The document provides an overview of illness in communities and the role of medical students. It defines key terms like community, disease, and illness. It describes how soil-transmitted helminthiasis, malnutrition, and maternal mortality disproportionately impact poor communities. An ill community is unable to fulfill its health role and the cycle of illness in communities leading to ill communities is discussed. Issues with the Philippine health system in perpetuating inequities are analyzed. The primary health care approach and medical students' ability to break the cycle by adopting a community-based approach are presented as ways forward.

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Illness and the Community
HS 202 Biopsychosocial Dimensions of Illness
August 26, 2015
Paolo Victor N. Medina, M.D.
Section of Community Medicine
Department of Family and Community Medicine
UP College of Medicine

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By the end of the session, the student
should be able to:
• Recall Primary Health Care principles and concepts
from HS 201
• Describe the impact of illness on the Filipino
community
• Discuss the dynamics of illness and the community
• Analyze the dynamics of illness and the community
within the context of the Philippine Health Care
System
• Articulate the UPCM student’s role in breaking the
cycle involving illness in communities and ill
communities

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SOME DEFINITIONS…

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Community
• A group of people in a specific geographical
location sharing economic, social, cultural
and political dynamics. (UPCM COME Unit,
2014)

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Disease and Illness
• Disease – broadly refers to any condition that
impairs the normal functioning of the
body/dysfunction of the body’s homeostasis
(Wikipedia)
• Illness – generally a synonym of “disease”;
occasionally used to refer specifically to a
patient’s personal experience of his/her
disease (Wikipedia)
• In Filipino: “Sakit”, “May sakit”

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ILLNESS IN THE COMMUNITY

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What do These Have in Common?
• Soil Transmitted Helminthiasis (STH)?
• Malnutrition
• Maternal Mortality

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Soil Transmitted Helminthiasis
~ 2B people worldwide
are affected (WHO)
– >270M preschoolers
– >600M school age children
Classified as one of the
Neglected Tropical
Diseases
STH infections among
Filipino school children:
13.2% - 52% (Belizario, et
al. 2007, 2009, 2011)
Usually affects the
poorest and most
deprived populations
(greatest burden of
disease)
Causes anemia, malaise,
diarrhea, pneumonias,
etc.
Nutritional impairment
Significant detrimental
impact on cognitive and
physical development

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Malnutrition (NNS, 2013)
Micronutrient deficiencies still
prevalent and persistent (IDA,
IDD, etc.)
Under 5 malnutrition is still a
very big problem
– Underweight Prevalence:
19.8% (20.7% in 2008)
– Stunting Prevalence: 30.3%
(32.3% in 2008)
– 0 to 5 years – crucial stage
for mental and physical
development
Mean heights (cm) and weights
(kg), 20 years old and above:
– Rich vs poor males:
• 164.9/67.7 vs 161.2/55.8
– Rich vs poor females:
• 152.6/57.5 vs 149.9/50.2

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Maternal Mortality
• The Philippines will most
likely NOT achieve its MDG
5 target
– MMR 162 to 52 by 2015
– MMR 221 in 2011 (DOH)
– MMR trend has been flat
(120s to 130s) over the last
25 years (WHO, et al)
• High MMR disparity
between the rich and the
poor; the poor marry
earlier, have more children
and less access to RH
leading them further into
poverty (UNFPA, 2015)

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ILLNESS IN THE COMMUNITY = ILL COMMUNITY
Image by National Geographic

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Illness in the Community
• The poorest and most
disenfranchised are usually
the most vulnerable.
– Burden of disease is greater
• Ill community members are
non-productive
– Community resources are
heavily drained
• Weaknesses and flaws in
health system are exposed
• Illness worsens the effects
and impacts of baseline
unfavorable Social
Determinants of Health

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ILL COMMUNITIES

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The community is not just a
physical landscape. It is a social
landscape. - G. Nisperos

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What might seem idyllic on the
outside could easily be seething and
hurting from within…

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REALITY BITES
“Sixtypercent
ofour
countrymen
whosuccumb
tosicknessdie
withoutseeing
a doctor.”
-Pres. Noynoy
Aquino

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HINDI LANG
KUWENTO SI
ROSARIO
Image from QRomualdez UPCM Centennial Lecture

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Ill Communities
• The poor, the starving, the
orphaned, the abused, the
neglected, the underserved…
They are the most vulnerable
to disease and illness.
– Children, Women, Elderly, etc
• Children, who represent a
community’s future, fail to
reach their full potential.
• The adults, who are supposed
to lead productive lives in
order to contribute to the
community’s well-being are
either too sick or too busy
taking care of those who are,
to do so
• The illness of communities
are manifested in their social
structures and institutions.

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Ill Communities
• People’s basic needs are
almost impossible to
come by; “Kayod
kalabaw” pero “isang
kahig at isang tuka” pa rin
ang pamumuhay.
– Prone to exploitation and
abuse by unscrupulous
individuals, groups and/or
institutions
– Disempowering social
structures and systems
– Disadvantaged state is
perpetuated

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Ill Communities

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An Ill Community is Unable to Fulfill
its Role in Health
• The community is unable to recognize and meet its
obligation to its members. With basic living as a
constant struggle, individualism becomes preferred
over collective duty
– The burden of health care, which ideally should be
diminished because it is shared, becomes even heavier
• The attainment of health, which should begin in the
community, becomes dependent on a few individuals
or groups
– Health and Health Care are equated (reduced) to health
services only (biomedical)
– People are not inclined to participate in the attainment of
their health beyond their own individual needs

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ILL COMMUNITY = ILLNESS IN THE COMMUNITY

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THE IMPACT OF THE PHILIPPINE HEALTH
CARE SYSTEM ON FILIPINO
COMMUNITIES
The Irony that is the Philippine Health Care System

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AHA-UHC
DOH’s
Enterprise Architecture Vision
KP

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Two-Tiered Health System
• Public, government-run system
– Schizophrenic; Devolution has a
significant impact
– Mostly “Technical Assistance” by
National DOH (except for EPI, NTP,
NTDs)
– Health Program Implementation
and Development by LGUs
• Private System
– Very strong
– Market-oriented; for profit
mentality
• Wide Gap between the two
– Non-complimentary; often at odds
with each other
– Promotes inequities in health
Image from worldtravelerserver.com

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Health Financing
• Health Expenditure is
still primarily Out of
Pocket (OOP)
• PhilHealth is mainly a
purchaser of health
services
– Doubts about
government claims of
coverage (87%, 2015)
– Complicated system of
provider accreditation
vis a vis beneficiary
membership/enrollment Image from pids.gov.ph

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Health Human Resources
• Health Human Resource
Development and
Management NOT based
on NEED
– Market-orientation over
service
– Health worker production
does not match health
system needs
– High impact of devolution
Image from worldpoliticsreview.com

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Health Information Systems
• Problems and issues with
health information
management = inability
to fully utilize health
information for health
system decision making
– Beyond modernization
and computerization
– Beyond compliance to
health statistics reporting
– Monitoring and evaluation
systems too
biomedical/technical
– Community rarely
involved

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Access to Essential Medicines and
Technologies
• Market-driven
• Prices of medicine,
diagnostics,
technologies remain
high and prohibitive
– Communities settle for
substandard
interventions due to
resource limitations,
etc.

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Health Service Delivery
• Health services largely
underfunded and
neglected
– Devolved to LGUs
• Primary level of care is
woefully
underdeveloped
• Referral systems in a lot
of areas are
dysfunctional
– GIDAs
– Effect of Devolution
– Fragmentation of health
services

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INACCESSIBLE:
DISTANCE
COST
CULTURE
ALLOPATHIC
WESTERN
MEDICINE
Dispensary/
Post
Medical
Center
UNDESIRABLE
Original Slide by T. Gonzales, MD

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Only those with money (i.e., the rich) can
fully pay for out of pocket payments and
often they have generous health insurance
The near-poor and the lower middle
classes can become impoverished to
meet out of pocket payments for health
care.
The very poor don’t even
have pockets

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Access or the LACK of access to
basic health services remains the
most significant health problem.
The health system, which ideally
should be the ENABLER of
communities to enjoy their RIGHT
to HEALTH, ironically becomes the
very problem.
GREATER BURDEN on the
Community

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Illness and the Community (CYCLE)
ILLNESS IN THE COMMUNITY
ILL COMMUNITIES

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SO WHAT NOW?
Bilang mag-aaral ng medisina, may magagawa ka ba???

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BREAK THE CYCLE!!!
ILLNESS IN THE COMMUNITY
ILL COMMUNITIES

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Health is the complete state of physical, mental and
social well-being and not merely the absence of
disease and infirmity (WHO)

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What good is it to treat a person’s illness if
the person goes back to the conditions that
brought about the illness in the first place?
F. Baum, paraphrased

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THE PRIMARY HEALTH CARE APPROACH (Alma Ata, 1978)
Health is a fundamental HUMAN RIGHT. The goal is the highest
possible level of health.
Government is duty-bound to ensure the health of its
constituents.
Gross inequities in health NOT acceptable.
Economic and Social Development, based on a New
International Economic Order, is of basic importance to the
fullest attainment of HEALTH FOR ALL.
The people have the right and duty to participate.
PRIMARY HEALTH CARE is the key to attaining HEALTH FOR ALL.

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HEALTH IS THE
RESPONSIBILITY
OF THE:
INDIVIDUAL
FAMILY
COMMUNITY
COMMUNITY BASED
Medical Center
Dispensary/Post
DESIRABLE
Original Slide by T. Gonzales, MD

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BREAK THE CYCLE!!!
ILLNESS IN THE COMMUNITY
ILL COMMUNITIES

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The Challenge…
For the Philippines
and the Filipino…
– How much are we
willing TO DO?
– How hard are we
willing TO TRY?
– How far are we
willing TO GO?

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THANK YOU!!!
Is there anything you wish to clarify?