By Mechelle Acero Palma, MD, MMHA, DIPIBLM, FACLM
Health care in the Philippines is never without cost and it is consistently driving its significance in economic, political, and even social concern among our national and local governance. Our country is currently facing a double burden of disease where chronic non-communicable diseases have emerged as the major cause of morbidity and mortality hence draining the budget from household to local and national level.
Lifestyle-related unhealthy behaviors such as poor nutrition, physical inactivity, poor sleep, alcohol, and tobacco use are the proven actual causes of premature adult deaths, the preponderance of noncommunicable chronic diseases. Even though changing unhealthy behaviors is foundational to disease prevention, medical care, and health promotion as depicted in National guidelines and algorithms, health care providers often do not give behavioral change counseling as lifestyle intervention in their routine care. Physicians also have cited identified barriers including lack of time, compensation, knowledge, skills and resources. This is basically due to the fact that Lifestyle Medicine has never been emphasized in medical education.
The steadily arising crisis in chronic disease triggered the development of LIFESTYLE MEDICINE (LM) training courses and certification of medical practitioners and other health care professionals globally.
Lifestyle Medicine Curriculum
To begin to address the identified gap, LM medical education was initiated as the necessary solution. In the United States, a blue-ribbon panel was formed composing of interested medical professional societies and developed the lifestyle medicine competencies for primary care physicians and was published in the Journal of American Medical Association in 2010. From then on, Lifestyle medicine curricula, including nutrition, exercise, behavioral change, self-care, sleep health, and other non-drug modalities were developed. And further work continues in developing training materials, evaluation, and system-based practice tools and performance measures to help health care providers achieve their goal. LM has then evolved in all levels of medical education worldwide and is now adopted by medical schools and societies in the Philippines. These curricula have been described and found to improve self-perceived attitudes, knowledge, and confidence toward prescribing LM intervention.
Lifestyle Medicine Course
Lifestyle Medicine is a fast-growing field of practice, defined in the Journal of the American Medical Association as the “evidence-based practice of assisting individuals and their families to adopt and sustain behaviors that can improve health and quality of life.” Primary care LM medical education was defined with core competencies developed largely to guide Continuing Medical Education (CME) for primary care and preventive care physicians including educators. Both the undergraduate Medical Education (UME) and Graduate Medical Education (GME) levels were also encouraged to incorporate LM into their training programs. LM education is also offered to allied health professionals and health coaches who are working in a team approach with LM physicians.
Lifestyle Medicine Certification
Lifestyle medicine education was initially offered by the American College of Preventive Medicine (ACPM) and American College of Lifestyle Medicine (ACLM) then many other institutions followed including the Harvard School of Medicine. In 2017, the American Board of Lifestyle Medicine (ABLM) conducted the Inaugural Board Certification examination in Tucson Arizona with almost 300 takers coming from different parts of the world. The International Board of Lifestyle Medicine (IBLM) was also created and became the certifying body outside the United States. Currently, there are only 12 Board Certified Lifestyle Medicine Physicians and 2 allied health professionals in the Philippines.
Philippine College of Lifestyle Medicine
The Philippine College of Lifestyle Medicine (PCLM) is the first Philippine national medical specialty society for health care professionals who utilize lifestyle interventions as the primary therapeutic tool in the treatment and management of disease. The PCLM serves its members and affiliates by advancing the field of lifestyle medicine, promoting excellence in clinical practice and advocating on behalf of medical and public policy issues related to the practice and promotion of lifestyle medicine. The society holds an annual conference to provide continuing education programs to its growing number of members in collaboration with several institutions.
Lifestyle medicine education in the Philippines
At present, the Adventist University of the Philippines (AUP) College of Medicine is the first and only medical school that officially integrates Lifestyle Medicine in their teaching curriculum intending to produce physicians honed to become LM providers. The AUP Graduate School has also pioneered the Masters Degree in Public Health Majorin Lifestyle Medicine and is also offering LM certification course through satellite training for non-health care professionals and community-based workers.
There are also growing numbers of hospitals in the country that are offering LM intervention to patients but there are only two training hospitals that are starting to integrate LM competencies to Family and Community Medicine residency programs namely the Adventist Medical Center Bacolod and the Antique Medical Center.
According to the National Statistics Office, Filipinos are dying at an average age of 62 and the top 5 killer diseases are all lifestyle-related. The eminent health condition in the country demands more Physicians and Allied Health Professionals with appropriate competencies and skills to match the demand of the growing trends of lifestyle disease and the changing context of health care delivery. LM education should be available and affordable not only for physicians but also for public health specialists holding a position in universities, public offices, churches, and even non-government organizations that are capable of promoting lifestyle programs in their respective fields of practice.