Question: To what extent has Globalisation been the cause of global health problems? 

Introduction 

Globalization is widespread and is often inconclusive and open to many interpretations. It can be described as the interdependence and relationship of people and countries. Alternatively, global health focuses on many countries’ challenges and concerns, and emphasizes transnational issues like climate change and urbanization. World Systems Theory, Solid Modernity, and Liquid Modernity are theories that attempt to explain Globalization. To evaluate the extent of Globalization on a global health issue, case studies will be used. For example, global rates of obesity and associated non-communicable diseases have been rising for the last four decades (Raine, 2012). Obesity rates have been related to globalization processes that encourage obesity by overwhelming low-income country economies with cheap, obesity – promoting products and disseminating Western-style fast food restaurants (dependency/world system’s theory) (Fox, Feng and Asal, 2019).  Domestic factors such as increased excessive calorie consumption in addition to income and increased female labour force participation as economies grow (the “modernization” theory) are potential hypotheses (Fox, Feng, and Asal, 2019). Globalization, or the unrestricted flow of information, technology, culture, and capital between countries, has been both a beneficial and detrimental force, especially in the realm of health. Globalization has aided in the emancipation of thousands of people from severe poverty, reduced hunger and infectious disease, and improved people’s overall quality of life. The problem is that the same social and economic changes that raised individuals’ prosperity have expanded their waist sizes, leading to the worldwide epidemic of obesity. The concept of “globalization” is also widespread in contemporary academia and is often inconclusive and open to many interpretations, which will be seen throughout the different case studies.  

  Define what Globalisation and global health are. 

The concept of “globalization” has become widespread in contemporary academia and is often inconclusive and open to many interpretations (Mir, Majeed, Qadri, & Hassan, 2014; Upali, 2017). As stated by the WHO, Globalization can be characterised as the growing interrelation and corelation of nations and individuals, which are two interconnected components. Globalization, according to Anthony Giddens, is the strengthening of global social links that bind distant locales in such a way that events in one country impact events in another country, even if they are miles away (IInfed (2017) and Upali (2017). This requires a paradigm change in our thinking regarding geography and our perception of the locality. Along with opportunities, it often involves significant threats, among which are those associated with technological development. The enhanced interrelationship and interdependence of peoples and countries (Economics Online, 2020) and changes in structures and policies that foster or facilitate such flows. Globalization refers to developing various economic, social, cultural, and technological processes that increase inter-connectivity between societies and people worldwide (IInfed.org, no date).  Michael Mann, for example, has recently stated: 

“… what is generally called globalization involves the extension of distinct relations of ideological, economic, military, and political power across the world.” (IInfed, 2017). 

However, other views, including transformationalists and postmodernists, except that globalists have exaggerated globalization’s influence. They argue that dismissing the idea outright is foolish. Globalization, according to this theoretical perspective, would have to be regarded as a intricate network of interrelated associations in which authority is often implemented indirectly. They argue Globalization can be slowed or stopped, mainly where it is harmful or at least regulated (Thompson, 2015). Global optimists conclude Globalization is taking place and that local identities are eroding due to multinational capitalism’s growth and the rise of a homogeneous global society. They perceive Globalization as an optimistic phenomenon, marked by increased development, economic growth, and the spread of democracy (Thompson, 2015). Globalization, according to pessimist globalists, is a process of Western American imperialism. They argue Globalization serves as a mechanism for enforcing Western institutions and values on the rest of the world. 

With the globalization of ideas, goods, and resources, the term is often used in industry to refer to an interconnected economy categorised by free trade and unrestricted capital flows, while using external labour trades to boost income (Lutkevich, 2021). As diverse nations become more politically, culturally, and economically linked, the world becomes more globalized. Technological advancements, especially in transportation and telecommunications, enable and accelerate these cross-border interactions and dependencies (Lutkevich, 2021). As a result, globalization can be classified into three distinct phases. Economic globalization is the process of integrating and integrating international financial markets and multinational corporations with significant market influence. Political globalization is a concept that refers to policies that facilitate international trade and commerce. Additionally, it includes the organisations that carry out these strategies, including national governments and foreign organizations such as the International Monetary Fund (IMF) and the World Trade Organization (Economics Online, 2020). Globalization of culture focuses on the social forces that allow societies to mix, such as increased communication and transportation facilitated by technology. It is critical to keep in mind that each form has an impact on the others (Lutkevich, 2021). For instance, certain liberal trade policies, collectively referred to as political Globalization, promote economic Globalization. Cultural globalization is driven by policies implemented as part of political and economic globalization, such as trade and imports. Technological innovation is the unifying theme that runs across all three strands of Globalization. As discussed previously, technology plays a role in the acceleration of each form. 

Each form of globalization has implications that can be seen locally and globally and can be established in interactions at all levels of society, from the individual to society. Each country or region considers the effect of foreign influence on its ordinary people. At the community level, the effects on local or regional organisations, markets, and economies are included. Although the ramifications of globalization are obvious, assessing the net effect of globalization is a difficult job, as some globalization results are often regarded as positive by proponents and as negative by critics. Sometimes, a relationship that benefits one party can hurt another, and the debate continues about whether Globalization benefits the world. 

Global health (GH) has replaced international public health, and in different ways, both concepts are equally applicable. International public health centres themselves on applying public health principles to health problems and issues affecting LMICs, and the diverse set of global and local determinants that form them. GH focuses on many countries’ challenges and concerns and emphasizes transnational issues like climate change and urbanization (Merson, Black, and Mills, 2018). 

GH considers health issues deemed global relevance and magnitude, attracting interest funding and cooperation from the public sector and private sector actors. This would also include corporations, foundations, and NGOs. Determining whether a particular health issue is recognized as a global or international issue, and how the response is constructed or governed, is strongly influenced by the shifts in political and financial power distribution (Tarontala, Ferguson & Gruskin, 2012).  

GH recognizes that malnutrition, infectious diseases, environmental destruction, and global warming all pose threats to the planet. It acknowledges how pervasive inequality misrepresents the inequalities between the global North and South in terms of wellness, medical advances, and economic development (Benatar, 2009). Global North institutions, particularly those in North America and Europe, receive significantly more funding than those in the global South. However, having information to positively impact global health problems also encourages scholars to migrate from the global South’s less developed nations. This results in ‘brain drain,’ in which indigenous wisdom is diluted in order to strengthen the global North (Hunt, 2019).  This disparity in the number of professionals demands a shift in the number of individuals emigrating from less-developed countries. This enables countries that have lost competent people to wealthy nations to participate on an equal footing in resource sharing (Hunt, 2019), resulting in a truly global approach to health. 

Health is not merely the absence of illness or the absence of symptoms. A state of complete physical, emotional, and social well-being is described as health. Health is not only physical; it is also psychological and social. Our social relationships can have a profound effect on an individual’s health and the health of a family, a group, or a society. GH is concerned with international health concerns. In other words, it is not only concerned with health problems within a specific country, but also with global issues. Numerous infectious diseases, for example, do not require passports. They fly easily between countries. 

Covid 19 is a recent example of this. Additionally, many health problems that would be classified as NCDs affect a substantial percentage of the world’s population. Thus, the definition of GH is synonymous with collaboration and trade. In other words, as a global phenomenon, GH can only be strengthened by cooperation and knowledge exchange between not only societies and communities within countries, but also between countries. Additionally, this partnership and trade must be global in scope. 

Increasingly in GH over the last few decades, both developed and developing countries can provide valuable lessons and guidance about how to manage health issues. The principle of GH is a combination of two distinct principles. The first is the philosophy of public health, which emphasizes population-based interventions and solutions that could be most effective for a given situation. At other times, offering individual treatment may be just as necessary, if not more so. Taking both and using them as required is one of GH’s defining characteristics, as it strives to be adaptable in addressing and resolving health issues. Now, numerous functions within GH tend to perform, or attempt to perform. One is to track and assess the global health status and health conditions. By collecting data, we hope to educate, inform, and empower nations, societies, and individuals. To establish mechanisms conducive to improved health and to concentrate on establishing and mobilizing partnerships. Both with governments or non-governmental organisations, human rights and the right to health care are well-established in the majority of countries (Tarontala, Ferguson & Gruskin, 2012). 

GH is a significant security hazard. Unhealthy populations, where illness can ravage groups, can breed political instability (Fox, Feng, and Asal, 2019; Shanmugam, 2020). Globalization is also dependent on GH. We are increasingly living in a globalized world. Where people cross borders easily, economics is now changing between countries. Certain countries prosper, while others do not. All becomes global, including health and disease. 

Additionally, as the world becomes more globalized, it is important for countries to view health as a global phenomenon, rather than a national one. A population with significant illness cannot grow economically as rapidly as other populations. As is frequently the case, improving one’s health will aid in growth. 

 Evaluate the theories of Globalisation, which help explain its impact. 

The term “globalization” has been misused and overused, according to Lee and Collin (2010). Lee and Collin (2010) describe globalization as three distinct forms of changes that have occurred at a rapid pace over the last few decades. They suggest explaining globalization. There are three dimensions of global change – spatial change, temporal changes, and cognitive changes. Globalization influences how physical or territorial space is perceived or experienced by spatial changes. It is how time is experienced or perceived with temporal changes, while cognitive changes are how people regard themselves and the world (Lee, 2004). 

Since there are various ideas and arguments on Globalization, three main theoretical perspectives from prominent scholars will be discussed that contribute to globalization literature. These include World Systems Theory, Solid Modernity, and Liquid Modernity. According to Wallerstein, the world-systems theory is characterized by an international division of labour comprised of a hierarchical set of relationships between three distinct types of capitalist zones (Thompson, 2015a). The core or developing countries have a monopoly on the supply of consumer products and regulate global wages. Countries like South Africa and Brazil are in the semi-peripheral region, which has urban centres that resemble the core, but still has rural poverty that resembles the peripheral countries. These are the countries that will receive the core contracts. Countries at the bottom of the food chain, for example, Africa, provide raw materials such as cash crops to the centre and semi-periphery. Additionally, the developing markets are where the core intends to sell their manufactured goods. 

 The Modern World-System is intricate, with core countries constantly devising new ways to profit from developed countries and regions. Wallerstein may also be chastised because underdevelopment is caused by various factors other than capitalism. Cultural influences, corruption, and ethnic strife are other examples. Wallerstein places much too much focus on economics and capitalism’s supremacy. People may also be abused and oppressed in other ways, including by tyrannical religious regimes. Some regions remain outside of the World System, including some indigenous groups in South America, who are relatively untouched by global capitalism. Finally, Wallerstein’s conceptions of the Core, Semi-Periphery, and Periphery are ambiguous, making it difficult to assess his theory in practice (Thompson, 2015b). 

The emergence of two main factors characterizes a social imaginary: mass migration and electronic mediation. Appadurai explains that global interactions between culture, economy, and politics have led to certain profound disjunctions between culture, economy, and policy. He describes how modernity impacts daily life and the significance of innovating as a social practice. Ethnoscapes, mediascapes, technoscapes, finanscapes, and ideoscapes comprise a unique group of five global flows of cultural imagination. To better understand this global concept, Ethnoscape considers it through culture and borders. Technoscapes also incorporate new exchanges and experiences that result from technological advances. Finance is connected to the economy and to the competitive nature of the economy, which is highly unpredictable. Mediacircumstance and informationscape relate to the development and distribution of information through the internet and media sources. 

The works of Ulrik Beck are considered the beginning of “risk society.” He discusses the political, economic, and social causes and effects of Globalization. This conceptual framework incorporates three interrelated elements: risk, individualization, and reflexive modernization. Beck identifies a process propelled by an increase in risks and science’s capacity to detect increasingly minute risks. He would suggest this contributes to a shift in social roles in society and a change in risk’s cultural definitions. The key argument is that the distribution of wealth results in the amount of risk. Social factors produce societal risks that threaten humankind’s survival. Leading institutions, including economic, political, legal, and administrative, generate certain risks and determine the resulting risks non-existent in society’s eyes (Beck, 1992). Beck speculated that those who stray from tradition face danger as a result of modern life’s globalization, such as those who move from rural to urban areas. Unpredictable results become the primary catalyst of social change in this danger society. Global economic growth would entice the poor to more affluent urban areas, despite the possibility of negative consequences (Beck, 1992). India faces challenges in combating poor public health among those who live in and migrate to megacities from rural areas, owing to the country’s dense and high population density. They live in filthy conditions in Mumbai, which is home to nearly half of the population. Families who bathe, brush their teeth, and wash their clothes in excrement-filled rivers are at the epi-centre of these unsanitary conditions, which provide an ideal environment for the spread of cholera (Hamner et al., 2006). These deplorable living conditions, as well as the risk of contracting cholera, are significant risks associated with slum living. 

Critique the theories of Globalisation that you use. 

The Network Society is the name given to the critical theory of Globalization that Manuel Castell has advanced. Globalization refers to a transition from a post-industrial society to an information society. Globalization, he explained, is the new basis of modern production and social organization through knowledge. Manuel Castell’s rise of the network society demonstrates how Globalization takes a technological approach. Although his theory employs a similar approach to analysing the capitalist system and its dynamics in the world-system and global capitalism, it is the logic of technological revolution, rather than capitalist growth, that is shown to enforce fundamental causal determination on the plethora of data obtained through Globalization. 

Multinational corporations are a clear example of Globalization. The word “multinational corporation” essentially refers to a company that operates in many countries. McDonald’s, for example, is a global fast-food company. McDonald’s’ global presence is understandable as a global brand, operating in over 100 countries and serving nearly 70 million customers daily. It employs over 2 million people and produced more than $22 billion in revenue yearly (Racoma, 2019). Owing to their widespread presence and effect on social and economic development in the countries in which they operate, multinational corporations such as McDonald’s are representation of Globalization’s contradictions. 

On the one side, multinational corporations would invest in indigenous people and facilities in order to create jobs, skills, and stability in the communities where they work. However, multinational companies, comparatively, can kill small industries, exploit cheap labour in developing countries, and disrupt cultural diversity. Although they provide benefits to the communities in which they work, they are often unsustainable. The corporation’s sole allegiance is to its bottom line, not the community through which it has incorporated itself. 

Offer specific case studies of globalisations impact on global health problems, both positive and negative. 

Communicable and non-communicable diseases account for a significant portion of global mortality. Heart disease, cancer, obesity, and respiratory problems account for roughly seven out of ten deaths worldwide. Eighty-two percent of premature deaths occur in low- and middle-income countries (LMICs) (WHO, 2019). These statistics have risen due to four main risk factors: tobacco use, excessive alcohol use, sedentary lifestyles, and unhealthy diets (WHO, 2019). 

Three significant inventions led to tobacco’s popularity during the nineteenth century. A method has been discovered for manufacturing cigarettes that are lighter and more pleasurable to smoke. The invention of safety matches greatly improved the ease of smoking. The first cigarette processing machine was invented, resulting in a major reduction in cigarette production (Bach, 2007). Around a billion tobacco users live in developing countries, out of a total global population of 1.22 billion (Yach and Bettcher, 2000). The US’s global hegemony has influenced marketing campaigns in low- and middle-income countries (LMICs), where the highest proportion of people die from cardiovascular and lung diseases. (2008) (World Health Organization). The marketing campaign targets women by capitalizing on the non-Western world’s view of Western society’s democratic, glamorous, and sophisticated picture. Weight loss and beauty are portrayed in a misleading manner in order to appeal to women’s interests and desires. This portrayal of Western culture has an impact on those living in LMICs. This then has an impact on the global increase of non-communicable diseases, resulting in a mode of Globalisation in which the tobacco industry’s Globalisation coexists with the smoking populations of their respective countries (Yach and Bettcher, 2000). 

Obesity is a condition that can be prevented in large part by changing one’s diet and adopting healthy lifestyle habits. Obesity, however, is a risk factor for many NCDs and is related to increased morbidity and mortality (Nishida, Borghi, Branca & De Onis, no date). Prevalence rates have continued to rise across the world, affecting every country regardless of socioeconomic status, culture, or race (Antipatis & Gill, 2001). The rate has tripled since the late 1990s (Wolfenden et al., 2019). According to statistics, obesity-related diseases result in 3 million deaths and merely under 36 million disability-adjusted life years per year. The WHO’s recently appointed Director-General has often mentioned obesity as a significant new global epidemic. Even though she expressly stated industry caused the outbreak, only a few attempts to fix the problem have been made so far. Obesity was once considered a fringe interest in most major medical societies. It was only in the last two decades it became a commonly accepted medical issue in clinical practice. Governments’ interests in public health are restricted unless driven by decades of solid lobbying and overwhelming medical evidence, including the dangers of smoking or potentially dangerous diseases like SARS or Ebola. Nevertheless, it has been proposed that no healthcare system in the world will cope with the full impact of the immense cost of care incurred due to obesity and its complications (James, 2018). 

The obesity epidemic has been linked to mechanisms of globalization that encourage obesity by overwhelming low-income country economies with affordable, obesity – promoting products and distributing Western-style fast food chains (dependency/world system’s theory). Domestic factors such as the increasing consumption of processed foods in reaction to economic production and greater opportunities for women as economies develop (the “modernization” theory) are possible explanations (Fox, Feng, and Asal, 2019). Globalization, or the unrestricted flow of information, technology, culture, and capital between countries, has been both a beneficial and detrimental force, especially in the realm of health. Globalization has aided in the emancipation of thousands of people from severe poverty, reduced hunger and infectious disease, and improved people’s overall quality of life. The problem is that the same economic and social changes that improved peoples and countries wealth have actually expanded their waistlines too, leading to developing countries’ global obesity epidemic. 

Numerous LMICs grapple with the so-called “dual burden” of obesity and malnutrition; however, while malnutrition continues in many countries, obesity has surpassed underweight in prevalence. Currently, there are more people are obese on a global scale, owing largely to globalization. It has developed McDonald’s franchises in cities such as Mumbai. As a result, the “nutrition revolution,” a term that refers to the obesity-causing transition away from conventional diets toward Western ones brought on by modernization and wealth, has been accelerated (Boston and Ma, 2012). 

The transition, which has been exacerbated by the global obesity epidemic and nutrition relation illnesses, is ingrained in globalization processes. It alters the fundamental characteristics of agricultural and food structures, by varying the accessibility, price, and attractiveness of foods on the market (Hawkes, 2006). 

Conclusion 

Globalisation, therefore, has progressed in synch with the fruition of social cultures. Nonetheless, the existing globalization process is unprecedented in terms of its pace and depth of change. To label globalization as “beneficial” or “disadvantageous” for health would be oversimplistic and inaccurate. For example, global migration is increasing as a result of spatial change (Lee, 2004). The debate about globalization and health in high-income countries is often presented around the risk of transmitting severe and infectious diseases like SARS and more recently, Covid 19. Additionally, developed countries fear the financial burden associated with the influx of obese people from developing countries. The threats that high-income economies can distribute to other parts of the globe through goods like cigarettes and processed food, as well as macroeconomic policies that influence foreign direct investment and debt levels, are less well-known. Furthermore, there is a tendency to overlook the benefits of migration flows for high-income countries. For example, the distribution of health workers from poorer nations helps under-resourced healthcare systems in high-income countries, sometimes at the expense of developing-world capacity. To put it another way, increased movement of people and goods leads to a complex calculation of benefits and costs for each group. 

Equally, temporal variation influences disease/illness transmission. Owing to the rapidity with which modern transportation networks run, pathogens have the ability to spread worldwide in a matter of hours (as illustrated by the SARS outbreak). By contrast, advanced technology allows the health system to respond to such emergencies more efficiently (Lee, 2004; Hunt, 2019). For instance, an international system of institutions organized by the WHO and connected through international infrastructures is capable of rapidly detecting and reacting to influenza virus changes. 

Finally, Western publicity and advancements have assisted in the expansion of knowledge of so-called “lifestyle” diseases (e.g., obesity) within specific populations within LMICs. Since it comprises of the global transfer of policies regulating the provision and financing of health services, the expansion of health sector restructuring can also be considered a process of cognitive globalisation. Thus, national health systems are tasked with the responsibility of sorting through and adapting these policies to local conditions. Additionally, global recognition results in an increase in the sharing of health care principles, ethical values, and standards (Lee and Collin, 2016; Lee, 2004). 

Along with individual change, global health laws must be changed. In the year after the introduction of the smoking ban, the UK saw nearly a 3% drop in hospital stays for people with cardiac ailments. It also saw a 93 percent decrease in air pollution levels in public buildings in the twelve months following the smoking ban in 2007. The smoking ban showed that policy changes can improve society’s health, and similar results are needed for LMICs to improve theirs. To assist in this endeavour, the NCD Alliance was founded by over 2,000 non-governmental organizations and charities to raise cardiovascular diseases to a public health priority (Yach and Bettcher, 2000; BauLd, 2011). 

Castell’s network society concept exemplifies how IGOs and NGOs will work cooperatively to reduce NCDs in epidemic-prone countries. The UN’s efforts to combat poverty through the Millennium Development Goals reflect how globalisation has brought nations together to ensure that everybody has access to knowledge about global events. This encourages non-governmental organizations to campaign on behalf of the health and rights of the entire world’s population. To be deemed a globalisation success, the earth must be treated as a single entity, with all governments, global North or South, cooperating holistically to improve the lives of the world’s most oppressed people. 

References

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Mental Health – Male Suicide in Ireland

​Issue: Male suicide in Ireland

Suicide is a substantial cause of mortality in Ireland and Mental health disorders are the highest risk factor for suicide in Ireland (Department of Public Health, 2001). In Ireland 80% of suicides are committed by men (Ryan, 2018) and  are less likely to attend mental health services (Department of Public Health, 2001). Can the stigma of men accessing mental health support as a cultural behaviour issue (O’Donnell & Richardson, 2018) and economic crisis causing male unemployment (McGuill, 2016), be the causes for this phenomenon or does current policy lack gender sensitive and wider social determinants of health (O’Donnell & Richardson, 2018)? ​

Background

Several Acts relating to Mental Health Legislation were implemented in Ireland in the nineteen centuries however it was not until 1945 that an important change in the delivery and development of psychiatric services was introduced in Ireland with The Mental Treatment Act of 1945 (Kelly, 2008). In 1971 the Health Care Board took over responsibility from the Local Health Authorities and developed a Community Care programme and mental health services began to implement changes in line with the policy document “Planning for the Future” (Community Health Organizations, 2014). Recognition of mentally ill patients was established in 1991 by the United Nations and The Human Rights Act (Kelly, 2008).  In the mid to late 1990’s an important change surged with the formation of the National Task Force on Suicide which resulted in an interdisciplinary communication system between General Practitioners and Primary Care Teams with Volunteer Organizations (Mugtaba, Parnell, & Haley, 2016). A new piece of Legislation was established in Ireland in 2001, the Mental Health Act 2001, although this Act was only fully implemented in 2006 (Zahid & Mansoor, 2012). ​

Since 2001 Ireland has witnessed the male suicide rate being in average four times higher than female suicide (National Suicide Research Foundation, 2020) and on examination of data provided it was determined that rural areas with common levels of religious celebration have higher levels of suicide (Cleary, 2005). Social and cultural expectations of masculinity through times have played a negative role on the well-being of Irish Men as well as expected male behaviour patterns like alcohol and drug abuse, coping mechanisms and risky behaviour (Garcia, 2016). Alcohol abuse has been a significant risk factor for suicide in Ireland (Department of Health, 2001).  Additionally, men disclosing difficulties and struggles to others were perceived as weak and associated with feminine or homosexual type behaviour (Cleary, 2005).​

The History of Suicide in Ireland is long charged with the taboo stigma of religious beliefs in conjunction with Criminal Law (Hanna, 1997). Suicide was decriminalized in Ireland in June of 1993 with the Introduction of the Criminal Law (Suicide) Act, 1993 (Mugtaba, Parnell & Haley, 2016) however, the role on taboo around suicide continue to be played by the Church (McGarry, 2016). Unemployment amongst men has been identified as another risk factor of suicide and during the Celtic Tiger, a period of economic boom (1996-2006) although suicide rates were stable, suicide amongst unemployed men raised (Corcoran & Arensman, 2010). Irish Society has always viewed men as bread winners or carers to their partners or children and these expectations continue to be cultural issues to the well-being of men (Garcia, 2016). In 2001, a published study on Suicide in Ireland concluded that Mental Health disorders remained the highest factor for suicide in Ireland and even though suicide in men is five times higher than in women, men are less likely than women to have attended mental health services (Department of Public Health, 2001). ​

Current Status

Irish Government current policy ‘Sharing the Vision – a Mental Health Policy for Everyone’ is an upgrade to ‘A Vision for change’ policy and aims to prioritize mental health in Ireland and to focus on primary intervention and positive mental health for everyone (Department of Health, 2020). In response to the promotion of mental health, the Government created in recent years, “Connecting for Life – Ireland National Strategy to Reduce Suicide 2015-2020” which is now prolonged until 2024 (Department of Health, 2020) and identifies men as being amongst the highest at-risk cohorts with evidence of vulnerability and at increased risk of suicidal behaviour (HSE, 2018). Last year the HSE also devised a review and proposal “Integrating Suicide Prevention into policy- making” (HSE,2020). Another welcome addition to this strategy is the development of a national free training plan on suicide awareness and prevention for local authorities and frontline staff (ASIST – Applied Suicide Intervention Skills Training), and SAFE TALK which is a basic free suicide prevention training programme available to everyone (HSE, 2021). ​

Despite the upgrades of Irish policies regarding suicide, currently there is still limited progress on implementation of previous set goals (Mental Health Reform, 2020). Staffing goals from previous policy ‘A Vision for Change’ only reached 78% of recommended mental health staffing and  today there are fewer staff working in mental health  than in 2008 (MHR, 2020). It has also been identified that early intervention is essential to prevent suicide despite this, 33% of people are waiting over a year for a primary care psychological appointment (MHR, 2020). Access to these services can only be granted through a referral by the patient’s GP and are not available in all centres neither some of the counties have an emergency care psychological service available (HSE, 2020). ​

Current policy has limitations on current data systems on suicide in Ireland and fails to provide broader characteristics on people who died by suicide despite World Health Organization (WHO) recommendations that Governments should provide real time data, which is essential to national suicide prevention strategies to accurately identify cohorts and risk factors to suicide and self-harm (HSE, 2019). Ireland’s National strategy to reduce suicide also presents limited progress on many of its goals since it was first implemented in 2015 (HSE, 2019) and lacks gender sensitivity and wider social determinants of health (O’Donnell & Richardson, 2018). Irish mental health policy does not categorically deal with gender (Bergin, Wells & Owen, 2013) although WHO recommendations alert for a gender sensitivity within policy development and health services and it considers gender a paramount determinant of mental health and mental illness (WHO, 2004).​

Currently, there are also several  volunteer services available such as a 24hour helpline provided by the Samaritans (Mental Health Ireland.ie, 2021), and counselling services provided by Pieta House who are Volunteer Organizations and rely on public donations.

Key Considerations

Irish Government current policy ‘Sharing the Vision – a Mental Health Policy for Everyone’ has allocated a budget of €38 M for the implementation of new mental health services (gov.ie, 2020), however it was recommended that to develop the new mental health services it would be necessary at least €50 M (Mental Health Reform, 2020). The budget is strongly criticised by the Psychiatric Nurses Association (PNA) and deemed inadequate to meet growing service demand (PNA.ie, 2020). The budget has a direct impact on mental health services availability and provision. Current policy is strongly criticized by the Irish Hospital Consultants Association (IHCA) who argue that this policy fails to address critical staffing shortages in mental health. IHCA also argue that the funding allocated to Mental Health is insufficient and therefore it will not be possible to reduce long waiting lists for access to mental health services or to provide quality care to mental health patients (IHCA, 2020). Statistics show that of all males that have committed suicide only 20% received out-patient psychiatric treatment and less than 15% received in-patient psychiatric treatment (National Suicide Research Foundation, 2020).​

Social Justice Ireland (2019) argues that to provide good mental health services it necessary to consider the connection between ill health and issues regarding social determinants of health such as housing, employment, education, etc., however this is not being met. Rates of unemployment are associated with mental health decline and rise of suicide rates in men (O’Donnell & Richardson, 2018). There is  evidence that employment is positive for mental health, however, in current Irish policies, very little has been fulfilled relating to unemployment among people with mental health issues  and, there is also a lack of early intervention in assisting people who develop mental health problems with their vocational and employment needs (Mental Health Reform, 2012).​

To tackle the suicide issue in Ireland it is essential to understand suicidal behaviour and focus on priority groups such as men who currently present much higher rates of suicide. Despite this, limited progress has been made in relation to the collection on baseline data on suicidal behaviour. Although it would be more difficult and costly to carry surveys focused on priority groups, it would be a major contribution on understanding suicidal behaviour, as suggested by Professor Steve Plat and could provide an important impact in shaping focused policies and adequate and relevant resources. In addition, available accurate and timely data on suicide would allow the provision of national and local responses to the changing epidemiology and characteristics of suicidal behaviour in Ireland (HSE, 2019). ​

Conclusion/Recommendations

• Alongside outdated Mental health policy (Mental Health Reform, 2021), staffing deficits within psychiatric services, lengthy waiting lists for mental health services and the percentage of funding allocated to mental services dropping, the Mental Health System in Ireland is at crisis (Press association, 2021). ​
• To successfully tackle the male suicide issue in Ireland it is foremost necessary to understand its causes and to address them to successfully implement a relevant and efficient policy and adequate preventative and response services. This can only be achieved with a significant increase of budget allocated for mental health services, focused research and implementation of educational programmes as well as addressing the issues surrounding the various social determinants of health.​

References

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