Many times, when we think about health, we tend to think of the services being offered to manage specific conditions. However, what determines health goes far beyond this.
The World Health Organisation considers that the health status of a population is determined by a mix of factors including income, housing, employment and lifestyles. These conditions in which people are born grow, live, work and age are termed social determinants.
Variances in these factors lead to significant inequalities in health between individuals and different groups in society. Health inequalities are more common in vulnerable groups due to their socio-economic status, ethnicity, disability or other issues. This leads to a lower status of health for these specific population groups, which ultimately affects the employability of these people. If employability is affected, the person tends to end in a vicious circle of having less money and thus being more vulnerable to disease.
Evidence shows that these health inequalities can be reduced by tackling social determinants through a ‘health in all policies’ approach. This means involving all sectors within government and all of society, including NGOs. Such an approach is dependent on awareness within all sectors, including policy-makers, government, civil society and the public.
Looking at local statistics, many chronic conditions and lifestyle risk factors are more prevalent in people with a lower level of education
While considering that all the sectors in government and civil society are instrumental in achieving a ‘health in all policies’ approach, the Health Ministry – through the Superintendence of Public Health – has partnered with those ministries and parts of civil society that are evidently the most influential on social determinants.
These partners include the Ministry for the Environment, Sustainable Development and Climate Change; the Ministry for Education and Employment; the Ministry for the Family, Children’s Rights and Social Solidarity; the Ministry for Gozo; Sport Malta; the President’s Foundation for the Wellbeing of Society; the Malta Council for Economic and Social Development; and the Malta Council for the Voluntary Sector.
A project supported by the European Social Fund, amounting to €2.2 million, will focus on reducing health inequalities through establishing a national platform to address social determinants of health. This will be an intersectoral group to act on areas of health inequalities. This project is supported by the World Health Organisation, who is providing technical advice and support with shared experiences of other countries. Investment will be aimed at research, training and awareness campaigns.
The first activity of the project is to carry out local research, which will be expected to generate information similar to that covered on the international scale in the Review of Social Determinants and the Health Divide in the WHO European Region reports.
The main objectives of the study are to identify, document and review the health inequalities situation in Malta; outline the main social determinants of health and their impact on health; identify specific vulnerable groups; quantify the problem; and analyse and document the current policy response to health inequalities.
The results will inform on reasoned, evidence-based proposals for action in the areas where gaps and inequalities have been identified. In addition, a qualitative research task will be held among service providers, policymakers and civil society with the aim to analyse current knowledge related to social determinants of health. This will form the basis of the training programme for the same service providers. Public awareness campaigns and skills development initiatives will address the health inequality gaps, as identified from the research.
Investment in capacity building is the forte of this project, whereby training will be provided to people who give work to vulnerable people, service providers and any other individuals who would be interested in participating in such training.
Learning from others will be supported by the WHO. In line with achieving an ‘all-government’ approach, another component of the project is to provide specialised training on social determinants of health and an intersectoral attitude through shadowing at the WHO European Region office dealing with social determinants of health.
Education is a top social determinant of health. Looking at local statistics, many chronic conditions and lifestyle risk factors are more prevalent in people with a lower level of education. Hence, a focus will be made on the education sector.
The ultimate aim and sustainability of the project revolves around the creation of a national platform to address social determinants of health through a ‘health in all policies’ approach. The project aims to achieve this through the establishment of a sub-committee under the Healthy Lifestyles Advisory Council. The legal status and expertise within this council would facilitate the ultimate effectiveness of the national platform.
Dr Charmaine Gauci is Superintendent of Public Health.