Often these days we hear of a premature death of a friend or loved one.  Possibly it seems more relevant due to our own advance in ageing.  We compare the news of the passing of an active and social person, enjoying a family life or peaceful retirement with life expectancy.  Nowadays, sixties is just another decade.  And yet, it happens.

According to data based on the latest United Nations Population Division estimates, Malta is classified at 15 in the ranking on life expectancy.  In world population, the expectation for males is 70.8 years and 75.6 for females with 73.2 for both sexes. 

For Malta the figures are 83.06 for both sexes, 84.68 for females and 81.37 for males.  Malta ranks above countries like Finland and Germany, Norway and Canada and even New Zealand which is in the 19^th place.

It registers significantly higher ages for the Maltese population.  Italy comes in at 6^th place.

If there really seems to be a trend of younger deaths, age below 70 or just above, it would be a good time to make an assessment and analyse the reasons for these early cases.  What was the cause of death?  Are we seeing more cancer amongst our population?  Cardiac problems or more obesity and diabetes?  Is one kind of cancer more prevalent than another?  Is it linked to location of where you live?

Currently, 93.1 % of the population of Malta is urban (410,188 people in 2019).  The 2019 population density in Malta is 1376 people per Km² (3,564 people per mi²), calculated on a total land area of 320 Km2 (124 sq. miles).

In Italy, ranked at 6^th place currently, 69.2 % of the population of Italy is urban (41,887,345 people in 2019).  The 2019 population density in Italy is 206 people per Km² (533 people per mi²), calculated on a total land area of 294,140 Km2 (113,568 sq. miles).  Of course, the density varies from city to city.  Rome comes in at first place with a population of 2,318,895 followed by Milan at 1,236,837.

Exposure to high levels of air pollution can cause a variety of adverse health outcomes. It increases the risk of respiratory infections, heart disease and lung cancer. Both short and long term exposure to air pollutants have been associated with health impacts. More severe impacts affect people who are already ill.  Children, the elderly and poor people are more susceptible.  The most health-harmful pollutants – closely associated with excessive premature mortality –  are fine PM2.5 particles that penetrate deep into lung passageways. 

Malta has the fourth highest level of particles in the air.
Pollution in Malta continues to be among the worst in Europe, with the island having the fourth highest levels of particles in the air compared to all Member States. (16 Oct 2017).  However in Malta, road transport is the major contributor to air pollution in urban areas. High levels of particulate matter (PM₁₀ and PM_2.5) and of nitrogen oxides (NO_X) are normally associated with areas exposed to heavy traffic flows.

According to ERA, Air pollution is caused by solid and liquid particles and certain gases that are suspended in the air. These particles and gases can come from car and truck exhaust, factories, dust, pollen, mold spores, volcanoes and wildfires. The solid and liquid particles suspended in our air are called aerosols.

Malta and Gozo have plenty of all.  Where maybe they have less, this government seeks to address that deficiency and expand roads and dust.  Take the latest Marsalforn road widening project.  Totally against any common sense, environmental policies and health benefit.  The quarries, the demolition of buildings followed by excavations and removal of debris with not enough place to dump it all contributing further to the pollution.  As is the removal of trees.

There is no other serious plan to reduce traffic.  Ridiculously, you see blocks of apartments being built right adjacent or overlooking a main artery, like the one in Gzira by the Regional road.  If anyone in that block opens their bedroom window at night, they are likely to breathe all the fumes of the day of the many cars and trucks passing from Sliema to Valletta and vice-versa. 

But here in Malta and sadly now in Gozo too, no other consideration is taken on issuing a building permit other than whether there is a clause for it in the MEPA policy or who it benefits.  Like with that supermarket permit in Luqa which was previously denied a permit for building a green-house due to impacts from other factors but which now did not even require a consultation, claiming that it was not in the remit of the PA to look at those factors. 

We may not have wild fires in the scale of green countries like Portugal, Spain and Greece but these fires that are happening more and more frequently from fireworks or negligence are becoming a serious cause for concern.  We need legislation to prevent such incidents especially since fireworks are becoming more and more popular.  One festa in Gozo had a major fireworks display lasting 2 solid hours.  Should we set a limit especially in view of the high level of rivalry and competition amongst the Maltese and the dry vegetation?  Should a village of a thousand or less emit so many particles into the area over surrounding villages?

Add the static area of low pressure that has engulfed the central Mediterranean to the pollutants in the air and we have a congestion that can really harm our health.

Our health system is praised and anyone who has needed treatment at Mater Dei knows that much attention is given to patients.  However, the time it takes to get results seems to be undermining the good intentions.  Anyone who has a suspicion of cancer naturally wants to have results in a reasonable period.  Anxiety can continue to add stress and aggravate the situation.  It is not normal to expect patients to go home and wait indefinitely for a CT Scan report.  The people should be informed if tests are going abroad for analysis.  The quality of stay in the hospital too needs to be improved.  Attention should be given to where certain patients are accommodated in the wards.  Alzheimer and dementia patients sharing a room with other sick people can be very distressing.  It means that some patients cannot get any sleep or decent rest.  Perhaps, just as we have an oncology unit, the hospital needs a unit for Alzheimer and dementia patients when they are admitted for treatment.  This will ensure better treatment for them too as other patients sometimes end up consoling them or helping them.  Sometimes patients are admitted for a routine case and never return home.  Explanations are needed.  Same as with the prisoners who are losing their life. 

Outpatients can be a real nightmare with a wait of about 4 hours to see the doctor. 

If a patient dies of cancer whilst being treated abroad, is their cause of death registered here in Malta? 

We have no real audit on what Stewards are doing to fulfill their contract.  The infrastructure that was meant to be built, the emergency helicopter service operation, the provision of certain treatments and services in Gozo.

We are still in the grip of Covid and this has added pressure to the difficulties and shortcomings but not everything can be excused by it. 

The early flop of re-opening tourism, so mis-managed and reactive has once again indicated that responsibility needs to be taken.  We cannot afford to lay the burden on the elderly again. 

The country needs a comprehensive review of its current life expectancy and what could jeopardise it, whilst making recommendations, in the same way that we have climate change targets, to ensure that improvements are made in our air, the food we eat and the health service as our population grows and the threats to good health increase daily.  Together with what is needed to be done, if there are certain exceptionally high causes that are prevailing.