Below is the IPH response to the Department of Agriculture and Rural Development's (DARD) rural anti-poverty/social inclusion framework.

Access the original consultation document from DARD here
This consultation closed on 23 March 2009.

IPH Submission to Department of Agriculture and Rural Development
Rural anti-poverty / Social inclusion Framework

Introduction

The Institute of Public Health in Ireland
The Institute of Public Health in Ireland (IPH) is an all-island body which aims to improve health in Ireland, by working to combat health inequalities and influence public policies in favour of health. The Institute promotes cooperation in research, training, information and policy in order to contribute to policies which tackle inequalities in health.

IPH welcomes the opportunity to comment on the DARD Rural anti-poverty and social inclusion Framework.  IPH has conducted extensive work on poverty, equality and health across the island of Ireland.  We have also been specifically involved in other projects looking at the impact of rural areas and health, which may be found at www.publichealth.ie.  We would like to highlight the importance of considering the health needs of rural communities in policy such as the Rural Anti Poverty and Social Inclusion Framework. A wide variety of issues affect people’s health including employment, transport and access to services, for example the health and wellbeing of people in rural communities can be adversely affected by social isolation from a lack of public transport.

Key points
We would particularly like to highlight the following key points in the consultation:

•    IPH welcomes the approach DARD has taken within this Framework to identify and focus on vulnerable groups in rural areas.
•    IPH suggest the Framework could be strengthened by focusing more on specific outcomes for each of the five key areas.
•    IPH believes more attention should be given to how fuel poverty will be addressed within rural areas.
•    IPH recommends consideration is given to cross-border working as a large geographical section of rural Northern Ireland is situated on the border with the Republic of Ireland.
•    IPH highlights that addressing poverty is not the same as addressing inequality and therefore there should be a greater focus to addressing inequalities within the Framework.

 In response to the consultation, IPH would like to make the following comments:

1.    Are the aims and objectives of this framework right?

IPH believes this consultation could be strengthened by clearly identifying the vision, specific outcomes and timescale to reduce poverty within this Framework. A more focused approach linked to SMART (Specific, Measurable, Achievable, Realistic, Timely) objectives would be welcomed to tackling poverty and social inclusion in rural areas.

Poverty is not just about income but education, wellbeing, employment, good housing and a safe and healthy environment. This framework recognises the importance of a cross-sectoral approach towards tackling poverty and also identifies partners with which this may be progressed.

Poverty has major implications on health and well-being which are not experienced equally by all people.  The framework has identified there are major inequalities evident between urban and rural areas and amongst different population groups and communities of interest e.g. farmers.  IPH welcomes the attempt DARD has made to identify communities suffering from or vulnerable to poverty (child, fuel and food) and social exclusion.  It is essential the framework specifically targets these groups to address inequalities which exist and avoid exacerbating the problems.

2.    Have we got the five priorities right?  If not what other priorities might be appropriate?

The five priority areas seem appropriate for action. IPH calls for a greater acknowledgement of the impact of poverty and social inclusion on health throughout the five priorities.  We support that mental health issues amongst specific rural groups e.g. farmers have been identified but there are also major implications for physical and social health which should be taken into account.

IPH calls for more focused outcomes in relation to each of the five areas. For example a desired outcome for fuel poverty would be for the eradication of fuel poverty in rural areas by (desired date).  Each desired outcomes needs to connect to the overall objectives and again be SMART.

3.    What kind of projects/actions will contribute to the achievement of priorities?

Throughout the Framework there is a recognized need for joined up working between government departments.  Initiating and supporting joined up working will contribute to ensuring the Framework reaches its full potential.  
•    Fuel poverty
IPH has conducted extensive work on fuel poverty which has included supporting a cross-sectoral group in both Northern Ireland and the Republic of Ireland.  IPH recognise DARD is a member of the Fuel Poverty Interdepartmental Group and also the Fuel Poverty taskforce and it is clear a joined up coordinated approach is required to tackle this issue.  IPH support the cross-departmental approach in place for targeting fuel poverty.  There are several issues contributing to fuel poverty in rural areas which all need to be addressed, these include low incomes, quality of housing and type of fuel and higher percentage of older people.
•    Community development
IPH welcomes the identification of the need to support community development in rural areas.  In developing rural communities there is an important opportunity to enhance people’s health. Health Impact Assessment (HIA) is a methodology which can identify potential positive and negative health impacts and we consider the health and wellbeing of people in rural communities would be well served if HIA was carried out on aspects of this programme.  
•    Rural transport and access
There are major health impacts associated with transport and access in rural areas.  Lack of access to local amenities, employment etc can result in social exclusion which is detrimental for social and mental health.  IPH support the need for appropriate rural transport to facilitate social inclusion.  
•    Childcare
Childcare and child poverty are major issues in rural areas.  A recent report conducted by Derry Well Woman and IPH identified the need for the development of a strategy to review cross border planning in the area of child care .  IPH recommend DARD contribute to this work which is being undertaken by local councils, north and south, located along the border.
•    Anti-poverty and social inclusion challenge programme
IPH welcomes the identification of the effect poverty and social exclusion has on mental health and we support the development of projects which address these issues. However there is also a need to ensure all projects are health proofed to ensure they consider the wider determinants of health which acknowledges that the work of all sectors impacts on health.  

There is an overall need for all projects to be sustainable to promote long term health benefits in each of these areas.

4.    As part of the appraisal process the budget for the framework will be considered.  Do you feel each priority should have equal funding?  If not how would you apportion funding to each priority?

It is hard to determine the funding required for the delivery of the framework as the outcomes for each area are not clear.  However each priority should be assessed individually given the contributions and linkages to other government funded programmes e.g. Warm homes scheme and the Department for Social Development.  Again IPH calls for strong cross-departmental support in delivering the framework to ensure limited resources are used in a co-ordinated and effective way.

5.    How can we best monitor and evaluate the impact of this framework?

It is essential that baseline data is collected and collated at the start of the framework implementation.  Health indicators should be included as part of this baseline data and IPH suggests the following should be included and monitored at regular stages throughout implementation:
•    Fuel poverty related illnesses/deaths
•    Recorded suicide incidences in rural areas
•    Level of increased take up of benefits
•    Monitoring of positive ageing outcomes such as access to sustainable transport, involvement in social activities and groups.

IPH would welcome the opportunity to work with DARD and other organizations to assist in the development of indicators.

6.    Have you any comments /suggestions on the rural proofing, equality impact and social exclusion aspects of this framework? (checklist’s attached at Annex B/C/D)

Alongside the mandatory impact assessments, IPH calls for the framework to be assessed for health and health inequalities. Undertaking a Health Impact Assessment (HIA) will assess the potential and unintended health impacts of the framework. HIA uses both quantitative and qualitative methods to identify the health impacts on the population’s health and makes recommendations as to how negative health impacts can be mitigated and positive ones enhanced.  HIA can also make a contribution to tackling health inequalities in that it specifically explores the impact of the proposal on sub-groups within the population.

7.    What other comments would you like to make about this framework?

IPH welcomes the approach DARD is taking.   However we would advocate for increased focus on the potential health impacts of the Framework which requires greater clarification of the overall vision and objectives.

Contact details

For further information on this submission, please contact

Claire Higgins
Public Health Development Officer
Institute of Public Health in Ireland
Forestview
Purdy’s Lane
Belfast
BT8 7ZX
Tel:     028 90648494
Email:     Claire.higgins@publichealth.ie

Dr Jane Wilde
Chief Executive
Institute of Public Health in Ireland
Forestview
Purdy’s Lane
Belfast
BT8 7ZX

Tel: +44 28 9064 8494
Email: jane.wilde@publichealth.ie

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