The health status of the Irish nation

Life expectancy in Ireland has increased by almost two and a half years since 2006, with male life expectancy consistently higher than the EU average throughout the last decade, writes Maureen Browne.

Maureen Browne
Maureen Browne

Much of this increase in life expectancy is due to significant reductions in major causes of death such as circulatory system diseases and cancer. The overall mortality rate has reduced by 14.9% since 2008. As seen in most European countries however, the rate of improvement in Ireland’s life expectancy has begun to slow in recent years.

These trends emerged in 11th edition of Health in Ireland: Key Trends, published by the Department of Health. higher than the EU average throughout the last decade. Maureen Browne reports.

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The report also highlights the challenges that persist in terms of the accessibility of timely and efficient healthcare across the population.
It shows:

We are living longer.
Over the past decade we have added, on average, 3 months per year to our life expectancy, which is currently standing at 83.6 years for women and 79.9 years for men.
The life expectancy gap between men and women has narrowed from 5.6 years to 3.7 years.

Life expectancy at birth for women in Ireland was 3.7 years longer than for men in 2016; this has improved from a 5.6 year difference in 1996.
Irish men are living longer than their European counterparts. Male life expectancy in Ireland has been above the EU average over the past decade. The life expectancy at birth for men in Ireland has been consistently greater than that of the EU average by over a year. Female life expectancy in Ireland matches the EU average.
Increase in life expectancy is due to significant reductions in major causes of death such as circulatory system diseases and cancer
This decrease is particularly strong for mortality rates from stroke (-39%), breast cancer (-16%), suicide (-26%) and pneumonia (-39%) (Table 2.4). The overall mortality rate has reduced by 14.9% since 2008.

We think we are healthier than our European neighbours, especially if we are higher earners.
In 2016, 83% of Irish men and women rated their health as good or very good. This is the highest in the EU and compares with an average of 70% and 64% for males and females respectively across the EU. Those in higher income brackets tend to report better health than those in lower income brackets.

We are getting better at curing cancer but not as good as our neighbours.
There have been improvements seen in survival rates from breast, cervical, colon and rectal cancer in the last 15 years However, with the exception of rectal cancer, 5-year net survival rates are lower in Ireland than the average for OECD countries where data is available.

Our mortality rate from respiratory diseases higher than ER average.
While there has been a reduction in the mortality rate from respiratory diseases of almost 12.6% since 2008 the rate in Ireland is 37.4% higher than the EU28 average.

We are seeing a reduction in deaths from suicide.
There has been a 26% reduction in the mortality rate from suicide since 2008. After a rise in the male suicide rate from 2008 to 2012, the three-year moving average has decreased and the latest figures (2015) have fallen below the EU average for the first time since 2010.

Men are more inclined to binge drink than women.
Over half of Irish men binge drink on a typical day of drinking, compared to just under 20% of women in 2018. A gender gap is present across all age groups, but the highest rates of binge drinking among the 15-24 age group.

The average length of hospital stay is 5.6 day.
From 2008 to 2014 the average length of stay decreased by 10.6%. It has since increased by 3.7%, with the average length of stay currently at 5.6 days.

The number of patients waiting over nine months for an Inpatient or Day Case procedure has fallen by 24%
The total number of patients waiting over 9 months for an inpatient or day case procedure has fallen by 5,300 or 24% since October 2017 to 15,523 as of Oct 2018.

Number of children waiting over six months remains relatively stable.
For children waiting 6 months or longer the number waiting for elective procedures remained relatively stable throughout the year.

Outpatient waiting lists increased.
The total number of people on outpatient waiting lists increased between October 2017 and October 2018. The number of people waiting longer than 52 weeks also increased during the year.

Numbers on trolleys.
The 30-day moving average of the number of admitted patients on trolleys at 2pm in emergency departments saw a spike during the first 5 months of 2018. It has since fallen and in October, was similar to figures for 2017 and 2016.

Busiest time in ED.
11am to 2pm on a Monday is the busiest time for Irish emergency departments. The highest attendances to hospital emergency departments occur between 9am and 5pm on weekdays, with Monday mornings between 11am and 1pm seeing the highest attendance volumes across the week. Less than 2% of the population donate blood.

Blood donations.
Both the number of blood donations and the percentage of blood donors in the Irish population have declined in the past 5 years. The percentage of blood donors in the population in 2017 was 1.7%.

Live Births.
The number of live births has been falling year-on-year since 2009 and in 2017 the number of registered births was 62,053. Despite reductions in the numbers of births in recent years, the fertility rate in Ireland is the third highest in the EU, behind France and Sweden.

Population Ageing
Ireland is now beginning to catch up with other European countries in terms of population ageing. The population of those aged 65 years and over has increased by 35% since 2009 and has been increasing at a faster rate than that of our EU neighbours. The numbers of people in this age group is expected to almost double in the next 20 years, with the greatest proportional increase in the 85+ age group.
Total hospital discharges continue to rise with 63% of this activity now carried out on a day case basis (including dialysis).

Bed Numbers
While there are fewer public inpatient beds than a decade ago, there has been a 25% increase in day beds and a reduction in the average length of stay. The increase in day beds has allowed for a 39% increase in the number of day case patients over the last decade. There are 1,796 inpatient beds in private acute hospitals in Ireland.

Medical Cards
Between 2016 and 2017 there was a decrease (6.1%) in the number of medical cards to 1.58 million. Numbers of GP only visit cards in 2017 increased to just over 486,000, though it should be noted that this is largely due to the introduction of GP visit cards to all children under six in 2015.

Sports participation
Sports participation among 16-19 year olds declined between 2015 to 2017, however the 20-24 year old age group has seen a slight increase in sports participation over the same period.

Smoking
Cigarette consumption has declined over the past decade, while alcohol consumption has also decreased but at a slower rate .

Numbers on Disability Database
The number of people registered with the National Physical and Sensory Disability Database was 20,676 in 2016, with half of these having a physical disability only.

Intellectual Disability Services
The number of persons under 18 with an intellectual disability availing of day services has increased by 9.3% over the period 2008-2017. There has been a fall of 8.5% in full time residents availing of these services, compared to an increase of 19.2% availing of the services as day attendees only.

Problem Drug Use
The number of cases in treatment for problem drug use (including alcohol) has increased by 15.4% during the period 2008-2017. The number of cases in treatment for problem drug use (excluding alcohol) has increased by 42.7% over the same period.

Staff Numbers
Over the period 2009 to 2013 total numbers employed in the public health services saw a gradual decline, however in recent years this trend has been reversed. There were 116,496 whole time equivalents employed in September 2018; this represents a 1.9% increase from December 2017. All grade categories have shown an increase since 2017. Nurses make up the largest grade category in the public health service, with 31.9% of total staff employed.

Hospital Consultants
The number of hospital consultants employed by the public health service increased by 32.8% in the period 2009-2017. They also increased by 3.2% between December 2017 and September 2018.

NCHDs
The number of non-consultant hospital doctors increased by 34.2% in the period 2008-2017. They also increased by 3.3% between December 2017 and September 2018.
Number of practising doctors
There were 2.94 practising doctors per 1,000 population in Ireland in 2016. This is below the OECD28 average of 3.39.

Health Expenditure
According to the System of Health accounts (SHA) methodology, Ireland’s total (public and private) health expenditure was estimated to be €20.3 billion in 2016. The largest financing scheme in Ireland is Government financing schemes and compulsory contributory health care financing schemes, accounting for 72% of all finance in health care expenditure. Curative and rehabilitative care accounted for 55% of total current health care expenditure, and hospitals accounted for 36% of total current health care expenditure.
Ireland’s total current health expenditure as a percentage of GDP/GNI* ranks 3rd behind the United States and Switzerland. This position changes to 8th when looking at public expenditure only.

Pharmaceutical Generics
The percent share of generics has more than doubled in Ireland since 2008, while the OECD average has increased by 36.6% in the same period. However, Ireland is still significantly below other OECD countries for use of generics.