A study has found that, whilst Malta has drastically changed in the past twenty years into a multi-ethnic population, the planning of national healthcare must be improved as while the ageing of the local population was a predictable event, the healthcare system was not well prepared enough for it.

The article ‘The Impact of Demographic Changes in Malta on Health and the Health system over the past two Decades’ by Kathleen England and Sandra Buttigieg delves into how the population growth, the ageing population and change in fertility patterns has transformed the Maltese demography over the past 20 years.

England and Buttigieg highlight how Maltese healthcare system has changed from 1999 to 2019; keeping a close eye on the impact net immigration has had on Malta, not just in regards to economic development but also the planning and delivery of healthcare services.

The population size and structure has drastically changed since 1999. The study reflects that the population grew from 385,287 in 1998 to 468,056 in 2017; a 21% increase in resident population. 

According to the article, the population growth over this period of time changed from a stable population growth rate up to 2011, to a much faster rate afterwards. What exactly caused this increase? Throughout the article England and Buttigieg highlight the changing demographic trends in Malta throughout the two decades.

 ‘Persons over 65 years make up 19% of the population in 2017’: The increase in ageing population

The increase in the ageing native population has had an impact on the demographic changes on the Maltese islands.

After the Second World War, just like other European countries, Malta experienced a massive baby boom which ultimately led to the ageing population we are witnessing today. Alongside low fertility rates and a decrease in mortality in the older age groups, persons over 65 years make up 19% of the population in 2017, compared to only 12% in 1998. Life expectancy (LE) has also continued to rise; in 2017 LE in males was 80.2 years whilst that in females was 84.6 years, which according to the article are both above the EU average.

Lower fertility rates but an increase in number of births

The article highlights the fall in fertility rates from 1.84 in 1998 to a record low level of 1.26 in 2017. However interestingly enough the number of births has increased from 2007 onwards, despite the a decrease in the number of births per woman is attributed to the increase in the number of women of child bearing age; which is expected by the net inward migration Malta has faced in the past few years.

The article states that the number of deliveries by non-Maltese women has increased from 4.9% of all deliveries in 2000 to 22.2% of all deliveries in 2017.

76% of net migrants in 2016 were under 40 years of age: an increase in the population aged 15-44

Irregular migrants, mainly from Africa started to come to Malta in 2005, yet according to the article the ‘greatest increase in net migration’ started in 2012 and has continued to increase. In recent studies, the increase in net migration is composed of migrants from both EU countries, as well as from countries outside of the EU and Europe. 76% of net migrants in 2016 were under 40 years of age, which resulted not only in an increase in population aged 15-44 years, but the overall structure of the islands population.

Increase in life expectancy; but are people spending that time in good health?

The article notes that whilst the increase in life expectancy is somewhat positive; how much of that time that person is spending in good health which ultimately has an impact on his/her quality of life. The study shows that in the last 10 years, life expectancy at age 65 years in females has increased from 19.4% to 22.1 years; yet on average less than 60% of those years were spent in good health.

The European Health Interview Survey carried out in 2014/5 shows that 58.7% of males and 65.1%of females aged 65 years reported long-standing health problems. Conditions such as arthritis, obesity, hypertension and diabetes in those aged 65+ years are extremely common- yet how does this impact the healthcare services?

The ageing population has impacted the growth of residential homes for the elderly and the reorganisation of Zammit Clapp Hospital and Karen Grech Hospital; along with the setting up of a Commissioner for the Elderly.

Population growth and population ageing has also added pressure to health expenditure. In 2000, health expenditure as a percentage of GDP increased from 6.5 to 9.6 in 2015. The increased demands on the healthcare system was not only due to the growth and ageing of the native population, but also  advancement in medicines, treatments and infrastructural developments such as Mater Dei Hospital and Sir Anthony Mamo Hospital.

On a positive note; the study highlights that policy makers have increased the promotion of active ageing. Through the National Strategic Policy for Active Ageing, there have been measures to promote work participation of the older age groups and promotion of independent living focusing on the needs of the elderly.

The future: ‘Need for better planning of different levels of healthcare is essential’

Whilst Malta has drastically changed in the past twenty years into a multi-ethnic population, the study reflects that the planning of national healthcare must be improved. As the ageing of the local population was a predictable event, the healthcare system was not well prepared enough for it; and according to the study “attempted to respond in a reactive manner with a resulting increasing strain on the main acute hospitals, emergency services and primary care services.” In simpler terms; more planning is necessary and essential for the ageing population and population growth.

The study highlights that back in 1994, there needed to be an increase in community health and social services support for the older people, so as to reduce the load on hospitals and residential care.

Whilst the construction of Mater Dei Hospital was to support the increasing load of people; there is still overcrowding of the A&E Department and the hospital operates at close to full capacity.

“Policy makers are thus attempting to balance demand and supply when it comes to the demographic shifts of the Maltese populations by investing in more public-private partnerships in geriatric settings and reorganising secondary care so as to cope with the acute inpatient population’s needs.”

England and Buttigieg also highlight the importance of increasing social diversity as a result to net immigration and development of different migrant groups settling in Malta. Also that there needs to be required special attention to the healthcare needs of different ethnic groups ; as seen by the opening of a Migrant Health Unit due to the high influx of irregular migrants. On the note of healthcare, the study states that little research is available locally on the matter of migrants mental healthcare and that this must be bridged immediately.

Planning of health care services must meet and address the needs of the ageing native and multi-ethnic society in order to continue improving and achieving good health outcomes.