‘Government has role in shaping health habits’

In his latest book Health and Society – Personal and Social Determinant of Health, published by the Malta University Press in 2018, Maurice Cauchi embarks upon the important endeavour of communicating and analysing trends shaping health and disease in Malta. Natasha Azzopardi-Muscat reports.

Maurice Cauchi chooses to start his book by giving a snapshot of trends in demography, economy and social deve­lopment in Malta. By doing so, he firmly orients the reader to the wider determinants of health beyond the classic biomedical model.

He then goes on to describe the epidemiological transition, illustrating how obesity, cardiovascular disease and cancer affect our population. I personally prefer to refer to diseases associated with deve­lopment rather than ‘affluent society’ since within the affluent society, it is usually people with lowest education and income that tend to bear the disproportionate burden of the so-called lifestyle-associated diseases. This issue is tackled in the chapter discussing the social factors that affect health.

However, one needs to delve beyond the notion that health will improve with increasing education merely as a direct result of more knowledge and health lite­racy since the structural and social context and environment is a powerful combination of factors that lead to the adoption of particular behaviours. As expected, Prof. Cauchi also discusses the role of religiosity and spirituality as determinants of health, an issue that is often overlooked in the literature.

The book includes an interesting chapter on the role of genetics and genomics in determining health outcomes. It is nowadays increasingly recognised that the interplay between one’s genetic make-up and exposure to particular risk factors ultimately determines the likelihood of becoming ill.

As we learn more about these interactions, we can better explain why individuals with similar exposures often end up with different outcomes. This new knowledge should in no way deter us from reducing harmful exposures since the population health approach should anyway lead policymakers to protect the interests of the most vulnerable.

Prof. Cauchi rightly highlights the fact that the development of a disease is the result of a combination of personal and social factors. Some factors are clearly beyond our control (age, gender, genetic makeup); other factors can be modified through personal behaviour (diet, exercise, smoking, alcohol abuse). The issue that remains rather peripherally addressed is the extent to which governments should intervene to use tools of public policy to modify behaviours that lead to health/disease.

In the final chapter, Prof. Cauchi emphasises the government’s role in educating the population about health risk factors and disease. While improving education and literacy in general will have a positive impact on population health, there is much evidence to show that regu­latory and fiscal policies are powerful, albeit controversial, tools that can influence population health habits.

The book has the added advantage of using data from Malta. This renders it particularly relevant to all those working in the public and private sectors who wish to understand what is driving health behaviours and patterns in the Maltese population over recent years.

Overall, I found the book to be an important addition to the domestic litera­ture on drivers of health and well-being and I wholeheartedly recommend it as essential reading for all those working in educational, social and health sectors that aim to improve health and well-being in Malta.

The book fills an important void in health literacy since while one can find many publications on every aspect of illness and disease, it is difficult to come across a publication that focuses on the factors that actually predispose or lead to illness in the first place, written in a highly comprehensive yet fully accessible language.

It provides an easy introduction to public health issues for all healthcare professionals and should be essential reading for students of medicine, nursing and allied health. Prof. Cauchi succeeds in making the complex arguments surrounding the determinants of health accessible to the lay public in a highly readable style.

The book is available in major bookshops in Malta, or may be ordered online directly from BDL Distributors Ltd: https://bdlbooks.com/product/health-and-society-personal-and-social-determinants-of-health/.

Dr Natasha Azzopardi-Muscat is a senior lecturer in health services at the University of Malta and president of the European Public Health Association.

[First published in timesofmalta.com on 25 November 2018]

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