Photo: Darrin Zammit Lupi

The recent report by The Today Public Policy Institute entitled ‘The environmental dimension of Malta’s ill-health and action to prevent obesity, diabetes, cardiovascular disease and dementia’ under lead author George Debono, is a well-researched magnum opus, scrupulously backed up by hundreds of references to peer-reviewed studies.

The think-tank report includes six technical supplements which have been distributed to all Malta’s doctors through the good offices of the Medical Association of Malta. These cover detailed proposals on: physical exercise and health; obesity and type 2 diabetes; heart and blood vessels; mental well-being; diet, food and drink; and health aspects of transport and the urban environment.

Together, the documents constitute a powerful and passionate plea not only for the Maltese to incorporate healthy living into their everyday lives but also for the government to take the necessary steps to improve the medical health promotion aspects of healthy living, together with the environmental planning aspects which so affect daily life in Malta, especially in transport, pollution reduction and the quality of life of the urban environment.

The statistics show that when it comes to healthy lifestyles and physical exercise, the Maltese are one of the most obese, laziest and most car-dependent nations on earth. International Diabetes Federation statistics place the prevalence of diabetes in Maltese adults top among 56 European countries.

Maltese people suffer more deaths from heart disease and enjoy shorter lives than their Mediterranean counterparts in Italy, Spain and Cyprus. If nothing is done by the government and health authorities to encourage a healthy physical lifestyle this will continue to cast a long shadow over Malta’s future health.

The report underlines that exercise is the thread that unites most preventive measures. It is hailed as a “miracle cure” and “best buy treatment” and increasingly recognised as the pivotal factor in reducing non-communicable diseases, including obesity, type 2 diabetes, cardiovascular disease and dementia.

There seems little appreciation of the importance and economic benefit of maintaining good health by appropriate preventive lifestyle measures. The crux of the issue is that a lifelong healthy lifestyle reduces the likelihood of the aged becoming a burden on society.

In the upper echelons of any government in the western world, few have the power to save hundreds of lives by championing one policy over another. The Parliamentary Secretary for Health, Chris Fearne, could save scores of lives and millions of euros by facing up to the gravity of Malta’s obesity problems and persuading his ministerial colleagues in the planning authority, transport, environment, local government and education that they too have a part to play in the battle of the bulge.

The introduction of changes, like dietary modifications, could save Malta’s health service between €40 million and €60 million annually

The proportion of Maltese who are obese or overweight is a relatively recent phenomenon, perhaps a symptom of prosperity. But it is also a national scandal affecting hundreds of young children, youths and middle-aged people. Inadequate exercise is a major factor, but poor diet is also a culprit. The levels of activity required to get rid of our collective, bulging waistline of its excess kilos would literally require participation by all 415,000 of us in the Olympic games.

We are what we eat. Our diet does not conform to a so-called ‘Mediterranean diet’. There is a greater need to eat more fresh vegetables, fruit and fish. Too much fat contributes to obesity, but cutting back on sugar is the single most efficient strategy for losing weight and limiting the risks of diabetes and its complications.

These complications include heart disease, kidney failures, blindness, loss of hearing and amputations. Obesity more broadly is closely correlated with a high risk of cancer, liver disease and depression and leads inexorably to type 2 diabetes and early onset dementia.

Diabetes and diabetes-related illnesses alone consume almost 14 per cent of Malta’s health service budget and cause many premature deaths a year.

This is a public health disaster expanding incrementally. However, an incremental response will not suffice. A range of actions across many fronts is needed.

A child obesity strategy which includes public education and awareness campaigns should take centre stage. But this should be linked to campaigns to reduce car dependence and to encourage physical and social engagement among the elderly.

It is also for serious consideration that a tax on sugar consumption should be introduced. Voluntary agreements with the food and drink industry all have a role to play but so far have failed to make an impact. Fiscal measures aimed at the food and drinks industry – though the industry will, of course, strenuously resist them – should be considered. A ban or controls on advertising of high-sugar food for children should also be examined.

Excessive sugar consumption is closely linked to obesity, which is ‘the new smoking’. Smoking in cinemas and restaurants used to be accepted with barely a murmur. Today it is hard to imagine.

As the Parliamentary Secretary for Health considers an obesity strategy, he should contemplate whether he wants to be remembered as a minister shackled by inertia or the minister who followed the dictates of reason and insisted on reforming action. This entails cajoling and educating Maltese consumers to eat better and adopt a healthier lifestyle while heaping pressure on food and drink manufacturers to cut levels of harmful ingredients.

It requires tough legislative action, too. The Healthy Living Bill – inspired by a Nationalist MP’s private Member’s Bill - became law by happy coincidence just a few days after the publication of Debono’s report. Its purpose is “to ensure an inter-ministerial lifelong approach favouring physical education and healthy balanced diets for a healthy lifestyle, reducing the level of non-communicable diseases throughout all age groups”.

It establishes an advisory council on healthy lifestyles under the Permanent Secretary at the Office of the Prime Minister and is given some regulatory powers providing for the imposition of criminal offences. These include “the regulation of marketing of products which may have adverse effects on healthy lifestyle”.

Malta currently spends about €490 million (six per cent of GDP) on health, of which hospital services account for some €330 million. In a brief overview of the costs of ill-health, the think tank report highlights that Malta’s health costs for diabetes have been estimated at €65 million annually. The cost of obesity was estimated at €19.5 million in 2008 and likely to rise to between €27 million and €35 million by 2020 if no action is taken.

The costs of dementia care are estimated at between €63 million and €96 million annually. Appropriate lifestyle changes could reduce dementia costs by up to €30 million annually. Obesity, type 2 diabetes and dementia are eminently preventable.

Debono’s report suggests that the introduction of changes, including dietary modifications, could save Malta’s health service anything between €40 million and €60 million annually. In a budget of almost €500 million which is already under pressure, this is not insignificant.

The failure of successive governments and health authorities to recognise that encouraging a healthy, physically active lifestyle on a national basis is a good investment is a serious indictment of the last 30 years. The think tank report offers a detailed, cross-sector disciplinary strategy, uniting the environment and medicine, to combat unhealthy living in Malta. The costs of doing nothing are unacceptable.