WHO puts Malta among GROUP A for health services - 22/12/2003

From The Times

Healthcare league puts Malta in group A
Ariadne Massa

Maltese men are less likely to die when aged between 15 and 60 compared with other males in most other countries.

In fact, males in Malta aged between 15 and 60 were found to have the fourth lowest probability of dying according to the World Health Report 2003: Shaping The Future.

In contrast, women who normally have a higher life expectancy than men, ranked ninth in the world.

The director general for health, Ray Busuttil, said they were studying whether the programme of cardiac care, normally required more by men, could have led to these statistics.

"Figures cannot be taken in isolation and we are also looking into whether more females were last year involved in traffic accidents or the like. For example, just one mortality during child birth will have a major impact on the final result," he said.

Dr Busuttil, together with the director of institutional health, John Cachia, yesterday presented some results which emerged from the WHO report and which placed Malta among the top in terms of performance in the health sector.

Whereas in previous years Malta had ranked fifth in the evaluation of WHO on healthcare systems in 191 countries, this year's report stopped short of specifically ranking the countries.

Instead, the countries were split into five groups according to their performance in the health sector and Malta placed in group A.

The statistics also showed that 8.8 per cent of the Gross Domestic Product was spent on the health sector in Malta - two thirds forked out by the government and a third spent privately by citizens.

This balance was achieved despite the fact that the per capita cost in Malta was among the lowest - 818 international dollars in terms of purchasing power parity (PPP), as opposed to 2,800 dollars (PPP) in Germany and 2,000 dollars (PPP) in the UK.

This meant that, overall, Malta was more efficient in the utilisation of its resources, Dr Busuttil said.

Another interesting figure which emerged was that Malta ranked in 22nd position, from 192 countries, in terms of life expectancy at birth. Dr Cachia said this meant that the probability of dying among those aged under five years stood at 6.5 per 1,000 children, as opposed to 3.5 per 1,000 in Sweden which placed first.

Asked if placing in 22nd position was a good statistic, both Dr Busuttil and Dr Cachia agreed that in all probability the majority of those who died in this age group suffered from congenital abnormalities, an element that was eliminated in other countries which allowed abortion.

Malta did not embrace this policy and strove to provide treatment and attention to those who were born with any form of disability, Dr Cachia said. The WHO report contains an assessment of the global health situation, reviews trends in the HIV epidemic and the impact on developing countries of rapidly evolving epidemics of non-communicable disease and injuries such as the tobacco epidemic and traffic accidents.

It highlights how Polio, a major disease in the past, has been conquered, how the severe acute respiratory syndrome (SARS) had been contained through the collaboration of public health across the globe and the challenges ahead.

A tale of two girls
The WHO World Report 2003 showed how global health is a study in contrast.

While a baby girl born in Japan today can expect to live for about 85 years, a girl born at the same moment in Sierra Leone has a life expectancy of 36 years.

The Japanese child will receive vaccinations, adequate nutrition and good schooling. If she becomes a mother she will benefit from high quality maternity care. Growing older, she may eventually develop chronic diseases, but excellent treatment and rehabilitation services will be available; she can expect to receive, on average, medications worth about Lm191 per year and much more if needed.

Meanwhile, the girl in Sierra Leone has little chance of receiving immunisations and a high probability of being underweight throughout childhood.

She will probably marry in adolescence and go on to give birth to six or more children without the assistance of a trained birth attendant.

One or more of her babies will die in infancy and she herself will be at high risk of grey death in childbirth. If she falls ill, she can expect, on average, medicines worth about Lm1 per year.

If she survives middle age she, too, will develop chronic diseases but, without access to adequate treatment, she will die prematurely.

These contrasting stories reveal much about what medicine and public health can achieve and about unmet needs in a world of vast and growing health inequalities.

This report affirms that the key task of the global health community is to close the gap between such contrasting lives.

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