A report by the Today Public Policy Institute (TPPI), an autonomous non-profit, non-governmental Organisation, states that Malta’s transport remains ‘unhealthy and dysfunctional’ with undue reliance on private car transport, adding that it is probably the major determinant of Malta’s ill-health.

The report called ‘the environmental dimension of Malta’s ill-health and action to prevent obesity, diabetes, cardiovascular disease and dementia’, read that the most successful way to encourage people to exercise is by promoting so-called ‘active mobility’, since this is the most readily available means for introducing physical exercise into daily routines. “Active mobility is represented by three transport options: using public transport, walking or cycling”.

Most modern countries are now promoting active mobility and discouraging private car use, especially in the urban environment, they explained. “This step includes substantial investment in creating environmental conditions and amenities to enable and encourage active mobility”.

The report also mentions pollution, and describes it as a “major problem which continues to be ignored in Malta, and its potential for harm remains underestimated and neglected. Intense pollution from fossil-fuel combustion by our heavy traffic is particularly associated with negative effects on cardiovascular health in addition to cancer, respiratory disease and a host of other harms. There is evidence, as yet preliminary, noting that pollution may predispose to cognitive decline”

The costs of Malta’s “dysfunctional transport” for 2012 was estimated at €274 million by the UOM Institute for Climate Change and Sustainable Development. “This was largely accounted for by traffic congestion (€118 million) and accidents (€83 million). Health related costs, not specifically included in the report, could partly be attributed to air pollution, the costs of which were calculated at €83.9 million and noise (€11million). Health costs arising out of lack of exercise (consequent on predominant car-dependence for commuting) did not feature in this report”.

Though there are no figures to indicate the health gains and savings from active mobility (by public  transport, walking or bicycle), it has been shown that schemes based solely on enabling shorter motor vehicle travelling times do not deliver value for money, while transport schemes which  facilitate active transport can deliver value for money many times greater than the investment, the report read. “About 60% of the benefit comes from health savings due to increased physical fitness and 20% from traffic congestion relief and decrease in pollution”. Other benefits are derived from fewer traffic accidents and improved ambience.

“A World Health Organisation Health Economic Assessment Tool (HEAT) indicated thatthe return on investing in encouraging cycling can be expected to be around five timesthe amount invested”

Cycling has become quite popular in a number of EU countries, however has not really caught on in Malta. The country has the lowest rate of bicycle use in the EU, with only 0.3 - 1% of people in Malta cycling, the report explains. “The islands also have the highest rate of people who never rode a bicycle (93%) and is rated the worst and most dangerous country for cycling and cycling tourism in the EU”.

In one of the Supplements accompanying the report, the Today Public Policy Institute described one of the causes for the abundant use of private cars is that it “holds a privileged position both in peoples’ minds and on the road. Great status symbolism is attached to the car, while walking, cycling and (especially) use of public transport were allowed to become low-status transport options through lack of encouragement. Our street environment acts as a disincentive to people making healthier choices like cycling and walking. Street quality has deteriorated, pavements continue to narrow to accommodate cars”.

They argued that Malta has yet to recognise the public health importance of active mobility, and stated that obesity and diabetes has been exacerbated by the surge in car ownership and creeping urban sprawl, “which has resulted in an environment which inhibits active mobility. In addition to serious street level pollution from traffic congestion, there are few road characteristics that help to raise the profile of walking and cycling in Malta; consequently people who have the option of driving their own car shun walking even for short distances”. This results in few people benefitting from transport-associated physical exercise.

“This unhealthy transport environment is the result of decades of out-dated transportpolicies which prioritized private car transport while allowing public transport to becomeramshackle. At the same time the design of our roads and streets has been such that itnever supported healthy mobility choices as walking or commuting bicycle. This resultedin the high rate of car ownership and excessive car dependency”.

An ideal urban environment

Provision of an environment that prompts people to engage in regular daily physical activity needs to be given priority, the report states.

“Attempts at persuading people to take more exercise are unlikely to succeed in the absence of an enabling environment which encourages and facilitates active mobility. An enabling environment includes as a minimum: safe and attractive ‘walkable’ streets which encourage both walking and bicycle use for short trips and an efficient public transport system”.

The report also mentions that children need the right living environment conditions to exercise when not at school. “This applies equally to adults, namely that, given the right environment, adults will exercise more”.

Some initiatives have been introduced, such as increasing physical training time at schools, however TPPI believes that this is not enough. “Provision of, or subsidising access to facilities such as sports fields, gyms, fitness centres does not go far enough since only the motivated and only those who have the time and money will benefit from these”.

Approach to health remains unduly disease-orientated to the detriment of prevention

“There are many environmental factors that impinge our lifestyle and on our health, not only have these been neglected by our road and urban planners; our living and transport environment has been systematically degraded to the extent that people are not inclined to opt for active mobility options but use their car as default transport even for short journeys”. 

Some of the NGO’s recommendations in this respect surround preserving open spaces, green areas and gardens; encouragement of outdoor life, the encouragement of sports through, for example, public tennis courts; discouraging further zoning.

The report states that there seems to be little appreciation of the importance and economic benefit of maintaining good health by appropriate preventive lifestyle measures aimed at reducing non-communicable disease such as heart disease, obesity, type 2 diabetes and a host of other conditions.

The Today Public Policy Institute explained that policy and strategy documents issued by health and other government authorities tend to dowell mostly on surveillance or treatment of established disease. This, they said, resulted in approaches to health which remains “unduly disease-orientated to the detriment of prevention”.

They warn that if immediate action is not taken, the contribution of Malta high rates of obesity, type 2 diabetes and other disorders to future costs of ill-health will continue to escalate. “Added to this is the impending threat from dementia as our population ages, they warned”.

“Over half of cases of type 2 diabetes can be avoided by prevention of obesity and regular physical exercise”

Recent findings suggest that physical fitness, rather than ideal weight, is the more important factor for health and well-being, the report continued. “The health benefits of regular physical activity have been shown to exceed those of weight reduction in simple overweight subjects or in subjects with uncomplicated mild-to-moderate obesity. In other words, it is possible to be overweight but be physically fit and greater health gains can be achieved through improving physical fitness even in the absence of weight loss”.

 

Hours spent watching television by children in Malta highest in EU

The report highlights that Malta is the least physically active country in the world with 71.9% of Maltese people qualifying as inactive. In addition, it states that Maltese children are the least physically active in the EU with only one in four (26 %) of Maltese children being physically active.

“The hours spent watching television by Maltese children are among the highest in the EU, with nearly half (42.7%) of Maltese children watching television for three or more hours on Weekdays”.

These statistics, the report read, go hand in hand with the obesity rate, where Malta has one of the highest obesity rates in the EU (22.3%). 58% of Maltese adults are overweight and 22% are obese. This figure is far higher than the European average, it explains.

Aside from adults, Maltese youths are also at risk. “Maltese children and adolescents have the highest overall prevalence of overweight and obesity in the EU and one of the highest prevalence of childhood obesity in the world with 25.4% being pre-obese or obese and 7.9% being frankly obese”.

“Thus it comes as no surprise that Malta has the highest prevalence in Type II Diabetes in the EU”.

A physically and mentally active life could make you less prone to develop symptoms of dementia

New evidence suggests that people who have lived a physically and mentally active lifeare less prone to develop symptoms of dementia.

Though the evidence of protection against dementia by a number of healthy lifestyle factors reviewed in this report is mostly derived from observational studies, it is sufficiently indicative to be of public health significance, TTPI argued. “Waiting for confirmatory evidence before acting could delay action for years or even decades while awaiting the results of further large-scale prospective trials. Such prevarication will result in loss of precious time”.

Foreign analyses of the evidence on lifestyle risk factors for cognitive decline, Alzheimer’s disease and other forms of dementia suggested that reduction or elimination of seven specific risk factors (physical inactivity, type 2 diabetes, midlife hypertension, midlife obesity, depression, smoking, and low educational attainment) had a potential for reducing the prevalence of dementia by approximately a third.

“Although the net effect of preventive measures can only be expected to result only in a small reduction in incidence of new dementia cases, shortening of the duration of symptoms can be expected to result in a reduction in the prevalence of manifest dementia at any given point in time”.

“The potential social and economic benefit from such a delay in onset of dementia symptoms is considerable and it is estimated that delaying symptoms by one year would reduce the total worldwide number of cases of Alzheimer’s disease in people aged over60 years in 2050 by 11%”.

Malta’s annual health expenditure for diabetes were estimated at €65 million by the International Diabetes Federation. The cost of obesity to the Maltese health service was estimated at €19.5 million for 2008 and likely to rise to between €27 million and €35 million in 2020 if no action is taken, the report explained. The overall costs of dementia care in Malta are estimated at between €63 million and €96 million annually.