The popular saying of the headline clearly reflects the fact that as individuals we tend to value health as one of the most important assets. This is because the effects of ill-health are pervasive in all areas of an individual’s life, reducing one’s quality of life and well-being.
When we fall ill, our social realities are altered. Depending on the severity of the case, one might be unable to become employed, face an increased risk of poverty and suffer from isolation, just to mention a few. However, social realities themselves could be the underlying cause of ill-health.
Over the years, various studies have shown health outcomes are not only the result of genetics, services and medicines available but they are also closely linked to other social circumstances that people experience in their daily life.
The World Health Organisation (WHO) claims there are a number of social determinants of health which are often tied with the condition and environments in which an individual is born, raised, grows, lives and works.
Various social factors could play a role, including, but not limited to, education, income, employment conditions, social exclusion, public health programmes and health systems, women and gender equality, globalisation, early child development and urbanisation, as well as social support networks and stress.
Different health outcomes are often a result of the different distribution of money, power and resources at national and global levels. This inevitably leads to health inequalities, whereby particular groups (e.g. the unemployed or people in poverty) tend to be at a higher risk of ill-health.
This realisation therefore calls for further in-depth studies to identify the major social determinants of health on a local level. This is important for a variety of reasons. Firstly, such identification could help policymakers understand the channels through which they can directly impact health outcomes.
Over the coming weeks, around 5,000 individuals will be receiving an invitation to participate in the survey through a one-to-one interview
Over the years, national treatments have been mostly administered through blanket approaches. One-size-fits-all approaches could end up with suboptimal results. Identifying the real causes behind particular health issues could also help to provide a more holistic healthcare, ranging from prevention to treatment, integrating social assistance along with direct medical care, and achieving better results in addressing the issues once they manifest themselves, as well as to prevent them a priori.
This will improve social justice. Health inequalities often plague vulnerable groups who, due to their disadvantaged state, are at a higher risk of health issues and often lack resources to prevent and cure such conditions. It is therefore the responsibility of policymakers to shape policy accordingly to ensure a healthier and more just society and help individuals achieve better health outcomes where ill-health is avoidable. In so doing, authorities do not only improve health outcomes but social justice and equality for the whole of society.
Currently in Malta, data linking social determinants to health remains limited. Data is usually segregated to either health outcomes alone or to social indicators, often not linking the two. Information on social determinants of health is mainly attached to regional, educational, age-related, income and ethnic issues, even if the latter has now been changing drastically due to a bigger influx of foreigners. To design specific policies, further research and data collection must be carried out.
The Health Ministry, through the Superintendence of Public Health’s Social Determinants Unit, has secured European social funding to establish a national platform to address social determinants of health, aimed to collect such data. The Superintendence of Public Health, in collaboration with Ernst and Young, who have been contracted to carry out the survey through a public tender, will shortly be carrying out a nationwide survey as part of this research.
Such data will enable the identification of health inequalities in Malta and will feed into subsequent discussions which will feature the Health Ministry collaborating with other ministries and organisations, including the voluntary sector. This process will then lead to the strengthening of overarching and cross-cutting policies. For this reason, the local population is encouraged to participate in this exercise as their contribution is imperative for the project to be successful.
Over the coming weeks, around 5,000 individuals who have been randomly selected from the Electoral Register will be receiving a letter of introduction and an invitation to participate in the survey through a one-to-one interview. These individuals will subsequently be contacted by telephone to set an appointment.
Information given during the survey will not be retraceable to individual respondents and none of the reports will ever present individual results. The survey will cover various topics such as quality of life, diet, physical exercise, body height and weight, tobacco and alcohol use, illness, disability and also the use of health services and medicines.
Dr Charmaine Gauci is Superintendent of Public Health.