Health Outcomes Are Worse Living In A Deprived Area Of Fermanagh

Impartial Reporter journalist, Colm Bradley, carried out a special investigation into the health inequalities facing people who live in deprived areas. In this, part one of the two part investigation, he explains how an area is classified as deprived, what inequalities you face if you live in one of those deprived areas and finally how long the Western Health and Social Care Trust have known about some of these inequalities and what they plan to do about them.

If you live in a deprived area your health outcomes are worse

If you live in a deprived area your health outcomes are worse


What areas are classified as deprived in Fermanagh?

Northern Ireland is split into 890 Super Output Areas for the purposes of the gathering of statistics. Super Output Areas (SOAs) are geographical areas that were developed to help the Northern Ireland Statistics and Research Agency to improve the reporting of small area statistics. Across Northern Ireland there are 890 SOAs. For the purposes of analysing health inequality, the 20 per cent of most deprived SOAs are analysed against the average.

There are five SOAs in Fermanagh that fall into the 20 percent most deprived areas of Northern Ireland, with Devenish, which covers parts of Enniskillen in the top five per cent of most deprived areas in Northern Ireland. The other areas in Fermanagh that fall in the top 20 per cent of deprived areas are Belleek and Boa, Newtownbutler, Rosslea, and Irvinestown.

If You Live In A Deprived Area What Are The Health Inequalities That You Face?

  • Life expectancy for women who live in deprived areas in Fermanagh and Omagh District (FOD) fell from 83 to 79 years between 2011-13 and 2015-17.
  • In 2011 women in deprived areas of FOD had equal life expectancy with the Northern Ireland average. Now this has moved to a position of relative disadvantage
  • There has been an increase in preventable causes of death between 2009 and 2017 in the most deprived areas of FOD from 250 to 278 deaths per 100,000. A reduction has been seen in other areas in FOD.
  • FOD has a slightly lower rate of hospital admission for alcohol-related causes than Northern Ireland average, but the most deprived areas of FOD have almost double the average rate.
  • Death rate due to alcohol is 70 per cent higher in the more deprived areas of FOD than Northern Ireland average
  • The death rate from smoking in FOD is similar to the NI average at 160 deaths per 100,000 but is much higher in deprived areas of FOD at 219
  • The death rate from smoking related causes has been falling in NI overall over last five years but has climbed in the deprived parts of F&O.
  •  The rate of new diagnoses of lung cancer has climbed sharply in FOD deprived areas from 70 per 100,000 population in 2006-12 to 111 per 100,000 population in 2010-16.
  •  The death rate due to lung cancer has been stable in NI at 66 deaths per 100,000 population between 2009 and 2017, but has increased from 53 to 88 per 100,000 in F&O deprived areas
  • Number of people diagnosed with cancer in deprived areas rose by over 20 per cent from 605 to 737 per 100,000. In the same six year period non deprived areas saw diagnoses rise from 561 to 584, a rise of 4 per cent
  • Above statistics are taken from two reports: 1) Health and Social care Needs in Fermanagh and West Tyrone; by Dr Declan Bradley. 2) Health and Inequalities Annual Report 2019; by the Department of Health.

Series Of Reports Show The Growing Gap In Health Inequalities

Living in the most deprived areas of Fermanagh has a negative impact on your health, a series of reports have shown.

Considers these shocking statistics: life expectancy of women reduced by four years; 20 per cent rise in cancer diagnosis; 70 per cent more likely to be admitted to hospital with alcohol related illness; 59 per cent increase in diagnosis of lung cancer; 66 per cent increase in deaths by lung cancer and 36 per cent higher death rate from smoking than the Northern Ireland average.

Indeed, these are just some of the stark figures that portray the changing health landscape for people who live in the most deprived areas of Fermanagh.

It has also emerged that Northern Ireland has the worst health outcome of any of the four countries in the United Kingdom and that according to one health expert, people in Northern Ireland have “poorer health than most comparable countries”.

The Health and Inequalities Annual Report 2019, commissioned by the Department of Health contain raw statistics showing the changing trends for health outcomes across each Health Trust and each District Council area.

Meanwhile another report, produced last November for the Pathfinder programme, spoke in stark terms about the inequalities that existed within the Fermanagh and West Tyrone area.

This latter report revealed that of the 54 areas in the Pathfinder catchment area, 46 are in the most deprived half of areas in Northern Ireland. In the report, written by Dr. Declan Bradley and entitled ‘Health and Social Care Needs in Fermanagh and West Tyrone’, Dr Bradley draws attention to these inequalities and pays particular reference to the falling life expectancy of women in deprived areas: “People in NI have, on average, poorer health than most comparable countries, and the people who live in the more deprived parts of Fermanagh and West Tyrone experience worse health outcomes more often than the average. The changing life expectancy of women from deprived areas is an important development that should be included in the work developing from the Pathfinder project.”

The Health Inequalities Report 2019 shows a downward trend in women’s life expectancy in the most deprived area over a number of years and the Impartial Reporter asked the Western Health and Social Care Trust  (WHSCT) specific questions in relation to when downward trends in health inequalities were identified and also how Pathfinder aims to redress the imbalance.

The Trust would not be drawn on when the downward trends were identified but did state that Pathfinder hopes to use the evidence to improve health outcomes: “Pathfinder, through the current series of independently facilitated ‘Moving to Action Workshops’, is currently working with key stakeholders to look at a number of areas, including health inequalities which are highlighted within Dr Bradley’s report.

“Through collaboration with the Community and Voluntary Sector, Statutory bodies and users of services from within communities, Pathfinder will thus develop a plan aimed at improving health outcomes of people in the area,” a spokeswoman for the Trust said.

Dr Bradley, for his part, believes that the evidence of inequality should be central to work that the WHSCT does during the next stage of their Pathfinder project.

“The issues identified in this report will be passed to multi-disciplinary teams of HSC staff, stakeholders and experts-by-experience who will be tasked with prioritising the issues in their remit and redesigning services to improve access, safety, flow and quality.”

(Source – Impartial Reporter – News – Colm Bradley – 11/02/2020)

Poverty In Fermanagh Is ‘Real And Impacts On People’s Health’

In the second part of a two part investigation into health inequalities in Fermanagh, Impartial Reporter journalist Colm Bradley speaks to community workers and elected representatives in some of Fermanagh’s most deprived areas.

Jenny Irvine - Poverty is 'real and impacts on people's health'

Jenny Irvine – Poverty is ‘real and impacts on people’s health’

Poverty is ‘real and impacts on people’s health’ says community activist

Irvinestown has been identified as one of five areas in Fermanagh that is among the top 20 per cent most deprived areas in Northern Ireland.

The Arc Healthy Living Centre is a charity organisation in the town and its CEO Jenny Irvine was very clear in her appraisal that poverty plays a huge part in prospective health outcomes: “We have all heard the saying that ‘your health is your wealth’ well it is more accurate to say that your ‘wealth is you health’ because there is no doubt that the more affluent that you are then the better your health outcomes will be,” she said.

Ms. Irvine also believes that there is refusal among wider society to properly acknowledge the complex issues that surround poverty and indeed at times a refusal to acknowledge that poverty actually exists.

“It is wrong, and we need to do something about it. We must stop shaming poor people for being ill. There is already a shame felt by people in poverty and when society shames them for also being ill then it makes things worse again,” she said, before adding: “I hear people say to me that there is no poverty and it is just wrong to say that. There is real poverty all around. People are going to foodbanks. People are going to foodbanks who are working and earning a wage so we must understand that poverty affects working people too and we absolutely have to understand that poverty is real and that it impacts on people’s health.”

Ms. Irvine also believes that there has to be more joined up thinking and a real effort to look at what are the actual causes of the health issues that people living in deprived experience: “I was at a meeting the other day where the increase in respiratory illness was discussed and it was talked about the need for more consultants in this area. But it was never raised that people are leaving hospital, vulnerable, and returning to damp cold homes. We are not looking to get to the root of the problem and instead we are treating the symptoms and we should not be surprised when there is no real progress made.”

The Chief Executive of the ARC Healthy Living Centre is however optimistic that real effective change can happen for those living in deprived areas but argues that there needs to proper investment: “Change can happen, but it requires work and it requires proper investment in the specific areas where poverty is at its greatest. Invest in young people in those areas and make sure they are getting the educational support that they need. Give the people hope and something to strive for. In areas of poverty there are expectations of failure and we need to stop the cycle that is a lack of hope. We need to give hope to not only individuals but also to the areas in which those individuals live.”

A ‘Toxic Mix’ of factors are at play in most deprived areas of Ennsikillen

The most deprived area of Fermanagh according to the Northern Ireland Statistics and Research Agency is the Super Output Area called Devenish, which is located in Enniskillen. Taking in parts of Kilmacormick, Hillview and Cornagrade, Devenish is ranked as the 44th most deprived area in Northern Ireland from a total of 890 areas. This puts it in the top five per cent of most deprived areas in Northern Ireland.

According to one Independent Labour Enniskillen Councillor, Donal O’Cofaigh, a number of factors have contributed to what he terms as a “toxic mix” that “discriminates against working class people to keep them in the bind that they are in”.

“The figures in these reports are very concerning and there is a systematic discrimination against working class people. Things like zero hour contracts and lack of education provision, particularly in the vocational sector all play a part,” Councillor O’Cofaigh stated before adding that there was some excellent work going on in the community, including projects like the Neighbourhood Renewal Scheme.

“I have no doubt though that in the health service there has been a managed decline of services with the provision of services being moved further and further away. I know that many people believe that they have been forgotten and working-class people have been exploited. There needs to be further research into what is causing the widening of the health gap and steps need to be taken to address these causes,” Councillor O’Cofaigh said.

Another Enniskillen Councillor, Keith Elliott, feels that it is incumbent on the new Health Minister at Stormont, Robin Swann of the UUP, to grasp the nettle when it comes to health reform: “It is important that we have a health service that is fit for purpose, sustainable and can adapt to the changes that are taking place in our society. People here are well versed in the challenges affecting health care, regrettably this has been exacerbated as a result of no Health Minister being in place for over three years. It is important that the new Health Minister commits to transforming our healthcare, so that people have confidence in the services provided and can access services easily. I will be working with my DUP colleagues to ensure Enniskillen and indeed Fermanagh isn’t left behind.”

Joined up thinking needed to tackle problems in rural areas, says Gannon

Four of the five most deprived areas of Fermanagh fall into the rural category according to the Northern Ireland Statistical Research Agency (NISRA). Belleek and Boa, Rosslea, Newtownbutler and Irvinestown are the four rural SOAs in the county. Erne West Councillor, Adam Gannon of the SDLP is his party’s spokesperson on Rural Health and says that rural communities have been struggling: “Dr Bradley’s report highlights some of the many disadvantages faced by those in rural areas when accessing healthcare. The fact that nearly all of Fermanagh and West Tyrone are in the most deprived 50 per cent of areas within NI is unsurprising -  rural communities have been struggling for quite some time already.”

Councillor Gannon believes that there are short term measures which could be taken to help matters: “In the short term, investment will ease our problems. Ensuring proper staffing levels and higher wages for staff in rural areas will attract more doctors, nurses and other healthcare professionals.

“This alone would improve the services here. Additional investment in community care will also remove immediate pressure on hospital services and by brining care directly into the community we can tailor it to directly address issues such as, lower life expectancy for women and higher rates of lung cancer.”

Parts of the Belleek and Boa SOA are located in Councillor Gannon’s Erne West ward and the SDLP man believes that moves must be made to locate more specialist services at South West Acute Hospital: “Currently the travel burden falls solely on those living in rural areas and automatically decreases our ability to access important medical facilities. This is fundamentally unfair and needs to be addressed. By moving one or two specialist services to a hospital like the SWAH it will improve access to services and share out travel more evenly across the North.

“Ultimately a joined up interdepartmental approach, which is currently lacking, is needed in the long term to lift the barriers to healthcare access and to address the root causes of economic and social inequality faced by people here.”

(Source – Impartial Reporter – News – Colm Bradley – 11/02/2020)


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