Jan 3 how healthy is the filipino revised december 10

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Jan 3 how healthy is the filipino revised december 10

  1. 1. How healthy is the Filipino? Dr. Ramon Lorenzo Luis R. Guinto Independent Consultant 1
  2. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 75. Thank you for listening! 75

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