Sustainable Inter-sectoral Collaboration: Addressing Non-Communicable Diseases (NCDs)

Over the years, we have experienced what is now known as the epidemiological shift.  We have seen significant reduction in deaths from infections and communicable diseases but even as we have yet to fully deal with this menace, we are in the midst of the global emergence of non-communicable disease as a major public health and economic threat.

 Keynote Speech of Secretary Enrique T. Ona Sustainable Inter-sectoral Collaboration: Addressing Non-Communicable Diseases (NCDs)

According to the first WHO Global status report on non-communicable diseases (NCDs), NCDs have become the world’s biggest killer. In 2008, 36.1 million people died from complications that resulted from conditions such as heart disease, strokes, chronic lung diseases, cancers and diabetes. Three out of five deaths every year are attributable to these diseases and the fact that nearly 80% of these deaths occurred in low to middle-income countries shows that it is indeed a global problem, something that is not exclusive to developed and advanced nations.

 

In the Philippines, our health profile has changed considerably given the increase in life expectancy, rapid urbanization, and lifestyle trends. Our current data reveals that 7 of the 10 leading causes of death in the country are non-communicable diseases. Heart diseases, strokes, cancers, accidents, diabetes mellitus, chronic lower respiratory diseases and renal disease account for over 50% of deaths that occur annually.  More importantly, the Philippine is one of the 23 countries that contribute to around 80% of the total mortality burden attributed to chronic disease in developing countries.

 

The World Economic Forum’s 2009 Global Risks Landscape Assessment Report identified NCDs and chronic diseases as one of the most significant threats facing global economies. In fact, according to the WHO, lost productivity from non-communicable diseases in China between 2005 and 2015 will have cost them over $550 billion. I’m not sure if we have similar studies to determine the cost of NCDs in our setting but I’m sure you will understand it when I say that the costs are unbearable for so many of our countrymen who are afflicted by these diseases.  Lost productivity and high health care costs of catastrophic outcomes resulting from non-communicable disease can certainly drive any family into impoverishment and poverty. You can just imagine how this will impact to those who are already very poor to begin with. Sadly, this is always the story when it comes to non-communicable diseases. As a clinician, I’ve seen this so many times in my practice.

 

The DOH’s health reform agenda of Kalusugan Pangkalahatan is directed towards improving access of the poor to quality health care. It is centered on providing financial risk protection to our people who traditionally do not have access to life-saving health care. Reforms are underway to expand coverage and to enhance benefits of PhilHealth.  I am happy to tell you that this year, we have already enrolled the 5.2 million poorest Filipinos families identified by the DSWD’s National Household Targeting System. Around 3.8 million near poor families were also enrolled in partnership with the different local government units. I fully understand however, that the current measure of protection afforded by PhilHealth insofar as non-communicable diseases are concerned is not enough. We know that the support value is limited. But we intend to improve that. This month, we are going to roll out Case Rate Schemes which is an all-in rate for some of the most common medical and surgical procedures that our people suffer from. The current list of 22 includes packages for caesarian section, hysterectomy, mastectomy, thyroidectomy, essential hypertension, and cerebrovascular accidents, among others. The Case Rate scheme will allow us to implement the no-balance billing or zero co-payment for the 5.2 million NHTS identified families admitted in government hospitals. In the future, we are looking at expanding the list and non-communicable diseases will surely be high on the agenda. In addition, currently in the pipeline are improved out-patient benefit packages and we are certainly studying how to use PhilHealth to finance maintenance medications for hypertension and diabetes.

 

Kalusugan Pangkalahatan is also focused on improving the quality of health services particularly in the public sector. We have allotted significant amount of funds in building infrastructure and improving the capability of health facilities, such as rural health units and health centers, district hospitals, and provincial hospitals as well as DOH Medical Centers. We are placing up-to-date diagnostic equipment that will allow these facilities to respond to the common health care needs and of course this includes management of non-communicable diseases and trauma. Likewise, we will be launching the DOH Complete Treatment Pack next week and this will make a number of maintenance medications for hypertension and diabetes more accessible for the poor.

 

All of these interventions are directed to improve access to health services, services that take the form of secondary or even tertiary prevention against NCDs. These interventions are designed to respond to the immediate needs of our people for access to quality health services.  However, in the context of non-communicable disease, we all know that the most critical component of the agenda ofKalusugan Pangkalahatan is that of health promotion.

 

The most common non-communicable diseases are collectively known as Lifestyle Related NCDs particularly because these diseases have common risk factors.  Tobacco use, unhealthy diet, physical inactivity and excessive alcohol use lead to the development of NCDs. To a great extent, we can prevent non-communicable diseases if we are able to prevent and modify these risk factors among Filipinos. And to do this, we need to empower people to be responsible for their own health. We need to educate them about the potential harm that unhealthy lifestyles would bring. This is essentially what health promotion is all about.

 

Recent evidence shows that health promotion strategies are best done at the level of the community and the family. This is the reason why healthy lifestyle messages will be among the main topics to be taken up by our Community Health Teams, an initiative of the DOH in partnership with the local government units, DSWD and DepEd. Inspired by our Measles Rubella door-to-door immunization campaign last summer, the community health teams will be deployed to provide comprehensive public health services such as immunization, family planning counseling, among others right at the doorstep of families. Part of the services they will perform is to deliver these key messages on healthy lifestyles: avoid tobacco smoking, a balanced diet, exercise, and avoiding excessive alcohol use.

 

To reinforce the message, health promotion strategies should have a handle in mainstream media. Last summer, we held the Ehersisyong Pangkalusugan Para sa Lahat Program which was participated by the President himself.  I know we were able to get a lot of attention especially since it was the President talking about healthy lifestyles and exercise. But of course we know that what we need is something more sustainable.  And this is where I think, we need to do more. We are happy with the response that the private sector has given. Currently, we have an on-going program with the Philippine Medical Association which centers on conducting a media blitz on Non-Communicable Diseases. Other non-governmental organizations are all willing to help generate awareness for NCDs and healthy lifestyles.

 

But apart from these strategies, interventions should also be directed at making our society and environment conducive to healthy lifestyles. The restructuring of excise taxes for sin products was included as one of the priority legislation of this administration. While many see its value in infusing more funds for the health sector, we also recognize its potential in deterring potential smokers, particularly the youth, to engage in the deadly habit. A long battle lies ahead of us to pass this law, but I believe that with everyone’s support we can do it. Likewise, the Metro-Manila Development Authority has not wavered in its campaign for a smoke-free metropolis. And while, their current efforts have hit a snag, we are behind them. Promotion of smoke free environments is also the idea behind the DOH Red Orchid Awards which recognizes best practices of LGUs in implementing these initiatives. There are ongoing activities in pursuit of a healthy and enabling environment such as the: continuous implementation of the Clean Air Act, Development of the inter-agency, Decade of Action for Road Safety 2011 – 2020, among others.

 

Indeed, multi-sectoral and inter-sectoral collaboration is the key if we are going to significantly reduce the burden of non-communicable diseases. The private sector, non-governmental organizations, and the academe have an important role to play in this endeavor. Research and Development, which the private sector and the academe are capable of generating, can certainly help us. One research topic that is certainly of interest to us is on how to best finance out-patient health care for chronic diseases. There are many other areas of interest but what is important is that we generate the knowledge, evidence and other best practices to implement our programs. We realize that government and multi-sectoral approaches that originate at the national level may not work if these initiatives are not supported at the local level.   Finally, the private sector can help us generate awareness on a larger scale to help us emphasize the importance of non-communicable diseases and how it can be prevented by healthy lifestyles.

 

Indeed this Forum, initiated by Health Justice, Philippines will provide us an opportunity to discuss the threat of non-communicable disease not only on our health but also of its effects in our economy. For this, I thank Health Justice Philippines and the University of the Philippines National Center for Public Administration and Governance who organized this forum.

 

I end by enjoining everyone to work in synergy against the growing menace of non-communicable disease. Let us commit ourselves to winning our goals by putting good health in the hands of our people.

 

Thank you very and mabuhay kayong lahat.