A t the end of 2015, The Today Public Policy Institute published a report prepared by George Debono with the admittedly long title, The Environmental Dimension of Malta’s Ill-health and Action to Prevent Obesity, Diabetes, Cardiovascular Disease and Dementia.
The report does not portray itself as a comprehensive report on the nation’s health but it certainly leads one to think about the bigger picture. My contribution today will be to try and extrapolate some of the issues raised in the report (hopefully not too much out of the context in which they were written) to think of the bigger picture and how that picture links to the economy.
We need to provide the link to the economy as all too often we think of the costs in the health sector but we do not talk enough of the costs of ill-health. We talk of the economic sustainability of the public sector-funded health sector but we do not talk about the economic sustainability of ill-health. Moreover, we rarely talk of what may be the causes of certain forms of ill-health – something that the TTPPI report does very well.
We should consider the fact life expectancy is increasing, but while we shall be living longer, we may not be very healthy people
Let me take it a bit further. Very often the debate on the health sector in Malta focuses on the resources that are being allocated to it, but very rarely on the outcome of those resources. We forget that the outcome of any health expenditure is not the number of surgical interventions carried out at Mater Dei Hospital (important though these may be) but rather the healthy lifestyle of the Maltese. We seem happy to address health-related problems but are not terribly happy to adopt the old adage, “prevention is better than cure”.
We need to keep in mind that when the UN talks of the Human Development Index, it does not only make reference to the gross domestic product per capita but also to life expectancy and the level of literacy in a country. Apart from the fact that man does not live by bread alone (to borrow yet another phrase), it is recognised that a low level of life expectancy (and for that one can also read a healthy lifestyle) cannot sustain steady economic growth. The two are dependent on each other and on education.
In the covering statement to the TTPPI report, Martin Scicluna, its director general, states that “there seems to be little appreciation of the importance and economic benefit [my italics] of maintaining good health by appropriate preventive lifestyle measures”. He then writes that “a lifelong healthy lifestyle reduces the likelihood of the aged becoming a burden [and I would add economic burden] on society”.
The TTPPI report also claims that “the appropriate lifestyle changes… could save Malta’s health service between €40 million and €60 million annually”.
This is also indicative of the link between health, ill-health and the economy. The preface to the report is very damning as it provides statistics that show that Malta comes out worst in almost every health-related index.
Maybe we should consider the fact life expectancy is increasing (which is increasing the burden on our social welfare system), but while we shall be living longer, we may not be very healthy people. Therefore, the burden on the social welfare system will be made worse by an increased burden on the healthcare system.
I believe that the TTPPI report has two main benefits. The first is quite straightforward. It contributes to the debate on such an important subject. I trust that decision-makers and stakeholders do not leave the report to gather dust. If they do so, it will be to the nation’s peril.
The second is less straightforward but far more interesting. The TTPPI report forces us to assess the health sector in a totally different dimension. It forces us to think of the environment, the transport sector, agriculture and rural development, leisure and other aspects. We all know that these are also hot political issues in this country.
The need to have sustainable economic growth compels us to adopt a holistic long-term approach as there is no room for soft, short-term options.