"the stark reallity is that local men's life expectancy is reduced by 13-14 years. In effect men in the Market are losing a fifth of their years".

Market Survey

Survey:

>> 82%

of people agree that there is not enough support for people with addiction and substance abuse issues.

>> Human Rights Indicator

Addiction and substance abuse issues cut by 50% through increase in support services and access by January 2022

>> Action

We demand the immediate development and implementation of a community health strategy, along with all the necessary resources to ensure its successful implementation.

KNOW YOUR RIGHTS:

HEALTH

The right to the protection of health
– Article 11 European Social Charter (1961)

The right of everyone to the enjoyment of the highest attainable standard of physical and mental health
– Article 12 UN International Covenant on Economic, Social and Cultural Rights (1966)

The right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health

– Article 24 UNCRC (1989)

Everyone’s right to life shall be protected by law – Article 2.1 UK Human Rights Act (1998)

Everyone has the right to timely access to affordable, preventative and curative health care of good quality – Article 16 European Pillar of Social Rights (2017)

The Survey also showed that:

>> 23%

of residents have a disability.

>> 37%

of residents physical health prevents them from

doing things they would like to do.

>> 27%

of residents mental health prevents them from

doing things they would like to do.

>> 33%

of people would like to get involved in health schemes.

>> 33%

of people would like to get involved in addiction/substance

abuse programmes.

Health in the Market:

A Community Crisis

The results of the 2018 Market Community Survey demonstrate that the rights of residents’ to healthy lives and adequate health care provision are not being met. The dire state of the community’s health, both physically and mentally, demonstrated in the survey also tallies with the latest Multiple Deprivation Measures which place the Market in the top 10% of areas suffering from health deprivation, with poor mental health figures being particularly notable.63 The results are unsurprising, and fit with the broader pattern of physical, social, and economic marginalisation to which the community has been exposed for decades, as outlined throughout this document. It is also unsurprising that it was therefore a mental health indicator – addiction and substance abuse – residents selected to measure progress in their quality of life. 

 

A 2006 study of men’s health in the Market found that the average age for death was aged 59, a full 14 years less than the then national average, the report finding that “the stark reality is that local men’s life expectancy is reduced by 13-14 years. In effect men in the Market are losing a fifth of their years”. The report went on to conclude that “this ‘cull’ of older men, is a loss to spouses, to children and to grandchildren. It is strongly felt in a community that has few older male role models and it reflects an unnatural picture of one gender only surviving into old age.” One health professional interviewed in the report added that ”There is a missing generation of men now in the area and there will be another time bomb of male ill health and early death in 10 years’ time.”64 

Poverty and Premature Death

The situation has not improved the years since 2006, and given the levels of deprivation in the Market shown across the survey results and Multiple Deprivation Measures, it is likely to decline further unless remedial action is taken immediately. A July 2018 report by the BBC has found that “people living in deprived parts of the UK are more likely to die prematurely … nearly a quarter (24%) of all UK deaths in 2016 were considered avoidable … our analysis shows a correlation between the level of deprivation in an area and the rate of avoidable deaths.” Locally the report found that “there is a correlation between deprivation and avoidable death rates” and that “in the deprived parts of Belfast, the avoidable death rate was the highest in the UK at 517 per 100,000 people,” with a spokesman for the Belfast Public Health Agency adding that “poverty is an important risk factor for illness and premature death. It affects health directly and indirectly in many ways, such as financial strain; poor housing; poorer living environments; poorer diet; and limited access to employment; other resources; services and opportunities. Poor health can also cause poverty. It is well established that the poorest people live the shortest live with the worst health.”65 

Addiction:

A Symptom of Poverty

Areas of high poverty become the perfect breeding grounds for addiction, which is a leading cause of premature death. The Coroner for Belfast, Joe McCrisken, has been particularly outspoken in relation to addiction and premature death, highlighting in particular the unacknowledged dangers from prescription drugs (which are killing far more people than illicit substances like heroin, ecstasy and cocaine) as being an area which requires urgent attention.66 He has also highlighted how alcohol addiction is an even bigger cause for concern, which he labelled as “the greatest health care problem facing Northern Ireland,” with an estimated 3,500 premature deaths blamed on it in the 15 years between 2001 and 2016, McCrisken adding “we have an enormous problem with alcohol use, misuse and abuse … the figures are frightening because they show that the number of alcohol-related deaths
is increasing … I’ve spoken before about how worrying the drug-death statistics are … but alcohol deaths dwarf those figures in terms of the sheer numbers.”67 While the figures may be worrying, they are again unsurprising given the levels of deprivation in our society. One recent book synthesising the vast array of studies on the subject of addiction noted two central causes leading to a high probability of addiction: deprivation and trauma. In relation to deprivation, it noted that:

If your environment is ... a safe, happy community with lots of healthy bonds and - pleasurable things to do you will not be especially vulnerable to addiction. If your -environment is like the rat cages where you feel alone, powerless and purposeless you will be.68

As demonstrated in the introduction and by the other indicators, this is exactly the type of physical, economic and social environment that has been created in the Market in the last 50 years by the statutory authorities – how the area was planned and designed during the conflict (and after) has created the conditions for addiction to thrive. There is also the more direct, conflict related issue: trauma. In the same study, it was outlined that In communities like the Market, trauma is not just a “legacy issue”, but a continuing lived reality which, even down to the physical shape of the area, residents are forced to live with and relive every day.

Scientists discovered that for each traumatic event that happened to a child, they were two to four times more likely to grow up to be an addicted adult. Nearly two-thirds of injection drug use, they found, is the product of childhood trauma. This is a correlation so strong the scientists said it is "of an order of magnitude rarely seen in epidemiology or public health." It means that child abuse is as likely to cause drug addiction as obesity is to cause heart disease.69

Suicide:

a Symptom of Poverty...

A failure to properly address these myriad issues has also seen another grim trend develop since the 2006 health report which had hitherto been rarely seen in the Market: suicide. A number of international studies of trauma and suicidal behaviour have already shown that traumatic events are associated with suicide, with the department of health acknowledging that “it is clear that poverty, recession, deprivation, the legacy of the conflict, exposure to violence, and higher levels of mental health needs are all influencing factors [in suicide].”70 This fits with a broader trend over the last 20 years. In February 2014 Kathryn Tomey notably reported for The Detail that “almost as many people have died from suicide in Northern Ireland since the signing of the Good Friday Agreement as were killed during the entire trouble”, with official figures showing a total of 3,288 deaths. Unsurprisingly, the report continued to highlight the link with poverty as their “analysis confirmed that the highest suicide rate over the last three years was in the most deprived council area (Belfast) and the lowest was in the least deprived area.”71 This harrowing figure has only increased in the intervening years, with 318 suicides in 2015,72 297 in 2016,73 307 in 2017, and a further 80 in the first quarter of 2018 alone – an average of 5 avoidable deaths a week due to suicide.74 Again, the class dimension in these statistics is unavoidable, as “suicide rates in the most deprived areas of Northern Ireland are three times higher than the least deprived.” 75 

The grim situation outlined here is only set to get worse if current policy persists, with one campaigner stating that “I fear that the number of deaths may even increase in the future due to the impact of welfare reform.  People working on the ground are talking about dealing with levels of poverty we have never seen before.”76 In the Market, with 23% of the adult population have some form of disability, this is particularly unsettling. One mental health campaigner has noted that “the economic cost of suicide has been estimated at around £1.5m for the loss of a single life to suicide. That would be a loss of £4.3 billion over the last 10 years. That is a staggering amount of loss to the economy here alongside the immense human cost.”77 As we have seen elsewhere in this document, if a fraction of these costs were allocated where needed, when needed, it would be transformative. Instead we have reactive policies which offer too little too late to the communities concerned, while all about them massive amounts of money are being funnelled through schemes like RHI and NAMA to the most affluent sections of society. If the top 10% most affluent areas were to witness the mortality rates a community like the Market endures, an emergency would be declared immediately. Instead, behind the roads, the walls, and the fences, communities endure as the crisis worsens. Mental health activist Phillip McTaggart has recently observed that:

The scary thing is that many people in the community feel like somebody dying by suicide is the norm. People have got used to it. If 80 people died in the first quarter of the year from road traffic accidents or in a plane crash, we would be talking about it a lot more. Everybody would be doing everything they could into preventing it, but here we are with 80 people dead from suicide in the first quarter and not a word about it, and that's what scares me. 78

Towards a Healthy Community:

Our Actions for Government

 It has been noted that “there is no simple explanation for why someone chooses to die by suicide and it is rarely due to one particular factor. Experts say mental health problems are important influences, as well as alcohol and substance misuse, feeling desperate, helpless or without hope.”79 While there may be no one factor involved, what we can say definitively is that all these factors are at
play in the Market community and that they have, to a large degree, been imposed on
that community against its will. The 2006 men’s health report noted that a key issue impacting health in the area was “the deficit of local facilities exasperated by the closure of Maysfield Leisure Centre and the lack of local amenities and resources”, further noting of one resident surveyed that “he often used Maysfield Leisure Centre when it was open and he thinks the closure of the facility had a major negative impact on the health of the area.”80 Maysfield’s closure in the early 2D00’s, and its recent redevelopment as an office complex, fits with the broader and ongoing pattern of the community’s isolation, marginalisation and disconnection physically, socially and economically from the wider city. The poor health of our community can be directly linked to this pattern, and the process continues apace. The property speculator attempting to build a skyscraper on Stewart Street is also delaying the redevelopment of the Tunnels, including the gym which will also act as the focus for a community health hub, social space and job creator. In his recent study on the causes of depression, anxiety and poor mental health, Johan Hari noted 

It was only a long time into talking with these social scientists that I realized every one of the social and psychological causes of depression and anxiety they have discovered has something in common. They are all forms of disconnection. They are all ways in which we have been cut off from something we innately need but seem to have lost along the way.81

The evidence of the various ways the Market has been cut off are documented at length here. The areas health cannot be treated in isolation.

As such, the Market demands the immediate development of a comprehensive and fully resourced health strategy for the area, to be formulated and implemented in conjunction with the other Human Rights Indicators contained in this document.

Have you been affected by any of these issues?

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