SAFEGUARDING THE HEALTH OF THE NATION

Dr MARIO SPITERI, the newly appointed director at the Health Promotion
Department speaks to Daniela Xuereb about the importance of adolescent
health to secure a health nation

When did you first get involved in health promotion?

I first started working at the Health Promotion Department in 1992. At the
time there was a post referred to as Professional Officer - grade 2A. We
were a team of three officers dealing with health issues such as nutrition,
I was responsible for the tobacco area. I had obtained a Masters degree from
the University of Southampton in the UK where I eventually took a Ph.D.
related to alcohol, tobacco and illegal drugs in adolescence - a study about
the perceptions and experiences of Maltese students.

I returned to Malta late last year and was appointed director of the Health
Promotion Department.

What did you base your research on when studying for your doctorate?

My research explored young people's perceptions and experiences of alcohol,
tobacco and illegal drug use. It explored the prevalence of substance use
among Maltese sixth form students, and a detailed understanding of the
motivating forces affecting substance use was arrived at. I compared the
findings I had from the UK with those of Malta.

How did Malta compare?

Unlike in the UK, illegal drug use in Malta is less widespread in closed
recreational areas. Drug use seems to be more evident in open-air
entertainment areas. It is more difficult to control drug use in open-air
venues than in closed areas. During my research some students told me they
actually hid their drugs at an open-air party venue some time, or even a day
before the party was held.

Malta is on a par with the UK when it comes to alcohol consumption among
adolescents, and is the worst problem we are facing. Many young people go
out with the sole intention of getting drunk. We have to consider the long
term physical effects it has on young people. These include kidney problems,
the nervous system and other complications they might suffer as they get
older due to excessive alcohol consumption.

The situation in the UK is somewhat better than that in Malta, because there
are more restrictions on alcohol sales and consumption in the UK. Until some
time ago there was one particular shop in Paceville which sold alcohol by
the bottle to young people. They would then drink the alcohol outside the
shop (which is now closed) and after that move on to an entertainment venue
drunk, or almost drunk.

What about cannabis use?

The use of cannabis is as widespread in Malta as it is overseas. According
to my study the use of cannabis is linked to places of entertainment where a
lot of drinking takes place, and remains the most common drug used.

Recent studies have also revealed the link between cannabis use and mental
illness. Although many young people are under the impression that cannabis
is less harmful or addictive than the tar found in tobacco they are
mistaken, because the substance found in the cannabis plant known as THC is
extremely harmful. Both tobacco and cannabis are equally damaging to health.

Do you think young people are victims of consumerism?

Yes. I believe the leisure industry has become a pillar of consumerism. The
leisure industry works to attract as many young people as possible, and
although in itself the advertising is not all negative approach it does
become destructive when young people are exploited.

Is there enough law enforcement in Malta?

No, not at all. If I had to mention one law, I would mention that which
states that the promotion of free cigarettes in entertainment areas is
prohibited. This law is completely ignored. I happened to see three women
giving out cigarettes to a group of young men in a popular entertainment
area. One young man did not even know how to smoke, yet in order not to feel
embarrassed took the cigarette and tried to smoke anyway. This kind of
marketing is destructive to young people's health.

Another area is the health warnings laid down in Maltese law. Now that we
are about to join the European Union, Malta will have to get in line with EU
standards vis-a-vis health warnings. Health warnings will now have to
specify that smoking cigarettes does kill and that passive smoking does
harm. Health warnings are unclear and not bold enough at present.

Are we a physically conscious nation?

According to my study young women are more conscious about their physical
appearance. Sixty-nine per cent of the female respondents between the age of
16 and 19 claimed their greatest worry was their appearance and their
weight. Compared to men, women are more concerned about their physical
appearance and maintaining an ideal weight.

As a department we are continuously promoting a healthy lifestyle. We advise
people what to eat; more fruit and vegetables, and engage in regular
physical activity. We have published recipes which include all the necessary
guidelines for healthy eating, and also as a prevention for cancer.

Now that summer is just round the corner, our department will shortly start
raising awareness on the hazards of excessive exposure to the sun. There are
so many sun rays, many of which one cannot even feel which are extremely
dangerous.

By doing all the above and more, we will be investing in our future as a
nation. Health promotion is very cost effective in the long term.

Is sexual health a priority?

Yes, it is. We are in the process of formulating a national sexual health
policy. I am chairing the policy's committee composed of a number of
professionals in the field of medicine, ethics and other areas.

We already have a Genito-Urinary clinic based at Boffa Hospital. Doctors
there advise people on all sexually transmitted infections including HIV.

However, there is a need for more awareness of sexual health. Many people
both young and adult seek advice and help on sexual health matters.

Some people indulge in very risky behaviour including casual sexual
relationships. They have sexual encounters with people they do not even
know, and others get involved with foreigners. We are concerned about the
way young people are living their relationships. We have to be in a position
to deal with the already existing ones and be able to prevent further
problems

Why don't all organisations working for youth join forces?

A coalition for adolescent health has been recently launched, of which I am
chairperson.

Non-governmental organisations and government departments which work for
young people have been gathered under one umbrella - the coalition for
adolescent health.

Sedqa, the national agency against drug and alcohol abuse, Caritas, the
Church-run organisation, OASI Foundation based in Gozo which offers
rehabilitation to young people fighting drug addiction, the Department of
Health Promotion, the Education Division, Appogg - the government agency for
social services and other organisations have started to formulate policies
on adolescent health together.

The aim is to avoid duplication of work, and to optimise resources. We want
to target adolescent health and this does not only include the problems of
alcohol and young people, we are also dealing with issues such as stress and
mental health as well.

How is mental health affected?

Some young people have to cope with a great deal of tension related to
traumas they are suffering, like for example peer pressure and family
problems

Unfortunately, young people try to ease the tension by either getting drunk
or in other destructive ways. Many young people suffer from depression and
most require professional help. The coalition will tackle these issues, and
more We are determined to eliminate the stigma linked to mental health
problems.

Can you list the department's main services?

The department provides information on health issues such as smoking (2122
1897), nutrition (2124 2862) and sexual health (2123 1247 ) to the general
public. Callers have the option to remain anonymous and, if required, they
have the possibility to obtain further information from our department by
appointment or by referral to health centres.

The department also provides smoking cessation classes, weight reduction
clinics and distribution of educational material.