CALIFORNIA, USA - On March 5th, the Philippine College of Physicians endorsed banning the sale of soft drinks in schools as a move to promote healthy habits among children and to prevent diabetes and obesity in later years. This expression of support comes two years after 8-year-old Daniel “Chip” Gatmaytan began a campaign against sugary drinks in his Quezon City school.
It is heartening to see that young kids like Chip have embraced advocacies such as this. But I wonder if people know that Chip’s actions mirror ideas beyond his years and that he symbolizes a movement that the country should seriously consider.
Health experts have long acknowledged that the conditions in which we live, work, and play exert greater influence on our overall health than medical care. This claim is drawn from accumulated knowledge over years of scientific research. And when you take time to think about this, it’s rather intuitive.
These conditions are popularly known in literature as the “social determinants of health.” Fancy as this term may sound, it’s actually pretty simple. It points to the physical, economic, and cultural environment that we are exposed to.
The key word here is “social” because it denotes forces beyond a single person’s control. In fact, social determinants are rooted in our collective beliefs, attitudes, and actions.
Prime examples of social determinants include air and water quality, economic opportunity, public safety, smoking culture, and health policy.
The Philippines, like many low- and middle-income countries, is experiencing a “double burden” of disease. This means that we are not only enduring the scourges of tuberculosis, pneumonia, and diarrhea, but also the affliction brought by cancer, diabetes, and heart disease – conditions collectively known as chronic diseases.
Here lies the connection: If we are at all serious about preventing chronic illness, we should include the social determinants in our conversations, whether in government or private industry. This proposal, which I am not the first to make, is easy to appreciate and tease out.
Chronic diseases have been called “lifestyle diseases” because we know that they stem from poor choices related to smoking, physical activity, and nutrition. Although family history or genetics plays an important part, we acknowledge that unhealthy choices contribute largely to our risk of developing these illnesses.
But no matter how easy finger-pointing is, we should also consider whether the people we blame for being “too fat” or “too lazy” can actually make the healthier choices that we expect them to make. Are the conditions in which Filipinos live, work, and play even conducive to making these decisions?
For instance, exercise in the form of jogging, walking, or biking is great. But how likely are you to do these activities if your neighborhood has high rates of burglary or gun violence? Are your sidewalks paved and is there a safe bike lane?
Consider an example that’s related to Chip’s advocacy, sugary drinks. What if you don’t have access to clean water and the only beverage available is soft drinks? Also, what if sodas are cheaper than fresh juice or water? Can we really fault a person who picks the more affordable drink?
From these illustrations, we realize there is more to personal choice in matters involving health. Sometimes, making the healthier choice isn’t as easy as saying yes to exercise and no to fatty foods.
And so the challenge for us is to make the healthier choice the easier choice. In fact, if possible, make it the default choice for everyone. There are many ways of doing this and there are successful examples from all around the world to draw from.
Soft drink ban
Consider the bills that I introduced in the beginning. By limiting access, these prohibitions on sugary drinks are essentially changing the food environment of our students. If soft drinks are not available, then children will not be able to drink them.
The added genius behind implementing this change in schools is that kids spend most of their day and eat most of their meals in school.
Simple and ingenious as these bills seem, there are several issues to consider. For instance, should we focus only on soft drinks? What about high calorie drinks that claim vitamin content? What role should parents, teachers, and school administrators play?
There is also an issue of balancing personal freedom and encouraging healthier choices. Critics argue that such beverage bans curtail civil liberties and undermine personal choice.
A possible compromise is to make the healthier option – which in this case is water –more enticing and accessible to children. For instance, provide adequate water fountains to students and reinforce the use of those facilities. Schools can also limit cup sizes for sodas and make those for water or fresh juices larger.
Difficult but necessary
I foresee that a conversation about the social determinants will be met with apprehension and skepticism, especially since our country is still facing issues on health care access and quality.
But if we are to learn anything from developed nations who have had to contend with the same question, it is that we cannot neglect the social determinants if we want to encourage disease prevention and health equity.
I believe that a discussion on the social determinants is also timely because of the recent successes we have had in legislation. The momentum garnered by the Responsible Parenthood and Sin Tax Reform laws is unprecedented and we should leverage that.
And if this is any indication of where we are in considering the social determinants, it appears that Filipinos already have a good understanding of these ideas and are willing to support measures that encourage better health. – Rappler.com
Anton Avanceña works for the California Department of Public Health and the Santa Clara County Mental Health Department, and volunteers as an HIV test counselor at the UCSF Alliance Health Project. Anton, who studied public health at Santa Clara University, will begin graduate studies in global health at the University of California, San Francisco in September.