This chapter reviews progress in the areas for Health and Social Gain highlighted in the 1996 Public Health Report. The topics of Teenage Pregnancy, Coronary Heart Disease and Cancer have been the focus of separate chapters in 1997.

2. Small Area Coding

The 1996 Public Health Report identified the need to code health information by small geographical areas to enable the targeting of services more effectively.

In 1997 this recommendation was progressed by joint work between the health boards in commissioning the Small Area Health Research Unit of Trinity College, Dublin to develop a material deprivation scale for Ireland. This information has been made available at small area level and is presented in Chapter 2 of the Report on Health Inequalities. Further progress on Small Area Coding of health information will be pursued in the coming years. 

3. Accidents

The 1996 Public Health Report highlighted accidents as the major cause of death, years of lives lost and serious disability in young people. Accidents remain the important public health issue in the South East.

In 1996 the Chief Executive Officers working conjointly set up a National Accident Forum. The Forum formed two sub-committees in 1997 to work on the priority areas of unintentional injuries in children and the elderly. The committees are preparing reports, identifying the main injury prevention priorities and proposing co-ordinated strategies to prevent accidents in each age group. Each region should compliment the national plans formulated by developing local implementation plans and a local focus for action in accident prevention.

4. The Elderly

The 1996 Public Health Report highlighted the unmet needs experienced by people with physical and sensory disability in the region. During 1997 considerable development took place to strengthen the disability services.

A regional advisory committee for physical and sensory disability has been set up and a regional Director of Disability Services appointed. Work has progressed on identifying local service needs and including the views of disabled people and their carers in this process. Services are being co-ordinated at regional and local level to ensure the development and implementation of individual care plans for users. Services to improve information available to clients have been established and services to improve carer and client support and social contact have been expanded. There has been an increase in para-medical resources for people with disabilities and plans have been progressed to develop a regional assessment facility.

These developments in structure and services have greatly enhanced the provision, co-ordination and client focus of services in the last year. Further work and resourcing for residential, day and respite care together with aids and appliances is needed with ongoing improvements in areas which have already been addressed.

6. Suicide

6.1 Introduction
Suicide is a major public health problem. Since 1987 the suicide rate has been rising. Although there has been no significant increase in suicides in women, suicides in men have shown a significant increase particularly in young and middle-aged men. It is the second most common cause of death in 15 to 24 year old males. The reason why suicide has increased is not clear, although several suggestions have been made including an alteration in social cohesion and changes in the social fabric of society.

6.2. Information relating to the South Eastern Health Board
The position in the South Eastern Health Board region was highlighted in the 1996 Report of the Director of Public Health. The suicide rate in the South East is one of the highest in the country. The trends for deaths from suicides from 1981 to 1995 are shown in the following figures. These trends are similar to the rest of the country, with male suicide rates rising considerably and female suicide rates remaining almost constant.

Figure 8.1 Standardised Death Rate from Suicide in Males 1981 -1996 per 100,000 Population

• To establish the incidence and associated factors of suicide nationally - on a Health Board basis and to inform the present knowledge base on suicides.
• To provide information in order to facilitate future planning for a suicide prevention programme.

Preliminary analysis has been carried out on 40 deaths that occurred in the SEHB region, in 1997 which have been notified to the Public Health Department and the results are as follows:

• The age group 15-24 accounted for 25% of the deaths,18% of the deaths were in the 25-34 age group, 25% of the deaths in the 35-44 age group, 10% of deaths in the 45-54 age group, 7% in the 55-64 age group and 15% over 65 years of age.
• Male suicides accounted for over 87% and females nearly 13% of the total. Over 40% had a primary education or less, 27% had secondary education and 12% had third level education. In cases where the employment history was known, 28% were unemployed, 10% unskilled workers, 10% skilled workers, 15% farmers, 7% students, 7% homemakers and 5% were professional or managerial.
• With regard to medical intervention: 75% had attended their family doctor but only 44% had attended the doctor with a relevant complaint and 35% of the patients had attended a psychiatrist. Of those attending the psychiatric services, 70% were being treated for depression, 20% were being treated for drug or alcohol dependency and 10% for other psychiatric illness including schizophrenia.
• The main mode of suicide was hanging in 37% of the cases, followed by drowning, shooting, car exhaust fumes, and poisoning. Consumption of alcohol preceded the event in 25% of the cases. The other factors involved were break up of marriage/relationship in 15% of the cases followed by alcohol and drug abuse, financial difficulties and trouble with the law.

At the end of the survey more detailed information will be available to enable the board to plan facilities for prevention/ reduction measures.

It is recommended that:

Following the completion of the study the national group will report and it is recommended that the South Eastern Health Board devise local plans for prevention and reduction measures.

7.1 Introduction
During its presidency of the European Union in 1996, the government prioritised the campaign against drugs. The updated European Action Plan to combat drugs was agreed by the heads of state. This plan seeks to combat drug misuse, firstly, by introducing measures to reduce the supply of illicit drugs and secondly to reduce the demand for these drugs. International action and the pooling and sharing of information and knowledge among policy makers, professionals and citizens of the European Union is essential for success.

Implementation of the strategy for the reduction of supply of illicit drugs is the responsibility of the Department of Justice and is implemented through the Gardai and Customs.

The measures to be put in place for the reduction in the demand for illicit drugs are a responsibility of the Health Boards. The South Eastern Health Board has established a co-ordinating committee made up of statutory, community and voluntary organisations to advise the Board on a strategy for demand reduction measures for drug usage, and to act as a forum for joint planning between the various agencies and the voluntary community sector. 

7.2 Information relating to drug misuse in the SEHB Region
Table 8.1 shows the numbers of persons prosecuted for possession (Section 3 of the Misuse of Drugs Act) or supply of drugs (Section 15). Carlow is part of the Eastern Region and the South Eastern Region includes North Tipperary.

Table 8.1 Persons Prosecuted for Possession or Supply of Drugs

*Includes North Tipperary

Figure 8.3 The Number of Persons Prosecuted for Drug Offences per 100,000 population.

A survey was conducted by the South Eastern Health Board on children aged 15 to 17 years attending school and youth centres in Waterford City and County. The size of the sample surveyed was 637 adolescents, with approximately twice as many boys (438) as girls (199).

A self-administered questionnaire was completed under supervision.

In relation to the question on illicit drug usage, 37% of boys and 27% of the girls stated that they had taken drugs. Of these, 57% stated that they had taken drugs only once (17.6% of the total sample), but 35.5% of those who had taken drugs said that they had taken drugs weekly or more often (12.7% of the sample).

With regard to alcohol consumption, 84% of boys and 78% of girls stated that they had consumed alcohol. Of these 52% reported that they had drunk alcohol only once (42% of the sample), whilst 35% stated that they consumed alcohol at least once a week or more often (29% of the sample). These children are under the legal age for alcohol consumption.

Figure 8.4 Drug Usage by type, SEHB Survey, Children Aged 15-17

7.3 Initiatives in the South Eastern Health Board Area
The South Eastern Health Board provides preventive and treatment services either directly or in partnership with voluntary and community groups. A Drugs Co-ordination Officer has recently been appointed to the Board. His remit is to reach agreement with community groups and with the local authorities in the four community care areas, to develop community based drug initiatives which would increase their awareness of drug related issues and to help develop strategies to reduce the demand for drugs within communities.

Waterford Drug Helpline provides a telephone information and counselling service and is supported by the Health Board.

The Health Promotion Unit (HPU) of the Health Board through their Social, Personal and Health Education Programme, provides drug awareness training to teachers and health workers. The training is being expanded to provide programmes for regional youth service providers.

The HPU and the addiction counsellors, through the 'Drug Questions Local Answers' Programme, have provided training to local groups.

It is recommended that:

Drug Education Officers/Outreach workers be appointed to all the community care areas to develop drug awareness campaigns in the community and to support the local communities in developing measures for reduction of drug misuse.

Develop a database of the known extent of the problem, which includes indirect evidence and services being provided by voluntary and statutory agencies.

The co-ordination and co-operation be increased between regional groups and agencies involved in the reduction of the supply of illicit drugs.

The addiction services provided by the Health Board should be enhanced and a low threshold of referral service should be developed.

Training of health professionals in the management of drug misuse be provided.

Data collection is uniform and services are evaluated.

A protocol for Methadone replacement therapy be developed and training of general practitioners in the treatment and care of opiate misusers be improved.