In the second part of a two part investigation into health inequalities in Fermanagh, Impartial Reporter journalist Colm Bradley speaks to community workers and elected representatives in some of Fermanagh's most deprived areas. 

Poverty is 'real and impacts on people's health' says community activist

Irvinestown has been identified as one of five areas in Fermanagh that is among the top 20 per cent most deprived areas in Northern Ireland.

The Arc Healthy Living Centre is a charity organisation in the town and its CEO Jenny Irvine was very clear in her appraisal that poverty plays a huge part in prospective health outcomes: “We have all heard the saying that ‘your health is your wealth’ well it is more accurate to say that your ‘wealth is you health’ because there is no doubt that the more affluent that you are then the better your health outcomes will be,” she said.

Ms. Irvine also believes that there is refusal among wider society to properly acknowledge the complex issues that surround poverty and indeed at times a refusal to acknowledge that poverty actually exists.

“It is wrong, and we need to do something about it. We must stop shaming poor people for being ill. There is already a shame felt by people in poverty and when society shames them for also being ill then it makes things worse again,” she said, before adding: “I hear people say to me that there is no poverty and it is just wrong to say that. There is real poverty all around. People are going to foodbanks. People are going to foodbanks who are working and earning a wage so we must understand that poverty affects working people too and we absolutely have to understand that poverty is real and that it impacts on people’s health.”

Ms. Irvine also believes that there has to be more joined up thinking and a real effort to look at what are the actual causes of the health issues that people living in deprived experience: “I was at a meeting the other day where the increase in respiratory illness was discussed and it was talked about the need for more consultants in this area. But it was never raised that people are leaving hospital, vulnerable, and returning to damp cold homes. We are not looking to get to the root of the problem and instead we are treating the symptoms and we should not be surprised when there is no real progress made.”

The Chief Executive of the ARC Healthy Living Centre is however optimistic that real effective change can happen for those living in deprived areas but argues that there needs to proper investment: “Change can happen, but it requires work and it requires proper investment in the specific areas where poverty is at its greatest. Invest in young people in those areas and make sure they are getting the educational support that they need. Give the people hope and something to strive for. In areas of poverty there are expectations of failure and we need to stop the cycle that is a lack of hope. We need to give hope to not only individuals but also to the areas in which those individuals live.”


A 'toxic mix' of factors are at play in most deprived areas of Ennsikillen

The most deprived area of Fermanagh according to the Northern Ireland Statistics and Research Agency is the Super Output Area called Devenish, which is located in Enniskillen. Taking in parts of Kilmacormick, Hillview and Cornagrade, Devenish is ranked as the 44th most deprived area in Northern Ireland from a total of 890 areas. This puts it in the top five per cent of most deprived areas in Northern Ireland.

According to one Independent Labour Enniskillen Councillor, Donal O’Cofaigh, a number of factors have contributed to what he terms as a “toxic mix” that “discriminates against working class people to keep them in the bind that they are in”.

“The figures in these reports are very concerning and there is a systematic discrimination against working class people. Things like zero hour contracts and lack of education provision, particularly in the vocational sector all play a part,” Councillor O’Cofaigh stated before adding that there was some excellent work going on in the community, including projects like the Neighbourhood Renewal Scheme.

“I have no doubt though that in the health service there has been a managed decline of services with the provision of services being moved further and further away. I know that many people believe that they have been forgotten and working-class people have been exploited. There needs to be further research into what is causing the widening of the health gap and steps need to be taken to address these causes,” Councillor O’Cofaigh said.

Another Enniskillen Councillor, Keith Elliott, feels that it is incumbent on the new Health Minister at Stormont, Robin Swann of the UUP, to grasp the nettle when it comes to health reform: “It is important that we have a health service that is fit for purpose, sustainable and can adapt to the changes that are taking place in our society. People here are well versed in the challenges affecting health care, regrettably this has been exacerbated as a result of no Health Minister being in place for over three years. It is important that the new Health Minister commits to transforming our healthcare, so that people have confidence in the services provided and can access services easily. I will be working with my DUP colleagues to ensure Enniskillen and indeed Fermanagh isn’t left behind.”


Joined up thinking needed to tackle problems in rural areas, says Gannon

Four of the five most deprived areas of Fermanagh fall into the rural category according to the Northern Ireland Statistical Research Agency (NISRA). Belleek and Boa, Rosslea, Newtownbutler and Irvinestown are the four rural SOAs in the county. Erne West Councillor, Adam Gannon of the SDLP is his party’s spokesperson on Rural Health and says that rural communities have been struggling: “Dr Bradley’s report highlights some of the many disadvantages faced by those in rural areas when accessing healthcare. The fact that nearly all of Fermanagh and West Tyrone are in the most deprived 50 per cent of areas within NI is unsurprising -  rural communities have been struggling for quite some time already.”

Councillor Gannon believes that there are short term measures which could be taken to help matters: “In the short term, investment will ease our problems. Ensuring proper staffing levels and higher wages for staff in rural areas will attract more doctors, nurses and other healthcare professionals.

“This alone would improve the services here. Additional investment in community care will also remove immediate pressure on hospital services and by brining care directly into the community we can tailor it to directly address issues such as, lower life expectancy for women and higher rates of lung cancer.”

Parts of the Belleek and Boa SOA are located in Councillor Gannon’s Erne West ward and the SDLP man believes that moves must be made to locate more specialist services at South West Acute Hospital: “Currently the travel burden falls solely on those living in rural areas and automatically decreases our ability to access important medical facilities. This is fundamentally unfair and needs to be addressed. By moving one or two specialist services to a hospital like the SWAH it will improve access to services and share out travel more evenly across the North.

“Ultimately a joined up interdepartmental approach, which is currently lacking, is needed in the long term to lift the barriers to healthcare access and to address the root causes of economic and social inequality faced by people here.”