Progress has been achieved in each area highlighted in last year's Report, ranging from substantial progress in services in the area of physical and sensory disability and substance abuse, in comprehensive regional strategy developments in services for the elderly and in cancer services, to national fora working on accidents and suicides.

This Report highlights important issues for health and social gain, and makes recommendations within each chapter for action. The following priority areas are emphasised.

2.  Health Inequalities

Groups of people within our population experience a poorer health status than most of our residents. Health status is determined by genetic factors, environmental influences, lifestyles, as well as social and economic circumstances. People experiencing material deprivation have been consistently shown to have poorer health status. Research into the effectiveness of health and social services to impact on health inequalities is being conducted. In order to achieve health and social gain for all our population, health inequalities must be addressed effectively and appropriate services targeted at deprived individuals and areas.

It is recommended that:

The provision of health services to deprived areas be reviewed to ensure equality of access and to begin to address health inequalities.

Services which have been shown to impact on health inequalities should be identified and targeted at deprived areas.

3.  Cardiovascular Disease

Cardiovascular disease, and particularly coronary heart disease, is the major cause of death in the south east. Much work is being done throughout the Health Board to combat this disease. It is timely to develop a co-ordinated approach between all service providers. A strategic plan to address coronary heart disease should be developed jointly between health professionals and the managers within the service. This plan should range from health promotion through primary and secondary care to rehabilitation, and should be underpinned by accurate timely data and based on best evidence. Such a disease orientated strategic plan would focus service developments throughout the region and complement forthcoming national initiatives on coronary heart disease.

It is recommended that:

The Health Board should act to focus on coronary heart disease by developing a regional coronary heart disease strategy, with service plans agreed locally to implement the strategy.

Improve and co-ordinate the provision of information on risk factors on mortality and morbidity, service use, clinical audit and outcomes.

Develop, adopt, and audit protocols for the prevention and diagnosis of coronary heart disease and for medical, surgical and rehabilitation services which impact on coronary heart disease.

Cancer is the most common cause of premature death in the South Eastern Health Board region, accounting for over 800 deaths in the region each year. Services to combat cancer include health promotion, early detection, diagnosis, treatment, rehabilitation and palliative care services. The National Cancer Strategy has targeted a reduction in cancer deaths by 15% by the year 2004. The National Cancer Strategy recommended that health boards draw up a strategic plan for cancer services in their region to ensure the provision of an equitable and uniformly high quality service. The South Eastern Health Board Cancer Plan outlines how cancer services should be developed by strengthening health promotion, including general practitioners and local voluntary support groups and improving secondary care treatment facilities. The Plan proposes the development of services structured to achieve best medical outcomes as evidenced by scientific research and promotes the development and audit of evidence based protocols throughout the region.

It is recommended that:

The implementation of the SEHB Cancer Plan be prioritised and additional resources sought.

Clinical guidelines and audit systems be initiated by clinicians in the region, and these be supported and resourced.

5.  Women's Health

The National Plan for Women's Health was published in 1997. This requires each Health Board to establish an advisory committee on women's health and prepare a regional plan. The regional advisory committee for the SEHB has been formed and has begun the planning process. Therefore, it is timely that the Public Health Report on health status highlight issues of particular importance for women's health. Two areas have been focused on; the major causes of death i.e. cardiovascular disease and cancer in women and women's reproductive health.

5.1  Health Status
Areas within the South Eastern Health Board region experience higher than expected death rates in women from cardiovascular disease and cancer. Therefore a focus on lifestyle risk factors, particularly smoking in women, should be given a priority.

It is recommended that:

Priority be given to interventions which reduce or prevent smoking in women.

Interventions aimed at changing the other lifestyle factors which cause cardiovascular disease and cancer be especially targeted at women.

Interventions aimed at preventing falls in older women be introduced.

It is recommended that:

The provision of an equitable and comprehensive family planning service throughout the region be evaluated.

5.3  Teenage Pregnancy
Teenage pregnancy was identified as an important public health issue in 1996. A region-wide initiative has been taken by the Health Board in partnership with voluntary organisations, to strengthen preventive and support services for teenagers.

It is recommended that:

The Health Board supports schools as they introduce the Relationship and Sexuality Education (RSE) programme.

The Health Board review the comprehensiveness and accessibility of contraceptive and counselling services available to teenagers in the region.

Support be given from health service personnel to the county based working groups on teenage pregnancy.

5.4  Screening Services
Pilot breast and cervical screening programmes are been developed nationally.

It is recommended that:

The SEHB implement the national screening programmes when they are extended to the whole country.

Cervical cytology and diagnostic mammography services be strengthened.

5.5  Breastfeeding
The importance to the health of a newborn child of breastfeeding cannot be over emphasised. The Health Board drew up a breast feeding policy in 1995, and progress has occurred in improving support and encouragement to women on breast feeding. However the initiation rates for breastfeeding in each area of the Board still fall short of the national target.

It is recommended that:

The Health Board re-emphasise the importance of breast feeding and co-ordinate activities between programmes to achieve improved rates.

The control of communicable and infectious disease continues to be a challenge for health services. Considerable progress has been made in developing standard regional policies and protocols for the surveillance, prevention and control of communicable diseases. Gastrointestinal and waterborne illness are of particular public concern, and joint work with sanitary authorities is essential in controlling these public health risks.

It is recommended that:

South Eastern Health Board policies support, through regional and local policies, the attainment of national vaccination targets for the population as a whole and specific vulnerable subgroups.

For all communicable diseases including those where vaccination is not available or not appropriate, that the South Eastern Health Board at regional and local level, continue to support and strengthen the development of protocols, based on best evidence, for surveillance, prevention, control and treatment.

A protocol for responding to infringements in water quality be agreed with all Sanitary Authorities in the South Eastern Health Board region.

7.  Suicide

Suicide is an issue of increasing public health concern. A number of national initiatives have occurred on suicide within the last year and regional structures are being set up to make recommendations and local plans for prevention and reduction measures.

It is recommended that: