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1
How healthy is the Filipino?
Dr. Ramon Lorenzo Luis R. GuintoIndependent Consultant
2
What is Health?
• “complete state of physical, mental, and social wellbeing, and not merely the absence of disease or infirmity “
World Health Organization
• “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family...”
Universal Declaration on Human Rights
• “The State shall protect and promote the right to health of the people and instill health consciousness among them”
1987 Constitution of the Philippines
3
How do we measure health?
• What are the changes affecting the Philippine population, including major causes of disease and death?
Health Outcomes
• What are the factors that influence the health of Filipinos, both at the individual and population level?
Health Determinants
• How do Filipinos gain access to health care when they need it?Health System
4
How healthy is the Filipino?
We are living longer, and the elderly population is
gradually increasing.
We get sick and we die more often than ever
from chronic noncommunicable
diseases.
The factors that lead to disease affect the
population differently.
People are not protected enough from financial risks that come with ill
health.
5
We are living longer, and the elderly population is
gradually increasing.
We get sick and we die more often than ever
from chronic noncommunicable
diseases.
The factors that lead to disease affect the
population differently.
People are not protected enough from financial risks that come with ill
health.
6
The Philippine population is continuously growing, expecting to reach 140 million by 2040.
2000 2005 2010 2015 2020 2025 2030 2035 20400
20000000
40000000
60000000
80000000
100000000
120000000
140000000
160000000
76946500
85261000 94013200
102965300 111784600
120224500 128110000
135301100 141669900
Year
Popu
latio
n
Summary of Projected Population, Philippines: 2000-2040 (Medium Assumption) Source: National Statistics Coordinating Board
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
7
The Philippines remains to be a generally young population, but the number of elderly people is
expected to further increase.
Source: UN DESA
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
8Source: Chongsuvivatwong, et al, 2011
While life expectancy across the ASEAN region has generally increased over the past fifty years, Philippines remained in the
middle, with Vietnam recently catching up.
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
9
While generally, Filipinos are now living longer lives, men still die earlier than women.
1960 1970 1980 1990 2000 201150
55
60
65
70
75
53
57
61
66
69 69
51
55
59
63
67 66
55
59
63
70 7173
BothMaleFemale
Year
Life
Exp
ecta
ncy
at B
irth
But retirement age stays at 65 – hence, more life years as an elderly!
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
10
Projected Population, by Five-Year Interval, Philippines: 2000-2040 (Medium Assumption)Source: National Statistics Coordinating Board
2000-2005 2005-2010 2010-2015 2015-2020 2020-2025 2025-2030 2030-2035 2035-204050
55
60
65
70
75
80
Male Female Both
Year Interval
Life
Exp
ecta
ncy
at B
irth
Life expectancy is projected to further increase, with females still living longer than males.
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
11
Longer Lives: Implications
1Individuals need to
ensure financial security as their
chances of joining the elderly
population increase
2In the long run,
health systems will need more resources,
especially health workforce, to meet
the needs of the aging population
3Cautionary tale: Today’s younger
generation has to consider this
transition as they prepare for future
life
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
12
We are living longer, and the elderly population is
gradually increasing.
We get sick and we die more often than ever
from chronic noncommunicable
diseases.
The factors that lead to disease affect the
population differently.
People are not protected enough from financial risks that come with ill
health.
13
Infectious Diseases
• caused by disease-causing microorganisms, such as bacteria, viruses, parasites or fungi
• can be spread, directly or indirectly, from one person to another
• generally treated with antimicrobial agents that eradicate microbes
Noncommunicable Diseases
• not caused by a pathogen and cannot be shared from one person to another
• caused by either the environment, nutritional deficiencies, lifestyle choices, or genetic inheritances
• not communicable or contagious, although some kinds can be passed down genetically to the children of a carrier
• treated with a wide range of drugs, mostly to delay progression
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
14Source: Philippine Health Statistics, various yearsLeading Causes of Disease
For the past three decades, Filipinos have been getting sick of infectious disease, but chronic hypertension is
rising as a leading cause of illness.
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
15Source: Philippine Health Statistics, various yearsLeading Causes of Death
While we still get sick of infectious disease, today we Filipinos die more of chronic, noncommunicable diseases
– like heart disease and cancer.
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
16
Transition in Causes of Death:More people have been dying of lifestyle-related diseases.
19591961
19631965
19671969
19711973
19751977
19791981
19831985
19871989
19911993
19951997
19992001
20032005
20072009
0
30
60
90
120
150
180
210
240
270
300
330
360
390
420
0
10
20
30
40
50
60
70
80
90
100
110
120Communicable Diseases
Cancer
Diseases of the Heart
Rate
(per
100
,000
) of C
omm
unic
able
Dise
ases
Year
Rate
(per
100
,000
) of M
alig
nant
Neo
plas
m a
nd D
isea
ses
of th
e H
eart
Source: Philippine Health Statistics, 1959-2009
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
17
NONCOMMUNICABLE DISEASES comprise 61% of total deaths in 2010.
Communicable, ma-ternal, pregnancy-re-lated, and nutritional
conditions, 30
Injuries; 8
Cardiovascular diseases; 30
Cancers; 10
Respiratory diseases; 5
Diabetes; 4
Other NCDs; 13
Source: WHO, 2010
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
18
We get more sick because of our LUNGS, but we die because of our HEART.
Morbidity MortalityCause Per 100,000 Cause Per 100,000
1. Acute Respiratory Infection 1203.0 1. Diseases of the heart 109.4
2. Acute Lower Respiratory Tract Infection and Pneumonia
612.6 2. Diseases of the vascular system 71.0
3. Bronchitis / Bronchiolitis 380.7 3. Cancer 51.8
4. Hypertension 366.3 4. Pneumonia 46.2
5. Acute Watery Diarrhea 354.5 5. Accidents 39.0
6. Influenza 297.7 6. Tuberculosis, all forms 27.6
7. Urinary Tract Infection 91.0 7. Chronic lower respiratory disease
24.7
8. TB Respiratory 80.9 8. Diabetes mellitus 24.2
9. Injuries 38.9 9. Nephritis, nephrotic syndrome and nephrosis
15.0
10. Acute Febrile Illness 22.2 10. Certain conditions originating in the perinatal period
12.5
Source: Philippine Health Statistics, 2009Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
19
HEART DISEASES are affecting both men and women.
Stroke
Myocardial Infarction
Disease of pulmonary circulation and other heart diseases
Hypertension without heart involvement
Atherosclerosis
Aortic aneurysm and dissection
Angina Pectoris
Hypertension with heart involvement
5,000 15,000 25,000 35,000 45,000 55,000Stroke Myocardial
InfarctionDisease of pulmonary circulation and other heart dis-
eases
Hyperten-sion without
heart in-volvement
Atheroscle-rosis
Aortic aneurysm
and dissec-tion
Angina Pec-toris
Hyperten-sion with heart in-
volvement
Male 28911 23440 10322 9959 889 343 255 58
Female 22364 12759 9209 8119 1217 211 185 38
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
20
In general, elderly people experience more HEART ATTACKS, but females past midlife are at increased risk.
Distribution of population diagnosed with myocardial infarction, by age, 2008 Source: Ulep, et al., 2012
Male Female0
1
2
3
4
5
6
0.1 0.20.2
0.80.6
0.80.7
2.4
3.6
2
3.4
5.1
0.8
1.3
20-2930-3940-4950-5960-6970 and aboveTotal
Perc
enta
ge (%
)
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
21
While prevalence of CORONARY HEART DISEASE increases with age, more males are affected by the disease.
Male Female0
1
2
3
4
5
6
0.2 0.30.3
1.2
0.8
1.3
2.3 2.4
5
2
3
2.6
1.3 1.4
20-2930-3940-4950-5960-6970 and aboveTotal
Perc
enta
ge (%
)
Distribution of population diagnosed with coronary heart disease, by age, 2008 Source: Ulep, et al., 2012
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
22
While BREAST CANCER is the leading cause of death among women, LUNG CANCER is the leading cause of
death for both sexes.
Others41%
Lungs and respi-ratory22%
Prostate6%
Leukemia
7%
Colon9%
Breast15%
Trachea, Bronchus
Lungs33%
Prostate12%
Colon11%
Lip, Oral Cavity and Pharynx
8%
Leukemia7%
Others29%
Breast29%
Trachea, bronchus,
lungs11%Colon
8%Cervix7%
Other Female Genitalia
7%
Leukemia7%
Others31%
BOTH SEXES
MALES
FEMALES
Source: NSO Mortality Data, 2008Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
23
10 Most Common Cancers in 2010Breast
Lung
Liver
Colon/Rectum
Cervix Uteri
Leukemia
Stomach
Prostate
Brain/Nervous System
Ovary
0 2000 4000 6000 8000 10000 12000 14000
12262
11458
7331
5787
4812
3153
3129
2712
2236
2165
4371
9184
6819
3060
1984
2609
2274
1410
1855
1016
Death New Cases
Number
Source: GLOBOCAN, 2008Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
10 Most Common Cancers among Males, 2010
Source: GLOBOCAN, 2008
Lung
Liver
Colon/Rectum
Prostate
Stomach
Leukemia
Brain/Nervous System
Other Pharynx
Non-Hodgkin Lymphona
Kidney
0 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000
8772
5522
3208
2712
1920
1669
1236
1145
982
848
6987
5102
1690
1410
1340
1381
1069
804
598
389
Deaths New Cases
Number
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
24
10 Most Common Cancers among Females, 2010
Source: GLOBOCAN, 2008
Breast
Cervix Uteri
Lung
Colon/Rectum
Ovary
Liver
Corpust Uteri
Leukemia
Thyroid
Stomach
0 2000 4000 6000 8000 10000 12000 14000
12262
4812
2686
2579
2165
1809
1760
1484
1474
1209
4371
1984
2197
1370
1016
1717
796
1228
450
934
Deaths New Cases
Number
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
25
26
Q & A: Diabetes Checklist
Sex
• Male• Female
Residence
• Urban• Rural
Income Group
• Poorest• Poor• Middle• Rich• Richest
Education
• No formal education
• Elementary• Secondary• Tertiary
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
27
Diabetes Mellitus in Focus:You’re more likely to get diabetes if you are female, rich, based in an
urban city, and college-educated.
Poorest Poor Middle Rich RichestSocio-economic Status
0
1
2
3
4
5
6
7
8
9
1.8
33.5
6.4
8.1
Rural UrbanUrbanization
0
1
2
3
4
5
6
7
8
9
3.7
5.6
No Education Elementary Secondary TertiaryEducational Attianment
0
1
2
3
4
5
6
7
8
9
2.6
4.6 4.4
5.3
Male Female TotalSex
0
1
2
3
4
5
6
7
8
9
4.85.5
4
Source: National Nutrition Survey 2008Y-axis – prevalence (in percent)Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
Non-communicable diseases: Common characteristics
Require long-term treatment
May require acute care for complications
Require more than one drug
Can be debilitating and disabling Limit productivity Cost financial burden
to entire household
Necessitate involvement of family
and friends in providing holistic care
Require management by more than one
healthcare provider
But – preventable, avoidable, and
manageable
29
We are living longer, and the elderly population is
gradually increasing.
We get sick and we die more often than ever
from chronic noncommunicable
diseases.
The factors that lead to disease affect the
population differently.
People are not protected enough from financial risks that come with ill
health.
How are NCDs produced?
GlobalizationUrbanization
PovertyLow Education
AgingStress
Culture
Tobacco useUnhealthy diet
Physical inactivityAlcohol intake
High blood pressureHigh blood glucose
Abnormal blood lipids
Central obesityAbnormal lung
function
Heart diseaseStroke
DiabetesCancer
Chronic lung disease
Modified from WHO, 2005
Social and environmental determinants
Behavioral/ lifestyle factors
Biological risk factors
Chronic noncommunicable
diseases
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
30
31
Biological Risk Factors
High blood pressureHigh blood glucose
Abnormal blood lipidsCentral obesity
Heart diseaseStroke
DiabetesCancer
Biological risk factors Chronic noncommunicable diseases
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
32
Prevalence of Selected Risk Factors, by Sex, Philippines 2008
Hypertensio
n
High Total Choleste
rol
High Bad Cholestero
l
Low Good Choleste
rol
High Triclyce
ride
0
10
20
30
40
50
60
70
80
29.1
7.3 8.1
71.1
18.522.2
12.8 15
57.8
11.2
Males Females
Risk Factors
Perc
enta
ge
Source: National Nutrition Survey, 2008
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
33
While risk for HYPERTENSION increases with age, nearly half of Filipinos in early adulthood have blood pressures above normal.
20-29 30-39 40-49 50-59 60-69 70 and above
0
10
20
30
40
50
60
70
80
90
100
53.943.7
32.522.6
17.8 14.7
28.3
27.2
26.1
18.217.8
17.8
7.4
11.6
10.3
14.315.6
14.1
8.413.8
19.5
26.727.1
24.7
2 3.711.5
18.3 21.828.8
Hypertension Stage 2Hypertension Stage 1Pre-HypertensionHigh NormalNormal
Age Group
Perc
enta
ge (%
)
Percent distribution of blood pressure readings based on a single visit among adults, by age Source: National Nutrition Survey, 2008
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
34
1 out of 4 Filipinos are HYPERTENSIVE.
1993 1998 2003 20080
5
10
15
20
25
30
22 2122.5
25.3
Year
Prevalence of hypertension among adults based on a single Visit, Philippines 1993-2008 Source: National Nutrition Survey, 2008
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
35
1 out of 20 Filipinos have HIGH FASTING BLOOD SUGAR.
Prevalence of High Fasting Blood Sugar among Adults, Philippines 1998-2008 Source: National Nutrition Survey, 2008
1998 2003 20080
1
2
3
4
5
6
3.9
3.4
4.8
Year
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
36
Nearly 1 out of 4 Filipinos are either OVERWEIGHT or OBESE.
Male Female Both0
10
20
30
40
50
60
70
80
9.2 10.7 10
66.1
57.361.6
20.124.4
22.3
4.57.6 6.1
UnderweightNormalOverweightObese
Nutritional Status of Adults, 20 years old and over, by sex based on BMI classification, Philippines 2011
Source: National Nutrition Survey, 2011
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
37
The proportion of overweight and obese Filipinos is increasing over the years.
1993 1998 2003 2008 20110
5
10
15
20
25
30
13.9 13.2 12.3 11.610
16.6
20.2
24
26.628.4
Underweight Overweight/Obese
Prev
alen
ce (%
)
Trends in the Prevalence of Underweight and Overweight among Adults 20 years old and over based on BMI, Philippines 1993-2011
Source: National Nutrition Survey, 2011
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
38
Females are roughly 6 times more likely to have a high WAIST CIRCUMFERENCE than males.
1998 2003 2008 20110
5
10
15
20
25
2.7 2.4 3.1 3.2
10.7
1719
19.9
Male Female
Year
Prev
alen
ce (%
)
Trends in the High Waist Circumference Prevalence among Adults, 20 years old and over, Philippines 1998-2011
Source: National Nutrition Survey, 2011
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
39
Females are roughly 10 times more likely to have a high WAIST TO HIP RATIO than males.
1998 2003 2008 20110
10
20
30
40
50
60
70
7.912.1 11.1
6.9
39.5
54.8
65.562.5
Male Female
Year
Prev
alen
ce (%
)
Trends in High Waist to Hip Ratio (WHR) Prevalence among Adults, 20 years old and over, Philippines 1998-2011
Source: National Nutrition Survey, 2011
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
40
The people who are most likely to have diabetes – female, rich, urban, and college-educated – are the same people most likely
to become OBESE.
Male Female TotalSex
0
1
2
3
4
5
6
7
8
9
3.7
6.6
5.2
Poorest Poor Middle Rich RichestSocio-economic Status
0
1
2
3
4
5
6
7
8
9
1.1
2.5
5
6.2
7.9
No Education Elementary Secondary TertiaryEducational Attianment
0
1
2
3
4
5
6
7
8
9
0.5
3.6
4.9
6.3
Source: National Nutrition Survey 2008
Rural UrbanUrbanization
0
1
2
3
4
5
6
7
8
9
3.6
5.7
Y-axis – prevalence (in percent)Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
41
The people who are most likely to have diabetes and obesity – female, rich, urban, and college-educated – are the same people most likely to acquire
HIGH CHOLESTEROL levels in the blood.
Source: National Nutrition Survey 2008
Male Female TotalSex
0
2
4
6
8
10
12
14
16
18
20
7.3
12.8
10.2
Poorest Poor Middle Rich RichestSocio-economic Status
0
2
4
6
8
10
12
14
16
18
20
4.7
6.78.1
12.5
17.3
Rural UrbanUrbanization
0
2
4
6
8
10
12
14
16
18
20
8
11.9
No Education Elementary Secondary TertiaryEducational Attianment
0
2
4
6
8
10
12
14
16
18
20
5.8
8.39.6
13.1
Y-axis – prevalence (in percent)Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
42
Metabolic Syndrome
Central Obesity
Raised triglycerides
Reduced HDL cholesterol
Raised blood pressure
Raised fasting plasma glucose
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
43
Behavioral/Lifestyle Factors
Tobacco useUnhealthy diet
Physical inactivityAlcohol intake
High blood glucoseHigh blood pressure
Abnormal blood lipidsCentral obesity
Behavioral/lifestyle factors Biological risk factors
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
44
Men smoke five times more than women.
Current Smoker Current Daily Smoker0
10
20
30
40
50
60
47.7
38.2
96.9
28.3
22.5MenWomenOverall
Smoking Status
Perc
enta
ge (%
)
Percentage Distribution of Adults 15 years and older by Smoking Status and Sex, Philippines Source: Global Adult Tobacco Survey (GATS), 2009
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
45
1998 2003 20080
10
20
30
40
50
60
70
5457.4
53.2
12.610.9 12.5
32.735.2
31 MalesFemalesBoth
Year
Perc
enta
ge (%
)
Prevalence Trend of Cigarette Smoking, by Sex in the Philippines Source: National Nutrition Survey, 2008
Men smoke five times more than women.
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
46Source: National Nutrition Survey 2008
Male Female TotalSex
0
10
20
30
40
50
6053.2
12.5
31
Poorest Poor Middle Rich RichestSocio-economic Status
0
10
20
30
40
50
60
39.936.4
29.725.3 24.8
Rural UrbanUrbanization
0
10
20
30
40
50
60
33.128.9
No Education Elementary Secondary TertiaryEducational Attianment
0
10
20
30
40
50
60
41.3
35.131.5
23.7
SMOKING is most prevalent among males, the poor, those who live in rural areas, and those who never went to school.
Y-axis – prevalence (in percent)Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
47Source: National Nutrition Survey 2008
Male Female TotalSex
0
2
4
6
8
10
12
14
108.8
9.4
Poorest Poor Middle Rich RichestSocio-economic Status
0
2
4
6
8
10
12
14
8.19 8.9 8.9
11.7
Rural UrbanUrbanization
0
2
4
6
8
10
12
14
8.710
No Education Elementary Secondary TertiaryEducational Attianment
0
2
4
6
8
10
12
14
7.28
9.4
11.4
Who consumes the highest level of SATURATED OILS in their diet? The males, the rich, the urbanized, and the college-educated
Y-axis – grams per dayLiving longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
48
Unhealthy diets: Filipinos are #3 consumers of take-away food
Source: AC Nielsen Consumer Survey Report, 2004
Hong Kong Malaysia Philippines Singapore Thailand China India U.S.A Australia New Zealand0%
10%
20%
30%
40%
50%
60%
70%
61%59%
54%
50%
44%41%
37%35%
30% 29%
Percentage of population that eats at take-away restaurants at least once a week, by selected countries, 2004.
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
49Source: National Nutrition Survey 2008
Male Female TotalSex
0
10
20
30
40
50
60
70
80
90
100
53.447.4 50.3
Poorest Poor Middle Rich RichestSocio-economic Status
0
10
20
30
40
50
60
70
80
90
100
19.2
33.5
44.1
59.4
86.5
Rural UrbanUrbanization
0
10
20
30
40
50
60
70
80
90
100
39
60.3
No Education Elementary Secondary TertiaryEducational Attianment
0
10
20
30
40
50
60
70
80
90
100
12.5
25.1
53
81.8
Who consumes the highest level of SOFTDRINKS? The males, the rich, the urbanized, and the college-educated
Y-axis – grams per dayLiving longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
50Source: National Nutrition Survey 2008
Male Female TotalSex
0
2
4
6
8
10
12
14
3.63 3.3
Poorest Poor Middle Rich RichestSocio-economic Status
0
2
4
6
8
10
12
1412.6
1.4 1.1 1.6 1.3
Rural UrbanUrbanization
0
2
4
6
8
10
12
14
5.8
1
No Education Elementary Secondary TertiaryEducational Attianment
0
2
4
6
8
10
12
14
10.3
6.2
1.6 1.1
Who consumes the highest level of SALT in their diet? The poor, those who live in rural areas, and those who did not
undergo any formal education
Y-axis – grams per dayLiving longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
51
1998 2003 20080
10
20
30
40
50
60
70
80
90
53.3
78.2
47.5
11.1
25.6
9.8
30.6
53
26.9
MalesFemalesBoth
Year
Perc
enta
ge
Prevalence Trend of Alcohol Drinking, by Sex in the Philippines Source: National Nutrition Survey, 2008
Men consume alcohol nearly five times more than women.
Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
52
In general, Filipinos have low physical activity, regardless of the purpose.
2003 20080
10
20
30
40
50
60
70
80
90
100
72.276.3
92.6 94.592.6 92.7
Work-related PATravel-related PALeisure-related PA
Year
Perc
enta
ge (%
)
Comparison of Low Physical Activity (PA) by Domain, Philippines: 2003 and 2008 Source: National Nutrition Survey, 2008
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53
While in general, Filipinos are physically inactive, males are a bit more physically active than females.
Liesure-related PA
Travel-related PA
Nonwork-related PA
Work-related PA
Liesure-related PA
Travel-related PA
Nonwork-related PA
Work-related PA
Mal
eFe
mal
e
0 10 20 30 40 50 60 70 80 90 100
89.1
93.8
83
76.3
95.7
95.2
70
76.2
10.9
6.2
17
23.7
4.3
4.8
30
23.8
LowHigh
Prevalence (Percentage)
Percent distribution of adults 20 years and over, by Physical Activity (PA) and by Sex, Philippine 2008
Source: National Nutrition Survey, 2008
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Increasing URBANIZATION in the Philippines has a role to play in limiting physical activity and shaping lifestyles
that lead to chronic noncommunicable disease.
1970 1890 1990 2000 20080
10
20
30
40
50
60
31.837.3
47 48 50.3
Total Population
Year
Leve
l of U
rban
izati
on (i
n Pe
rcen
t)
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55
Poorest
5,958
Poor
8,594
Middle Income
12,269
Rich
18,497
Richest
40,590
Social Determinants of HealthThe poorest pay the most as a share of their monthly income
for food, which is a critical determinant of health.
57%67% 49%
AVERAGE HOUSEHOLD MONTHLY INCOME
40% 27%
FOOD EXPENDITURE SHARE
Source: Family Income and Expenditure Survey, 2009
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56
The Vulnerable Filipino Woman
• Predilection for diabetes• Risk factors: Obesity, High cholesterol levels, Physically inactivity
Biological Risk Factors
• What more – the poor, uneducated woman who lives in the province?
Social Determinants of Health
• Social factors will further complicate the situation: limited employment opportunities, less working years, role in child rearing, gender violence, access to reproductive health services
Other Social Issues Confronting Women
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57
We are living longer, and the elderly population is
gradually increasing.
We get sick and we die more often than ever
from chronic noncommunicable
diseases.
The factors that lead to disease affect the
population differently.
People are not protected enough from financial risks that come with ill
health.
58
As of 2011. the Philippines spends 4.4% of its GDP for health – still short of the 5% WHO recommendation.
2005 2006 2007 2008 2009 2010 20110
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
3.1 3.1 3.1 3.1 3.2 3.2 3.3
3.9 4 3.9 3.9
4.3 4.24.4
Share to GNI Share to GDP
Year
Perc
enta
ge (%
)
Share of Health Expenditure to GDP and GNI, 2005-2011Source: Philippine National Health Accounts, 2011
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In 2011, the Philippines spent only PhP 4,577 per person for health care for the entire year.
2005 2006 2007 2008 2009 2010 20110
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
26242783
3061
3377
3759
4112
4577
2022 2083 2159 21792298
24422639
At Current Prices At Constant 2000 prices
Year
In P
hilip
pine
Pes
os
Per capita health expenditure, 2003-2011Source: Philippine National Health Accounts, 2011
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60
The Philippines is financing a predominantly “disease care” system, with little funding allotted for health promotion and
disease prevention.
Personal Care79%
Public Health12%
Others9%
Total Health Expenditure by Use of Funds, 2011Source: Philippine National Health Accounts, 2011
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61
In 2011, Filipinos spent more from OUT-OF-POCKET sources for health care than any other source.
12%
15%
9%
53%
2%
6%4% National Government
Local Government
Social Insurance
Out-of-Pocket
Private Insurance
Health Maintenance Orga-nizations
Others
Source: Philippine National Health Accounts, 2011Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
62
HEALTH INSURANCE COVERAGE increases with income, with private health insurance only comprising
2.1% of the total population.
Lowest Second Third Fourth Highest Total0
10
20
30
40
50
60
70
20.6
31
39.4
53.8
65
42
19.6
28.6
35.3
48.2
57
37.3
0.2 0.3 1.1 27
2.1
Any Insurance PhilHealth Private Insurance/HMO
Wealth Quintiles
Perc
enta
ge
Source: National Demographic and Health Survey, 2008Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
63
Even with PRIVATE HEALTH INSURANCE, there is very little coverage among the middle and upper class.
NCRCAR
III
IIIIVAIVB
VVI
VIIVIII
IXX
XIXII
XIIIARMM
0 10 20 30 40 50 60 70 80 90 100
Population covered with private insurance Uncovered population from 3rd to 5th wealth quintiles
Source: National Demographic and Health Survey, 2008Living longer and older Getting sick and dying of NCDs How disease factors affect people Health financing
64
The elderly spend the most for health care, and they pay mostly from out of their pockets.
Health expenditures by financing agent and by population age group, 2003Source: Racelis, et al., 2007
0-4y 5-9y 10-14y 15-19y 20-39y 40-49y 50-64y 65y and above0
5
10
15
20
25
Natl Govt Local Govt Philhealth Out of Pocket
In B
illio
n Pe
sos
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65
The rich pays the most for health care, and mostly from out of their pockets – because the poor has no pocket at all.
Health expenditures by financing agent and by income quintile, 2003Source: Racelis, et al., 2007
Poorest Poor Middle Rich Richest0
10
20
30
40
50
60
Natl Govt Local Govt Philhealth Out of Pocket
In B
illio
n Pe
sos
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66
68.00%
4.10%
8.00%
4.30%
15.60%
Drugs and Medicine
Hospital Charges
Professional fees
Contraceptives
Others
Households' out-of-pocket payments, by expenditure item, 2006Source: Family Income and Expenditure Survey, 2006
Filipino households spend 68% of its out-of-pocket payments for health care just for DRUGS AND
MEDICINES alone.
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67
Despite the Cheaper Medicines Act, there is still a wide variation of medicine prices at retail.
Product Unit GENERIKA Generics Pharmacy
Watson's Pharmacy
Mercury Drug Store
Current Price
Amlodipine tablet peso/10mg 3.25-19.65 3.25-8.00 7.25-38.50 5.00-38.50 3.25-38.50
Losartan tablet peso/50mg 4.75-19.50 5.00-8.75 11.00-24.00 10.75-24.50 4.75-24.50
Metoprolol tablet peso/50mg 1.75-3.10 1.75-2.50 2.42-15.00 2.75-18.75 1.75-18.75
Telmisartan tablet peso/40mg 25.00-25.75 NA 25.75 25 25.00-25.75
Warfarin Na tablet peso/1mg 14.75-18.00 NA 21.75 14.75-21.75 14.75-21.75
Aspirin tablet
peso/ 100mg 1.25-1.75 1.8 2.50-2.75 1.90-4.50 1.25-4.50
Source: DOH Price Monitoring Chart, July 2013
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While the COST OF HEALTH CARE is higher in private facilities, the Filipino still cannot pay for health care
without incurring the risk of impoverishment.Type of care Both Types Public Facility Private Facility
Person visited a health facility in the past 30 days
Average cost of transport 109 80 134
Average cost of treatment 1,872 1,051 2,864
Person confined in a hospital or clinic in past 12 months
Average cost of confinement 16,802 9,849 24,278
Source: National Demographic and Health Survey, 2008
* In Philippine Pesos
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69
Paying for Health Care in the Philippines
Filipinos still pay mostly from out of
their pockets for health care, which oftentimes leads to impoverishment.
Health care costs remain high, with
the bulk being spent to cover for
medicines and drugs.
There is a role for both publicly-
administered and privately-provided insurance schemes to ensure financial
risk protection during times of
illness.
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70
How healthy is the Filipino?
We are living longer, and the elderly population is
gradually increasing.
We get sick and we die more often than ever
from chronic noncommunicable
diseases.
The factors that lead to disease affect the
population differently.
People are not protected enough from financial risks that come with ill
health.
71
Are we ready to address their health needs?
40 year old single mother, obese, with a history of diabetes, working in the
corporate sector
20 year old fresh graduate, chain smoker,
working in his first job in a call center
65 year old grandmother, widow, with high blood pressure and history of heart disease, about to
retire
34 year old businessman, with wife and three
children, heavy eater and drinker, running his restaurant business
72
Are we ready to address their health needs?
40 year old single mother, obese, with a history of diabetes, working in the
corporate sector
20 year old fresh graduate, chain smoker,
working in his first job in a call center
65 year old grandmother, widow, with high blood pressure and history of heart disease, about to
retire
34 year old businessman, with wife and three
children, heavy eater and drinker, running his restaurant business
73
Are we ready to address their health needs?
40 year old single mother, obese, with a history of diabetes, working in the
corporate sector
20 year old fresh graduate, chain smoker,
working in his first job in a call center
65 year old grandmother, widow, with high blood pressure and history of heart disease, about to
retire
34 year old businessman, with wife and three
children, heavy eater and drinker, running his restaurant business
74
Are we ready to address their health needs?
40 year old single mother, obese, with a history of diabetes, working in the
corporate sector
20 year old fresh graduate, chain smoker,
working in his first job in a call center
65 year old grandmother, widow, with high blood pressure and history of heart disease, about to
retire
34 year old businessman, with wife and three
children, heavy eater and drinker, running his restaurant business
75
Thank you for listening!