Interventions to improve international health and related delivery systems started during rapid economic growth and its diffusion in the 19th century in countries of the North Atlantic. Right after, human mortality rates decreased and health care improved significantly to the rest of the world. Despite this partial success during our century, the whole world still faces critical challenges on health such as the epidemiological transmission, HIV/AID epidemic, new pandemics, and unequal progress most specially seen in developing countries. Although the leading global risks were already identified (high blood pressure, tobacco use, high blood glucose, physical inactivity, overweight and obesity), they are still partially uncontrolled, therefore leading to more cases of heart disease, diabetes, and certain cancers worldwide. Global diseases were found to be socioeconomically related and they are now being measured in Disability-Adjusted Life Years (DALYs) and its leading risks were underweight, unsafe sex, alcohol use, and unsafe water, sanitation and hygiene. Among these leading risks, alcohol use has a unique geographic and sex pattern, with its prevalence highest for men living in Africa, in middle-income countries in the USA, and in some developed countries. Furthermore, developing countries were already found to have a double burden of disease – a combination of chronic, non-communicable conditions and communicable/infectious diseases.
To overcome these complicated health problems among nations, the focus on medical research also transitioned. Initially, most health behavior theories focused more at the intrapersonal level and the approach was proven to be inadequate in addressing the health care problems. A Social Ecological Model (SEM) was then proposed to address health factors at multiple levels, namely intrapersonal, interpersonal, institutional, community, and policy levels. The multifactorial approach had proven to be more effective in several countries and it paved the way for nations to plan and create a primary health care system, which also focuses on the social determinants of health. These social determinants have overarching recommendations: (1) to improve daily lifestyle, (2) to challenge the inequitable distribution of power, money and natural resources, and (3) to measure and comprehend the problem and assess its impact of action. Although with promising target goals, these social determinants are mainly affected by poverty, inequality and ‘the causes of the causes’. To address these socioeconomic inequalities and inequities, Primary Health Care (PHC) became the international goal, as announced during the 1978 International Conference on Primary Care in Alma Ata. Key characteristics and particular recommendations of PHC were established to develop a healthcare available for all – from preventive, curative up to rehabilitative health programs. But until now, only a few countries had achieved this Millennium Development Goal.
In our country, an attempt on primary health care was done but the strategy was said to be just “banking on the barangays.” Positively, our country’s health status improved dramatically ever since the Alma Ata Declaration, with infant mortality drop by more than 60% percent, decreased prevalence of infectious diseases and increased life expectancy to over 70 years. However, our health system is still not a complete success since significant inequities in health care between socioeconomic groups still remain. As a developing country, a major factor of inequity is due to high cost of health care and inadequate health care coverage. Even with a national health insurance agency called PhilHealth since 2005, significant challenges/setbacks, such as understaffed workers and under-served areas, greatly affected the health care outcome. Sadly, even though our country is a major exporter of nurses and doctors, we still face critical shortages due to government inefficiency and poverty/salary problems. As a general practitioner, I have seen our existing health care problem with my own eyes – both in private and government hospitals. Our health care system still needs to be more aggressive on the approaches in every level (according to the SEM) and at the same time, it also needs to be more realistic and more practical so that primary health care can be readily available for all. Our government should also value medical research since it has immediate and long-term benefits for the Filipinos.
References:
Bambra, C., Gibson, M., Snowden, A., Wright, K., Whitehead, M. & Petticrew, M. (2011) Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews, Journal of Epidemiology and Community Health, Vol. 64, No. 4, pp. 284–291, Retrieved September 12, 2016 from http:// ww.ncbi.nlm.nih.gov/pmc/articles/PMC2921286/
Gillam, S. (2007) The declaration of Alma Ata: still relevant after all these years? Institute of Public Health, Cambridge. Retrieved September 12, 2016 from http://www.15by15.org/wp-content/uploads/2008/01/declaration-ofalmaata-stephen-gillam.pdf
Hall, J. J. and Taylor, R. (2003) Health for all beyond 2000: the demise of the Alma-Ata Declaration and primary health care in developing countries, Medical Journal of Australia, Vol. 178, No. 1, pp 17-20. Retrieved September 12, 2016 from https://www.mja.com.au/journal/2003/178/1/health-all-beyond-2000-demise-alma-ata-declaration-and-primary-health-care
Jamison, D.T. (2006) Investing in Health. In: Jamison DT, Breman JG, Measham AR, et al., editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington (DC): World Bank. Chapter 1. Retrieved September 12, 2016 from http://www.ncbi.nlm.nih.gov/books/NBK11754/pdf/ch1.pdf
Marmot, M. (2005) Social determinants of health inequities. Lancet, Vol 365, Retrieved September 12, 2016 from http://www.who.int/social_determinants/strategy/Marmot-Social%20determinants%20of%20health%20inqualities.pdf
Martin, C. M. and Kaufman, T. (2008) Addressing health inequities: A case for implementing primary health care, Canadian Family Physician, Vol. 54, No. 11, pp. 1515-1517. Retrieved September 12, 2016 from http://www.cfp.ca/content/54/11/1515.full.pdf+html
Philipps, D.R. (1986) Primary health care in the Philippines: banking on the barangays? Social Science and Medicine, Vol. 23, No. 10, pp. 1105-17, Retrieved September 12, 2016 from http://www.ncbi.nlm.nih.gov/pubmed/3823975
Romualdez, A.G., Dela Rosa, J.F., Flavier, J.D., Quimbo, S.L., Hartigan-Go, K.Y., Lagrada, L.P., & David, L.C. (2011) The Philippines Health System Review, Health Systems in Transition, Vol. 1, No. 2, Retrieved September 12, 2016 from http://www.wpro.who.int/philippines/areas/health_systems/financing/philippines_health_system_review.pdf
WHO (2009) Global Patterns of Health Risks in Global Health Risk, WHO, Geneva, Vol. 9-12, Retrieved September 12, 2016 from http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf
WHO (2012) Outcome of the World Conference on Social Determinants of Health, 65th World Health Assembly, Agenda 13.6. Retrieved September 12, 2016 from http://www.who.int/sdhconference/background/A65_R8-en.pdf?ua=1
To overcome these complicated health problems among nations, the focus on medical research also transitioned. Initially, most health behavior theories focused more at the intrapersonal level and the approach was proven to be inadequate in addressing the health care problems. A Social Ecological Model (SEM) was then proposed to address health factors at multiple levels, namely intrapersonal, interpersonal, institutional, community, and policy levels. The multifactorial approach had proven to be more effective in several countries and it paved the way for nations to plan and create a primary health care system, which also focuses on the social determinants of health. These social determinants have overarching recommendations: (1) to improve daily lifestyle, (2) to challenge the inequitable distribution of power, money and natural resources, and (3) to measure and comprehend the problem and assess its impact of action. Although with promising target goals, these social determinants are mainly affected by poverty, inequality and ‘the causes of the causes’. To address these socioeconomic inequalities and inequities, Primary Health Care (PHC) became the international goal, as announced during the 1978 International Conference on Primary Care in Alma Ata. Key characteristics and particular recommendations of PHC were established to develop a healthcare available for all – from preventive, curative up to rehabilitative health programs. But until now, only a few countries had achieved this Millennium Development Goal.
In our country, an attempt on primary health care was done but the strategy was said to be just “banking on the barangays.” Positively, our country’s health status improved dramatically ever since the Alma Ata Declaration, with infant mortality drop by more than 60% percent, decreased prevalence of infectious diseases and increased life expectancy to over 70 years. However, our health system is still not a complete success since significant inequities in health care between socioeconomic groups still remain. As a developing country, a major factor of inequity is due to high cost of health care and inadequate health care coverage. Even with a national health insurance agency called PhilHealth since 2005, significant challenges/setbacks, such as understaffed workers and under-served areas, greatly affected the health care outcome. Sadly, even though our country is a major exporter of nurses and doctors, we still face critical shortages due to government inefficiency and poverty/salary problems. As a general practitioner, I have seen our existing health care problem with my own eyes – both in private and government hospitals. Our health care system still needs to be more aggressive on the approaches in every level (according to the SEM) and at the same time, it also needs to be more realistic and more practical so that primary health care can be readily available for all. Our government should also value medical research since it has immediate and long-term benefits for the Filipinos.
References:
Bambra, C., Gibson, M., Snowden, A., Wright, K., Whitehead, M. & Petticrew, M. (2011) Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews, Journal of Epidemiology and Community Health, Vol. 64, No. 4, pp. 284–291, Retrieved September 12, 2016 from http:// ww.ncbi.nlm.nih.gov/pmc/articles/PMC2921286/
Gillam, S. (2007) The declaration of Alma Ata: still relevant after all these years? Institute of Public Health, Cambridge. Retrieved September 12, 2016 from http://www.15by15.org/wp-content/uploads/2008/01/declaration-ofalmaata-stephen-gillam.pdf
Hall, J. J. and Taylor, R. (2003) Health for all beyond 2000: the demise of the Alma-Ata Declaration and primary health care in developing countries, Medical Journal of Australia, Vol. 178, No. 1, pp 17-20. Retrieved September 12, 2016 from https://www.mja.com.au/journal/2003/178/1/health-all-beyond-2000-demise-alma-ata-declaration-and-primary-health-care
Jamison, D.T. (2006) Investing in Health. In: Jamison DT, Breman JG, Measham AR, et al., editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington (DC): World Bank. Chapter 1. Retrieved September 12, 2016 from http://www.ncbi.nlm.nih.gov/books/NBK11754/pdf/ch1.pdf
Marmot, M. (2005) Social determinants of health inequities. Lancet, Vol 365, Retrieved September 12, 2016 from http://www.who.int/social_determinants/strategy/Marmot-Social%20determinants%20of%20health%20inqualities.pdf
Martin, C. M. and Kaufman, T. (2008) Addressing health inequities: A case for implementing primary health care, Canadian Family Physician, Vol. 54, No. 11, pp. 1515-1517. Retrieved September 12, 2016 from http://www.cfp.ca/content/54/11/1515.full.pdf+html
Philipps, D.R. (1986) Primary health care in the Philippines: banking on the barangays? Social Science and Medicine, Vol. 23, No. 10, pp. 1105-17, Retrieved September 12, 2016 from http://www.ncbi.nlm.nih.gov/pubmed/3823975
Romualdez, A.G., Dela Rosa, J.F., Flavier, J.D., Quimbo, S.L., Hartigan-Go, K.Y., Lagrada, L.P., & David, L.C. (2011) The Philippines Health System Review, Health Systems in Transition, Vol. 1, No. 2, Retrieved September 12, 2016 from http://www.wpro.who.int/philippines/areas/health_systems/financing/philippines_health_system_review.pdf
WHO (2009) Global Patterns of Health Risks in Global Health Risk, WHO, Geneva, Vol. 9-12, Retrieved September 12, 2016 from http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf
WHO (2012) Outcome of the World Conference on Social Determinants of Health, 65th World Health Assembly, Agenda 13.6. Retrieved September 12, 2016 from http://www.who.int/sdhconference/background/A65_R8-en.pdf?ua=1
