Charles Scerri’s article A Global Public Health Crisis (29 May) rightfully draws attention to important public health issues in the context of the sheer enormity of the expected increase in dementia, the incidence of which is expected to double or treble between now and 2060.

... degraded urban surroundings will simply leave the door wide open to depression and dementia- George Debono, Sliema

This is the European Year of Active Ageing. The World Health Organisation recommends measures aimed at encouraging healthy lifestyles and enhancement of the quality of life in anticipation of increasing population age. The underlying basis for this is that a healthy lifestyle today ensures that tomorrow’s old people remain physically fit, and not a burden to society, for as long as possible. Recommendations include provision of an environment which enables coming generations to remain physically active, in touch with their surroundings and useful to society into middle and old age. This also has the potential to reduce and delay future age-related physical and cognitive decline.

Based on these considerations, the World Health Organisation recommends the development of “age-friendly” urban environments to optimise quality of life and ensure active, healthy ageing by providing opportunities for physical exercise and participation in community life.

The foregoing has great relevance when considering the question of dementia.

Most health policies and suggested approaches to the growing problem of dementia tend to omit the aspect of preventive measures. Population studies of dementia have identified many factors that determine the probability and timing of onset of disease. There are, on the one hand, risk factors of dementia such as age, family history and heredity which are unalterable. On the other hand, there are many other risk factors which it is possible to influence. Acting on these can significantly reduce the incidence of dementia or, at least, can delay its onset.

For instance, it is generally accepted that simply remaining physically and mentally active into old age can delay the onset or even reduce the likelihood of developing dementia. A recent general population study in Montpellier, France, (British Medical Journal, 2010;341:c3885) found that simple measures aimed at increasing mental ability (so-called crystallised intelligence), reducing or eliminating mental depression and Type II diabetes and increasing fruit and vegetable consumption can lead to a 20 per cent reduction in the incidence of dementia. In Malta, such measures, if successful, could translate into huge savings in health costs. In today’s terms, these could amount to as much as €20 million annually.

When it comes to urban age friendliness, Malta unfortunately seems to be heading in quite the opposite direction. Our frenetic, quick-buck pursuit of wealth has resulted in runaway urban overdevelopment which has destroyed most of our town environments and depersonalised street life. It has spelled the end of village cores and erosion of the social function of our residential streets – a function which is particularly beneficial to the aged.

The craze for supermarkets is systematically forcing closure of once-familiar corner stores and street vendors. When the last of these shops go, we will have irretrievably lost something that was fundamental to our society. It will deal a blow especially to the old among us by increasing their isolation through depriving them of a focus that helps make life friendlier and putting impossible distance between where they live and where they shop. Another unhealthy consequence is that younger people become more reliant on cars to shop and therefore walk less.

As long as Malta keeps moving away from the recommended concept of a healthy, age-friendly urban environment in which shopping, medical services and leisure spaces are within walking (or cycling) distance, everybody, especially the aged, will be not be enabled to age healthily by being given encouragement to keep walking and physically active as long as possible and remain engaged in civic life.

Our degraded urban surroundings will simply leave the door wide open to depression and dementia.

Malta will pay dearly for this in the future.