Background to the Research

• This report seeks to provide information on issues that will affect future health and social care policy and provision in NI. It builds on themes and issues raised in the Pathfinder Report (1999) and the Policy Futures for UK Health Project 2000 Report in a NI context.
  

Research Approach

• The report examines data on demographics, disease, lifestyle, poverty and deprivation in order to pinpoint the implications of these various trends for health and social care needs in NI by 2025.
  

Main Findings

Demography

• By 2015, life expectancy is likely to be 77 years for men and 82 years for women (previously 74 and 79 years).
• By 2015, 13.9% of the population will be aged 60-74 years and 6.8% aged 75years+ (currently 13% and 6%).
• In 1999, there were 5 people of working age for every pensioner; by 2013 there will be three.
• There will be a decrease in the number of available carers as family structure changes and the birth rate declines (by 2016 children under 15 years will be 19.6% of the total population).

Implications for policy

• Health and social care for the elderly will need to be improved and there is a need to foster healthy lifestyles for active ageing by promoting community-based approaches.
• Attention will need to be given to the needs of ageing populations in relation to disease prevention and service delivery by building up capacity within primary care.
• Resources will shift towards older people, especially in relation to those with chronic diseases.
• Families will require more respite care and community support and the problems of availability and support for informal carers will need to addressed.
• Policy markers will need to address the funding of long-term care, particularly the contribution of individual versus public funds.
• The ability of the working population to support the more dependent sections of the population will need to be examined.
• Innovative private and public pension schemes will need to be introduced.

Trends in Disease

• Life expectancy in NI is among the worst in Europe and the burden of disease is shifting from young to old and from communicable to chronic disease.
• 6 out of 10 people die of heart disease and cancer, with coronary heart disease killing 1 in 3 men and 1 in 4 women and cancer killing 1 in 4 people.
• Cancer will overtake heart disease as the main cause of death by 2007, currently the breast cancer death rate is the highest in Europe.
• Currently, 9.3% of the population suffer from mental illness and suicide is a common cause of death amongst young people.

Implications for policy

• Resources will shift towards the treatment and long-term care of those older people with chronic disease.
• Awareness of the social, economic and lifestyle factors that affect health will increase.
• Given that the poor are hardest hit by disease and ill health, previous approaches to policy-making need to be re-evaluated.
• There is a need for more integrated services to tackle interrelated problems and there is a need for greater interagency as well as multidisciplinary working.

Lifestyle Trends

• The percentage of school children between the ages of 11-15 years who smoke regularly is rising. Although the number of adults smoking is in decline, this is unevenly distributed among the social classes.
• There are increasing numbers of girls under the age of 16 giving birth, the teenage pregnancy rate is among the highest in Europe.
• The use of illicit drugs and alcohol consumption is rising.

Policy Implications

• Trends relating to lifestyle will manifest in increasing incidence of disease in the future.
• There is a need for smoking cessation programmes for disadvantaged groups, and health education needs to take account of smoking and drinking amongst adolescents.
• The increase in the incidence of disease associated with lifestyle factors will put increasing demands on health and social services.
• Traditional health and social service delivery needs to become more diverse and there is a need for innovate and targeted health promotion programmes.

Environmental Trends

• With the emergence of BSE and re-emergence of TB, there is increasing public concern with food safety.
• Poor air quality is having a detrimental effect on health, and matters relating to air quality need consideration.
• Links are increasingly being made between poor housing and long-term illness, respiratory disease and psychological problems.

Policy Implications

• The evidence base for assessing environmental hazards to health is weak.
• There is a need for an integrated health and social care policy that addresses the causes of ill health, be they social, educational, environmental and/or economic.

Trends in Poverty and Deprivation

• The poor are hit by illness and death more frequently and earlier than the better off.
• Teenage pregnancy is more common in areas of deprivation.
• A growing number of the older population are dependent on social security and therefore vulnerable to poverty.
• Fewer lone parents are in employment than in the Britain, resulting in greater dependence on Income Support.

Policy Implications

• All policies relating to health and social care need to be evaluated in relation to their impact on health and social inequalities and should favour the less well off.
• The future implications of changes to pensions and disability benefits on household income need to be monitored.
• Steps should be taken to reduce income inequalities and improve standards of poor households.
• Employment policies need to take account of the complexity of decisions about entering/re-entering employment that lone mothers face.
• Any additional resources are to be targeted on means tested minimum income guarantee for pensioners (increased Income Support).
• Government policy should continue to encourage increased economic participation of the 50+ age group.

Rising Public Expectations

• Public expectations of health and social care provision are rising and the public are gaining and demanding more information concerning these issues.
• There is widening gap between those who have and those who have not access to information.
• Scientific and technological advances will mean an increased potential for screening and treatment of common disorders.

Implications for service provision

• More explicit standards of care and increased disclosure of medical information.
• Increase in self-care and the provision of patient held records.
• More explicit standards of performance so that consumers can make more informed choices about services.
• There will be more opportunity for individuals to take more responsibility for their health.
• There will be greater debate concerning the ethical issues brought about by scientific advances.