The biggest fast-food chain in the Philippines is not McDonald’s or Kentucky Fried Chicken, it is Jollibee, a local firm that has made a fortune out of burgers, fried chicken and local favourites covered in sweet sauces. However, this sweet tooth is helping fuel a rise in diseases more often associated with the consumption of processed food laden with sugar and fat, a sedentary existence, smoking and drinking. More Filipinos are succumbing to lifestyle diseases such as strokes, heart disease and diabetes, and non-communicable diseases (NCDs) are now responsible for two-thirds of all deaths.
Serious Issues
The 2016 Healthy Living Index, compiled by local unit of AIA the Philippine American Life and General Insurance Company, found that Filipinos are among the unhealthiest people in the Asia-Pacific region. The study found 80% of respondents felt their health was worse than five years ago, including 69% of people under the age of 30. Those surveyed reported being overweight due to a lack of exercise, snacking between meals and eating while distracted, with 25% stating that they would like to lose weight.
The current government of President Rodrigo Duterte refers to the health problems the Philippines’ faces as the “triple burden” – reflecting not only the battle with infectious diseases, but also lifestyle diseases and the effect of accidents and natural disasters. The World Health Organisation (WHO) describes cardiovascular disease, cancer, diabetes and chronic respiratory disease as the “fatal four”, with as much as half of all deaths from these NCDs occurring before the age of 60. In recognition of the severity of the situation, the UN agency developed the Global Action Plan for the Prevention and Control of NCDs 2013-20, laying down a roadmap and a series of suggested policy actions to help member states tackle these illnesses.
Early Start
The Philippines recognised as early as the 1980s the need to address the problem of NCDs when it established the NCD Control Service under Executive Order No. 109 to develop programmes aimed at prevention and control of illnesses such as cancer and cardiovascular disease. Over the years these initiatives have been expanded to include cancer registries and an increasing number of disease prevention strategies. In 2011 the Philippines signed the National Policy on Strengthening the Prevention and Control of Chronic Lifestyle Related NCDs, and a year later the government passed Republic Act 10351, also known as the Sin Tax Law, with the intention of using the money raised from higher levies for tobacco and alcohol to fund health initiatives. The sin tax was a major step forward in the Philippines’ commitment to the WHO Framework Convention on Tobacco Control, but by increasing taxes on tobacco and alcohol it also provided a major injection of funds to boost universal health coverage, expand the National Health Insurance Programme (PhilHealth), and step up NCD prevention and treatment at primary care facilities. Health initiatives under ASEAN integration should also lead to changes in the health sector. Rosalie R Montenegro, president and CEO of Makati Medical Centre, told OBG, “ASEAN integration can trigger opportunities, but also challenges, for the Philippine health care sector.”
New Strategy
In collaboration with the WHO and the University of the Philippines’ College of Public Health, the Department of Health (DoH) is now following the Philippine Multisectoral Action Plan for the Prevention and Control of NCDs 2015-25. The key goal for the plan is to achieve a 25% relative reduction in premature mortality from the four main NCDs within a decade through the prevention, surveillance and management of the most prevalent diseases. In addition, the administration of President Duterte has devised the Philippine Health Agenda 2016-22, which is guided by the UN’s Sustainable Development Goal (SDG) 3: ensure healthy lives and promote well-being for all at all ages. SDG 3 has nine major targets, three of which will have direct bearing on the government’s plans to reduce NCDs. These include ending epidemics of major diseases, in which NCDS are included; a one-third reduction in premature mortality due to NCDs through prevention and treatment; universal health coverage that will allow for better treatment; and the more general promotion of mental health and well-being.
“While part of the increase in proportion of deaths [from NCDs] is due to the ageing of the population and having more people at risk, it is also a result of rising rates of NCDs at younger ages. NCDs thus impact the working-age population and increase the economic burdens of the country,” Esperanza I Cabral, former secretary of health and a cardiologist and clinical pharmacologist, wrote in the April/June 2016 edition of the Philippine Journal of Internal Medicine.
Diabetes
The Philippines is an emerging hotspot for diabetes and is among the top 15 countries in the world in terms of diabetes prevalence, according to the International Diabetes Foundation, which does research and advocacy on the disease. There were some 3.5m diabetes sufferers in the country in 2015, the third-highest number in ASEAN, after Indonesia and Thailand, according mClinica, a medical research and consultancy firm. By 2040 this is expected to rise to 6.3m, putting the country in second place after Indonesia, which has more than twice the population of the Philippines. There are also a larger number of people who are not even aware that they have the disease, with mClinica estimating the number of undiagnosed cases of diabetes at 1.8m in 2015, rising to 3.3m by 2040.
A DoH-led diabetes control and prevention programme was implemented in 2016 with the aim of educating Filipinos about the risks of the disease and ways to prevent it. The department now sponsors Diabetes and Hypertension Clubs, which provide advice on healthy living and free medication for those diagnosed with the condition at primary health care facilities. The health clubs also provide access to the medications losartan, amlodipine and metoprolol for the treatment of hypertension, as well as metformin for diabetes.
Greater Access
Expanded PhilHealth coverage under the TseKap programme will also provide a package of preventative health checks such as blood pressure, blood sugar and cancer screening for more than 15m people. The initiative is being expanded to include those identified by the Department of Social Welfare and Development as having “no visible means of income”, as well as sponsored members, whether by the government or private companies. These initiatives build on Pilipinas Go4Health, launched in 2013 with the goal of encouraging citizens to lead a healthier lifestyle through physical activity, proper nutrition and reducing, or eliminating completely, smoking and alcohol consumption. At the launch of the programme, the government noted that only seven out of 100 Filipinos engaged in vigorous exercise three or four times a week.
In 2016 the DoH also rolled out initiatives to address other NCDs such as strokes by providing free medication at selected government hospitals. It also stepped up the fight against cancer by establishing specialist treatment centres beyond Metro Manila to give more patients access to radiation therapy, as well as offering a series of treatment packages under PhilHealth for a wider range of cancers. The seven centres will be set up at hospitals in cities including Davao City, Tuguegarao City in Cagayan province, Naga City in Camarines Sur, Zamboanga City, Quezon City and Cebu City.
Lighting Up
The passage of the so-called sin tax in 2012 showed the Philippines was willing to use financial measures to address health issues. While the tax has contributed directly to boosting the DoH’s budget, it also appears to have contributed to a decline in smoking, which has led to an average of 240 Filipinos dying each day due to smoking-related diseases. The 2015 National Nutrition Survey showed that the number of smokers aged below 20 declined to 5.5% in 2015, compared with 9.1% in 2008. For adults, smoking prevalence dropped from 31% in 2008 to 23.3% in 2015. However, anti-smoking campaigners are calling for further increases in the tax as the Philippines has among the lowest cigarette prices in the world. The WHO noted that a single cigarette costs just $0.02, and the illicit trade in tobacco remains a problem.
The Sin Tax Law has given the government the means to expand its NCD programme, but some observers say that the scale of the problem will require more innovative financing and the support of private partners. “The private sector therefore should be allowed to play a much bigger role in comprehensive health financing,” Cabral wrote. “Public-private partnership [PPPs] in health requires governments to design and implement fairly, policy and regulatory frameworks to ensure affordable high-quality service delivery.”
The administration of former President Benigno Aquino III put PPPs at the centre of its strategy to achieve its health policy aims. His successor, Duterte, has been less explicit in his support for PPPs, amid concern about the longer-term implications for health equity, but the current government has also made clear that it welcomes private sector support as it tries to create a more equitable health system in the Philippines.
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