Speech by the Hon. Dr. Michael Farrugia, Minister for Health, Care of the Elderly and Family Affairs at the 1st Meeting of the St. Vincent Declaration Convenors Working Groups on the initiative of WHO and International Diabetes Federation -Qawra -12.03.98

Ladies and Gentlemen,

First of all I would like to welcome you all to Malta and on behalf of my Government I wish to thank WHO(Euro) for giving us the opportunity to host this meeting.

As you are well aware Malta is derived from the Greek words "Land of Honey" and what better place to discuss Diabetes Mellitus than in the Sweet Island of Malta. Although this is not the first time an International meeting on Diabetes is being held here this is the first time so many experts have honored us with their presence and I am sure that the results of these two days will be fruitful to the European community at large.

10% of the Maltese population over 15 years of age suffer from diabetes. This prevalence increases with age. Besides about 5% of the Maltese suffer from glucose intolerance. It is one of the top ranking conditions which take a huge percentage of our health service resources. We estimate that a considerable percentage of the health service resources are dedicated to diabetes and its complications.

21% of cardiac patients in hospital are diabetics, so are 81% of those admitted as inpatients in the acute hospital with peripheral vascular disease. This not to mention the ever increasing numbers with renal insufficiency. Pre-existing diabetes was present in 31% of patients admitted to the Coronary Care Unit and it is estimated that 6% of those registered at the Diabetes Clinic had an annual hospitalization with a mean stay of 3 weeks.

This meeting is a preparatory meeting for next year when the 10th Anniversary of the St.Vincent Declaration will be celebrated. Malta, having been one of the countries at the St.Vincent Meeting has strived to meet the goals set by that declaration and the subsequent meetings. The main aims of the declaration is to achieve a major reduction in complications of diabetes, improving the social conditions and achieving a normal life expectancy for diabetics. One of the targets was the establishment of monitoring and control systems using information technology for quality assurance of diabetes health care provision. This led to the development of the DiabCare program of which Malta has been one of the pioneers. We have been collecting this data from our hospital and peripheral clinics and have been using this as a tool to streamline our care as well as to have a quality assurance tool.

Doctors record details of the patients life style, risk factors, form of treatment, degree of education on diabetes, intermediate metabolic outcomes, ophtalmic and feet observations, self monitoring, markers of diabetes tissue damage, pregnancy and complications of diabetes. All this information is evaluated and external comparison is done at centre, regional, country and international levels.

Not only have we been in the birth of this concept but we have held the torch high and spread the idea. Malta, through Mediterranean Group for the Study of Diabetes (MGSD) has been the focal point for DiabCare in the Mediterranean and we hope to continue adding to our 10 centers to spread the web even further within the Mediterranean countries.

Informatics in the field of medicine is on my government's agenda. We are in the final stages of establishing within a few weeks telemedicine and we hope to start using this regularly with our sister island Gozo (which I hope we can all visit on Saturday) and also with Great Ormond Street Hospital, London which is our specialist pediatric referral center. We therefore support the project of Diabetes Informatics and we welcome your help in improving our systems to be able to contribute more. As you are well aware we are not a very rich country, but I am proud to say that our human resources are hard working and efficient and our population group makes us the ideal setting for projects which WHO and especially WHO(Euro) are planning.

Back to the Maltese population and Diabetes, one of our major problem in Malta is obesity. 42% of males and 31% of females have been classified as overweight and 20% of males and 34% of females as obese. Two-thirds of the people with newly diagnosed diabetes were found to be obese. We know that we have moved away from a Mediterranean type diet. Both the quality and also the quantity of our food is not conducive to health. It is in this light that next week the Health Promotion Department will be launching a campaign to promote the benefits of a Mediterranean diet, a diet that not only helps one maintain an ideal weight but is also conducive to health. Diet alone is not enough. In a small island like ours we have more than one car per household and walking has become a thing of the past. We must emphasize the importance of exercise and that this is not wasted time but is essential time for ones health.

Diabetes Prevention is a concerted effort, the doctor, paramedic, pharmacist, health promotion and the patient must all work together with the same message and the same aim in mind. I cannot but congratulate WHO Europe for being able to convene such an extensive and diverse list of participants who I am sure will all contribute to the richness of this meeting.

I am sure that this working group will not only prepare a good structure for the 10th Anniversary of the St.Vincent Declaration but will prepare a sound foundation for the work that will be taking place in Turkey where we will all be looking at the threshold of the 21st Century. This meeting is but the start of a momentum which will culminate in the 21st Century where we should all be aiming at making sure that Diabetics in Europe and Around the World have a better quality of life and that the services we offer are of the best quality available.

Once again I welcome you to Malta, hope that you have a good and productive meeting and that the little we will show you of our islands will wet your appetite to come again and explore better our beautiful land of honey.