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CULTURAL HEALTH ASSESSMENT: MALTA
Location: Malta [capital: Valletta] is the larger of a group of small inhabited islands situated in the Central Mediterranean - 93 km (58 miles) away from Sicily, 288 km (179 miles) from North Africa, 1826 km (1139 miles) from Gibraltar, 1519 km (947 miles) from Alexandria. The archipelago is small with a total land area of only 315.12 km2 (122 square miles). The islands consist of a series of low hills with terraced fields and natural harbors. Their climate is characterized with mild, rainy winters and hot, dry summers. Average rainfall is 578 mm falling mainly in September-March.
Major Languages Ethnic Groups Major Religions
Maltese (official) Maltese 98.1% Roman Catholic (official) 91%
English (official) other 1.9% Other 9%
Italian (widely spoken)Archaeological remains suggest that the first settlers in the Islands came from Sicily towards the end of the 5th millennium BC. These were throughout history influenced by the major circum-Mediterranean cultures, resulting in an assimilation of Carthaginian, Greco-Roman, Arab and Southern European influences. Traces of Anglo-Saxon are the result of the long period of British rule of the 19th-20th centuries. The language is Maltese, which has Semitic roots and an assimilation of the romance languages. With an ever-increasing population (2003: 399,867), the archipelago has one of the highest world population densities 1265 people per km2). The number of foreign residents account for 2.8%. There have been a total of 4744 returning migrants during the last ten years, the majority coming from the United Kingdom (33%), Australia (25%), the United States (13%), and Canada (9%). There has also in recent years been an influx of irregular migrants from Northern Africa. The population is significantly augmented during the summer months by a major temporary influx of tourists.
Health Care Beliefs: Active involvement; health promotion important. Over the last two decades, there has been increasing awareness of the links between lifestyle and chronic disease conditions. The population generally strives to follow the general guidelines of health promotion. The national health sector incorporates a health promotion agency that in the last decade has initiated national campaigns for health education related to nutrition and smoking. Other campaigns relate to sexually transmitted disease, exercise and other specific disease awareness.
Predominant Sick Care Practices: Biomedical and religious. The Maltese are very health conscious particularly when they feel unwell. In sickness, the family doctor is usually consulted first, although direct recourse is also made to a specialist even for relatively minor disorders. Folk medicine is no longer practiced; but religious traditions still influences health attitudes among older adults and very religious people when facing an incurable disease. Recourse is then made to increasing participation in private and public religious services, and attendance to faith-healing services.
Ethnic/Race Specific or Endemic Disease: The increasing socio-economic and associated dietary changes of the last century have made the Metabolic Syndrome with its various facets the primary health problem of the population. Obesity (Age 55-64 years - males: 77%; females: 85%), late-onset diabetes mellitus (Age >15 years - males: 12.0%; females: 14.4%), hypercholesterolemia (males: 72%; females: 75%), and hypertension (26%) are all common conditions in adults. Long-term complications arising from these conditions, e.g. coronary heart disease and stroke remain major causes of mortality (33.0% of all deaths). Neoplasms account for 23.2% of deaths, with lung (4.0% of all deaths), large bowel (2.9%), and breast (2.2%) being the most common. Endocrine-related malignancies such as endometrial cancer (crude incidence 27.8 per 100000 population) and breast cancer (108.4) in females appear to be commoner than the European average. Because of the high population density and resulting road-traffic density, accidents are an important cause of death (0.5% of deaths). Certain genetic disorders, such as thalassaemia and G6PD deficiency, are endemic to the population. Communicable disease of major public health significance include food-borne illnesses such as salmonellosis (271 cases in last five years), Campylobacter infections (131 cases), and meningococcal disease (107 cases). Infections such as murine typhus (147 cases), tick-borne typhus (73 cases), leishmaniasis (57 cases) and brucellosis (1 case) are endemic to the islands. The HIV/AIDS estimated prevalence remains low with 17 cases of AIDS being reported in the last five years. There are generally transmitted by male homosexuals. There has so far been no local outbreaks of HIV infection among intravenous drug abusers, who however have high prevalence rates of Hepatitis C infection (3 cases in last five years).
Health Team Relationships: The medical profession retains a dominant position over other health care professionals in the health services, though inter-professional working relationships are generally good. In the state hospitals, the nursing and midwifery profession has increasingly undertaken self-management to establish a professional niche.
Families' Role in Hospital Care: Generally, Maltese families remain close and patient relatives regularly visit their sick relatives. Social problems experienced by most families, compounded by restricted entry to the state’s old people’s hospice, often induces relatives to leave sick and incapacitated older individuals as hospital in-patients in the hopes of obtaining early admission into the hospice.
Dominance Patterns: Malta has a typical patriarchal culture; however the mother has near absolute control in the domestic arena, especially for education and child care issues. Legislation ensures equal opportunities for the sexes, but male dominance still remains the norm on executive boards, in top management positions, and in the civil service.
Eye Contact and Touch Practices: The Maltese have basic Mediterranean attitudes. During conversation, eye contract is regularly maintained by the listener. The speaker may however avert the eyes occasionally during the dialogue. The Maltese tend to be very expressive during conversation often using gestures and hand movements. Physical touching, particularly of arms and shoulders, is part of this expression. Depending on the degree of familiarity, a simple handshake usually suffices at greeting. With increasing familiarity, this may be replaced by an embrace and cheek kissing.
Perceptions of Time: In line with the relaxed Mediterranean attitudes, punctuality is not the norm among Maltese. The population has generally a strong sense of history and traditions, but is very adaptable to social and political change.
Pain Reactions: Attitudes and reactions to pain are generally Mediterranean being overtly expressive.
Birth Rites: The crude birth rate has been steadily decreasing reaching 10.06 per 1000 population in 2003. The Total Fertility rate was 1.48. Perinatal mortality stood at 9.5 per 1000 total births. Pregnancy termination remains illegal. Infant mortality rate stood at 5.9 per 1000 live births with congenital anomalies accounting for 47.8% of these deaths. The majority of births occur in hospitals with standard obstetric practices and supervision. Normal deliveries are conducted by trained midwives supervised by an obstetric specialist. Old folklore beliefs are basically extinct though pregnant women occasionally still enquire about beliefs heard from the older generation. Some individual women opt for alternative means of pain relief such as water births and homeopathy, but retain specialist medical supervision.
Death Rites: The crude death rate stands at 7.92 per 1000 population. Attitudes towards death are generally positive because of the strong Christian belief in the afterlife. Mourning involves demonstrative expressions of emotions by surviving family members and close friends. The funeral services include a dedicated church service followed by a burial service at the cemetery. The close relatives generally wear black or dark clothing at the time of death and for some period thereafter as a mark of respect for the deceased. Concepts of organ donations and autopsies have steadily become accepted.
Food Practices and Intolerances: The Maltese diet is traditionally Mediterranean but has during the 20th century taken on European components. This dietary change has contributed towards the increase in the Metabolic Syndrome. In recent years, a public educational program towards health nutrition has emphasized the importance of a low-fat, low-sugar, and no-salt diet, resulting in an increased consumption of low-fat and whole-grain products.
Infant Feeding Practices: Breastfeeding rates approximate 54% on the second day of life, the remainder opting for mixed or bottle feeding. Bottle feeding is based on industrial preparations. Weaning foods are generally introduced early at about the third month. The concept that a big baby is a healthy one still persists. Childhood obesity is an increasing problem with 18.9-24.3% of 10-year old children being obese.
Child Rearing Practices: Day-to-day child rearing and discipline is generally carried out by the mother. Schooling is legally compulsory for all between the ages of 5 to 16 years being freely available by the state. The church and other foundations provide alternative paying education facilities used by about a third of the children. Children generally remain with their parents until marriage.
National Childhood Immunizations: The legal requirements regarding vaccinations introduced in the latter part of the 20th century have resulted in a significant drop of vaccine-preventable diseases in Malta. The law requires compulsory vaccination against diphtheria, polio, tetanus, and rubella for females. During the last five years, there have been no reported cases of diphtheria and polio, while there were only 5 cases of tetanus and 20 cases of rubella reported. The recommended immunization protocol includes:- at 2, 3 and 4 months of age Diphtheria – Tetanus - Pertussis - Polio - Haemophilus influenzae B; at 15 mmonths and 7 years Measles - Mumps – Rubella; at 4 and 16 years Diphtheria – Tetanus – Polio; at 9 years Hepatitis B; at 12-14 years BCG – Tuberculosis. The number of cases reported during the past five years for vaccine-preventable infections varied: mumps (506 cases), pertussis (75 cases), tuberculosis (85 cases), measles (16 cases), and hepatitis B (19 cases).
Other Characteristics: According to 2003 data, Malta scores high on the human development index, with a life expectancy of 76.39 years for men and 80.43 years for women. The population is still “young” by European standards with the 0-14 age group representing 18.2% and the 65+ age group representing 13.0% of the population.
1. Central Office of Statistics: Census of population and housing – Malta 1995. Vol. 1 Population, Age, Gender and Citizenship. Malta, 1997, COS.
2. Department of Health Information: National Obstetric Information System [NOIS] Malta - Annual Report 2004. Malta, 2005, DHI.3. Disease Surveillance Unit: Annual Report 2003. Malta, 2004, DSU.
4. Department of Health Information: National Cancer Registry - Cancer Incidence 1994-2003. Malta, 2005, DHI: http://health.gov.mt/ministry/dhi/publications/tables/Incidence tables.xls (retrieved November 20, 2005)
5. National Statistical Office: Demographic Review 2003. Malta, 2004, NSO.
6. Savona-Ventura C: Thrifty Diet Phenotype in a Small Island Community. Cajanus – The Caribbean Food & Nutrition Institute Quarterly 36(1):42-53, 2003.
It would be appreciated if source acknowledgement is made whenever any material is used from this source.
Citation: C. Savona-Ventura: The Health of the Maltese Population. Internet Home Page [http://www.oocities.org/savona.geo/index.html], 1996