Public health capitalises on private
By David Lindsay
As the old adage goes: prevention is better than cure and the Health
Promotion Department, headed by Dr Mario Spiteri, has set itself the
task of transforming the saying into actual deeds.
This, however, is far more easily said than done given the Departments
funding constraints. This lack of funding has seen the Departments
specialised staff complement being limited to seven each specialised
in one particular area of health promotion such as nutrition from both
the public health perspective and in providing one-on-one counselling,
sexual health, tobacco and alcohol prevention, and womens and
To combat this state of affairs, and to help support the Departments
number of ongoing campaigns, the Department has turned increasingly
toward the private, commercial sector to help make ends meet, particularly
in light of the enormous costs associated with publishing the dozens
of public health brochures, booklets and pamphlets drawn up by the Department.
Dr Spiteri explains, "Nowadays when we carry out a mass media campaign
we involve an outreach programme that involves government departments
and schools. As such there is a huge amount of cost involved.
"These mounting costs are why we have been involving the commercial
sector in certain projects. We find a reputable firm that has an extremely
non-controversial product, even a healthy product in terms of nutrition,
and we join forces based on certain costs. They are given an endorsement
but of course we still retain our complete editorial control in the
publications. That, in turn, allows us to keep giving these publications
out for free."
This year, more than 600 people would have been helped through the Departments
one on one counselling sessions, but the cost in terms of manpower is
As such, the Department tries, where possible, to reach what Dr Spiteri
refers to a "captive audiences". He exemplifies with the practice
of holding smoking cessation clinics at health centres and places of
work, the latter of which have seen a good amount of success. And with
the World Health Organisation citing exposure to second hand smoke in
the workplace as one of the most harmful practices in the workplace,
the issue has caught the eye of the large employers. STMicroelectronics,
Dowty O Rings, Water Services Corporation are some of the larger corporations
that have utilised the Departments services.
Dr Spiteri explains, "Some workplaces were interested in carrying
out their own support service so we negotiated with them and provided
them with staff proficient in smoking cessation.
"Some workplaces have been very proactive in this area. Its
not a question of introducing a smoking policy overnight, this is bound
to fail unless you bring in consensus, you help them quit and you give
them time to advance through the stages.
"Its an outreach programme because we work on a thematic
basis and in a setting. It could be the workplace where you have a target
audience, such as the recent breast awareness campaign, which was carried
out on a large scale at STMicroelectronics one of Maltas
largest employers. We offered them talks, the women there were shown
how to conduct a self-examination, while information and guides on how
to become more breast aware were distributed.
"We really appreciate that we are able to find partners in industry
who are really putting their money where their mouth is and are truly
putting staff welfare at the forefront, and not just for public relations
What would incentivise a company to hold such programmes, I ask?
"Any company worth its salt is bound to see the positive advantages
in investing in staff. I think it would be blinkered vision for any
manager to not see the huge potential in investing in their human resources."
The Department has a number of ongoing campaigns, one of its most recent
being the Breast Awareness campaign, and it will soon be launching an
alcohol awareness initiative.
"We see alcohol from various perspectives and not just in terms
of car accidents, which are unfortunately the only ones that hit the
headlines," Dr Spiteri explains. "There is also the long-term
cost of alcohol abuse to consider. You get people very much addicted
to the substance and they end up falling by the wayside, literally.
They become human detritus, their family life and most other aspects
of their lives are dashed on the rocks. Its a huge, huge problem.
"Worryingly, it is no secret that in the Paceville area more and
more young people are literally meeting to get drunk, which will hopefully
be tackled soon with an introduction of by-laws through local council
legislation. In this case we are mainly talking about young people who
seem to be taking on board the binge drinking habits of our northern
European neighbours, a phenomenon practically unheard of up to possibly
six to eight years ago. Of course the affinity for alcohol always been
in Malta, but the problem of binge drinking is a recent adoption.
"Despite the severity of the problem, we definitely dont
want to be seen as a fundamental faction where we give a whole list
of and donts and do nots - there is much more to it than that.
"In addition, binge drinking also brings on a host of other consequences.
Since inhibitions become lowered with alcohol consumption, there could
be a greater likelihood of unprotected sexual contact, road rage and
other violent incidents."
As we talk, my eyes are persistently drawn toward a large poster depicting
the seen and unseen toll smoking takes on the human body, which has
been highly publicised of late by the Department across Maltas
magazines and newspapers.
The poster is certainly effective, I comment, but I question whether
these are mere scaremongering tactics. Dr Spiteri disagrees.
"Should scaremongering be avoided? Yes, I agree. But on the other
hand if you tell the truth about the gruesome facts smokers have to
face, youre not scaremongering, youre actually being very
truthful about it. The harm caused to a smokers body basically
begins at the very top of the head and reaches as far as the toes. It
also takes its toll everywhere in between and in some particularly strategic
areas, such as inhibiting potency and increasing sexual dysfunction.
This has often been instrumental in encouraging males aged between 35
and 45 to really quit smoking.
"Unfortunately, younger people still think theyre invulnerable
but when they are faced with a poster such as this, which shows in a
graphic way the proven harm caused, they begin to reconsider their habit.
"Young people tend to be reactive when they feel they are being
led by the nose, and when we deliver the message that they are being
literally led by the nose by the tobacco industry - an over-manipulative
industry that has billions at its disposal thanks to peoples health
and the gullibility of young people - we hope this will spur them to
become more rebellious and that innate rebelliousness must be used to
safeguard their interests."
Smoking and alcohol abuse are undoubtedly among the most deadly vices
known to man, but what is the most concerning health problem facing
"Speaking of adults, we tend to be very much lazy, we tend not
adopt healthy lifestyles unless we are really threatened with the prospect
of having an angioplasty, by pass or other surgery.
"But it is so easy to adopt a healthy lifestyle in terms of the
foods we eat. Unfortunately the healthy Mediterranean has been lost
through the influence weve had in the English way of eating such
as using fats, butter, and unhealthy cooking processes, which can be
quite tasty but are at the same time harmful. The traditional Mediterranean
way of eating, where you have more fruit and vegetables and healthy
olive oil has lost favour.
"Exercise is crucial as well, we take our cars everywhere, while
smoking is still a huge problem, but with young people drinking is an
even bigger hazard.
"A recent study found that young people are failing to recognise
the virtues of exercise, which, coupled by bad eating habits, has led
to a certain amount of obesity. However, on the other hand, we also
have the problem of eating disorders, not just binge eating, but we
are coming across cases of bulimia and anorexia, which can be very serious.
Its hard for some people to believe that an attractive young woman
is literally starving herself to death. We recently started offering
the service of a qualified psychotherapist for people with eating disorders
and who have been referred to us by a general practitioner. At the same
time we can also refer them for other specialised support as well."
But at the end of the day these activities and services boil down to
the availability of funds and Dr Spiteri makes a heartfelt appeal to
the powers that be to ensure that further funding for the Departments
crucial mission statement are forthcoming.
"It is far more worthwhile to invest in prevention because the
funds involved are appreciably much less than the huge amounts needed
for secondary and tertiary health care."
However, to supplement current funding levels, the Department intends
to continue working in collaboration with the private sector.
"These last months weve taken on board several partnerships
with commercial companies and we intend to keep on that foot in the
future. It is envisaged that and the Health Promotion Department will
become even more proactive in its work because we will have less obstacles
in attaining funds through this practice. But of course we do rely heavily
on our main source of funding, central government.
"Unfortunately, we cannot produce instant results as our results
deal with the longer term and are not immediately tangible and thats
an obstacle. But the fact that we have more and more people are seeking
our services is in a way a good certificate because who would be interested
in learning more about health unless they have been impressed or encouraged
to take on board some of the material we provide? If these people are
adopting healthier lifestyles, then that means we are getting somewhere."