We’ve had peace on this island for so long now that it’s hard to imagine a return to the murder and mayhem that blighted all our lives and tarnished our nation’s reputation for three decades.

As Sinn Fein and the DUP edge closer to the inevitable sharing of power, their ability and willingness to work together in tackling bread-and-butter issues will soon be tested. The novelty of normalisation, which was brought about by the Belfast Agreement, is long gone. What remains now are real, everyday issues.

Northern Ireland is now an altogether different and better place to the one which began to emerge from the ashes of armed conflict more than a decade ago. It has prospered from rising exports, falling unemployment and faster growth rates than in the UK. With armed conflict now all but gone, it’s clear the peace process has been a success even if the political dispensation at times seems elusive.

As Westminster begins its retreat in the months ahead, former sworn political enemies will have no choice except to work together and with the rest of the island.

Sinn Fein held the health ministry in the last power-sharing executive and may wish to do so again. As successive ministers in this part of the island have discovered though, the job usually attracts more brickbats than bouquets. But there promises to be much co-operation between North and South on health issues into the future.

This is possible, not least because current levels of funding for the health services in Northern Ireland may not be able to deliver the required progress off the current base, but also because there are broader issues that would justify an all-island response, involving pooled expertise, experience, resources and initiative.

Health inequalities

A report from the all-Ireland Public Health Alliance, which drew together the facts and the findings of a raft of studies already in the public domain, has highlighted shocking health inequalities among the less well-off on both sides of the border.

It notes that men North and South have the lowest life expectancy of any country in the European Union, and that men from the poorest backgrounds in the North live an average of six years less than those from more affluent backgrounds.

When the poorest and richest groups north of the border are compared, the death rate from cancer was found to be 100 per cent higher, from injury and poisoning 150 per cent greater, and from respiratory disease 200 per cent higher. The incidence of mental health problems and suicide was also found to be higher among poorer groups.

For Ireland as a whole, the principal finding was that people in poverty are more likely to die younger and to endure more sickness along the way before they do.

North-South co-operation

The National Development Plan for 2007-2013 has ambitious targets for health infrastructure and health services, which will benefit people throughout the island. It envisages closer North-South co-operation on health promotion; on research and development into big killers, like cancer and heart disease; and on joint initiatives to improve access to health services, especially for those living in border areas.

People in Donegal, for example, can now access radiotherapy services at the Belfast Cancer Centre. Moves are also afoot to ensure that out-of-hours primary care services in the north-west will give people on both sides of the border access to a GP on either side of it.

Other areas being targeted for cross-border co-operation are high-tech hospital services, like paediatric cardiology, where the costs could be shared; and all-island population health research to identify common health needs.

Similar issues

We’re facing the same broad health issues on both sides of the border:

* growing populations;
* increasing life expectancy;
* rising levels of physical disability;
* continuing ethnic and income inequalities;
* the need to modernise the health service infrastructure;
* the requirement to bring new medical technologies on stream;
* the obligation to ensure safe, effective, high-quality services; and
* rising pressures to get value for money from health spending.

There’s still the matter of getting the new Assembly and Executive up-and-running, but if we’re as close as we seem to be to the breakthrough that people voted for at the election, then it’s only a matter of time until there is a genuine, co-operative drive to tackle deep-rooted health inequalities and issues on an all-island basis.