1. How healthy is the
Filipino?
Dr. Ramon Lorenzo Luis R. Guinto
Independent Consultant
1

2. What is Health?
World Health
Organization
• “complete state of physical, mental, and social
wellbeing, and not merely the absence of
disease or infirmity “
Universal
Declaration on
Human Rights
• “Everyone has the right to a standard of living
adequate for the health and well-being of
himself and of his family...”
protect and promote the
1987 Constitution of • “The State shall people and instill health right
to health of the
the Philippines
consciousness among them”
2

3. How do we measure health?
Health
Outcomes
• What are the changes affecting the
Philippine population, including major
causes of disease and death?
Health
Determinants
• What are the factors that influence the
health of Filipinos, both at the individual
and population level?
Health System
• How do Filipinos gain access to health
care when they need it?
3

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.
4

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.
5

6. The Philippine population is continuously growing,
expecting to reach 140 million by 2040.
16000000
135301100
14000000
120224500
141669900
128110000
12000000
111784600
102965300
Population
10000000
94013200
85261000
80000000
76946500
60000000
40000000
20000000
0
2000
2005
2010
2015
2020
2025
2030
2035
2040
Year
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
6
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
7
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing

8. 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.
Source: Chongsuvivatwong, et al, 2011
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
8
Health financing

9. While generally, Filipinos are now living longer
lives, men still die earlier than women.
Life Expectancy at Birth
75
73
70
70
69
65
59
67
69
66
Both
63
61
Male
55
57
53
50
66
63
60
55
71
55
51
1960
1970
59
Female
1980
1990
2000
2011
Year
But retirement age stays at 65 – hence, more life
years as an elderly!
9
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing

10. Life expectancy is projected to further
increase, with females still living longer than
males.
80
Life Expectancy at Birth
75
70
65
60
55
50
2000-2005
2005-2010
2010-2015
2015-2020
2020-2025
2025-2030
2030-2035
2035-2040
Year Interval
Male
Female
Both
Projected Population, by Five-Year Interval, 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
10
Health financing

11. Longer Lives: Implications
2
1
Individuals need to
ensure financial
security as their
chances of joining
the elderly
population increase
3
In the long
run, health systems
will need more
resources, especially
health workforce, to
meet the needs of
the aging population
Cautionary tale:
Today’s younger
generation has to
consider this
transition as they
prepare for future
life
11
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.
12

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
13
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing

14. For the past three decades, Filipinos have been getting
sick of infectious disease, but chronic hypertension is
rising as a leading cause of illness.
Leading Causes of Disease
Source: Philippine Health Statistics, various years
14
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing

15. While we still get sick of infectious disease, today we
Filipinos die more of chronic, noncommunicable diseases
– like heart disease and cancer.
Leading Causes of Death
Living longer and older
Getting sick and dying of NCDs
Source: Philippine Health Statistics, various years
15
How disease factors affect people
Health financing

16. Transition in Causes of Death:
More people have been dying of lifestyle-related diseases.
120
Communicable Diseases
Rate (per 100,000) of Communicable Diseases
110
Cancer
390
100
360
330
90
Diseases of the Heart
300
80
270
240
70
210
60
180
50
150
40
120
30
90
20
60
30
10
0
Rate (per 100,000) of Malignant Neoplasm and Diseases of the Heart
420
0
1959 1961 1963 1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009
Year
Source: Philippine Health Statistics, 1959-2009
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
16
Health financing

17. NONCOMMUNICABLE DISEASES
comprise 61% of total deaths in 2010.
Communicable, m
aternal, pregnancy
-related, and
nutritional
conditions, 30
Other NCDs, 13
Diabetes, 4
Respiratory
diseases, 5
Cancers, 10
Injuries, 8
Source: WHO, 2010
Cardiovascular
diseases, 30
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
17
Health financing

18. We get more sick because of our LUNGS,
but we die because of our HEART.
Morbidity
Mortality
Cause
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
24.7
8. TB Respiratory
80.9
7. Chronic lower respiratory
disease
8. Diabetes mellitus
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, 2009
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
24.2
18
Health financing

19. HEART DISEASES are affecting both men and women.
0
10,000
20,000
30,000
40,000
50,000
60,000
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
Atherosclerosis
Hypertension
without heart
involvement
Disease of
pulmonary
circulation and
other heart
diseases
Myocardial
Infarction
Stroke
343
889
9,959
10,322
23,440
28,911
211
1,217
8,119
9,209
12,759
22,364
Hypertension
with heart
involvement
Angina Pectoris
Aortic aneurysm
and dissection
Male
58
255
Female
38
185
19
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.
6
5.1
5
Percentage (%)
4
3.6
20-29
3.4
30-39
40-49
3
50-59
2.4
60-69
2
70 and above
2
1.3
1
0.6
0.1
0.7
0.2
0.8
0.8
Total
0.8
0.2
0
Male
Female
Distribution of population diagnosed with myocardial infarction, by age, 2008
Source: Ulep, et al., 2012
20
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.
6
5
5
Percentage (%)
4
20-29
30-39
3
40-49
3
2.6
2.4
2.3
50-59
60-69
2
70 and above
2
1.3
1.2
1.4
1.3
Total
0.8
1
0.2
0.3
0.3
0
Male
Female
Distribution of population diagnosed with coronary heart disease, by age, 2008
Source: Ulep, et al., 2012
21
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.
Trachea, B
ronchus
Lungs
33%
Others
29%
Breast
15%
MALES
Colon
9%
Others
41%
Leukemia
7%
Leukemia
7%
Lip, Oral
Cavity and
Pharynx
8%
Colon
11%
Prostate
12%
Breast
29%
Others
31%
Prostate
6%
BOTH SEXES
FEMALES
Lungs and
respiratory
22%
Source: NSO Mortality Data, 2008
Living longer and older
Getting sick and dying of NCDs
Leukemia
7%
Other Female
Genitalia
7%
How disease factors affect people
Trachea, bron
chus, lungs
11%
Cervix
7%
Health financing
Colon
8%
22

23. 10 Most Common Cancers in 2010
Number
0
2000
4000
Breast
6000
8000
9184
11458
7331
6819
Colon/Rectum
5787
3060
Cervix Uteri
4812
1984
3153
2609
Leukemia
Stomach
2274
1410
3129
2712
2236
1855
Brain/Nervous System
1016
2165
New Cases
Death
Source: GLOBOCAN, 2008
Living longer and older
14000
12262
Liver
Ovary
12000
4371
Lung
Prostate
10000
Getting sick and dying of NCDs
How disease factors affect people
Health financing
23

24. 10 Most Common Cancers among Males, 2010
Number
0
1000
2000
3000
4000
5000
6000
Lung
5102
Colon/Rectum
1340
8772
5522
1920
1669
1381
Leukemia
1236
1069
Brain/Nervous System
Other Pharynx
804
598
389
1145
982
848
New Cases
Deaths
Source: GLOBOCAN, 2008
Living longer and older
10000
2712
1410
Stomach
9000
3208
1690
Prostate
Kidney
8000
6987
Liver
Non-Hodgkin Lymphona
7000
Getting sick and dying of NCDs
How disease factors affect people
Health financing
24

25. 10 Most Common Cancers among Females, 2010
Number
0
2000
4000
Breast
12000
12262
2579
1370
Ovary
2165
1016
1809
1717
Liver
1760
796
1484
1228
Leukemia
450
1474
1209
934
New Cases
Deaths
Source: GLOBOCAN, 2008
Living longer and older
14000
2686
2197
Colon/Rectum
Stomach
10000
4812
1984
Lung
Thyroid
8000
4371
Cervix Uteri
Corpust Uteri
6000
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
26
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.
9
8
7
6
5
4
3
2
1
0
5.5
4.8
4
Male
Female
9
8
7
6
5
4
3
2
1
0
Total
8.1
6.4
1.8
Poorest
Sex
9
8
7
6
5
4
3
2
1
0
3.7
Urban
9
8
7
6
5
4
3
2
1
0
Middle
Rich
Richest
Y-axis – prevalence (in percent)
5.3
4.6
4.4
Elementary
Secondary
2.6
No Education
Urbanization
Living longer and older
Poor
Socio-economic Status
5.6
Rural
3.5
3
Educational Attianment
Source: National Nutrition Survey 2008
Getting sick and dying of NCDs
Tertiary
How disease factors affect people
Health financing
27

28. 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.
29

30. How are NCDs produced?
Globalization
Urbanization
Poverty
Low Education
Aging
Stress
High blood pressure
Tobacco use
High blood glucose
Heart disease
Unhealthy diet
Abnormal blood
lipids
Stroke
Diabetes
Central obesity
Cancer
Abnormal lung
function
Chronic lung disease
Biological risk
factors
Chronic
noncommunicable
diseases
Physical inactivity
Alcohol intake
Culture
Social and
environmental
determinants
Behavioral/
lifestyle factors
Modified from WHO, 2005
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing
30

31. Biological Risk Factors
High blood pressure
Heart disease
High blood glucose
Stroke
Abnormal blood lipids
Diabetes
Cancer
Central obesity
Biological risk factors
Chronic noncommunicable
diseases
31
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
80
71.1
70
57.8
60
Percentage
50
40
30
29.1
22.2
18.5
20
15
12.8
10
11.2
8.1
7.3
0
Hypertension
High Total
Cholesterol
High Bad Cholesterol
Low Good
Cholesterol
High Triclyceride
Risk Factors
Males
Females
Source: National Nutrition Survey, 2008
32
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.
100
2
3.7
11.5
8.4
90
18.3
13.8
7.4
28.8
80
19.5
11.6
Percentage (%)
70
26.7
28.3
27.1
10.3
60
24.7
27.2
Hypertension Stage 2
50
14.3
26.1
Hypertension Stage 1
15.6
40
30
21.8
14.1
High Normal
18.2
53.9
17.8
43.7
20
Pre-Hypertension
Normal
17.8
32.5
22.6
10
17.8
14.7
60-69
70 and above
0
20-29
30-39
40-49
50-59
Age Group
Percent distribution of blood pressure readings based on a single visit among adults, by age
Source: National Nutrition Survey, 2008
33
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.
30
25.3
25
22
22.5
21
20
15
10
5
0
1993
1998
2003
2008
Year
Prevalence of hypertension among adults based on a single Visit, Philippines 1993-2008
Source: National Nutrition Survey, 2008
34
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.
6
4.8
5
3.9
4
3.4
3
2
1
0
1998
2003
2008
Year
Prevalence of High Fasting Blood Sugar among Adults, Philippines 1998-2008
Source: National Nutrition Survey, 2008
35
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.
80
70
66.1
61.6
57.3
60
50
Underweight
40
Normal
Overweight
30
24.4
Obese
22.3
20.1
20
10
10.7
9.2
7.6
4.5
10
6.1
0
Male
Female
Both
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
36
Health financing

37. The proportion of overweight and obese
Filipinos is increasing over the years.
28.4
30
26.6
24
25
Prevalence (%)
20.2
20
16.6
15
13.9
13.2
12.3
11.6
10
10
5
0
1993
1998
Underweight
2003
2008
Overweight/Obese
2011
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
37
Health financing

38. Females are roughly 6 times more likely to have
a high WAIST CIRCUMFERENCE than males.
25
20
Prevalence (%)
19.9
19
17
15
10.7
10
2.7
2.4
3.1
3.2
1998
5
2003
2008
2011
0
Year
Male
Female
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
38
Health financing

39. Females are roughly 10 times more likely to
have a high WAIST TO HIP RATIO than males.
65.5
70
54.8
60
Prevalence (%)
62.5
50
39.5
40
30
20
10
12.1
7.9
11.1
6.9
0
1998
2003
2008
2011
Year
Male
Female
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
39
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.
9
8
7
6
5
4
3
2
1
0
6.6
5.2
3.7
Male
Female
9
8
7
6
5
4
3
2
1
0
Total
7.9
6.2
5
2.5
1.1
Poorest
Sex
9
8
7
6
5
4
3
2
1
0
3.6
Urban
9
8
7
6
5
4
3
2
1
0
Rich
Richest
6.3
4.9
3.6
0.5
No Education
Urbanization
Y-axis – prevalence (in percent)
Living longer and older
Middle
Socio-economic Status
5.7
Rural
Poor
Elementary
Secondary
Educational Attianment
Source: National Nutrition Survey 2008
Getting sick and dying of NCDs
Tertiary
How disease factors affect people
Health financing
40

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.
20
18
16
14
12
10
8
6
4
2
0
12.8
10.2
7.3
Male
Female
20
18
16
14
12
10
8
6
4
2
0
Total
17.3
12.5
4.7
Poorest
Sex
20
18
16
14
12
10
8
6
4
2
0
8
Urban
20
18
16
14
12
10
8
6
4
2
0
Middle
Rich
Richest
13.1
8.3
Y-axis – prevalence (in percent)
9.6
5.8
No Education
Urbanization
Living longer and older
Poor
Socio-economic Status
11.9
Rural
8.1
6.7
Elementary
Secondary
Educational Attianment
Source: National Nutrition Survey 2008
Getting sick and dying of NCDs
Tertiary
How disease factors affect people
Health financing
41

42. Metabolic Syndrome
Central Obesity
Raised triglycerides
Reduced HDL cholesterol
Raised blood pressure
Raised fasting plasma glucose
42
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing

43. Behavioral/Lifestyle Factors
Tobacco use
High blood glucose
Unhealthy diet
High blood pressure
Physical inactivity
Abnormal blood lipids
Central obesity
Alcohol intake
Behavioral/lifestyle factors
Biological risk factors
43
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.
60
Percentage (%)
50
47.7
38.2
40
28.3
30
Men
22.5
20
10
Women
Overall
9
6.9
0
Current Smoker
Current Daily Smoker
Smoking Status
Percentage Distribution of Adults 15 years and older by Smoking Status and Sex, Philippines
Source: Global Adult Tobacco Survey (GATS), 2009
44
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing

45. Men smoke five times more than women.
70
60
57.4
54
53.2
Percentage (%)
50
40
35.2
32.7
31
30
Males
Females
Both
20
12.6
10.9
12.5
10
0
1998
2003
2008
Year
Prevalence Trend of Cigarette Smoking, by Sex in the Philippines
Source: National Nutrition Survey, 2008
45
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing

46. SMOKING is most prevalent among males, the poor, those who live
in rural areas, and those who never went to school.
60
60
53.2
50
50
40
40
31
30
39.9
36.4
29.7
30
20
25.3
24.8
Rich
Richest
20
12.5
10
10
0
0
Male
Female
Total
Poorest
Sex
Poor
Middle
Socio-economic Status
60
60
50
50
40
40
33.1
28.9
30
41.3
35.1
31.5
30
20
20
10
10
0
23.7
0
Rural
Urban
No Education
Urbanization
Y-axis – prevalence (in percent)
Living longer and older
Elementary
Secondary
Educational Attianment
Source: National Nutrition Survey 2008
Getting sick and dying of NCDs
Tertiary
How disease factors affect people
Health financing
46

47. Who consumes the highest level of SATURATED OILS in their diet?
The males, the rich, the urbanized, and the college-educated
14
14
12
12
10
10
9.4
8.8
10
8
8.9
Poor
Middle
Rich
2
0
8.9
4
2
9
6
4
8.1
8
6
11.7
0
Male
Female
Total
Poorest
Sex
Socio-economic Status
14
14
12
10
Richest
10
11.4
12
9.4
10
8.7
8
8
6
4
2
2
0
8
6
4
7.2
0
Rural
Urban
No Education
Urbanization
Y-axis – grams per day
Living longer and older
Elementary
Secondary
Educational Attianment
Source: National Nutrition Survey 2008
Getting sick and dying of NCDs
Tertiary
How disease factors affect people
Health financing
47

48. Unhealthy diets: Filipinos are #3
consumers of take-away food
Percentage of population that eats at take-away restaurants at least
once a week, by selected countries, 2004.
70%
61%
60%
59%
54%
50%
50%
44%
41%
40%
37%
35%
30%
29%
Australia
New Zealand
30%
20%
10%
0%
Hong Kong
Malaysia
Philippines
Singapore
Thailand
China
India
U.S.A
Source: AC Nielsen Consumer Survey Report, 2004
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
48
Health financing

49. Who consumes the highest level of SOFTDRINKS?
The males, the rich, the urbanized, and the college-educated
100
90
80
70
60
50
40
30
20
10
0
53.4
50.3
47.4
Male
Female
100
90
80
70
60
50
40
30
20
10
0
Total
86.5
59.4
44.1
33.5
19.2
Poorest
Sex
100
90
80
70
60
50
40
30
20
10
0
39
Urban
100
90
80
70
60
50
40
30
20
10
0
Rich
Richest
81.8
53
25.1
12.5
No Education
Urbanization
Y-axis – grams per day
Living longer and older
Middle
Socio-economic Status
60.3
Rural
Poor
Elementary
Secondary
Educational Attianment
Source: National Nutrition Survey 2008
Getting sick and dying of NCDs
Tertiary
How disease factors affect people
Health financing
49

50. 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
14
14
12
12
10
10
8
8
6
4
12.6
6
3.6
3.3
3
4
2
0
1.4
2
1.1
1.6
1.3
Poor
Middle
Rich
Richest
0
Male
Female
Total
Poorest
Sex
Socio-economic Status
14
14
12
12
10
10
8
6
10.3
8
5.8
6.2
6
4
4
1
2
0
1.6
2
1.1
Secondary
Tertiary
0
Rural
Urban
No Education
Urbanization
Y-axis – grams per day
Living longer and older
Elementary
Educational Attianment
Source: National Nutrition Survey 2008
Getting sick and dying of NCDs
How disease factors affect people
Health financing
50

51. Men consume alcohol nearly five times
more than women.
90
78.2
80
70
Percentage
60
53.3
53
47.5
50
Males
40
30.6
25.6
30
26.9
Females
Both
20
11.1
9.8
10
0
1998
2003
2008
Year
Prevalence Trend of Alcohol Drinking, by Sex in the Philippines
Source: National Nutrition Survey, 2008
51
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.
100
92.6
94.5
92.6
92.7
90
Percentage (%)
80
76.3
72.2
70
60
50
Work-related PA
40
Travel-related PA
30
Leisure-related PA
20
10
0
2003
2008
Year
Comparison of Low Physical Activity (PA) by Domain, Philippines: 2003 and 2008
Source: National Nutrition Survey, 2008
52
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing

53. While in general, Filipinos are physically
inactive, males are a bit more physically active than
females.
Female
Work-related PA
76.2
Nonwork-related PA
23.8
70
30
Travel-related PA
95.2
4.8
Liesure-related PA
95.7
4.3
Low
Male
Work-related PA
76.3
Nonwork-related PA
High
23.7
83
Travel-related PA
17
93.8
Liesure-related PA
6.2
89.1
0
10
20
30
40
10.9
50
60
70
80
90
100
Prevalence (Percentage)
Percent distribution of adults 20 years and over, by Physical Activity (PA)
and by Sex, Philippine 2008
Source: National Nutrition Survey, 2008
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
53
Health financing

54. Increasing URBANIZATION in the Philippines has a role to
play in limiting physical activity and shaping lifestyles
that lead to chronic noncommunicable disease.
Level of Urbanization (in Percent)
60
48
47
50
50.3
37.3
40
31.8
30
20
10
Total Population
0
1970
1890
1990
2000
2008
Year
54
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing

55. Social Determinants of Health
The poorest pay the most as a share of their monthly income
for food, which is a critical determinant of health.
AVERAGE HOUSEHOLD MONTHLY INCOME
Poorest
5,958
Poor
Middle
Income
8,594
12,269
Rich
18,497
Richest
40,590
FOOD EXPENDITURE SHARE
67%
57%
49%
40%
Source: Family Income and Expenditure Survey, 2009
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing
27%
55

56. The Vulnerable Filipino Woman
Biological Risk Factors
• Predilection for diabetes
• Risk factors: Obesity, High cholesterol levels, Physically inactivity
Social Determinants of Health
• What more – the poor, uneducated woman who lives in the
province?
Other Social Issues Confronting Women
• Social factors will further complicate the situation: limited
employment opportunities, less working years, role in child
rearing, gender violence, access to reproductive health services
56
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing

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.
57

58. As of 2011. the Philippines spends 4.4% of its GDP for
health – still short of the 5% WHO recommendation.
5
4.4
4.3
4.5
3.9
4
4
3.9
4.2
3.9
Percentage (%)
3.5
3
3.1
3.1
3.1
3.1
2005
2006
2007
2008
3.2
3.2
2009
2010
3.3
2.5
2
1.5
1
0.5
0
2011
Year
Share to GNI
Share to GDP
Share of Health Expenditure to GDP and GNI, 2005-2011
Source: Philippine National Health Accounts, 2011
58
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing

59. In 2011, the Philippines spent only PhP 4,577
per person for health care for the entire year.
5000
4577
4500
4112
3759
4000
3377
In Philippine Pesos
3500
3000
2500
3061
2624
2783
2639
2022
2083
2159
2179
2005
2006
2007
2008
2442
2298
2000
1500
1000
500
0
2009
2010
2011
Year
At Current Prices
At Constant 2000 prices
Per capita health expenditure, 2003-2011
Source: Philippine National Health Accounts, 2011
59
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing

60. The Philippines is financing a predominantly “disease
care” system, with little funding allotted for health
promotion and disease prevention.
Others
9%
Public Health
12%
Personal Care
79%
Total Health Expenditure by Use of Funds, 2011
Source: Philippine National Health Accounts, 2011
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing
60

61. In 2011, Filipinos spent more from OUT-OF-POCKET
sources for health care than any other source.
1%
6%
4%
National Government
12%
Local Government
Social Insurance
15%
Out-of-Pocket
9%
Private Insurance
Health Maintenance
Organizations
53%
Others
Source: Philippine National Health Accounts, 2011
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing
61

62. HEALTH INSURANCE COVERAGE increases with
income, with private health insurance only comprising
2.1% of the total population.
70
65
60
48.2
Percentage
50
42
39.4
40
37.3
35.3
31
30
20
57
53.8
28.6
20.6 19.6
7
10
0.2
0
Lowest
Second
Third
2.1
2
1.1
0.3
Fourth
Highest
Total
Wealth Quintiles
Any Insurance
PhilHealth
Private Insurance/HMO
Source: National Demographic and Health Survey, 2008
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing
62

63. Even with PRIVATE HEALTH INSURANCE, there is very
little coverage among the middle and upper class.
0
10
20
30
40
50
60
70
80
90
100
NCR
CAR
I
II
III
IVA
IVB
V
VI
VII
VIII
IX
X
XI
XII
XIII
ARMM
Population covered with private insurance
Uncovered population from 3rd to 5th wealth quintiles
Source: National Demographic and Health Survey, 2008
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing
63

64. The elderly spend the most for health care, and they
pay mostly from out of their pockets.
25
In Billion Pesos
20
15
10
5
0
0-4y
5-9y
10-14y
Natl Govt
15-19y
20-39y
Local Govt
Philhealth
40-49y
50-64y
65y and above
Out of Pocket
Health expenditures by financing agent and by population age group, 2003
Source: Racelis, et al., 2007
64
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing

65. The rich pays the most for health care, and mostly from out of
their pockets – because the poor has no pocket at all.
60
In Billion Pesos
50
40
30
20
10
0
Poorest
Poor
Natl Govt
Middle
Local Govt
Philhealth
Rich
Richest
Out of Pocket
Health expenditures by financing agent and by income quintile, 2003
Source: Racelis, et al., 2007
65
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing

66. Filipino households spend 68% of its out-of-pocket
payments for health care just for DRUGS AND
MEDICINES alone.
15.60%
4.30%
Drugs and Medicine
8.00%
Hospital Charges
Professional fees
4.10%
68.00%
Contraceptives
Others
Households' out-of-pocket payments, by expenditure item, 2006
Source: Family Income and Expenditure Survey, 2006
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing
66

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
Aspirin
tablet
peso/
100mg
1.25-1.75
1.8
2.50-2.75
14.75-21.75 14.75-21.75
1.90-4.50
Source: DOH Price Monitoring Chart, July 2013
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing
1.25-4.50
67

68. 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
* In Philippine Pesos
Source: National Demographic and Health Survey, 2008
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing
68

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 publiclyadministered and
privately-provided
insurance schemes
to ensure financial
risk protection
during times of
illness.
69
Living longer and older
Getting sick and dying of NCDs
How disease factors affect people
Health financing

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.
70

71. Are we ready to address their health needs?
40 year old single mother,
20 year old fresh
obese, with a history of
graduate, chain smoker,
diabetes, working in the working in his first job in a
corporate sector
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
71

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
34 year old
grandmother, widow, with businessman, with wife
high blood pressure and and three children, heavy
history of heart
eater and drinker, running
disease, about to retire
his restaurant business
72

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
73

74. Are we ready to address their health needs?
40 year old single mother,
20 year old fresh
obese, with a history of
graduate, chain smoker,
diabetes, working in the working in his first job in a
corporate sector
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

75. Thank you for listening!
75