What it’s all about
Illness prevention and promoting good is what the Health Promotion and Disease Prevention Directorate stands for. Our ultimate aim is to improve the health and well-being of the Maltese population at large.
Most of our initiatives focus on promoting good healthy lifestyles amongst the population and to this effect we work in partnership with various stakeholders to tackle the determinants of illness. The focus on prevention of noncommunicable and communicable diseases is carried out at all levels including primary, secondary and tertiary.
We use two main strategies in our programmes – individual risk and population-based. The individual risk behaviour strategy focuses on programmes aimed at people at risk such as obesity, whereby we offer weight management classes and aerobics free of charge in the community. Similarly, we organise smoking cessation classes for smokers. The population based strategy focuses on initiatives towards the community, school, workplace and other special settings, which involve groups of people at risk. Such strategy aims to address the determinants of health and empower people to participate in improving their health.
In order for people to take up a healthy lifestyle, we need to create an environment that helps them. One basic concept is that the responsibility for the health of the nation lies with many stakeholders. For example, health cannot tackle the problem of obesity alone. There are various stakeholders who need to give in their input. This is the main concept behind the ‘healthy weight for life’ strategy launched in 2012 by the directorate to tackle the problem of obesity in Malta. Various stakeholders are involved in implementing the strategy including education, planning authority, sports sectors, agriculture and fisheries, catering industry, media regulation, transport authority and university amongst others.
Protection from communicable disease is another remit of the directorate whereby cases of infectious diseases are investigated and action taken to limit spread of infectious diseases. For example in cases of food-borne illness, the possible source is identified and an inspection is carried out on the premises. In cases of meningococcal disease, contacts are given prophylaxis. There is also a long-term vision for control of communicable diseases whereby strategies are developed to control priority infectious diseases. One such example is the TB strategy, which aims to control TB in view of the increasing influx of cases from high endemic countries.
Fortunately we have only small outbreaks. One has to weigh the risks of overreaction and panic among the public when information is released via the media. However the public needs to be informed if there is anything that should be done. Most times, when we get cases of meningococcal disease where children are affected, we hold a talk in schools and we have found that this allays a lot of anxiety. One experience of a kind was the 2009 H1N1 pandemic whereby we had a very good relationship with the media and they were being kept up to date on a daily basis. This has built a trust relationship between the health sector and the media, which were keeping the general public informed in a timely manner. Infectious diseases will remain a threat at a global level hence we need to be on the alert at all times to be able to take immediate action if any diseases come to our shores. Recent global alerts were to ebola and MERS-CoV, whereby we are on alert for any possible cases and having all the necessary contingency plans involving all relevant people if needed.
We identify priority areas based on a number of criteria including the burden of the risk actor or disease and preventability. We then build up interventions that are based on evidence. We do this by using data and information systems systematically. Decisions on applying programme frameworks are based on the best available peer-reviewed evidence (both quantitative and qualitative). When information is passed on to any target group, we ensure that the language and tone used is applicable to the target group. Many times we involve a representative of the target group in order to plan the initiatives. Another important aspect is conducting sound evaluation of initiatives and being prepared to change and adapt where things are not working.
When one thinks about prevention, as the saying says, “prevention is better than cure”, it is obvious that it is better to prevent illness rather than cure it. However in an age with limited budgets, we need to have a strong argument for investment in prevention. If you look at international literature, there are various initiatives that have been found to be cost-effective and others that have not. For example, smoking cessation programmes targeting adults have been found to be cost-effective, while targeted programmes for adolescents in schools are cost-effective. One needs to evaluate and ensure that the funds available are utilised to achieve the best outcomes.
An economic analysis was developed jointly by the Organization for Economic Cooperation and Development (OECD) and the World Health Organisation (WHO) with the aim of strengthening the existing evidence base on the efficiency of interventions to tackle unhealthy diets and sedentary lifestyles. This extensive analysis has showed that most of the preventive interventions that were evaluated have favourable cost-effectiveness ratios, relative to a scenario in which no systematic prevention is undertaken and chronic diseases are treated once they emerge.
The analysis further showed that interventions targeting the largest numbers of individuals (e.g. mass media campaigns, or fiscal measures), are among those that appear to have the largest impacts, even if their effects are smaller at the individual level.
Preventive measures are essential to the continuing rising demand on health care systems. Such systems are not sustainable if we don’t take the bull by the horns and work to reduce the burden of communicable and noncommunicable diseases. Health authorities have a major role in prevention by identifying people at risk and delivers effective counselling through primary care. Health is the major driver in promoting population based initiatives but needs other sectors on board to tackle population-wide initiatives including fiscal measures, legislative measures, reformulation of food products, setting an enabling environment and tackle inequalities.