Philippines eyes stronger measures to combat non-communicable diseases

The case for investment in NCD prevention and control in the Philippines. Source: WHO, UNDP

The Philippines needs to redirect its health care strategies in order to combat non-communicable diseases (NCDs), such as cancer and heart disease, which account for 68 percent of all deaths in the country and impose an enormous burden on the economy.

The economic cost of NCDs to the Philippine economy is P756.5 billion a year, which is equivalent to 4.8 percent of the country’s annual gross domestic product, according to a joint study by the World Health Organization (WHO) and the United Nations Development Program (UNDP).

Realizing the economic benefits of investing on measures to combat NCDs among Filipinos, the Department of Health (DOH) will redirect and strengthen interventions to prevent and control non-communicable diseases that cause death to one out of three Filipinos aged 30 to 70 years old.

“This investment case which we are launching today aims to serve as a guide in prioritizing and/or redirecting strategies and interventions. We do not have to reinvent the wheel, so to speak. Rather, we could capitalize or build on and strengthen what already exists,” Health Secretary Francisco Duque III said during the launch of the study Oct. 29.

Cancer, heart diseases, diabetes, and chronic respiratory diseases are the four main NCDs in the country. These are caused by a number of risk factors, with tobacco use, harmful alcohol intake, physical inactivity, unhealthy diet, and some metabolic risk factors such as high blood pressure, obesity, and high cholesterol levels topping the list.

The cost of the care and treatment of NCDs accounts for 30 percent of the total government expenditure on health, but more than the direct expenses in combatting the diseases, it is the indirect cost which causes the greater economic burden, the study shows.

In 2017, for example, P75.7 billion was spent by the government on NCD treatment. However, a resounding P680.8 billion was lost to diabetes and cardiovascular diseases alone, through the absenteeism, presenteeism (or being present at work but with reduced productivity), and premature death (or death before reaching 70 years old) in the country’s labor force.

High salt consumption

High salt content in food products is a major factor in the high rate of NCD cases in the Philippines.

“This investment case had been developed in about 20 countries now. Salt consumption in the Philippines is about two times higher than the WHO recommended level. WHO recommended level is two grams of sodium per day, which is about five grams of salt. In the Philippines, it's about twelve grams of salt per day,” said Dr. Alexey Kulikov of the UN Inter-agency Task Force on the Prevention and Control of Non-communicable Diseases.

Salt content in food exceeding the recommended level seems to be common among many countries, he added, pointing out that other countries have started reformulating recipes of their food, such as bread, to reduce its sodium content.

Kulikov warned that this intervention needs to be done gradually, with the government and private sector working together.

Duque, in a talk with reporters, said imposing a tax on salty food could curb excessive salt consumption, a strategy that worked in the case of taxes levied on so-called six products such as alcohol and cigarette.

Among the recommended interventions presented in the investment study, the salt-reduction policy package poses the highest return on investment (ROI) in the long run. A Philippine peso allotted for this intervention assures a return of P11.5 in five years, and P29.9 in 15 years. This package includes front-of-pack labelling of food products, harnessing industry for reformulation of salt content in food, and salt-reduction strategies in community-based eating spaces.

The tobacco control package, on the other hand, ranks second in the interventions with the highest ROI. This includes raising taxes on tobacco, monitoring of tobacco use among Filipinos, formulation of tobacco-use prevention policies, emphasizing warning labels in tobacco products, enforcing restriction of tobacco access among the youth, and putting a ban on tobacco advertising.

The other intervention packages in the report are on alcohol control, physical activity awareness, and clinical intervention. Investing in these packages would be able to save about 400,000 lives in 15 years, the report pointed out.

Preventive health care

Some of these interventions are already being observed in the country. Taxes on tobacco and liquor, for example, are already included in the Sin Tax Reform Law. The tax on sweetened beverages, on the other hand, is covered by the controversial Tax Reform Acceleration and Inclusion (TRAIN) Law. The government also has set guidelines on how to properly put front-of-pack labels on prepackaged food.

In addition, the DOH foresees the impact of the reforms that the implementation of the Universal Health Care (UHC) Law would bring the health sector in the coming years.

"We expect to have a health system anchored on primary health care shifting focus from curative to preventive, as well as promotive care," Duque said.

The UHC Law, in one of its provisions, aims to transform the Health Promotion and Communications Services of the DOH into a Health Promotion Bureau which would be tasked to promote health literacy among Filipinos, an aspect deemed important by Health Undersecretary Dr. Myrna Cabotaje.

“So, in the next year, when we are full blast with our Universal Health Care, health promotion will be emphasized. And we need to invest also. Although (expensive) in terms of resources, but when you invest in health promotion, then we can prevent disease occurrence, and we can prevent complications of disease,” she said.

The health promotion bureau will be tasked to fulfil the last recommendation in the investment report: the establishment of a “national multisectoral NCD coordination mechanism” which would “strengthen national coordination and planning for preventing and controlling NCDs.”

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