Succeeding in the fight against NCDs

ACCORDING to Antonio Dans et al. (Lancet, Feb 19, 2011) chronic non-communicable diseases or NCDs (stroke, heart disease, cancer and chronic obstructive pulmonary disease [COPD]) are a major public health problem in the Philippines and in Southeast Asia. Southeast Asia faces an epidemic of chronic non-communicable diseases, now responsible for 60% of deaths in the region. The problem stems from environmental factors that promote tobacco use, unhealthy diet, and inadequate physical activity. Disadvantaged populations are the hardest hit, with death rates inversely proportional to a country’s gross national income.

Families shoulder the financial burden, but entire economies suffer as well. Death and disability from NCDs exert an economic burden in two ways: indirectly, through loss of productivity and income, and directly, through household spending on chronic medical care, often of catastrophic proportions.

Developing countries have the double burden of communicable and chronic disease. They also face the challenge of health-system reform. Without universal access to care, well-integrated health services, and strong leadership in public health, response to the above challenges will be inefficient. The greatest health gains, in fact, could come from structured preventive strategies.

Our goal is to provide quality healthcare for all at a minimum cost to society by relying on a combination of public and private service delivery, even without a national insurance system. The Philippine government will play a key role. Preventing diseases will be the top priority of every government agency and local government unit (LGU) and not only the Department of Health (DoH), for health is everyone’s concern. Thus our government, through inter-agency collaboration, will promote a healthy lifestyle and prevent perennial killers like coronary artery disease, strokes from hypertension, cancers, diabetes and COPD and other tobacco-related illnesses by ensuring a healthy environment, good health conditions, and heavy penalty for smoking in public places.

If we put all our health services in a continuum, with promoting health on the one end and mitigating sickness on the other, we will realize that all the incentives of the healthcare system respond to signals from sickness. At present we have a system that pays for procedures not cures; interventions not outcomes; transactions not transformations. We “penalize” doctors for providing cost-effective care that promotes health but we reward them for interventions regardless of outcome, redundancy, and waste.

Despite some attempts to control NCDs, more needs to be done. Health-care systems need to be redesigned to deliver chronic care that is founded on existing primary health-care facilities, but supported by good referral systems. Surveillance of key modifiable risk factors is needed to monitor the magnitude of the problem and to study the effects of interventions. All branches of government and all sectors of society should get involved in establishing environments that are conducive to healthy living. Inaction will affect millions of lives-often, the lives of those who have the least in life.

The Health for the Filipinos is not about extending insurance coverage and deciding who to pay for health care, and how much — important as those things are, it makes no sense just to figure out a better way to pay the bills for a system that is dysfunctional, ineffective, and broken. We also have to change the health care system itself, beginning with a sharp new emphasis on prevention and public health.

Health Secretary Enrique Ona agrees that the Department of Health (DoH) should shift focus from sick care to health care. The DoH will take the lead in addressing ignorance and ineptitude in healthcare and will communicate with all government agencies to contribute their share in health.

Health is not only the DoH’s accountability but also ours as citizens. But our government leaders should step up and think of creative ways to improve our condition.

We can ask the different agencies, e.g., Education, to stress preventive health education modules and actions; we can ask Public Works and Highways, Metropolitan Manila Development Authority and LGU heads to clean up the streets and clear the waterways to prevent killer floods and dengue fever, leptospirosis, diarrhea and other water-borne and vector-borne illnesses. We ask the Finance department, Bureau of Internal Bureau, Budget Management management, Senate and House to continue measures that curb smoking and alcohol drinking, especially after the passage of the sin tax.

We can propose a summit where President Noynoy Aquino (PNoy), his Cabinet, government agencies, health organizations, the private sector, NGOs will express a National Commitment that our healthcare system values prevention, wellness, rapid diagnosis and early treatment.

A PPP (Public Private Partnership) Executive Committee can be formed to formulate the work plan. This same committee can monitor performance of the PPP components and publish results in the newspapers regularly. The DoH and other agencies can fund this project with the private sector group volunteering what they think is their best contribution to attain the programs’ objectives.

In order to succeed, wellness and prevention must be truly comprehensive. It is not just about what goes on in a doctor’s office. It encompasses having workplace and community-wide wellness programs, building bike paths and walking trails, getting junk food out of our schools, making school breakfasts and lunches more nutritious, increasing the amount of physical activity of our patients and those individuals at risk, etc.

We view this change in mindset as our opportunity to recreate the Philippines as a genuine wellness society — focused on prevention, good nutrition, fitness, and public health. Just as important, it will hold down health care costs by creating a sharp new emphasis on disease prevention and public health.

Anthony Leachon, M.D., is consultant of the Department of Health on noncommunicable diseases.

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