To the unknowing mind, the PN’s promise in its election programme seems like a cliché simply put there to fill a gap and sound nice. In reality, diabetes is a real threat to all of us as it is a disease of affluence in the first world!
There are two types of diabetes, Type I and Type II. Type I usually occurs in children and its pathogenesis is found in the event of a virus attacking the pancreas and stopping it from producing insulin, the hormone that is absolutely essential for the body’s cells’ uptake of glucose from the blood stream. That is why people with diabetes have a high glucose content in their blood! This type, however, is not common.
The much more common type of diabetes is Type II. This has its basis partly in genetic inheritance but also in the lifestyle choices we choose to practice in our daily routines. It transpires that our pancreas is genetically programmed to produce an amount of insulin to serve a particular body weight. However, when our body weights go over the limit that can be supported by the level of insulin our pancreas produces, a relative type of diabetes ensues. It’s not that we have no insulin, but that the amount of insulin we produce is not enough to serve the body’s needs! So the state, and we ourselves, can do much to prevent this type of diabetes from rearing its head, especially if there is a genetic predisposition in the family. Essentially, we all have to make an effort to change our lifestyle choices regarding what we eat and change our behaviour, and the government has to create the social and political milieu in order to facilitate this change. Our smoking, drug and excessive drinking habits all contribute to the emergence of diabetes.
However, one of the first things we have to look at is our weight. Looking at European statistics on obesity levels, calculated through the body mass index measurements, it transpires that we are in the top league, along with the UK and Ireland! Italy and other Mediterranean countries are usually found in the lower levels of the scale. When one thinks about this, it seems strange. How does our population, with a genetic assimilation more similar to Italy’s than that of the UK and Ireland, have statistics in line with the northwestern part of Europe, and not with southern Europe? When one stops to think about it, one asks what it may be that we have in common with the UK and Ireland that the rest of the Mediterranean does not, and the answer is then obvious. One hundred and eighty years of British colonialism have changed our culinary habits from one that was Mediterranean based to one based on fish and chips! On a recent trip to Rome I watched out for this and noticed that, in Italy, the image we have of post second world-war Italy with mamma in cucina as wide as a barrel, now no longer exists and it was difficult for me to see Italian adults and especially children who were obese.
The opposite is true here, where most adults are overweight and/or obese and the worse problem is that most of our children are as well! Once children become obese, the chances are that they will remain obese for the rest of their lives!
Where does the state come in on this subject to help resolve it? We need aggressive national public health programmes that teach which are the right types of food to eat, coupled with the right amounts! Make no mistake – the crux of this problem is proper diet, and it must also be tackled at primary and secondary school levels, with public health programmes and nutritional advice aimed at teaching children and parents what and how to eat. Children need not look like Humpty Dumpty to be healthy and lean children are not unhealthy. There is a public perception to change here too. Legislation and regulations should be enacted that do not allow children to buy unhealthy foods in canteens and in the immediate environs of our schools and colleges.
At a very close second to proper diet, but always a close second as far as diabetes is concerned, comes an increase in physical activity. We all need to raise our physical activity levels, which are not only important for the resulting benefits to prevent diabetes but also for a multiplicity of other factors important to our bodily health. Work timetables should be more flexible, allowing people the time to be able to practice a sport that need not necessarily be a competitive one. In fact, for people with stressful lives, non-competitive activity may be more useful as a stress-reducing activity.
There is a continuous need for the building of civic amenities and the provision of open spaces to give people the opportunity to practice some form of physical activity. Our towns and cities are too enclosed and confluent to allow for proper open spaces or “commons” where we can practice a physical activity or simply walk a dog. For example, in my home town of Birkirkara, there is no space left to properly take a dog for a walk and I have to go by car to Ta’ Qali to effectively be able to properly exercise both my dog and myself! I happen to have a Border Collie that needs prodigious amounts of exercise.
Physical activity teachers should be on the staff of schools at all levels – including kindergarten, primary, secondary and higher school and college – to encourage children and young adults to practice some sort of physical activity tailored to their own special needs – including those of children with a disability. Above all, time needs to be allowed – and encouragement given – for children to join organisations that are provide activity programmes for young people. The national curriculum needs to be adapted to recognise the educational achievements of these youth programmes – that are often run on international standards. For example, the Scouting Movement has an international, well-balanced programme that allows young people to work towards achieving specific aims and outcomes through both practical and theoretical learning which are important for character development but which are not then recognised by the State educational set-up. It also has intense formal programmes for youth leaders that are not recognised by the state!
There are many different types of intelligence! We are still immersed in the post-colonial way of achieving learning outcomes and grading criteria leading to the development of an educational fulfilment and many resources in Malta, although multiple, are wasted in this way. This is just one example with which I am familiar, but there are many other organisations with structured educational programmes that are left to chance by the state.
One such other programme is the President’s Award Scheme, which should be widely and actively encouraged in all schools, especially post-secondary and tertiary colleges and the achievements should be formally recognised by the state as an educational achievement, as is often the case abroad. The state must move away from a system based solely on classroom achievement and look at other informal but equally important ways of learning that would be more in line with a person’s natural, God-given talents.
All this also helps the quest for lowering diabetes quotients in |Malta! The Nationalist government is committed to continue to achieve all this in its election programme.
Dr Michael Asciak MD, MPhil, PhD, MP
Senior Lecturer in Health Studies MCAST
PN candidate for the 8th District