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.
Caption: DOH Data: