There is no doubt that health and illness are determined not only by individual factors such as personal habits or simply bad luck, but also by factors that fall under the rubric of ‘social determinants of health’, which have been defined by the World Health Organisation to include “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life”.
While a great deal of stress has been put on the need of individuals to take care of their own health, particularly through diet, exercise and regular monitoring, little emphasis has been put on appreciating those factors which are often beyond the power or any individual to control.
Likewise, while a lot of emphasis has rightly been put on the need to have the best qualified medical and related personnel and to provide centres of excellence, housing the latest technology, it is often not appreciated that environmental factors are crucial to ensure the health of the nation and the prevention of ill-health.
It is surprising to what extent inequality in the provision of services is to be found even in prosperous and developed countries. Even in a tiny place like Malta one can find serious variations in the level of health enjoyed by some sections of the population, with a much increased likelihood of poor health outcomes in the more deprived areas.
Even in a tiny place like Malta one can find serious variations in the level of health enjoyed by some sections of the population, with a much increased likelihood of poor health outcomes in the more deprived areas
Poverty and social exclusion are not unknown in Malta, as has been documented in reports showing that up to 15 per cent of the population is living in conditions of poverty. Perhaps more important is the fact that poverty is not equally distributed among the population and certain districts are more likely to be affected than others.
The factors that lead to social exclusion are varied but are intimately associated with the level of education of the individuals concerned.
A recent report , ‘A Framework for Educating Health Professionals to Address the Social Determinants of Health’ emphasises the need to recognise the connection between social factors and their effect on the health of the community. Moreover, there is a definite tendency for such factors to be perpetuated from one generation to the next unless the underlying causes are recognised and tackled.
This report emphasised the importance of ensuring that health professionals are aware of this issue. In this respect, it is relevant to highlight the role of the Malta Medical Association, which appears to be well aware of these issues. It organised a symposium recently (last November) which was opened by the Health Parliamentary Secretary Chris Fearne, which stressed the importance that political decisions can make by developing economic and social policies which could impact on the social factors that impinge on health.
The Institute of Medicine report mentioned above makes a special plea for the need of educating health professionals about the social determinants of health to generate “awareness among those professionals about the potential root causes of ill-health and the importance of addressing them in and with communities”.