Dr. Willie T. Ong, The Philippine Star, November 20, 2012

The top three leading causes of deaths in the Philippines are heart disease, stroke and cancer. Every day, heart disease kills 191 Filipinos, stroke takes away 120 lives and cancer kills 80 Filipinos.

In this article, I will enumerate the public health interventions that can help curb this epidemic of non-communicable diseases (also called lifestyle diseases). If we can make some headway in these five targets, then we will be saving a lot of lives. Perhaps, the Filipino life expectancy of 73 years old can be increased substantially.

1. Policy on healthy foods.

Experts estimate that 50% of heart disease is caused mainly or partly by an unhealthy diet. Studies show that a healthy diet can reduce one’s cancer risk by 3 to 10%. Since we all have to eat, so why not eat healthy foods? There are two issues here why heart disease is the number one killer: (1) healthy food is not readily available, especially in fast food restaurants, and (2) people tend to choose fatty and salty meals. Latest data shows that three out of five Filipino adults do not eat the required amounts of fruits and vegetables every day. Both men and women, regardless of age, level of education and income level, do not take enough fruits and vegetables.

Here are some initial policies: (1) A law that will make healthy foods readily available even in every restaurant and fast food chain; (2) Labeling of foods regarding its calories, cholesterol, salt and sugar content to help guide the consumer; (3) For fast food chains, avoid upsize or “go-large” promos. Make the default order just the regular size order; (4) Prohibition of fast food advertisements targeted to kids below two years old. Children should be encouraged by their parents to eat healthy foods; (5) For LGUs, a policy on serving healthy foods in school canteens and government offices. This means no junk food and unhealthy drinks in canteens.

2. City design that encourages exercise.

Regular exercise has been proven to help prevent heart disease, stroke, obesity, diabetes and arthritis. In the Philippines, research shows that 31% of women ages 50 to 65 years old are obese. This is based on central obesity, which is defined as an abdominal girth measured at the umbilicus of more than 35 inches for women.

So how can we encourage the public to exercise? Will telling people to exercise three to five times a week be enough? Not really. Studies show that the best way to encourage people to exercise is by building safe and comfortable areas where people can get a workout. LGUs should have specially designed parks and walkways with greenery that are safe even for the elderly. A basketball court may be okay for a group of young people but this isn’t enough.

The moral of the story is – if you build it, they will come. If you build your city to be an exercise haven, then people from all ages and all walks of life will come out and exercise. And once your constituents become fit, then they will get sick less often, thus reducing hospital expenses.

3. Ensuring free or affordable medicines for the poor.

One of the most effective ways to reduce heart attacks and strokes is by controlling the predisposing factors. I am referring to the treatment of the Big three: high blood pressure, diabetes and high cholesterol. First, high blood pressure is defined as a systolic blood pressure (the upper number) of more than or equal to 140 mmHg, or a diastolic blood pressure (the lower number) of more than or equal to 90. The prevalence of hypertension in the Philippines is at 25% of the adult population. Second, high cholesterol can be defined as total cholesterol levels of more than or equal to 240 mg/dl, with a local prevalence of 10%. Third, diabetes is defined as a fasting blood sugar of more than or equal to 126 mg/dl, and results show that 5% of Filipinos are diabetic.

Since these 3 conditions often require the intake of maintenance medicines, then medicines should be made affordable to the middle and upper income groups. For the poorer sector, DoH and PhilHealth should strive to provide free maintenance medicines. This isn’t as far-fetched as it seems since there are now cheap generic medicines. A budget of ten pesos per day per patient may be enough to treat hypertension and diabetes. In fact, PhilHealth packages for out-patient services may soon be started to include free maintenance medicines.

4. Reducing smoking prevalence in the country.

Many cancers, especially lung cancer, are directly related to cigarette smoking and exposure to cigarette smoke (called passive smoking). Smoking also has detrimental effects to the heart and brain. Cigarette smoke damages the lining of the blood vessels and increases the risk for blood clotting, leading to a heart attack or stroke.

Sad to say, the smoking prevalence in the country is very high, which is at around 56% in men and 12% in women. To avoid getting cancer, more people should quit smoking and avoid second hand smoke. However, this is easier said than done. Studies show that telling the public not to smoke (health education) is not as effective as increasing the cost of cigarettes. Moreover, a smoking ban in public places can help reduce cigarette consumption, and also protect non-smokers. A study done in a Colorado city shows that a city-wide smoking ban led to a dramatic reduction in heart attack cases within three years of implementation.

Hence, effective public health strategies to reduce smoking prevalence in the country may include (1) increasing taxes on cigarettes, (2) prohibiting smoking in public places, (3) placing graphic warning in cigarette packs, and (4) educating the public.

5. An effective health education campaign.

Although studies have shown that tri-media health campaigns alone are not sufficient in reducing unhealthy habits, we still need to maintain a high level of awareness on how to prevent these diseases. For example, unless a person knows that what he is eating may be unhealthy, then there is little chance for the person to avoid these foods. The challenge for health educators is to find new and unique ways to convince the public to give up their vices and practice a healthier lifestyle.

Aside from the five strategies mentioned above, there are two additional ways to reduce non-communicable disease. These include (1) reduction in alcohol consumption, and (2) reduction in air pollution. Overindulgence in alcohol can lead to vehicular accidents (no. 4 cause of deaths), some cancers, and heart and brain injury. In addition, many studies have shown a direct link between air pollution levels and the occurrence of heart attacks and strokes. With this roadmap, we hope more people will join us in this campaign to beat these deadly diseases.

	Top Causes of Mortality in the Philippines (2009) Total Deaths Per Year 1. Heart attack and heart disease 70, 861 2. Stroke 51,680 3. Cancer 40,524 4. Road Accidents 34,483 5. Pneumonia 32,098

Caption: DOH Data:

Ni Dr. Willie T. Ong (Pilipino Star Ngayon)

Napakahalaga ng ating kidneys o bato. Ang kidneys ay tumutulong sa pagtanggal ng dumi ng katawan sa pamamagitan ng pag-ihi. Kapag nasira ang ating kidneys, puwede itong magdulot ng kidney failure at pag-dialysis. Mahal at mahirap ang gamutan sa kidneys.

Masuwerte at na-interview ko sa aming DZRH program (“Docs on Call” Sabado 5 – 6 PM) ang isa sa pinakamagaling na kidney specialist sa buong bansa. Siya si Dra. Elizabeth Montemayor ang Head ng Section of Nephrology sa PGH, Head ng Hemodialysis Unit sa Manila Doctors Hospital, at Professor in Physiology sa UP College of Medicine.

Heto ang mga natatanging paraan para maalagaan ang kidneys:

1. Bawasan ang asin sa pagkain – Kailangan ay matuto tayong limitahan ang pagkain ng maaalat tulad ng asin, patis, toyo, bagoong at maaalat na isda. Mataas din ang asin ng mga instant noodles, sitsirya at de-lata. Basahin ang “Nutritional Label” para sa dami ng asin/salt. Kung maalat ang sabaw o sarsa ay huwag na itong ubusin. Sa pagluto ng noodles ay kalahati lang and seasoning o alat na ilagay. Hindi naman bawal ang pagkain ng maaalat, pero bawasan mo lamang. Kapag nasobrahan ang asin o alat sa katawan ay tataas ang ating presyon. At ang high blood pressure ang sisira sa ating kidneys.

2. Limitahan ang protina sa pagkain – Alam ba ninyo na ang pagkain ng sobrang protina, tulad ng karneng baka, baboy, lalo na ang malalaking steak, ay nagpapahirap sa kidney? Oo, tunay po iyan. Kaya nga ang mga may sakit sa kidneys ay nililimitahan ang protina sa pagkain. Ayon kay Dra. Montemayor, kapag madami ang protina mong kinain, kailangan mag-double time ang trabaho ng iyong kidneys. Bilang paghahambing, imbes na parang naglalakad lang ang trabaho ng kidneys, ay tumatakbo ang kidneys kapag madami tayong protinang kinain. Puwedeng mapagod at masira and kidneys sa katagalan. Dahil dito, hindi pinapayo ng mga doktor ang Atkin’s diet o South Beach Diet na mataas ang protina sa diyeta. Isang balanseng diyeta ang pinaka-healthy: may kanin, gulay, isda at prutas.

3. Gamutin ang Altapresyon o High Blood Pressure – Kapag mataas ang iyong presyon sa 140 over 90, dito na nag-uumpisa ang pagkasira ng kidneys. Gusto ng kidneys ang normal na presyon ng dugo lamang. Bawasan ang alat sa pagkain at uminom ng gamot sa altapresyon.

4. Gamutin ang diabetes – Napakasama ang naidudulot ng diabetes sa kidneys. Sinisira ng diabetes and kidneys at puwedeng magdulot ng kidney failure at pagda-dialysis. Ayon kay Dra. Montemayor, kahit bahagya lang ang taas ng iyong blood sugar (mild diabetes) ay puwede pa ring masira ang iyong kidneys. Wala daw ito sa taas ng blood sugar, kung hindi sa tagal ng iyong diabetes. Kapag 5-10 taon na ang diabetes, nag-uumpisa nang masira ang kidneys. Dahil dito, kumonsulta agad sa doktor at gamutin na ang diabetes at altapresyon.

By Yam dela Cruz, Multimedia Producer, Salamat Dok

Posted at 09/14/2012 6:22 PM

Marami tayong mga gawi o habit na hindi lamang nakakasama sa ating kalusugan, kundi nagdadala rin ng panganib sa ating kapwa.

Sa panayam nina Bernadette Sembrano at Alvin Elchico sa kilalang Internist, Cardiologist at Health columnist na si Dr. Willie Ong, isa-isa nitong ipinaliwanag ang anim na pangunahing maling gawi na maaaring makasama sa kapwa.

BAD HABIT #1: Hindi naghuhugas ng kamay matapos gumamit ng banyo

Marami sa atin ang hindi naghuhugas ng kamay pagkatapos gumamit ng banyo. Tinuturuan tayong maghugas bago kumain, pero hindi masyadong itinuturo ang pagkatapos magbanyo.

Sa tala ng Department of Health (DOH), lima hanggang pito sa bawat 10 Pinoy ay hindi naghuhugas ng kamay matapos umihi. Tatlo hanggang lima naman sa bawat 10 Pinoy ang hindi naghuhugas matapos dumumi.

“Maraming tao, lalo na sa pampublikong banyo, may dinadalang sakit na di nila alam. Kapag dumumi, hindi naghugas ng kamay at humawak sa gripo o door knob, maiiwan doon ang bacteria. Tapos, may susunod na papasok, hahawak sa door knob, hahawak sa mukha, pwede na siyang mahawa ng sakit,” paliwanag ni Dr. Ong.

BAD HABIT #2. Pag-ubo nang hindi nagtatakip ng ilong at bibig

Ang walang pakundangang pag-ubo ay sanhi ng mabilis na pagkalat ng mga nakahahawang sakit tulad ng trangkaso, pulmonya, sipon at tuberculosis.

Mga dapat tandaan:

• Gumamit ng tissue o panyo tuwing umuubo
• Itapon agad sa basurahan ang inubuhang tissue
• Kung walang tissue, imbes na takpan ng kamay ang bibig, gamitin ang manggas ng damit
• Lumayo nang mahigit apat na pulgada sa kaharap
• Kung hindi maiwasang umubo sa kamay, maghugas agad
• Kung may sakit na nakakahawa, huwag nang lumabas ng kwarto o bahay
• Huwag uubo nang pataas (upward), para maiwasang mai-spray ang mikrobyo sa hangin
• Dagdag ni Dr. Ong, “Ang isa pa nating problema ay yung pagdura kung saan-saan. Kapag ang plema ay napunta sa kalye, habang basa pa yan, di pa nakakahawa. Kapag naarawan at natuyo, mag i-evaporate, doon lilipad ang mga virus na maaari nating malanghap.”

BAD HABIT #3. Mali at hindi ligtas na preparasyon ng pagkain

Sa DOH survey noong 2007, isa lang sa apat na Pinoy ang naghuhugas bago maghanda ng pagkain. Ang maling paghawak, paghanda at pag-imbak ng pagkain ay maaaring pagmulan ng diarrhea, food poisoning at maging kamatayan.

Mga dapat tandaan:

• Maghugas ng kamay bago at pagkatapos humawak ng pagkain
• Ihiwalay ang luto at di-lutong pagkain, lalo na ang karne
• Hugasan ang mga sangkalan at kagamitan sa pagluluto bago at pagkatapos gamitin
• Bumili lamang ng ligtas na pagkain; Iwasan ang karneng “double dead,” isda mula sa fishkill o kaya’y naapektuhan ng red tide
• Lutuing mabuti ang inyong kakainin
• Takpan ang pagkain upang hindi madapuan ng langaw, langgam at ipis
• Huwag iwan sa mesa o paminggalan ang pagkain; ilagay agad sa loob ng refrigerator o sa isang ligtas na lugar
• Lagyan ng label ang mga sangkap o ingredients
• Huwag magluto kung may sugat o sakit sa balat
• Ugaliing mag-sanitize: Ibabad sa kumukulong tubig ang inyong mga kagamitan sa kusina, at siguruhing hindi ito nalulusaw sa init. Basta kumukulo, halos lahat ng bacteria ay namamatay.

BAD HABIT #4. Unsafe sex practices

Sabi ni Dok, “Ang problema ngayon, mataas ang HIV rate sa Pilipinas. Dati, 25 cases lang a month ang nagpa-positive eh ngayon 250 a month na. High risk ang may maraming partner, may possible sexually transmitted disease at hindi nagpapa-check-up. Pwedeng makahawa ang mga ito. Ang HIV, you will have it for 10-20 years, you need P50,000 a month sa gamutan.”

Mga Paraan para Makaiwas sa HIV/AIDS:

A – Abstinence from sex (Huwag makipagtalik)
B – Be faithful to your partner (Maging tapat sa asawa o kinakasama)
C – Proper condom use (Tamang paggamit ng condom)
D – Don’t share needles (Huwag ipahiram ang karayom o personal na gamit)

BAD HABIT #5. Walang pakundangang pagmamaneho

Sa Pilipinas, aksidente sa daan ang pang-apat na dahilan ng kamatayan. Ito ay dahil sa walang ingat na pagmamaneho; sobrang bilis na pagpapatakbo; pagmamaneho nang nakainom, inaantok at gumagamit ng cell phone; pangit na kondisyon ng daan; at sirang ilaw-trapiko.

“Mga 90% ng aksidente sa daan ay maiiwasan sa disiplina. Ang gobyerno ay dapat maghigpit sa pagpapatupad ng batas-trapiko. Dapat ding tiyaking maayos ang kondisyon ng mga lansangan,” mungkahi pa ni Dok.

BAD HABIT #6. Paninigarilyo sa harap ng ibang tao

Nakakabawas ng anim na taon sa buhay ang active smoking; dalawang taon naman ang passive smoking o ang paglanghap ng usok ng sigarilyo ng ibang tao.

Ayon kay Dr. Ong, “For every hour na exposed ka sa passive smoking, para kang nag-smoke ng isang stick. Ang ethical way ay no smoking in public places. Sa mga nagtatanong tungkol sa kaligtasan ng e-cigarette, base sa mga pag aaral, hindi proven na pampahinto ito ng paninigarilyo. Mas inirerekomenda ang nicotine patches o gamot.”

O ayan! Tandaang mabuti ang mga bilin ni Dok para maging ligtas sa sakit at mapangalagaan ang kalusugan ng ating kapwa. — aired April 14, 2012