A DIFFERENT DRUM
DR. MALAYA SANTOS
Dr. Malaya Pimentel-Santos is a long-time community health advocate, having worked with several non-government health organizations. She is a fellow of the Philippine Dermatological Society and a professor of microbiology at the St. Luke’s College of Medicine.
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“Noncommunicable diseases (NCDs), also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behavioural factors.The main types of NCDs are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes.– World Health Organization
The link between poverty and infectious disease is clear. Malnutrition, lack of education, overcrowding, incomplete vaccination coverage, inadequate toilet facilities, scarcity of potable water sources, and improper waste disposal mechanisms– conditions which have virtually disappeared from the ‘developed’ world – all contribute to enhanced transmission of communicable disease in low-income communities.
On a brighter note, our country has borne witness to recent developments and advances that have brought us up to (or at least close to) par with more industrialized societies in aspects such as science, technology and health care. But despite this apparent economic growth, large segments of our population – particularly those living in poor urban communities and remote rural areas – have not reaped the full benefits of progress. Notwithstanding health system reforms and bold efforts towards providing universal health care, social inequity remains a largely insurmountable barrier to improving access to health.
While communicable diseases such as tuberculosis, malaria, diarrheal disease and parasitic infections are still very much a problem in the Philippines, we are also seeing a change in demographic trends, with a resultant shift in the patterns of mortality and morbidity. In what is referred to as an ‘epidemiologic transition’, there has been a marked rise in the prevalence of noncommunicable diseases (NCDs) – sometimes referred to as ‘lifestyle diseases’– which have traditionally been associated not with poverty, but with affluence and excess.
Double burden of disease
Historically, and because many infectious diseases continue to be devastating, relatively less focus was initially placed on NCD prevention and control in the developing world. However, the aggregate burden of cardiovascular disease, diabetes, respiratory disease and cancer has steadily increased worldwide in both wealthy and emerging economies. The World Health Organization (WHO) estimates that 75 percent of all NCD related deaths occur in low- and middle income countries. Confirmatory data from the Department of Health identifies heart disease, vascular disease and malignancy as the top three causes of mortality (as of 2013), while pneumonia and tuberculosis remain among the top ten causes of death in the country.
Moreover, it has become increasingly clear that the very same poverty-related conditions that promote communicable disease: lack of education, poor diet and inadequate access to health care (including preventive care, early screening for disease and resources for maintenance medications) also leave poorer populations vulnerable to the most catastrophic – but also largely preventable – outcomes of NCDs such as stroke, heart attack, end-stage kidney disease and delayed detection of advanced neoplastic disease.
Rather than waiting to see a doctor when we are sick (or worse, dying), it is important that we make early, healthy choices with regard to the way we live; that we invest in the proverbial ounce of prevention. The principles of healthy living are basic: hand and home hygiene, healthy diet, adequate exercise, adequate rest, and avoidance of injuries and other risk behaviors such as smoking, drug abuse, and unsafe sex.
In order to have a large-scale impact on individual lifestyle choices, the government has to invest a substantial amount of resources to implement broad social and environmental interventions that promote the necessary changes in health seeking behavior, on a population level. This includes widespread health education, provision of preventive and curative care, as well as good governance for health: legislation of laws, creation of policies and allocation of budgets.
Smoking and NCDs
Smoking cessation is invariably linked to NCD control and prevention. The dangers of smoking are well established. Smoking damages nearly every organ system in the body, and is a known contributor to almost all categories of NCDs, including chronic respiratory disease, cardiovascular disease and many different types of cancer. The WHO states that tobacco use is responsible for over 7 million deaths worldwide every year.
Republic Act 10351, also known as the Sin Tax Reform Law, imposes excise taxes on alcohol and tobacco products. It generates tens of billions of pesos in revenues each year, and these funds are used to help finance the government’s universal health care program. As of July 22, 2017 a nationwide smoking ban is now in place all over the Philippines.
Successfully influencing systemic and socioeconomic realities can help us to create an environment that will either hinder or enable healthy lifestyle choices. In order to address both communicable and non-communicable diseases, the government and the public and private health sectors must all work together and embrace an all-encompassing and holistic approach to maintaining health: a full continuum starting from health promotion and disease prevention, all the way to the diagnosis, treatment, cure and control of disease.
March 2018 Health and Lifestyle