Priorities for Public Health

The Malta Association of Public Health Medicine (MAPHM) is presenting this open letter to political parties in view of the upcoming snap election. Whilst this election appears to be dominated by a single issue, it is important to ensure that health priorities do not find themselves on the back burner in the coming years. Much progress has been achieved in terms of health outcomes over the past two decades, yet there remain important outstanding and emerging challenges that need to be tackled. This letter highlights four salient policy issues which MAPHM believes deserve attention. There are several other issues which need to continue to be tackled, however, we wish to draw the attention of politicians specifically to the following points:

Getting serious about effectively addressing Childhood Obesity

The MAPHM notes with concern the increasing prevalence of childhood obesity in Malta and its associated health and economic consequences. Childhood obesity is largely determined by the environments in which children live and the opportunities available to them to engage in healthy eating and regular physical activity. Although education is a necessary component of obesity prevention, it is only one part of a whole system response and must be supported and augmented by a much greater number and intensity of upstream health policies and legislation that alter the structural and environmental drivers of behaviour. National and international actions such as trade treaties, fiscal measures, regulation of the food industry, regulation of marketing food to children, as well as national and local structural actions that lead to re-design of the built environment and transport systems, provision of public green space, promotion of active transport and regulation of retail and fast-food outlets can improve health and help to prevent childhood obesity. Whilst childhood obesity has been placed on the agenda for Malta’s

Presidency of the Council of the European Union, this alone is not enough to address the issue and several policies may be implemented on a national level.

In the light of the most recent research on the scale and consequences of childhood obesity, MAPHM calls on political parties to respond to the evidence and adopt concrete measures to make healthier choices the default choices, including:

• The implementation of a levy on beverages with excessive amounts of added sugar. MAPHM points to the success of similar fiscal measures introduced elsewhere (e.g. UK, Mexico, USA) in reducing the sale and consumption of sugary beverages, and in encouraging rapid industry reformulation. Revenue from the levy should be ring-fenced and directed towards measures to improve children’s health and reduce the inequalities arising from childhood obesity.
• The introduction of restrictions on advertising of high fat, salt and sugar foods and beverages to children under 16 years of age on television, digital media, and through sponsorship.
• The introduction of marketing regulation to provide a “level playing field” on discounting and price promotions around unhealthy food and beverages, discouraging pricing that incentivises the purchasing of a larger pack or portion sizes.
• Changing planning legislation to make it easier for planning authorities to limit the proliferation of food outlets and mobile vendors selling unhealthy food in and around areas where children congregate such as schools, public spaces, sports clubs, social venues.
• The provision of infrastructure that promotes active transport (e.g. cycling lanes, pedestrianised zones) to ensure that children can safely perform unstructured physical activity daily.
• The introduction of legislation making it mandatory for restaurants to provide free tap water upon request.

Making environmental health a real priority

The MAPHM calls on political parties to recognise the inseparable links between development, environment, human health and well-being.

Green spaces have been recognised as important spaces that are conducive to the health and well-being of communities. They have been shown to decrease health inequity and environmental injustice especially in areas with considerable social deprivation. Green spaces are of relevance in highly densely populated countries like Malta where the natural countryside is scarce and urban green spaces are few and far between.

Air pollution has widespread effects on health and is detrimental to the quality of life. It is perceived as a priority well-being issue in Malta, especially by those who live on lower incomes and who are therefore more likely to be vulnerable to the effects of air pollution in the places where they live and work.

Malta has one of the highest private cars per capita rates in the world. This, coupled with a very high population density for the islands, makes car traffic undoubtedly one of the primary sources of avoidable air pollution. Traffic has become an increasing source of mental stress. In addition, traffic makes the Maltese roads unsafe and unappealing for pedestrians to walk, jog or cycle. Every year, around 25 people die on Maltese roads because of traffic accidents. These are entirely avoidable causes of mortality and are a significant source of death among young people, car drivers, car passengers and vulnerable road users such as pedestrians, cyclists and motor-cyclists.

MAPHM calls on political parties to respond to the evidence and adopt concrete measures to give environmental health the priority it rightly deserves by:

• Generating urban green spaces, additional playgrounds and pedestrianised village zones, with a view to giving every Maltese child a space for physical activity and social interaction.
• Making specific commitments to reduce car traffic on Maltese roads, to take an unprecedented commitment to creating safe walkways and cycling lanes or tunnels that make it possible for any Maltese resident who chooses to walk, jog or cycle to work or to another destination, to do so in a safe manner. Highly technological solutions need to be coupled with more conventional measures such as strengthening public transport, creating safe walkways, safe cycling lanes, and creating incentives for car-pooling.
• Enforcing legislation and raising the penalties for over-speeding as well as addressing the issue of drinking and driving more effectively.

Strengthening public health governance institutions

The MAPHM acknowledges that the private health sector plays an important role in Malta and can partner effectively with Government to ensure the efficient delivery of quality health care services to the Maltese population. However, MAPHM believes that it is important for any government to put into place the requisite governance structures and processes to ensure that these public-private partnerships function well in a fully transparent manner and that the maximum benefit is derived for the tax payers, patients and society in general.

To uphold the required standards of care and to ensure that the private partner adheres to national and international regulations and norms, the public health regulatory function needs to be strengthened and consolidated. The current legislative framework is weak and does not cater for complex models of partnerships between the state and the private sector to guarantee a quality service, accessibility and continuity of care.

MAPHM, therefore, calls on political parties to commit themselves to strengthening the role of the public health institutions by:

• Setting up the required legislative framework that guarantees competent and independent supervisory health care authorities working in a fully transparent manner.
• Building the necessary skills, expertise and information systems to ensure quality of care and value for money in any form of public-private initiative.

Reducing Health Inequalities

MAPHM is calling on political parties to start giving overdue recognition to the phenomenon of health inequalities in Malta. Local evidence shows, like in other countries, in Malta too, persons with lower levels of education and income have poorer health. They are more likely to live and work in poor physical environments. They are also more likely to take up unhealthy behaviour including smoking and be overweight or obese. Locally men having the lowest educational levels experience a life expectancy four and a half years less than those in the highest educational groups. Despite having free public healthcare in Malta, disparities in health outcomes due to socio-economic differences still exist and out of pocket payment for health services including medicines is one of the highest in the EU.

MAPHM urges the government to develop a targeted approach which reaches out to disadvantaged groups including minority ethnic groups, persons with mental health problems and persons from socio-economic disadvantaged families, particularly children and adolescents.

In order for the government to be effective in reducing health disparities, concrete measures are needed. MAPHM calls on political parties:

• To target socio-economic determinants in a holistic approach bringing together actors from different fields including education (e.g. early education), employment and health.
• To approach health promotion in a manner that reaches out more effectively to disadvantaged groups in society.
• To invest in research and monitoring of health inequalities as well as the impact of policies on the health outcomes of vulnerable groups.

Original Letter available Open Letter to Political Parties – Final