Philippine healthcare system

How the next president should address health inequities in the Philippines

John Q. Wong, Carlo Yao, Kirsten Angeles, EpiMetrics
How the next president should address health inequities in the Philippines
Pick the president who can not only manage the health system effectively but who can also ensure that health is for all and is not only for the few

MANILA, Philippines – With COVID-19 still prevalent in the Philippines, there is a need for a leader capable of safeguarding the health and lives of the people. The next president will inherit a country with a health system in ruins and also one that is beset by unaddressed health inequities. Though the COVID-19 pandemic has affected everyone in the country, it has affected some more than others. A transformative president is necessary to change the circumstances “in which people are born, grow, live, work, and age.”

The main factors affecting Filipinos’ risk for developing diseases are diet, physical inactivity, pollution, and abuse of tobacco and alcohol. These diseases consequently increase one’s chances of death in the Philippines, regardless of age. But if we look at the “causes of causes,” there is also a socio-economic gradient in our exposure to these risks.

Reducing the exposure of all communities, rich and poor, to these risk factors will improve their health status, reduce the financial risks due to ill health, and provide them with “lives that they have reason to value.” We propose an agenda for correcting the health inequities in Philippine society.

The life cycle approach

As people go through their stages of life, they are exposed to specific factors that increase their risk for disease. However, social inequities exacerbate the effects of these risk factors. By addressing inequities in all of the life stages, the population stands a better chance of living healthy and well.

Pre-school children

The early years of childhood ultimately affect the way individuals grow and develop. It has been noted that early childhood education has many benefits in developing a child’s cognitive function, which in turn improves his/her overall quality of life in adulthood. Improving access to early childhood education has been mandated, by law, to be the local government’s role. However, the implementation has been difficult in the public sector.

Children without access to private preschools are cared for at home by a parent, usually the mother, who is, consequently, unable to work and to contribute to the family income. To address this, the government should enable local communities to create good quality, safe, and free daycare centers in each barangay that are run by trained childcare workers. These daycare centers can provide care for these children as parents work, as well as impart these children with a head start in cognitive development. The next administration should support local government units in the sustainable development of these daycare centers.

School-age children

At the age of five years old, children will enter formal schooling. If we want children to live healthier adult lives, they must be educated enough to make the right decisions regarding their health. Even in education, there is inequality. As the rich have access to quality education through private schooling, the poor are unable to receive the education they need, with more of them dropping out despite initial enrollment. There are even disparities noted between males and females in terms of educational attainment. Females are noted to have better educational attainment but have lower compensation when entering the workforce.

The public school system is in desperate need of a revamp. Many public schools still struggle to provide access to electricity, water, and proper sanitation. All of these are necessary and basic for a proper learning environment. During the COVID-19 pandemic, students and schools with access to proper digital facilities – that is, internet access and computers – were better at adjusting to a virtual form of education. The next president should invest well in our public schools.

Working adults

Healthy working adults are the backbone of the Philippine economy. Young adults who enter the workforce are most likely healthy at baseline. But as they are exposed to occupational hazards, they develop a variety of diseases and risks that contribute to poorer health outcomes. It has been noted that 94% of workers in medium- and large-enterprises work under poor conditions.

Labor laws already exist to safeguard workers’ occupational safety and health (OSH). However, there is a need to improve governance in OSH. For example, during the height of the COVID-19 pandemic, it was evident that health workers were faced with increased workload but were given low OSH protection and compensation. There is still much to do in ensuring safe workspaces and proper remuneration.

The next president need not reinvent the wheel here. He or she simply needs to enforce OSH laws. However, he/she will have to work together with the labor and the business sectors for OSH laws to be effective.

The elderly

About 25% of the poor are elderly making this group a particularly sizable part of the poor. It has also been noted that 73% of the elderly were deprived of the ability to work during the pandemic. As the population grows, so will the number of elderly and, as we age, it becomes more difficult to earn a living due to declining physical condition.

As our health as a society improves, our life expectancy is likely to improve as well. There will come a time when we will live a significant portion of our lives as elderly. But, for now, the needs of the elderly deserve more attention because they currently have the highest unmet health needs. Improving access to outpatient medicines and primary care will prevent debilitating disease among the elderly. The next administration should focus on this not just to reduce their financial strain but also to improve their quality of life.

Building healthy communities

An individual’s environment plays a major role in their behavior and also influences the risk factors they are exposed to. Because individuals live in a social context, a healthy community promotes a healthy individual in all stages of life. To keep a community healthy, it is important to support its basic needs: nutrition and physical activity, clean air, and housing.

Food and agriculture

A diet abundant in fruits and vegetables is the cornerstone of a sustainable and healthy diet. Modernizing the agricultural sector in a sustainable manner can provide a strong base for the country’s agriculture to thrive, contributing to the food security and rural development of the country. Modernization here includes developing and using evidence-based methods and techniques that yield efficiency, farmer welfare, and product quality with fewer inputs (such as those used in Israel’s “kibbutz” system, which is an agricultural system based on collective ownership).

It would take a collaborative effort among government, farmers, and researchers to improve the agricultural productivity of farms through sustainable technologies. This will improve public access to fresh, nutritious, and affordable produce.

Pollution and energy generation

Pollution threatens the Philippines in several ways. Our country faces population growth and rising energy demand. It is also extremely vulnerable to climate change and disasters – being ranked third most vulnerable – as it is susceptible to typhoons that can push non-poor families into poverty. Moreover, our country’s dependence on coal for energy and current low air quality standards are threatening the health of its citizens, resulting in premature deaths.

Integrated mass transport systems can mitigate vehicular pollution in highly urbanized cities. Electric-powered mass transport systems are efficient, safe, affordable, reliable, and clean. In addition, to mitigate pollution from electricity generation, we can increase the share of renewables in electricity production. To do so, we must provide incentives for industries and residential consumers to use renewables.

Investing in low-carbon transport and transitioning to renewable energy sources are both plausible and important to raise air quality standards, reduce risks for air pollution-related deaths, and contribute efforts against climate change.

Urbanization and housing

About 2.8 million informal settlers live in Metro Manila, usually migrating there for job opportunities. A majority live in “danger zones” – railroad tracks, garbage dumps, canals, rivers, creeks, and other flood-prone areas. They are in constant anxiety about their impending displacement to clear up urban areas (like the Bay) and are usually relocated to inaccessible and inadequate government housing. The manner in which informal settlements are relocated can be improved to mitigate disasters, build community resilience, and give vulnerable groups a voice.

This can be done by promoting properly-managed urban expansion and affordable housing through participatory upgrading of informal settlements. This means finding a way for families to take part in upgrading their homes on-site, rather than demolishing them. This can lead to ensuring community-empowered and government-supported adequate, secure, and affordable housing for all citizens.

Physical activity

While the Philippines has some bike-friendly cities, they are mostly found in the provinces, and there are only a few walkable parks. Providing access to parks has been shown to promote a community’s health, support physical activity, reduce air pollution, improve psychological health, and more. Creating walkable parks and bicycle-friendly pathways in every barangay can be a cost-effective way to benefit the health and wellbeing of its citizens.

Vote for the presidential candidate who will confront health inequity

As we enter the third year of the pandemic, the future president will have a lot of work to do. But it won’t be enough to focus on improving the country’s economy. Economic development alone does not address, and may even worsen, inequity in society. It would be the responsibility of the president not just to prevent the loss of life but to create the conditions for life to flourish.

Only by providing people with liberty from material deprivation, with the ability to make choices over their own health, and with a voice in governing their local health systems can they have the “freedom to lead lives they have reason to value.”

The next president should be able to manage the health system effectively and at the same time ensure that health is for all and is not only for the few.

In this hands, our countrymen’s health is literally in the voters’ hands. – Rappler.com

John Q. Wong, MD, MSc, Carlo Yao, MD, MBA, and Kirsten Angeles are from EpiMetrics Inc., a public health research institution focused on the achievement of health equity through rigorous and creative conception, execution, translation, and communication of health systems and policy research.

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