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20 June 2025 | Policy Analysis
National Sexual Health Strategy 2025–2030 launched for public consultation
1.4. Health status
Malta has experienced a steep rise in life expectancy since the 1990s (England, Vogt & Azzopardi-Muscat, 2016) and average life expectancy at birth in 2014 was 82.1 years, 79.8 years for men and 84.3 years for women (Table1.3). The probability of dying in the younger age groups (15–60 years) has been decreasing steadily with a wide gap between males and females, partly attributable to ischaemic heart disease and external causes of death, such as traffic accidents and suicides. The total crude death rate in 2014 stood at 7.7, whilst the infant mortality rate was 5.0 per 1000 live births.
Table1.3
Circulatory diseases accounted for 37.6% of deaths in 2014 and are the leading cause of death. Neoplasms accounted for 28.5% of all deaths, while 9.5% of deaths were due to respiratory conditions, mainly chronic obstructive airways diseases and chest infections. Diabetes as underlying cause of death accounted for 4.8% of all deaths. As the population survives to older age, deaths due to dementia become more important. Dementia accounted for 4.4% of all deaths in 2014 (Directorate for Health Information and Research, 2015).
While the overall number of deaths has been increasing over time, standardized mortality rates reveal a downward trend that compares well with the EU average.
Mortality from circulatory diseases has decreased markedly over the past 20 years and is now below the EU average, although it remains higher than in the EU15. This decrease may be attributed to the decline in smoking prevalence, as well as the investment in local cardiac services that took place in the mid-1990s (Azzopardi-Muscat, 1997). The relatively high and still increasing prevalence of obesity and diabetes remains an important risk factor for circulatory disease. Standardized mortality rates for diabetes remain mostly unchanged. The standardized mortality rate for neoplasms has declined and this is also reflected in an overall increase in five- and 10-year survival rates.
Lung cancer accounted for 18% of total deaths in 2013, followed by colorectal (13%), breast (10%) and pancreas (8%) (Directorate for Health Information and Research, 2013). Cancer incidence is expected to continue rising by 1.5–2% per year. On the other hand, cancer survival in Malta is continuously improving. The age-standardized 10-year survival rate from all cancer for patients diagnosed and managed in Malta (2008–2012) is now approaching 50%. Remarkable improvements in survival have been demonstrated for malignant melanoma, breast, testicular, thyroid and prostate cancer. However, outcomes have remained unchanged for some cancer, such as those of the lung, pancreas, stomach and brain, and specific types of acute leukaemia in adults (see also section 7.4).
Deaths from communicable diseases are low. Tuberculosis is an important condition in sub-Saharan migrants and the Chest Unit organizes screening and outreach programmes to monitor and manage this condition. In the years immediately following EU accession, when irregular immigration increased, an increase in HIV incidence was noted associated with sub-Saharan migrants. More recently, however, the increase in HIV incidence that has been documented is due to outbreaks of the disease amongst the men who have sex with men (MSM) community.
Whilst daily tobacco smoking prevalence has decreased (from 23.4% in 2002 to 20.1% in 2014; see Table1.4), obesity remains an important public health issue both in adults and in children, with 25.3% of the adult population (Eurostat, 2016a) and 27.0% of 11–15 year olds (HBSC, 2016) being obese (see Table1.4). Alcohol consumption is considered an important public health issue. Whilst binge drinking in adults appears to have increased between 2008 and 2014 (results from European Health Interview Survey; see Table1.4), data from ESPAD shows how since 1999 the trend has been a downward decline in most patterns of alcohol use among young people aged 15 and 16. Alcohol use in the last 12 months (20+ times) declined from 51% in 1999 to 19% in 2015, while alcohol use in the last 30 days declined from 30% to 11%. Heavy episodic drinking in the last month (drinking more than five drinks in a row) declined from 57% in 2007 to 47% in 2015. Drunkenness in the last 30 days also declined from 19% in 2007 to 15% in 2016. Those reporting being drunk at 13 years or younger declined from 14% in 1999 to 8% in 2015 (Ministry for the Family and Social Solidarity, 2016).
Table1.4
n 2012 the Mental Health Act was adopted (Ministry for Justice, Culture and Local Councils, 2016b). This came into force in 2013. Since 2012 there has also been a Commissioner for Mental Health, whose role is to promote and protect the rights and interests of persons with mental disorder and their carers. The European Health Interview Survey conducted in 2014 showed that 4.6% of persons reported the presence of depressive symptoms (see Table1.4). In the 2015 Annual Report, the Commissioner for Mental Health stated that patients are still far from being empowered about their rights, with fewer than 25% claiming that their rights had been explained to them, although two out of three respondents felt that they had participated in their care as much as they wished (Commissioner for Mental Health, 2016).
Whilst the birth rate declined in the first few years of this millennium, since 2007 an upward trend in deliveries has been observed. This is due to an increase in deliveries in non-Maltese nationals, which made up 17% of all deliveries in 2014. Maternal age at delivery has shown significant changes in recent years with the average age at delivery increasing from 28 years in 2000 to 30 years in 2014. The percentage of births to teenage mothers increased between the 1990s and 2010 but has started to decline in recent years. There were four maternal deaths registered in the past 15 years (2000–2014), giving a maternal mortality ratio of 6.5 per 100 000 live births over this period. The caesarean section rate remains rather high at 32.5%. This is notably higher in non-Maltese persons, who have also been found to be more likely to present at antenatal clinics for booking later than 14 weeks gestation (Directorate for Health Information and Research, 2014).
The infant mortality rate was 5.0 per 1000 live births in 2014, higher than the EU average of 3.8 (2013). An in-depth analysis has been conducted and shows that this figure is partly attributable to a higher rate of congenital anomalies which are carried to term delivery (Gatt et al., 2015). Furthermore, for example, the total prevalence rate of neural tube defects (i.e. including all cases: live births, stillbirths and terminations of pregnancy) reported for European countries (2008–2012) is similar to that reported by Malta. However, the live birth rate reported by Malta in the same period is the highest reported in Europe. Termination of pregnancy in Malta is illegal (Directorate for Health Information and Research, 2016b).
The National Immunization Service is responsible for the administration of all vaccines given to the public; the scheduled vaccines for infants and children up to 16 years are free of charge. While vaccination coverage for children is quite good, a degree of underreporting remains because some children are vaccinated in the private sector.
Chronic conditions associated with obesity, unhealthy lifestyles and frailty associated with ageing remain major challenges facing the population as a whole. A number of health policy documents, which have a strong focus on health promotion, primary disease prevention and intersectoral collaboration, have been launched since 2014. These include the Food and Action Nutrition Plan 2015 and the first National Diabetes Strategy 2015. Implementation of earlier strategies, including the Non-communicable Disease Strategy 2010, the National Cancer Plan 2011, the Sexual Health Strategy 2011, the Healthy Weight for Life Strategy 2012, and the Tuberculosis Prevention Strategy 2012, is ongoing. Work is also under way towards the publication of the second national cancer plan (Ministry for Health, 2016e).
Box1.1 describes health inequalities among people with different levels of educational attainment.
Box1.1
In December 2024, a National Sexual Health Strategy 2025–2030 was launched for public consultation until February 2025, updating the first strategy of its type, which had been published 14 years previously.
The impetus and context for the drafting of this updated strategy included a confluence of different factors, such as a rapidly changing socio-cultural environment, a demographic shift in terms of increased migrant workforce, significant legislative changes concerning legal gender recognition, and non-discrimination legislation on the basis of gender identity and sexual orientation.
The vision for the Sexual Health Strategy 2025–2030 is in line with that for the WHO European Region, whereby “all the Maltese population regardless of sex, age, gender, sexual orientation, gender identity, socio-economic condition, culture and ethnicity, and legal status is enabled and supported to achieve sexual and reproductive health and well-being with a focus on respect of one’s sexual and reproductive rights and a commitment to create an enabling environment through intersectoral action and by tackling inequalities.”
This consultation document was developed following a period of desktop research into current available evidence together with stakeholder consultation. It was also based on the outcomes of the nationally representative National Sexual Health Survey commissioned and carried out in 2022/2023 to update the evidence on the sexual health and well-being of the Maltese resident population. Consistency with the strategic direction across government was established through a pre-consultation exercise, which included other government ministries and agencies to ensure alignment in terms of terminology and proposed measures.
The initial chapter of the strategy deals with the policy context, methodology and alignment with international documents. It also provides details about the stakeholder engagement in the development and drafting phase. The strategy is subsequently divided into five priority areas for action with each area listing the overarching measures that fall within that subsection: The first priority relates to health promotion, prevention and education. The second priority area relates to medical services, including screening, management, treatment, and the organisation of health services. The corresponding section of the strategy document also provides a focus on the testing, clinical management and treatment of HIV. The third priority area focuses on the reproductive health needs of the Maltese population, including family planning and contraception. The fourth priority area highlights the specific needs of certain key populations with regards to STIs, including HIV. The key populations specifically considered in the strategy include men who have sex with men, persons involved in sex work, persons who reside in custodial settings or residential group settings, migrants, persons who experience sexual violence, and transgender or gender diverse persons. The final priority area of this document relates to governance, research and innovation and covers the proposals for further research and the proposed composition of the steering group tasked with implementing the strategy. This section outlines how digital technologies and AI can be used to advance various aspects of the existing and proposed sexual health services.
A range of stakeholders have provided inputs to the new strategy, including NGOs representing and defending the rights of the LGBTIQ+ community and of people living with HIV. While welcoming the updated strategy and its evidence-based approach, there are calls for the definition of clear deadlines, budget lines and additional actionable policies to facilitate its implementation.
After evaluation of all inputs collected during the public consultation, a final document will be published.
References
https://health.gov.mt/wp-content/uploads/2024/12/National_Sexual_Health_Strategy_2025_2030.pdf
Aditus (2025). Sharing our human rights focus on Malta’s national sexual health strategy, available from: https://aditus.org.mt/sharing-our-human-rights-focus-on-maltas-national-sexual-health-strategy