Public health capitalises on private sector partnerships

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 Department’s funding constraints. This lack of funding has seen the Department’s 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 women’s and adolescent health.
To combat this state of affairs, and to help support the Department’s 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 Department’s one on one counselling sessions, but the cost in terms of manpower is high.
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 Department’s 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. It’s 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.
"It’s 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 Malta’s 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 purposes.
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. It’s 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 don’t want to be seen as a fundamental faction where we give a whole list of and don’ts 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 Malta’s 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, you’re not scaremongering, you’re actually being very truthful about it. The harm caused to a smoker’s 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 they’re 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 people’s 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 Malta today?
"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 we’ve 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. It’s 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 Department’s 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 we’ve 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 that’s 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."