Chris J. Delicata made a very valid point in his letter A National Plan Is Now Required For Diabetes (February 18).
Plans exist in abundance but, even if these were implemented, they mostly fail to address the root of the problem. In the case of Malta’s cancer plan, for instance, the main thrust is on detection which, of course, is a good thing, but prevention receives little or no attention.
Yet two significant threats to health in Malta are pollution and lack of exercise – and these need to be placed higher on the agenda. The basic approach to prevention was neatly summed up by the World Health Organisation as follows: “If people didn’t smoke, drank less, ate healthier diets and were more active, the huge burden of chronic diseases such as cancer, heart disease and type 2 diabetes would be much reduced.”
This addresses the root of the problem, which is as it should be. Both exercise and overweight are recognised to be of pivotal significance to the development of late onset – or type 2 – diabetes. The recent explosion of obesity has been described by researchers from the Population Health Research Institute at McMaster University, Canada, as “a tsunami of obesity that will eventually affect all regions of the world”. A major contributory factor is the increasingly sedentary nature of modern lifestyle and overdependence on cars for movement.
The term “obesogenic environment” found its way into the vocabulary of health workers in the mid-1990s. In simple terms an “obesogenic environment” is an environment that discourages exercise and encourages overindulgence in unhealthy foods.
Given the overwhelming evidence that, in addition to decreasing the incidence of type 2 diabetes, regular physical activity has important and wide-ranging health benefits, modifying our environment in such a way as to favour healthy lifestyle decisions is now considered the “best buy” for health.
To this end towns and city councils in Europe and North America have begun to redesign streets so as to discourage car use and encourage walking or cycling. Laws and regulations aimed at limiting the advertising and sale of fast foods and sweetened beverages are also being considered. In Malta it is quite the opposite. Our environment continues to develop in such a way that traffic pollution continues to increase and exercise is not encouraged. All along the emphasis in Malta has been on accommodating car traffic while not encouraging healthy mobility choices like walking or cycling. It is incomprehensible how successive government administrations continue to ignore the significance of improving our environment so as to encourage exercise and healthy mobility choices. Fast foods are also freely advertised and available. Thus Malta continues to become increasingly “obesogenic” and unhealthy. As a result of this many of us are physically lazy and fatter and therefore more prone to type 2 diabetes. Initiatives modelled on other advanced countries need to be taken up in Malta in order to reverse the vicious spiral of lack of exercise and increasing pollution from traffic – both of which are killers. The question of getting people to move more needs imaginative thinking.
It needs more than leaflets to get people to do exercise since few pay attention to them. Also, provision of sports facilities, though a good thing in itself, only benefits the motivated or better off. So ways have to be found to provide environmental cues which encourage (or, better still, oblige) people to take more exercise as a matter of routine and lifestyle.
Much of this is discussed in Parts II and III of the think tank report Towards A Low Carbon Society – The Nation’s Health, Energy Security And Fossil Fuels available at www.tppi.org.mt/cms/index.php/reports.