A recent RTE programme, ‘Ireland’s Health Divide’, has caused controversy in Limerick.
Concentrating on pre-natal problems, childhood obesity, poor education, smoking and inadequate diet, the programme sought to establish a link between low income and poor health. The show drew a contrast between Glasthule, a wealthy Dublin suburb, and Moyross, an economically disadvantaged area in Limerick, illustrating the fact that children born in poverty in Ireland will die six years earlier than those born into affluence.
The author of Ireland’s Deprivation Index, Dr Trutz Haase, referred to a map which identifies ‘red spots’ of severe deprivation across Ireland, including a number in Dublin. He focused on Limerick, however, as the location of the worst-affected community in the country – although Donegal comes in at a very close second place – and highlighted Moyross in particular.
Well-known media personality Dr Eva Orsmond travelled to the city, interviewing families and community support workers, but the programme’s representation of these Moyross residents is likely to form part of a complaint which is being made to the Broadcasting Authority of Ireland. The team’s decision to focus on a small section of Limerick has been the subject of derision, with some critics accusing the programme of relying on stereotypes of Limerick that have formed a staple of media commentary for decades.
Others have argued that a more accurate investigation of an unbalanced society would have entailed looking at two communities within the same geographical area. Producers could have, for example, visited the Ennis Road, one of Limerick’s more privileged areas, instead of Glasthule in Dublin. They may well have found just as startling a health divide, without having to step outside the city boundaries.
Dr Izabela Handzlik of UL’s Sociology department told Limerick Life that choosing two unrelated locations on opposite sides of the country “firstly, doesn’t properly demonstrate the whole spectrum of the problem and secondly, may unnecessarily stigmatise one particular community.”
Local people in Moyross echo this feeling in their own way. A woman who took part in the programme told Limerick Life that the interviewers had used “all the bad bits I said and none of the good ones”. Residents in the area expressed annoyance that Moyross has once again been “scapegoated” and felt that some aspects of the programme were unbalanced.
No mention was made of the €3 million refurbishment currently taking place at the resource centre including the affordable community café, which provides high-quality food to anyone who wishes to eat there. While not denying that more needs to be done to properly educate children and their parents about healthy, nutritious eating, one local remarked that some questions in the programme were biased.
“You ask a child what their favourite food is”, he laughed, “and you expect them to say broccoli?”
In this edition of Focus, Limerick Life takes a magnifying glass to our own city, looking beyond the neat soundbites to get a true picture of Limerick’s health and longevity.
How Limerick really compares
While the newest CSO figures are expected soon, the last regional survey of life expectancy found that Limerick fared worst, when compared to other urban centres. Women in particular die three years earlier in the city than the national average age of 82.7, and one doesn’t have to look far for contributory causes. Limerick is among the top five worst locations in the country for deaths from heart attack and stroke, conditions that are heavily influenced by factors such as smoking, unsuitable diet and lack of aerobic fitness.
According to the TV programme, upwards of 25% of Irish schoolchildren are overweight or obese. The general population of Limerick has an obesity rate of 14.2 – 14.6%, however, which is lower than many other counties. Donegal’s, for example, stands at 16%. But the figure is still high and the statistics leave little room for comfort.
In the show, Dr Haase points out that in Moyross only one person in a hundred has a third level education, against a national average of about one in every three. Limited education can perpetuate a cycle of low employment, exclusion, lack of influence and a general shortage of social, cultural and economic capital, which are the markers of a thriving, healthy society. Taking Limerick as a whole, however, 78% of school-leavers went on to third level education in 2015, according to The Economic and Social Research Institute.
Of particular concern are the statistics relating to children: Limerick has the highest rate of infant deaths in the country. The World Health Organisation points to a number of causes for infant mortality, including pregnancy complications, birth defects, preterm birth and low birth weight, Sudden Infant Death Syndrome (SIDS) and accidents. It also has the highest number of children (and adults) with a disability. Again, there are environmental factors associated with economic circumstances. More affluent women tend to have better pre-natal care, better nutrition and lower rates of smoking, all of which contribute not only to the figures on infant mortality, but also influence birth-weight, a significant determinant of a child’s long-term development.
The mental health statistics are also stark: while Cork City has the highest number of deaths by suicide, the CSO found in 2014 that Limerick City was well above the national average, at 13.9 out of 100,000 people, compared to 11.5 in Ireland as a whole. A more recent report from the HSE pointed out that the rate of suicide in Limerick city increased by 43.9% since 2006. By the same token, the National Registry of Deliberate Self-Harm, looking at numbers in 2014, found that Limerick City had more than double the national average occurrences of self-harm. The rate of hospital-recorded self-harm among males in Limerick was 87% higher than the national average in 2014.
On a more positive note, Limerick boasts a large number of GPs, with 65 – 70 per 100,000 people. This is among the highest numbers in Ireland; some counties have only 35, for example, with Meath particularly under-staffed.
Limerick: A City of Two Halves
Limerick Life has long highlighted the contrast between the city’s haves and have-nots: a recent feature in this paper looked at the stark contrast in employment figures in the area, revealing a huge disparity in wealth between the richest and the least well-off.
Limerick has the highest percentage of unskilled workers in the country, but also boasts the second-highest net disposable income. Not only this, but it very nearly pips Dublin to the post – the CSO found that in 2014, the average Limerick resident had €20,395 left over to spend each year, whereas Dubliners had €21,963. This can be partially explained by the relatively low cost of living in Limerick: a global survey conducted last year found that the city was the most affordable place to buy a home, out of 367 cities across the world. Unsurprisingly, Dublin was deemed to be among the least affordable.
These figures demonstrate a vast wealth divide, within a very concentrated geographical area. The surrounding County is also prone to variables. A recent report by Teagasc found that two County Limerick towns, Rathkeale and Abbeyfeale, were in the top five most economically depressed towns in Ireland. On the other hand, Caherconlish, Adare and Castleconnell were classified as among the strongest, in terms of employment and inward migration.
Despite enjoying one of the fastest-growing employment rates in the country – with 8,000 new jobs created in the region in the last five years – eight out of ten of the country’s worst employment blackspots are in Limerick. In one area, King’s Island, there is 60% unemployment. Although recent figures show the number of people on Limerick’s Live Register has fallen 18% in the last year, the figures remain grossly disproportionate to those of Ireland as a whole, with economists now agreeing that the country is close to full employment.
Causes and Solutions
There are myriad issues to consider when attempting to establish the reasons for these statistics. Dr Haase points to education as a major factor in choosing a healthy lifestyle. However, this theory is hardly fool-proof. For example, the recent Growing Up in Ireland study found that women with higher levels of income and education are more likely to drink alcohol while pregnant.
While Dr Orsmond is vocal in her belief that healthy eating isn’t expensive, she does qualify this by pointing out that it’s only true if people are familiar with healthy, affordable recipes and cooking methods. Last year Safefood Ireland calculated that the cost of feeding a household healthily in Ireland is approximately €160 per week for a family of four.
Ciara Kane of Northside Family Resource Centre explained in the programme that there are many reasons for the less-than-perfect diets of families in disadvantaged areas, including poverty, lack of housing security and even, on occasion, domestic violence. These enormous challenges contribute to what Professor Richard Layte of Trinity College described as ‘cognitive load’. People who are living in stressful situations, he says, are concentrating so much on more urgent needs – where the rent money is going to come from, for example – that there is simply not enough head-space to give full consideration to longer-term goals such as giving up smoking and eating healthy foods.
This would suggest that there is no one easy solution to the problem of the health divide in our city and our country. Tackling the issue will require a holistic approach, one which addresses our housing crisis, anti-social behaviour, access to education, medical care and mental health services.
“You would hope that our legislators and our politicians will look at how we can improve – that something will come out of these programmes,” Dr Orsmond said in interviews this week, though it remains to be seen if politicians and decision-makers will respond to the issues raised.
For now, the fact remains that a person born on the Ennis Road can expect to live six years longer than his or her neighbour in Moyross, simply because of the circumstances of their birth.
Image 1. Dr Eva Orsmond travelled to Moyross, questioning residents on their lifestyles
Image 2: Limerick is among the top five worst locations for deaths from heart attack and stroke
Image 3: More than three quarters of school-leavers in Limerick went on to third level education in 2015