17 Mar 2006
The New Strategic Direction forAlcohol and Drugs 2006-2011
Consultation response from the Institute of Public Health in Ireland
The Institute of Public Health in Ireland welcomes the opportunity to comment on the consultation paper on the New Strategic Direction for Alcohol and Drugs 2006-2011 (NSD). We particularly welcome the approach taken in the strategy, which, from the conceptual base of the Programme Logic Approach, is firmly based on desired outcomes and the pathways leading to them.
The Institute aims to improve health in Ireland, North and South by working to combat health inequalities and influence public policies in favour of health. The Institute applies a holistic model of health which emphasises a wide range of social determinants, including economic, environmental, social and biological factors, as well as the health and social services. The Institute’s work is based on the premise that improving health and reducing health inequalities can only be achieved through addressing these broader determinants of health.
Given this perspective, we particularly welcome the recognition of the wider determinants of health that is implicit in many of the desired outcomes and proposed solutions. In our view, the topics of alcohol and drugs are often treated as a matter of individual choice or a lifestyle issue, when, in fact, they are intimately intertwined with the structure of society, social inequalities, fiscal policy and other legislative issues. We believe approaches to tackling alcohol and drugs misuse must take into account societal as well as individual factors, utilising the potential and powers of the statutory, community and voluntary sectors. A wider range of agencies and sectors have a contribution to make within their own areas of responsibility, and it is essential that cross-departmental and cross-sectoral co-operation is achieved. We are pleased that NSD recognise the need for this type of work. It would have been helpful if the envisaged role of the community and voluntary sectors in particular had been made more explicit throughout the document, and in particular in Chapter 15. Furthermore, wider use of fiscal policy and legislative measures to reach the desired outcomes, such as those underway in terms of smoking in workplaces and public spaces, could have been explored further.
We understand that a focus on inequalities will be incorporated in the delivery of NSD. We would recommend, however, that health inequalities form an integrated part of the NSD rationale. Social inequality causes health inequality, and the steep gradient in health in Northern Ireland, with the poorest carrying a disproportionate burden of ill health, can be found across health issues, including alcohol and drugs misuse. A stronger link to the Investing for Health Public Health Strategy, for which reducing inequality is a central aim, would strengthen NSD’s potential to contribute to reducing health inequalities. Moreover, given the link between health outcomes from alcohol and drugs and social inequality, NSD should advocate for the forthcoming Anti-Poverty Strategy to be strengthened and resourced so that it can make a real impact on the vast socio-economic differences in our society.
It is important that the NSD model, and its conceptual base, is evaluated and monitored so as to determine the potential for replication in other policies and strategies. The Programme Logic Approach lends itself well to evaluation and monitoring and this would contribute to developments of evidence-based policy making, but would require an evaluation framework to be developed and implemented at an early stage. As there are comparable trends in alcohol and drugs misuse in Northern Ireland and the Republic of Ireland, NSD provides a good opportunity for policy making in Northern Ireland to learn from, and extend lessons to, colleagues in the Republic. Stronger collaboration on these issues on a north/south basis has huge potential to improve health and reduce health inequalities for the populations in both jurisdictions through better use of resources, increased levels of evidence in policy making and alignment of policy issues and solutions.
Central to the work of the Institute is our role in strengthening the public health capacity across the island of Ireland. Of particular relevance to NSD is our programme on Health Impact Assessment, our Leadership Programme, work to strengthen partnerships, and the Public Health Observatory. We believe the issues covered by these programmes are essential to any policy formulation, implementation and evaluation. We would welcome a discussion of how these resources may support NSD implementation.