. Public funding accounts for 73 % of all health spending in Ireland, a lower share than the EU average (79 %). The remaining part is paid directly out of pocket by households (12 %) or through voluntary health insurance (13 %), which plays a much bigger role than in most other EU countries.

Countr

AccessibEiUlity

Ireland remains the only western European country without universal coverage for primary care. For those relying on the public system, long waiting times for specialist appointments and elective surgery in hospitals remaCionunatnr important source of patieEnUt dissatisfaction.

2015 2017

97%

90%

87%

72%

% of people w t n < 52 wee s for f rst spec l st consult t ons

% of dults w t n < 15 months for n elect ve procedure ( np t ent)

Resilience

The Sl?intecare Report of 2017 highlighted the importance of some fundamental changes in the Irish health system and the conviction that the system is not performing as well as it could. With the establishment of the Sl?intecare Implementation Office in September 2018, the implementation of its recommendations is gaining some traction.

State of Health in the EU ? Ireland ? Country Health Profile 2019 3

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2 Health in Ireland

Life expectancy in Ireland has increased by nearly six years since 2000

Life expectancy at birth reached 82.2 years in Ireland in 2017, up from 76.6 years in 2000 (Figure 1). Since life expectancy in Ireland has grown more rapidly than in most other EU countries, it is now more than

one year above the EU average (80.9 years) while it was still below the average in 2000.

Although the gender gap in life expectancy in Ireland is narrowing, Irish men could still expect to live almost four years less than women (80.4 years compared to 84.0 years) in 2017. This gap is, however, less pronounced than in many EU countries.

Figure 1. Life expectancy in Ireland has increased rapidly and is now above most EU countries

83 4 83 1 82 7 82 7 82 6 82 5 82 4 82 2 82 2 82 1 81 8 81 7 81 7 81 6 81 6 81 4 81 3 81 2 81 1 81 1 80 9 79 1 78 4 78 77 8 77 3 76 75 8 75 3 74 9 74 8

Ye rs 90 ?

85 ?

80 ?

2017

2000

Gender gap:

Ireland: 3.6 years EU: 5.2 years

75 ?

70 ?

65 ? Sp

n

It l Fr ncNeorw

Icel

nSdweden

M

lt

C

prusIrLeulxnedmbNoeuthr erl

ndsAustr

F nl

nd Bel

umPortu lGreecen Un ted

domSlovenGerm

n Denm

r

EUCzech

Eston

Cro

t

Pol

nd Slov

rn n Hun L thu Rom

L tvBul

r

Source: Eurostat Database.

The main causes of death remain circulatory diseases and cancer

The increase in life expectancy in Ireland since 2000 has mainly been driven by reductions in mortality rates from circulatory diseases, notably ischaemic heart disease (Figure 2). Despite this progress, circulatory diseases remain the leading cause of death in Ireland (30.1 % of all deaths) followed by cancer (29.9 %). Among the different types of cancer, lung, colorectal and breast cancer are the most frequent causes of death in Ireland.

Deaths from respiratory diseases have decreased starkly since 2000, reflecting in part recent drops in tobacco consumption, although mortality rates remain well above the EU average. On the other hand, mortality rates from Alzheimer's disease have increased greatly since 2000. This strong increase

is partly due to improvements in diagnostics and changes in death registration practices, but is also related to population ageing.

Most adults report being in good health, but the proportion is smaller among low-income groups

About 83 % of Irish adults reported being in good health in 2017, the highest share among all EU countries and substantially above the EU average of 70 % (Figure 3). As in other countries, there are some disparities in self-rated health across income groups. Only 73 % of people in the lowest income quintile assess their health as good, compared to 93 % in the highest. These disparities already exist in children's health: children from well-off parents are more likely to be in good health than those growing up in low-income households.

4 State of Health in the EU ? Ireland ? Country Health Profile 2019

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Figure 2. Circulatory diseases and cancer are still the leading causes of death

% ch n e 2000-16 (or ne rest e r) 100

50 Alzhe mer's d se se

Colorect l c ncer Lun c ncer

0

D betes

40

80

100

120

140

160

Bre st c ncer -50

Prost te c ncer

-100

Pneumon

Chron c obstruct ve pulmon r d se se

Stro e

Isch em c he rt d se se A e-st nd rd sed mort l t r te per 100 000 popul t on, 2016

Note: The size of the bubbles is proportional to the mortality rates in 2016. The increase in mortality rates from Alzheimer's disease is largely due to changes in diagnostic and death registration practices. Source: Eurostat Database.

Figure 3. Ireland has the highest share of the population that reports being in good health in the EU

Low ncome

Irel nd C prus Norw

It l Sweden Netherl nds Icel nd

M lt Un ted n dom

Bel um Sp n

Greece Denm r Luxembour Rom n

Austr F nl nd

EU Fr nce Slov Bul r Germ n Sloven Czech Cro t Hun r Pol nd Eston Portu l L tv L thu n

0

Tot l popul t on

H h ncome

20

40

60

80

100

% of dults who report be n n ood he lth

Note: 1. The shares for the total population and the population on low incomes are roughly the same. Source: Eurostat Database, based on EU-SILC (data refer to 2017).

The Irish are living longer than before, but not all remain healthy as they age

The proportion of people aged over 65 in Ireland is currently relatively low, accounting for 13 % of the population. However, due to rising life expectancy and declining fertility rates, this share is projected to double to 26 % by 2050, which will lead to growing demands on health and long-term care systems.

In 2017, Irish people aged 65 could expect to live another 20 years, with a 2.5-year gap between women and men (Figure 4). However, many years of life in old age are lived with some chronic diseases and disabilities. Around 50 % of Irish men and women aged 65 and over reported having at least one chronic condition, and around one in three reported some or severe limitations in carrying out usual activities because of health problems.

State of Health in the EU ? Ireland ? Country Health Profile 2019 5

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Figure 4. Many years of life after age 65 are lived with some chronic conditions and disabilities

L fe expect nc t e 65

Women

Men

8 21 4 13 4 e rs

65

19 0 e rs 12 5

Ye rs w thout ds blt

% of people ed 65+ report n chron c d se ses

Women

Men

50%

50%

49%

51%

Ye rs w th ds blt

% of people ed 65+ report n l m t t ons n usu l ct v t es due to he lth problems

Women

Men

13%

21% 66%

12% 20%

68%

No chron c d se se

At le st one chron c d se se

No l m t t on

Some l m t t ons

Severe l m t t ons

% of people ed 65+ report n depress on s mptoms1

Women

Men

14 %

10 %

Note: 1. People are considered to have depression symptoms if they report more than three depression symptoms (out of eight possible variables). Source: Eurostat Database (data refer to 2017).

6 State of Health in the EU ? Ireland ? Country Health Profile 2019

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3 Risk factors

Behavioural risk factors have important impact on mortality

Around 40 % of all deaths in Ireland in 2017 can be attributed to behavioural risk factors, a share close to the average across the EU (39 %). About one-fifth of all deaths in 2017 (6 000 deaths) are due

to tobacco consumption. Dietary risks (including low fruit and vegetable intake, and high sugar and salt consumption) are estimated to account for about 16 % of all deaths in Ireland. Alcohol consumption is associated with roughly 7 % of all deaths, while 3 % of deaths can be attributed to low physical activity (Figure 5).

Figure 5. About two-fifths of all deaths can be attributed to modifiable lifestyle risk factors

Tob cco Irel nd 19% EU 17%

D et r r s s Irel nd 16% EU 18%

Alcohol Irel nd 7% EU 6%

Low ph s c l ct v t Irel nd 3% EU 3%

Note: The overall number of deaths related to these risk factors (12 000) is lower than the sum of each one taken individually (14 000) because the same death can be attributed to more than one risk factor. Dietary risks include 14 components such as low fruit and vegetable consumption, and high sugarsweetened beverages and salt consumption. Source: IHME (2018), Global Health Data Exchange (estimates refer to 2017).

Despite reductions over the past decade, smoking rates among adults remain close to the EU average

Although progress has been made in reducing smoking rates, more than one in six Irish adults (17 %) smoked daily in 2018, a rate close to the EU average but still higher than in the best performing countries such as Sweden and Norway, where smoking rates are only 10-12 %. Smoking has become less popular among adolescents, especially among girls. Only about 13 % of 15- to 16-year-olds in Ireland reported that they had smoked cigarettes in the past month in 2015, one of the lowest rates in the EU. Initiatives are ongoing to further reduce tobacco consumption (see Section 5.1).

Overweight and obesity represent growing public health issues in Ireland

Overweight and obesity rates have increased among adults and teenagers. Among adults, the rate of obesity increased from 15 % in 2002 to 18 % in 20151 (Figure 6). Among 15-year-olds, the rate of overweight and obesity also rose to reach 19 % in 2013-14. As a result, overweight and obesity rates in Ireland are higher than in most other EU countries.

However, even though around one-third of Irish adults consume unhealthy foods at least once a day, a high proportion of Irish adults consume vegetables daily and they are also are among the most physically active in the EU. Implementing fiscal measures to support healthy eating and acknowledging the role of physical activity in the prevention of obesity are key steps identified in the country's Obesity and Policy Action Plan (Department of Health, 2016) (see Section 5.1).

1: Based on measured data of the actual weight and height of people, which is a more reliable measure, the obesity rate is even higher in Ireland but has remained stable at 23 % from 2007 to 2017.

State of Health in the EU ? Ireland ? Country Health Profile 2019 7

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Figure 6. Overweight and obesity, and alcohol consumption, are major public health concerns in Ireland

Ve et ble consumpt on ( dults)

Smo n (ch ldren) 6

Smo n ( dults)

Fru t consumpt on ( dults)

B n e dr n n (ch ldren)

Ph s c l ct v t ( dults)

B n e dr n n ( dults)

Ph s c l ct v t (ch ldren)

Obes t ( dults)

Overwe ht nd obes t (ch ldren)

Note: The closer the dot is to the centre, the better the country performs compared to other EU countries. No country is in the white `target area' as there is room for progress in all countries in all areas. Source: OECD calculations based on ESPAD survey 2015 and HBSC survey 2013-14 for children indicators; and EU-SILC 2017 and EHIS 2014 for adults indicators.

Select dots + Effect > Tr nsform sc le 130%

Heavy alcohol consumption is an important risk factor in Ireland

Social inequalities in risk factors contribute to inequalities in health

About one-third of adults in Ireland reported regular heavy alcohol consumption (binge drinking2) in 2015, a higher proportion than in most other EU countries. Regular binge drinking is twice as frequent among men than women.

Binge drinking among adolescents is, however, less widespread in Ireland than across the EU. The share of 15- to 16-year-olds who reported binge drinking at least once over the past month stood at 28 % compared to 38 % across the EU in 2015. While recording a comparably low rate is good news for Ireland, it should still be a reason for concern, since early drinking initiation can lead to harmful alcohol consumption habits later in life.

As in most other EU countries, many behavioural risk factors in Ireland are more common among people with lower education or income. Smoking rates among adults who have not completed secondary education are more than twice as high as among those with a university degree. This disparity is more pronounced in Ireland than in many other EU countries. Social differences also exist for obesity, as those with lower educational attainment display higher rates ? but here the difference in Ireland is smaller than on average across the EU. The higher prevalence of risk factors among socially disadvantaged groups is an important driver of inequalities in health and life expectancy. Reducing health inequalities is one of the four key objectives of the Healthy Ireland agenda (Department of Health, 2013).

2: Binge drinking is defined as consuming six or more alcoholic drinks on a single occasion for adults, and five or more alcoholic drinks for adolescents.

8 State of Health in the EU ? Ireland ? Country Health Profile 2019

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