Why do we fail in curbing and preventing NCDs?
Anthony C. Leachon, M.D.
The modern world has given us tremendous know-how, yet avoidable failures continue to plague us everywhere, in healthcare and government, in law, and in finance. And the reason is quite simple and obvious. The volume and complexity of things that we are doing, far exceeds our capacity to properly deliver and achieve it- consistently, correctly and safely.
In 1970’s, the philosophers Samuel Gorovitz and Alasdair MacIntyre published a short essay on the nature of human fallibility that I read two weeks ago and haven’t stopped pondering since. The query they sought to answer was why we fail at what we set out to do in the world. One reason, they said, is “ necessary fallibility” – some things we want to do are simply beyond our ability and capacity. We are not perfect and all knowing. Even enhanced by iPhones,iPads, technology, our physical and mental powers are limited. Much of the world and universe is- and will forever remain – outside our understanding and control.
IGNORANCE and INEPTITUDE
There are clear realities, however, in which control is within our reach. We can do coronary artery bypass grafts, lap surgeries, laser eye therapies and many more. In such realms, Gorovitz and MacIntyre pointed out, there are two reasons that we may nonetheless fail.
The first is IGNORANCE- we may err because science has given us only partial understanding of the world and how it works. There are skyscrapers we do not yet know how to build , typhoons we cannot predict, heart attacks we still haven’t how to stop. The second type of failure the philosophers call INEPTITUDE – because in these cases, the knowledge and awareness exist, yet we fail to apply it correctly; like smoking – we know it’s bad for our health and yet smokers allow themselves to suffer and die prematurely. This is really absurd.
According to Prof. Antonio Dans et al in the Lancet article, Feb 19, 2011, chronic non-communicable diseases or NCDs (stroke, heart disease, cancer,diabetes, and COPD) is a major public health problem in the Philippines and in the South East Asia. Southeast Asia faces an epidemic of chronic non-communicable diseases, now responsible for 60% of deaths in the region. The problem stems from environmental factors that promote tobacco use, unhealthy diet, and inadequate physical activity. Disadvantaged populations are the hardest hit, with death rates inversely proportional to a country's gross national income.
Families shoulder the financial burden, but entire economies suffer as well. Death and disability from NCDs can exert an economic burden in 2 ways: indirectly, through loss of productivity and income, and directly, through household spending on chronic medical care, often of catastrophic proportions. These preventable conditions can cause major drain on the economy because of avoidable morbidity and mortality.
Developing countries have not only the double burden of communicable and chronic disease, but many also experience the simultaneous challenge of health-system reform. Without universal access to care, well-integrated health services, and strong leadership in public health, response to the above challenges will be inefficient. In such circumstances, the greatest health gains could come from structured preventive strategies.
The success of any healthcare system despite the low financing for health from public funds, is related to a unique and innovative unique healthcare spending but the overall living condition in the country. The goal is to provide quality healthcare for all at a minimum cost to society by relying on a combination of public and private service delivery, but even without a national insurance system. The Philippine government will play a key role. Preventing diseases will be the top priority by every government agency and LGU and not only the Department of Health.
Health is everyone’s accountability. Thus our government through inter agency collaboration will promote healthy lifestyle and prevent perennial killers like coronary artery disease, strokes from hypertension, cancers, diabetes and COPD and other tobacco related illnesses by ensuring a healthy environment, good health conditions, and heavy penalty for smoking in public places, should take a high priority.
A Look into our Healthcare System
If we put all our health services in a continuum, with promoting health on the one end and mitigating sickness on the other, we will realize that, all the incentives of healthcare system now respond to signals from sickness. Why should health insurance be focused mostly on sickness? We have a present system as one that pays for procedures not cures; interventions not outcomes; transactions not transformations. We "penalize” doctors for providing cost-effective care that promotes health but we reward them for interventions regardless of outcome, redundancy, and waste.
Multi sectoral approach needed
Although attempts to control non-communicable diseases are increasing, more needs to be done. Health-care systems need to be redesigned to deliver chronic care that is founded on existing primary health-care facilities, but supported by good referral systems. Surveillance of key modifiable risk factors is needed to monitor the magnitude of the problem and to study the effects of interventions. All branches of government and all sectors of society have to get involved in establishing environments that are conducive to healthy living. Inaction will affect millions of lives—often, the lives of those who have the least in life.
Philippine Health Care – quo vadis ?
The Health for the Filipinos is not about extending insurance coverage and deciding who to pay for health care, and how much – important as those things are, it makes no sense just to figure out a better way to pay the bills for a system that is dysfunctional, ineffective, and broken. We also have to change the health care system itself, beginning with a sharp new emphasis on prevention and public health.
Perhaps we can convene a meeting with the medical societies, for a start. DOH Secretary Enrique Ona agrees with the suggestion to shift the focus of DOH from sick care to health care; The DOH will take the lead in addressing ignorance and ineptitude in healthcare and will communicate with all government agencies to contribute their share on health.
Health is not only the accountability of DOH it is our accountability as citizens. But, our government leaders should step up and think of creative ways to improve our condition.
We can ask DepEd, DOST, and CHED to insert preventive health education modules into the academic curriculum ; we can ask DPWH,DILG, MMDA and LGU heads to clean up the streets and clear the waterways to prevent killer floods and the presence of Dengue Fever, leptospirosis, diarrhea and other water borne and vector borne illnesses; We can ask the DENR to help implement the Clean Air Law to prevent COPD and cardiovascular diseases and plant trees every day to prevent massive flooding that lead to aforementioned diseases ; We can ask the DPWH, MMDA and the LGUs to create better roads to prevent the surge of vehicular accidents; We can talk with Department of Finance, Bureau of Internal Bureau, Department of Budget Management , Senate and Congress to help the physicians to lobby for higher sin tax for tobacco and alcohol; We can request the Communications Group to help DOH inform, influence, and inspire the nation that there is still hope for every Filipino.
We need a summit where President Noynoy Aquino together with his cabinet, government agencies, all health organizations, private sector, NGO’s and related societies for a National Commitment, a declaration that our healthcare system values prevention, wellness, rapid diagnosis and early treatment. It will hasten things if a draft can be shown to the body during that meeting. The DOH Secretary may then seek the support of his colleagues in the Human Development Cluster and may document their support in a formal signing event, with no less than PNoy as the leading health champion. The medical societies plus PHA, PHAP, PMA etc. may also sign a similar document as proof of their support.
A PPP (Public Private Partnership) Executive Committee may then be formed to formulate the work plan. This same committee may do the monitoring of performance by the PPP components and publish in the newspapers on a monthly basis. The DOH together with the other agencies can fund this project with the Private sector group volunteering whatever it is that they think is their best contribution towards the attainment of the programs’ objectives.
We must realize that wellness and prevention must be truly comprehensive if it is to really succeed. It is not only about what goes on in a doctor’s office. It encompasses workplace wellness programs, community-wide wellness programs, building bike paths and walking trails, getting junk food out of our schools, making school breakfasts and lunches more nutritious, increasing the amount of physical activity our patients and those individuals at risk.
We view this change in mindset as our opportunity to recreate Philippines as a genuine wellness society – a society that is focused on prevention, good nutrition, fitness, and public health. But, just as important, it will hold down health care costs by creating a sharp new emphasis on disease prevention and public health.
Lifestyle Diseases 6: Personal Care against NCDs, October 14, 2011
Lifestyle Diseases 7: Drinking and Healthcare, October 18, 2011
Lifestyle Diseases 8: WHO and the NCDs, December 08, 2011
Lifestyle Diseases 9: Overeating and Food Poisoning, December 24, 2011
Lifestyle Diseases 10: Financing Healthcare vs NCDs, December 30, 2011