Relatively healthy

It has become a cliché to say that health depends on two major and often independent factors, namely inheritance and environment. While we can do very little about the first, being lumbered with the genes of our parents for better or worse, we certainly can do our bit to ruin or improve the environment, with unescapable consequences to our health and chances of survival.

One way to gauge our health status is to compare the prevalence of disease in our community with that of others living under different conditions. Such studies may give some clear indication about what causes illnesses, and what is the relative contribution of genes as opposed to environment.

There is no doubt that certain diseases have a very clear "racial" distribution, affecting one group of people far more frequently than others. There is likewise no doubt whatsoever that certain environmental factors, which include both external factors, like air and water pollution, as well as internal factors, (say, what we eat and drink), can have a dramatic effect on disease susceptibility. More often, these two factors are inextricably intertwined in such a way that may be difficult to unravel. One example will suffice. Melanoma (a cancer of the skin) preferentially affects white-skinned persons (a genetic trait) following exposure to sunlight (obviously environmental factor).

One study in Australia, a nation which eminently lends itself to comparative studies of disease incidence among the hundreds of different ethnic groups, reports that compared to the average population, persons born in Malta show the following characteristics:

Higher standardised death rates.

One of the highest rates of diabetes.

Higher rates of lung cancer in males (one of the highest rates) and cancer of the cervix.

One of the highest rates for coronary heart disease but the lowest rate of stroke.

More likely to give birth to premature infants.

Below average rates of colo-rectal cancer, breast cancer (one of the lowest!), prostatic cancer, poisoning and injuries (one of the lowest), and respiratory disease.

Average rates for gastro-intestinal disorders.

In relation to lifestyle differences, Maltese are likely to eat more vegetables and fruit and, surprisingly, their smoking habits are not different from the average. Maltese are more likely to be overweight, and least likely to participate in exercise and physical activity. They are also likely to wear wide-brimmed hats when going out in the midday sun, and are among those who are most likely to seek the shade when available!

Migration itself may have a very dramatic effect on the incidence of disease. It obviously changes the environment and exposes those with varying genetic endowment to a normalising environmental influence. Many studies have shown that those living in a foreign country for a significant period of time tend to approximate the native population with respect to tendency to acquire various diseases.

It was therefore of interest to compare the above findings relating to the health of long-term Maltese migrants with data relating to the health of Maltese living in Malta and how they compare with the rest of Europe. One such study confirms the interesting finding mentioned above, namely that Maltese (males) have a higher risk of coronary heart disease and a lower risk of stroke than most other nationalities in Europe. Other results from this European study confirm that Maltese have a:

Higher incidence compared to EU average of - ischaemic heart disease; diabetes; infant mortality; smoking (males) and obesity; and lower incidence of - cancer overall; neuropsychiatric disorders; car traffic accidents and other injuries; respiratory disorders; infectious disorders; alcohol consumption and physical exercise.

The striking indirect correlation between coronary heart disease and stroke (present in both males and females, but particularly in the second group), seems to be unique to Maltese nationals and is not seen in other countries in Europe.

Intriguing also is the fact that, while the incidence of diabetes is the highest in the European group of nations, intake of fat seems to be the lowest. The relevance of this is far from clear. There seems to be ample confirmation, however, of the correlation between heart disease and obesity and tendency to avoid physical exercise.

It would appear that there are definite trends that characterise the Maltese population and distinguish it from other nations of Europe. Genes apart, one could point the finger to our peculiar diet, rich in carbohydrates, combined with our leisurely way of life devoid of marked physical activity, to account for our major health problems, of obesity, cardio-vascular disease and diabetes. Other major contributory factors include smoking and resultant high incidence of cancer of the lung, which in the Australian study showed an incidence in Maltese males second only to those born in Scotland.

One could not escape the conclusion that, overall, Maltese who have spent the best of the last half century away from Malta seem to continue to show the same trends in health and disease as those who have never left their native island. The reasons for this are not far to seek. Maltese overseas not only carry their genes with them, but they also tend to continue with the same traditions in relation to eating, drinking, smoking and indulgence in physical activity (or lack thereof). It would be of interest to see whether the second generation of migrants will show a greater approximation to the Australian norm, and, in view of the considerable intermixing with other ethnic groups, to what extent will the genetic effect still be a major factor in years to come.