Government and Taxes

RUM 2: SARAH, Drug Dependence

2012-01-30T17:00:00.002+08:00

(This is the continuation of RUM 1: Reducing Medicine Abuse which I posted last January 25.)

Ms. Marianne Dioso, also of NCPAM, presented the SARAH approach in the PMP:

Safety and effectivity of medicines,
Affordable and accessible,
Rational use of medicines,
Accountability and transparency of health players, and
Healthcare systems that are adequate.

She started with a quote from Dr. Alran Bengzon, a former DOH Secretary, saying that drugs and medicines are the key component of the Philippine healthcare system. Then showed these data:

- P124 billion pharmaceuticals market (2010)
- 40 percent of total health expenditures
- 30 percent of PhilHealth reimbursements
- 10 percent of DOH budget
- 10 to 12 percent of total pharma market accounted for by the public sector
- 70 percent of the P124 is accounted for the MNCs by value, and 60 percent by the national companies (NCs) by volume.

It is true that there is both demand and supply of high medicine use, from both the patients and physicians, but not in all cases. Some patients and physicians emphasize preventive healthcare like having the proper and nutritious diet and non-sedentary lifestyle, to take medicines only when really necessary, like when the disease is spreading fast.

The FDA is monitoring not only good manufacturing practices (GMP), but also good storage (GSP) and good distribution practices (GDP). There is also the "generics only" prescription policy in the public sector, covering physicians in government hospitals and clinics. And FDA will have a "generics fast lane" to fast track the entry of more new generic players.

RUM also covers antimicrobial resistance (AMR) program, truthfulness in medicines promotion, prescription audits, rational prescribing and dispensing guidelines.

So, why the need to promote RUM?
- problems with AMR
- worldwide, over half of all medicines are not appropriately used and dispensed, resulting in wastes if not adverse result to patients
- irrational use and abuse include: (a) non compliance with the treatment, (b) self medication, (c) misuse of anti-microbial among humans and animals, (d) penicillin resistance, about 82.5 percent prevalence rate in the Philippines.

During the open forum, Dr. Delen de la Paz of Health Action Information Network (HAIN) and UP College of Medicine-Philippine General Hospital (UPCM-PGH) suggested the need for right information among patients, and restrict untruthful drug promotions.

I also questioned the quote from Dr. Alran Bengzon (don't know when he said that) saying that medicines are the major component in healthcare. I have 3 examples.

a. My own experience when I suffered food poisoning last month and went to the hospital ER for treatment, medicine cost was only 10.5 percent of total costs, see Drug Price Control 22: Comparing Prices of Drugs, Diagnostic Tests, PFs.

b. My daughter's hospitalization also last month, her medicines bill was only 26.1 percent of the total hospital bill, see PhilHealth Watch 10: Hospital Bill Deductions,

c. And the son (2 years old) of my sister's staff who was also hospitalized last month, the medicines constituted only 9.7 percent of the total hospital bill, see PhilHealth Watch 11: Hospital Bill Deductions (b).

Then I narrated the case of my friend and former classmate from UP, we're of same age, but he's relatively fat, has hypertension and other diseases, he is taking 16 different tablets in the morning and 9 in the evening, a total of 25 different tablets per day! He said that if he skips some of those drugs, he would be trembling sometimes. I told him that I take zero medication, not even vitamins and food supplement. When I get sick, like my recent food poisoning last December due to over-eating (Lifestyle Diseases 9: Overeating and Food Poisoning), then I take medicines. When I get well, I stop taking any medicine, I just focus on taking healthy food, or even "non healthy" food and drinks like my favorite serbesa :-). But I compensate it by having a relatively active lifestyle, like walking about 2 kms a day on average.

(To be continued....)

Welfarism 14: Hard Work vs. Dependence, the Pacquiao Experience

2012-01-30T15:58:00.001+08:00

I saw this photo of Manny Pacquiao in one of my friends' facebook status today, I shared it in my wall and wrote this,

I like this. Hard work, high ambition, sturdy heart, focused mind. Leave the bondying, the cry babies always asking for protection, to mediocrity and poverty.

Some comments from friends:

Tata Very true 'noy! Thanks for spreading the inspiration.
"Our life, our future, is NOT somebody else's decision."
Nonoy Oplas Thanks to all who like. I think there is strong recognition that people taking responsibility of their own lives and that of their household is more important, more sustainable than govt nannying and over-taxing other people to "fight poverty".
Elizabeth Oh wow! That photo speaks for itself. Take responsibility. Take charge of one's own destiny. Of course, we need helpful people and opportunities along the way, but we have to be ready and claim our victory. :)
Vanni Aduentes Fortuna Juvat = Fortune favors the brave, ancient Roman saying.
Roy
Hindi naman lahat ng tao ay may angking talino sa boksing kagaya ni Manny.

Meron din diyang boksingero na nag sakripisyo at naghirap kagaya ni Manny pero dahil sa hindi sila kasing galing ni Manny, hindi sila naging kampeon at naka-ahon sa hirap.

Isang hakbang sa isang maginhawa at mabuting buhay ang pagsisikap, pero hindi porket nagsikap at nagsakripisyo ka ibig sabihin garantisadong magiging maginhawa at matagumpay ang buhay mo.
Nonoy Oplas
Tama Roy. Kung sa simula nag boksing ka at palagi kang talo, ibig sabihin, hindi boksing ang para sayo. Siguro soccer, or cycling, or chess. Kung di pa rin akma ang sports, siguro sa pagtatayo ng barbeque stand, or barber shop, or bake shop. Pag di pa rin akma, siguro sa construction, or farming, or tramspo (say taxi driver). Pag di pa rin akma, siguro sa pagiging seaman or work abroad.

Ibig sabihin, walang limit ang potential ng isang tao, basta may ambisyon at masipag. Ngayon pag sinabi mong "kahit anong sipag mo, baka di rin uunlad buhay mo", aba ang solusyon dyan pwedeng pabandying-bandying, painom-inom gabi-gabi, total may educ for the poor, healthcare for the poor, housing for the poor, agrarian reform and tractors for the poor, cash transfer for the poor, etc. O kaya, maging pulisman, o kaya right hand ni Mayor or congressman at tumulong manloko at magnakaw, quick money, konting hirap pa.

Yes, we need friends and honest supporters, but we also need to show them our sincerity and hard work in pursuing our dreams. And external factors like the government, should not unnecessarily intervene too much. Manny Pacquiao is actually among the rare exceptions. Many good Filipino athletes are ruined by too much politics in Philippine sports -- in athletics, cycling, ballgames, etc. One clear proof is that a country of now almost 100 million people has not produced a single gold medalist yet in any Olympics, would rank low in terms of medal standing even in the Asian Games (dominated by China and S. Korea), or the South East Asian (SEA) Games.

And yes, there is no guarantee that hard work and non-dependence will produce economic miracles to one's life. There are always misfortunes coming from different directions. But the absence of 100 percent guarantee, the presence of possible misfortunes, are no excuse for one to stop being ambitious and do hard work, and shift to dependence. Because the probability of becoming poor by being lazy and dependent is much higher than the probability of becoming economically well-off by being industrious and self-reliant.

Here are more photos of the young Pacquiao, taken from the web.

Last week, I posted in facebook my paper, Decentralization 10: Devolution, Federalism and Subsidiarity, here's the latter exchange with a friend, Star:

Nonoy Oplas I said govt, national and local, should focus on that very important job of stamping out criminality, then get out of endless regulations, like running after smokers, people who put up a carinderia or ambulant vendors, etc. Entrepreneurship is a productive activity, govt should step back.
Star while that is an important job to do, i believe that would be difficult to do until the issue of poverty is addressed.
Nonoy Oplas But poverty is mostly self inflicted. People who don't want to work, or work little and complain a lot then resign afterwards, or people who work 6 days a week and drink and party 7 nights a week and have zero savings, and so on. There will be no successful govt programs to fight poverty. But there can be successful govt programs to fight criminality, especially if the criminals or protector of criminals are within its ranks like the police, military and the judges.
Star then we should work on values as well. while it is true that offenders should really be punished, i think punishment itself is not a deterrent to hard line criminals
January 19 at 10:42pm ·
Nonoy Oplas For hardened criminals, I wish the government to simply shoot them down. Values are often shaped by government policies. When govt rewards laziness and dependence, many people will become lazy and dependent. Why work hard when govt will provide you unemployment allowance, govt will provide you free educ, free healthcare, free or subsidized housing, etc. That is why I argued that govt, national or local, should step back on its non-core function of promulgating the rule of law, of protecting private property rights and people against criminals like thieves, rapists and killers.

I failed to add here that there are dozens of reasons to be poor. People who may or may not work hard but drink and party harder. When emergencies strike, they have very little or zero savings, they sell off some assets or be indebted deeply. Or lose face and self-respect and become dependent forever on some family members.

Too often, welfarism and protectionism (trade, business) creates more weaklings and dependency among the citizens than sturdy people.
---------

See also:
Weekend fun 1: Pac U, November 21, 2010
Roger Federer, Manny Pacquiao and the free market, June 19, 2011
Boxing and Politics (Or Pacquiao as a Boxer and as a Congressman), November 13, 2011
Political Ideology 8: Diskurso sa Kapitalismo, Sosyalismo at Gobyerno, November 15, 2011

Welfarism 9: Conditional Cash Transfer (CCT), November 12, 2010Welfarism 11: Bureaucratizing Entrepreneurs, April 12, 2011
Welfarism 13: Decriminalize Prostitution, January 20, 2012

Weekend Fun 28: Men and Women

2012-01-28T06:00:00.004+08:00

Stories and jokes on "Men vs. Women" are plenty and endless. Here are some of them.

These images and photos are really cool, I enjoyed them.

This man may have married a shopaholic wife (and daughter/s?). Could be one of those very rare "men's right" rallies.

Not too hard to believe. Very lucky guy, indeed :-)

And look at the truck on the left! The driver may have briefly thought that he's Tiger Woods, on women, not on the golf course.

Ahhh, very creative (male) toilet designers. I'm wondering what the counterpart female toilet looks like.

Happy weekend.
----------

See also:

Weekend fun 18. Gloria Arroyo cartoons, June 11, 2011
Weekend fun 19: Sic o Clock News, June 19, 2011
Weekend fun 20: Taga-UP Diliman ka Kung..., August 20, 2011
Weekend fun 21: Humor in global financial turmoil, August 21, 2011
Weekend fun 22: Functions and equations, September 17, 2011
Weekend fun 23: Economists joke, September 24, 2011

Reducing Business Bureaucracies

2012-01-27T12:05:00.002+08:00

Yesterday, a friend working for a big power company here posted in her facebook wall, The Philippine government's attitude towards investments- parang babae na napakasungit sa manliligaw, samantalang hindi naman maganda. (like an ugly woman who is unfriendly to suitors).

To which I replied: And this is supposed to be a liberal government. Liberalism in theory loves free market, dislikes intrusive and bureaucratic govt. Most Filipino liberals do not understand liberalism, only politics and opportunism.

Today, there is this interesting news report,

http://business.inquirer.net/41613/gov’t-launches-one-stop-shop-for-entrepreneurs

Gov’t launches one-stop shop for entrepreneurs

10:27 am | Friday, January 27th, 2012

01616

MANILA, Philippines–President Benigno Aquino III on Friday witnessed the launch of the Philippine Business Registry–a one-stop shop for entrepreneurs that need to transact with several government agencies to start their business.

Trade Secretary Gregory Domingo said the PBR is one of the government’s priority projects to make business registration easier by streamlining the process and eliminating red tape.

Through the PBR, applicants no longer need to physically go to each government agency to start doing business.

These agencies include the Department of Trade Industry, Bureau of Internal Revenue, Social Security System, Pag-IBIG fund, Philippine Health and Insurance Corp., and the Securities and Exchange Commission.

The launch is just the first phase of the program as several other regulatory offices and even local governmentunits will connect to the PBR.

At the LGU level, Quezon City is already connected to the PBR. Cities with streamlined business permits and licensing systems such as Caloocan and Mandaluyong are expected to be linked to the system in the coming months.

PBR kiosks will also be put up in selected LGUs nationwide to facilitate registration in far-flung areas.

This is good news but long overdue. In his first State of the Nation Address (SONA) in July 2010, the President declared,

Ang walang-katapusang pabalik-balik sa proseso ng pagrehistro ng pangalan ng kumpanya, na kada dalaw ay umaabot ng apat hanggang walong oras, ibababa na natin sa labinlimang minuto. Ang dating listahan ng tatlumpu't anim na dokumento, ibababa natin sa anim. Ang dating walong pahinang application form, ibababa natin sa isang pahina.

(Translation: "The endless procedures in registering a business name, which takes between four to 8 hours per day, we will reduce it to 15 minutes. The old requirement of 36 documents, we will bring it down to six. The eight pages application form, we will make it one page.")

See The President's SONA, 2010, July 26, 2010.

I hope this one-stop-shop PBR is not only for starting a business, but also for renewing various business permits of existing businesses.

Ultimately, I wish to see that the number of business permits will be reduced to only two: one for national and one for local. Businesses simply show their transparency to the government, that they are a restaurant and not a beerhouse, that they are a beauty parlor and not a prostitution house, and so on. Local governments should also remove or abolish their multiple business permits -- electrical permit, health and sanitation permit, fire department permit, garbage collection permit, etc. before a Mayor's permit is issued.

Let the liberal leadership of the current administration implement really liberal policies, not bureaucratic and nearly socialistic ones.

Meanwhile, I wrote this last JULY 19, 2010

Unemployment and entrepreneurship

(This is my article for People's Brigada News, July 17, 2010)

Being jobless or unemployed for someone looking for work can be a devastating experience. A person wants to feel “needed” by society for some productive work and yet no one seems to be interested in hiring him/her.

Some people are unemployed because they chose to. Like those with job offers that pay P15,000 per month but they wish to receive at least P20,000 per month, so they reject job offers that pay lower than their expected or “reservation” wage.

An unemployment rate of 2 to 3 percent maybe considered as a “full employment” because those 2 to 3 percent of people who do not have jobs are those that maybe considered as the “voluntarily unemployed”, such as the one described above.

An unemployment rate of 8 percent or higher reflects a problematic economy. Much more for those with 20 percent or higher, like Spain and Latvia in Europe. And if underemployment (those who have jobs already but are looking for additional work) situation is to be added, the situation would look really bad.

Unemployment Rate, in percent, May 2010 (unless specified)

A. Europe
Latvia, 22.5 (April ’10)
Spain, 19.9
Estonia, 19.8 (Q1)
Turkey, 13.7
Ireland, 13.4 (June ’10)
Slovakia, 12.2
Poland, 11.9
Greece, 11.6
Hungary, 11.4
Belgium, 11.3
Portugal, 10.6 (Q1)
France, 9.9
Italy, 8.7
Britain, 7.8
Germany, 7.7 (June ’10)
Russia, 7.3

B. Other rich countries

US, 9.5 (June ‘10)
Canada, 7.9 (June ’10)

New Zealand, 6.0 (Q1)
Australia, 5.1

S. Africa, 25.2 (March ’10)
Israel, 7.2 (Q1)

C. Asia

India, 10.7 (2009)
China, 9.6 (2009)
Philippines, 8.0 (Q2)
Indonesia, 7.4 (Feb. ’10)
Japan, 5.2
Taiwan, 5.2
Hong Kong, 4.6
S. Korea, 3.5 (June ’10)
Malaysia, 3.2 (April ’10)
Singapore, 2.2 (Q1)
Thailand, 1.2 (April ’10)

Source: The Economist, July 15, 2010
http://www.economist.com/node/16592612?story_id=16592612

This is where entrepreneurs and job creators become really relevant. An economy and its government must strive to encourage more entrepreneurship, not discourage and penalize it with lots of bureaucracies and long business requirement regulations.

For the Philippines in particular with 8.0 percent unemployment rate and 17.8 percent underemployment rate, or one out of four able-bodied Filipinos are either unemployed or underemployed, the call for more entrepreneurship and less politics, less taxes and less bureaucracies, is even more relevant.

-------

Lifestyle Diseases 15: Preventing Metabolic Syndrome

2012-01-27T10:59:00.000+08:00

Another good article from a cardiologist-friend, also volunteer consultant to the DOH on non-communicable diseases (NCDs), Dr. Tony Leachon. Healthcare is first and foremost personal and parental/guardian responsibility, not government's. Especially for lifestyle-related diseases where people simply over-smoke, over-eat, over-eat and/or over-sit, and they later get various types of diseases like hypertension, high cholesterol, diabetes, lung/liver/throat/other types of cancer.

Let us guard our own health and that of our households, family and friends. And let us demand less government intervention in healthcare, like more drug price control, more free or highly subsidized medicines for NCDs, more taxes for bigger health subsidies, etc. Let government's intervention in healthcare be limited to infectious diseases, pediatric diseases, and support for people with mental and physical defect.
--------

Metabolic Syndrome: Losing Weight is Key

Anthony C. Leachon, M.D.

The metabolic syndrome is a constellation of 5 risk factors that are associated with increased risk for atherosclerotic cardiovascular disease (ASCVD.. One must have at least three metabolic risk factors to be diagnosed with metabolic syndrome.

• Large waistline. This also is called abdominal obesity or "having an apple shape." Excess fat in the stomach area is a greater risk factor for heart disease than excess fat in other parts of the body, such as on the hips.

• High triglyceride

• Low HDL cholesterol level

• Hypertension

• Diabetes Mellitus

The risk of having metabolic syndrome is closely linked to overweight and obesity and a lack of physical activity. We are in a period where there are more adults die than children, more people are obese than undernourished and more people live in cities than in rural areas.

Waist circumference should be the target of intervention in obese individuals.
Despres et al in 2001 stressed that intervention should aim for a modest reduction of 5% - 10% of initial body weight.

This has been shown to lead to marked reductions in blood pressure susceptibility, a marked improvement in the lipid profile and in insulin sensitivity, as well as improvements in other thrombotic factors and inflammatory markers.

So, just how do you become in control of your weight? The obvious answer is by controlling your diet. But, that answer only leads to another question. Just how does a person control their diet? It's this answer that is the key, and it can all be summed up with one single word... calories.Calories are everything. Let me repeat that. CALORIES ARE EVERYTHING.

Weight control is all about calories. Nothing else comes close. This is not a gimmick or a diet fad either. This is the proven science of the human body. Weight control is all about the battle between calories in and calories out. If they are both equal to each other, your weight will stay exactly the same. But, if one is higher than the other, your weight will change.If you consume more calories than you burn, you gain weight. If you burn more calories than you consume, you lose weight. And, if you both burn and consume the same amount of calories, your weight stays the same.

Obesity has been a great challenge in the modern world. After almost two decades, the USDA food pyramid is history. US First Lady Michelle Obama unveiled last Nov 2011, the USDA's update on America's visual nutrition guide, replacing the familiar - and much maligned - pyramid with a plate.

The new design incorporates seven key dietary messages:

- Enjoy your food, but eat less

- Avoid oversized portions

- Make half your plate fruits and vegetables

- Drink water instead of sugary drinks

- Make at least half your grains whole grains

- Switch to fat-free or low-fat (1 percent) milk

- Compare sodium in foods like soup, bread, and frozen meals.

It is possible to prevent or delay metabolic syndrome, mainly with lifestyle changes. A healthy lifestyle is a lifelong commitment. Successfully controlling metabolic syndrome requires long-term effort and teamwork with your health care providers.
--------

See also:
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
Lifestyle Diseases 11: Obesity and Cancer, January 08, 2012
Lifestyle Diseases 12: On Fat Filipinos, January 17, 2012
Lifestyle Diseases 13: Curbing and Preventing NCDs, January 17, 2012
Lifestyle Diseases 14: Transformative Education on Health, January 18, 2012

RUM 1: Reducing Medicine Abuse

2012-01-25T18:35:00.008+08:00

I am starting a new thread in healthcare, the "rational use of medicines" or RUM. This will be the 7th thread or sub-topic under health topics in this blog. The other 6 and their latest issues are:

1. Drug Price Control 24: Forcing Drug Firms to Report Payment to Doctors, January 24, 2012
2. PhilHealth Watch 11: Hospital Bill Deductions (b), January 19, 2012
3. Lifestyle Diseases 14: Transformative Education on Health, January 18, 2012
4. IPR and Medicines 20: Scherer Paper on Pharmaceuticals R&D, January 12, 2012
5. Healthcare Competition 14: Centralization vs. Deregulation of Healthcare, December 31, 2011
6. Generic Drugs Asia 4: Vaccines from China, November 29, 2011

The reason why I open a new thread on RUM is because I attended the DOH Consultative Meeting on the National Framework on Rational Use of Medicines (NaFRUM), Consumer Group, yesterday at the DOH compound. The DOH is planning to issue a new Administrative Order (AO) on RUM, and they are doing a consultative meeting for various sectors (academe, government agencies, pharma industry, hospitals and drugstores, consumer groups).

I was actually curious what's this new initiative by the DOH, why another AO, can't this subject be not implemented under existing programs? That is why I attended the consultation. Almost all participants who came yesterday were also from member-NGOs of the Coalition for Health Advocacy and Transparency (CHAT). Like leaders from HealthWatch and MeTA-Philippines (former Gov. Obet Pagdanganan, Cecile Sison), COPA, Botika Binhi, AltHealth, Woman Health, Kilos Damit, HAIN, etc.

The event was organized by the National Center for Pharmaceutical Access and Management (NCPAM), the lead agency under the DOH in implementing the Philippine Medicines Policy (PMP), like generics promotion, Botika ng Barangay (BnB) or village pharmacy, P100 or Compact Treatment program, drug price control and related programs and policies.

New NCPAM Director, Dr. Ma. Virginia Ala, MD, Director IV, gave the opening and welcome message. She mentioned some pathetic sights like so many softdrinks in elementary kids' canteen and diet, junk and fatty/preserved foods on toddlers and children's diet, which are unhealthy food and contribute to future diseases someday, which will require new medicines and other treatment. That was a good observation by Dr. Ala. She bolstered my repeated argument: healthcare is first and foremost, personal and parental/guardian responsibility, secondarily as government responsibility. I believe that government should come in only in controlling infectious and communicable diseases, in treating pediatric diseases, and helping people with mental and physical disabilities because the treatment and theraphy for such conditions are usually very high and expensive.

Dr. Irene Farinas of NCPAM gave an overview about their office and its major activities, as well as some facts on Philippine health and pharmaceutical situation. Here are some interesting facts (at least for me) that she shared:

1. Drug price control via maximum retail price (MRP) -- but the illegal terms and concepts GMAP and MDRP are still used by the DOH -- is now a regular (and long-term?) policy under "Affordable medicines" program.

2. Lots of interventions to keep drug prices as low as possible, some to be given out free as regular entitlements for the poor. Such interventions aside from MRP are the BnB, mandatory 20 percent discounts for senior citizens (RA 9994), generics promotion, etc.

I have argued in the past in this blog that drug price control policy -- forcing the more popular, more saleable branded drugs by the innovator and MNC companies to become -- contradicts and defeats the generics promotion policy, as people shift from the lesser known generics to the more popular innovator branded drugs. The DOH never took notice of this. Or they may, but the politics behind such policy declaration in 2009 has overtaken it and the politics of the current administration still prevails to keep that wrong policy.

3. BnB is a popular program that contributed to cheaper and more accessible medicines in more barangays or villages nationwide. Here are the relevant slides she presented.

But the program is also problematic not only in terms of maintenance but also because it is easily hijacked by the local politicians during elections. Now there are 16,350 BnBs nationwide (as of June 30, 2011) that cost the DOH P567 million so far, and there are variants, like Botika ng Manggagawa (workers' pharmacy), Botika ng Taumbayan (people's pharmacy). Seed capital is P50,000 per outlet, targetting 100 outlets or P5M.

4. The P100 or Compact Treatment program is tied up to the DSWD's 4Ps or conditional cash transfer (CCT) program, provided the poor are registed with the DSWD and are PhilHealth member under the sponsored program.

Makes one think, it really pays to remain poor forever for some people: free cash, free PhilHealth membership, super-subsidized medicines, free education, subsidized housing, etc. And since these programs have no titmetable, they are forever programs, why aspire to get out of poverty? Or why not pretend to be poor even if actual income has actually increased? But I digress....

5. Entitlement (or free) medicines program, at least for fixed number of beneficiaries: leukemia (ALL-L2), breast cancer (stages 1 and 2), anti-rabies, Vitamin A for pregnant women, TB (AFB smear, insulin (for diabetics), Fluids (for DOH hospitals), Valsartan (for hypertensive), Rotavirus (for 0-6 months old babies), BEMONC (for women of reproductive age).

6. Outpatient benefits (OPB) will soon be shouldered by PhilHealth, by 2016. This will be both good news and bad news. The good news is that all members, not just the sponsored or indigent group, will be covered by OPB; the bad news is that this will most likely require more or higher monthly contribution, both employers and employees.

These are the additional entitlement medicines. They will not just be "cheaper medicines" but "free medicines", for certain diseases.

7. Electronic drug price monitoring system (EDPMS), forcing drugstores, chain or non-chain, to regularly upload their drug prices to the DOH's EDP, to enable the consumers to compare prices of drugs among competing drugstores and pharmacies. I think this is cool, if the cost of compliance is low. If compliance cost is high, say for the small chain (2-3 stores) or single drugstores with a non-computerized system, this requirement means additional cost which they will have to pass on to the consumers, resulting in higher drug prices. The website of the EDPMS is http://uhmis.doh.gov.ph/eedpms.

In a free market situation, sellers develop their own brand and corporate image. Say drugstore chain A is very clean, all outlets are air-con, in strategic places and corner stores, have licensed pharmacists all the time, etc., and their drug prices are generally high. Drugstore chain B is also clean, all outlets are air-con, in malls, and their prices are a bit lower or higher than A. Drugstore chain C have cheap drugs but their outlets are non-air con, in less convenient areas, the staff may not be licensed pharmacists, etc. And so on. So people and consumers can expect certain drug prices even without checking the DOH's EDP and the internet. There is a tradeoff between drug prices and convenience, of being in a good brand or lesser-known brand drugstore.

There was a discussion and exchange after Dr. Farinas' presentation. Gov. Obet asked what constitutes "generic medicines" and "branded medicines". I followed it up by asking if all products of Unilab for instance, a domestic generic manufacturer, can be considered as "branded medicines" since all their products have brands (Biogesic and Tempra for paracetamol, for instance). NCPAM guys said Yes.

I shared what I learned from Lyle Morrel of Watsons, and from Joey Ochave of Unilab, that there are 3 types of generic drugs in the Philippines:

a. product-branded generics
b. company-branded generics
c. generic-generics.

Examples of (a) are Biogesic, Tempra, etc. (for paracetamol)
Examples of (b) are RiteMed, "Unilab yan", "Pharex yan", "Alagang Pfizer", etc.
(c) would have no product brand, only the name of the molecule, and a small label for the name of the manufacturer, its address, etc.

The Generics Law of 1988 actually referred to (c) only and would consider (a) and (b) as belonging to "branded medicines" already. The (c) constitutes a very small portion of Philippine pharmaceutical products, perhaps just 5 percent, or even less.

The discussion later shifted to lifestyle diseases. I am happy to hear that more NGO leaders now realize the need to focus on preventive healthcare as the bulk of DOH and LGUs' health activities are focused on treatment and curative healthcare. People are sick of various diseases, government instantly think of medicines and how to make them more affordable, more accessible.

(To be Continued...)

Climate Tricks 2: Solar Activities (TSI, Ap index, Neutrons) Don't Matter

2012-01-25T06:30:00.000+08:00

One of the climate tricks by the anthropogenic global warming (AGW) proponents is to almost totally ignore the role of the Sun on our climate. Thus, they do not pay any attention to solar activities as measured by total solar irradiance (TSI), geomagnetic field or the Ap index, and neutron count, among others.

Here are two recent papers by Australian geologist David Archibald, both posted in http://wattsupwiththat.com. Dr. Archibald is saying that as the current solar cycle 24 (one solar cycle is 11 years on average, some are shorter, some are longer) is projected to be long, probably 18 years. Longer time for the Sun to ramp up, global cooling happens and is extended.

I added a 3rd paper from http://notrickszone.com/ by Pierre Gosselin, more peer reviewed papers are coming out saying "It's the Sun, Stupid".

So even if each person on the planet will be riding a car and the number of SUVs will double to its current number, global cooling will still happen. So what's the fuss about all those UN and government efforts to "fight global warming and climate change" and "save the planet"?
-----------

(1) Solar Cycle 24 Length and Its Consequences

Posted on January 8, 2012 by Anthony Watts

Guest post by David Archibald

Solar Cycle 24 is now three years old and predictions of the date of solar maximum have settled upon mid-2013. For example, Jan Janssens has produced this graph predicting the month of maximum in mid-2013, which is 54 months after the Solar Cycle 23/24 minimum in December 2008:

For those of us who wish to predict climate, the most important solar cycle attribute is solar cycle length. Most of the curve-fitting exercises such as NASA’s place the next minimum between 2020 and 2022 (eg: http://wattsupwiththat.com/2011/11/06/nasas-november-solar-prediction/). Solar minimum in December 2022 would make Solar Cycle 24 fourteen years long, which in turn would make the climate of the mid-latitudes over Solar Cycle 25 about 1.0°C colder than the climate over Solar Cycle 24.

Curve-fitting leaves a lot to be desired. Even late in the progression of Solar Cycle 23, the curve fitters in NASA had poor predictive ability.

Examination of Altrock’s green corona emissions plot from mid-2011 suggests that a new predictive tool is available to us. The original is available here:

http://www.boulder.swri.edu/~deforest/SPD-sunspot-release/6_altrock_rttp.pdf

This is my annotated version:

Altrock had observed that solar maximum occurs when the “rush to the poles” reaches 76°. The magnetic poles of the Sun reverse at solar maximum, which is also considered to be the beginning of the new extended solar cycle.

We also observe that solar minimum for the last four minima has occurred when emissions are exhausted at 10°. The latitude of 10° is shown as the red line on the diagramme. Further to that, the last two solar cycles show that the month of minimum can be predicted by drawing a line between solar maximum (the point at which the rush to the poles intersects 76°) and the point of exhaustion at 10°. The bulk of activity is bounded by this line.

Altrock has noted that the “rush to the poles” in Solar Cycle 24 is much weaker and much slower than in previous solar cycles. The line he has drawn intersects 76° in mid-2013, consistent with other predictions of Solar Cycle 24 maximum.

The shape of the emission regions also suggests that Solar Cycle 24 will be quite extended. The blue bounding line from the Solar Cycle 23 maximum intersects 10° latitude in 2026, making Solar Cycle 24 eighteen years long.

That would be an exceptionally long solar cycle. The most recent cycle that neared that length was the seventeen years from the maximum of Solar Cycle 4 to the maximum of Solar Cycle 5. Prior to that, the Maunder Minimum had some very long solar cycles as interpreted from C¹⁴ data:

It seems that the first solar cycle of the Maunder Minimum was also eighteen years long.

An eighteen year long Solar Cycle 24 would be very significant in that it would be five and a half years longer that Solar Cycle 23. With the solar cycle length/temperature relationship for the US-Canadian border being 0.7°C for each year of solar cycle length, a further cooling of 3.8°C is in train for next decade. The evolution of Altrock’s green corona emissions diagramme as a predictive tool will be followed with some interest.

Back to the subject of curve-fitting, it may be still too early to call Solar Cycle 24 using that technique. The following graph shows the raw monthly data for sunspot number amplitude for Solar Cycles 5 and 6 (the Dalton Minimum) with Solar Cycle 24 to date aligned on the month of minimum. Solar Cycle 5 took about four years to get going before it had a sudden burst, and then died off over the following ten years. It is still a bit too early to be certain about how Solar Cycle 24 will shape up.

And here's the 2nd article by Dr. Archibald.

(2) Ap Index, Neutrons and Climate

Posted on January 21, 2012 by Anthony Watts

Guest post by David Archibald

Figure 1: Ap Index 1932 – 2012

The Ap Index is the weakest of the solar activity indicators and has returned below the floor value of solar minima over the last 80 years – the green line in the chart above.

Figure 2: Solar Cycles 20 and 24 Ap Index and Neutron Count

The last time there was a cooling event in the modern instrument record was during Solar Cycle 20. Aligned on the month of minimum, Figure 2 shows that while the Ap Index and neutron count are co-incident to date in Solar Cycle 24, they were quite divergent over two thirds of Solar Cycle 20.

Figure 3: Neutron Counts over Solar Cycles 20 to 24

One big difference between Solar Cycle 20 and the other solar cycles of the modern instrument record is that just over half way through the cycle, the neutron count returned to levels of solar minima and remained there for the balance of the cycle. That is shown in Figure 3 above which also shows that the neutron count of Solar Cycle 24 is yet to depart from levels associated with previous minima, three years into the solar cycle.

Further to the post on Solar Cycle 24 length based on Altrock’s green corona diagram at:

http://wattsupwiththat.com/2012/01/08/solar-cycle-24-length-and-its-consequences/, Altrock noted the slow progress of Solar Cycle 24 in mid-2011. From Altrock, R.C., 2010, “The Progress of Solar Cycle 24 at High Latitudes”:

“Cycle 24 began its migration at a rate 40% slower than the previous two solar cycles, thus indicating the possibility of a peculiar cycle. However, the onset of the “Rush to the Poles” of polar crown prominences and their associated coronal emission, which has been a precursor to solar maximum in recent cycles (cf. Altrock 2003), has just been identified in the northern hemisphere. Peculiarly, this “rush” is leisurely, at only 50% of the rate in the previous two cycles.”

Altrock’s green corona diagram is available here:http://www.boulder.swri.edu/~deforest/SPD-sunspot-release/6_altrock_rttp.pdf

If Solar Cycle 24 is progressing at 60% of the rate of the previous two cycles, which averaged ten years long, then it is likely to be 16.6 years long. Using that figure of 16.6 years would make Solar Cycle 24 seven years longer than Solar Cycle 22. Using a solar cycle length – temperature relationship for the US – Canadian border of 0.7°C per year of solar cycle length, a total temperature decline of 4.9°C is predicted over a period of about twenty years.

Has a fall of that magnitude happened in that time frame happened in the past? A good place to look is the Dye 3 temperature record from the Greenland Plateau, available here:ftp://ftp.ncdc.noaa.gov/pub/data/paleo/icecore/greenland/gisp/dye3/dye3-1yr.txt

Figure 4: Dye 3 Temperature Record from Oxygen Isotope Ratios

There is plenty of noise in this record and rapid swings in temperature, for example the 5.2°C fall from 526 to 531 at the beginning of the Dark Ages.

Figure 5: Dye 3 Temperature Record 22 Year Smoothed

Averaging the Dye 3 temperature record using the 22 year length of the Hale Cycle produces a lot of detail. What is evident is that there has been a very disciplined temperature decline over the last four thousand years. The whole temperature record is bounded by two parallel lines with a downslope of 0.3°C per thousand years. The fact that no cooling event took the Dye 3 temperature below the lower bounding green line over nearly four thousand years is quite remarkable. It implies that solar events do not exceed a particular combination of frequency and amplitude. From that it can be derived that this particular combination of frequency and amplitude with be ongoing – that is that cooling events will happen just as frequently as they did during the Dye 3 record.

Figure 6: North – South Transect through the Grain Belt

The relationship between temperature and growing conditions at about the latitude of the US – Canadian border is that one degree C will shift growing conditions by about 140 km. With a total 4.9°C temperature decline in train, that means a shift of about 700 km. Figure 6 shows the result of that temperature decline. Witchita will end up with the climate of Sioux Falls, which in turn will be like Saskatoon now. The growing season loses a month at each end.

(3)

More Peer Reviewed Papers Showing “It’s The Sun, Stupid!”

By P Gosselin on 24. Januar 2012

One of the IPCC’s most dubious achievements is ignoring so many papers showing that the sun plays a huge role in our climate. The sun play a role? Yeah, right!

A reader brings our attention to some recent papers showing that the sun plays a major role on climate, not that the IPCC will be the least bit interested. Here are a few in case you may have missed any.

1. Variations in tree ring stable isotope records from northern Finland and their possible connection to solar activity; Ogurtsov et al, 2010, see abstract here.

Statistical analysis of the carbon and oxygen stable isotope recordsr eveals variations in the periods around 100, 11 and 3 years.A century scale connection between the 13C/12C record and solar activity is most evident.”

2. A possible solar pacemaker for Holocene fluctuations of a salt-marsh in southern Italy; Di Rita, 2011 abstract here.

The chronological correspondence between the ages of saltmarsh vegetation reductions and the minimum concentration values of 10Be in the GISP2 ice core supports the hypothesis that important fluctuations in the extent of the salt-marsh in the coastal Tavoliere plain are related to variations of solar activity.”

3. Solar and volcanic fingerprints in tree-ring chronologies over the past 2000 years; Breitenmoser et al, 2012

Results from wavelet analysis and SEA reveal significant periodicities near the solar DeVries frequency in the volcanic and residual ‘volcano free’ contributions during the LIA, making a clear separation of the solar and volcanic forcing signals difficult. Nevertheless, the ‘volcano free’ temperatures show significant periodicities near the DeVries frequency during the entire past 1500 years, pointing to a solar imprint on global climate.

4. Holocene hydrological changes in south-western Mediterranean as recorded by lake-level fluctuations at Lago Preola, a coastal lake in southern Sicily, Italy; Magny et al, 2011, see abstract here.

This major oscillation may be related to a non-linear response of the climatic system to the gradual decrease in insolation, in addition to seasonal and inter-hemispherical changes in insolation. Another major climate oscillation around 7500 – 7000 cal BP may have resulted from combined effects of a strong rate of change in insolation and of variations in solar activity.”

5. Variations in climate parameters at time intervals from hundreds to tens of millions of years in the past and its relation to solar activity; Raspopov et al, 2010, see abstract here.

Our analysis of 200-year climatic oscillations in modern times and also data of other researchers referred to above suggest that these climatic oscillations can be attributed to solar forcing. The results obtained in our study for climatic variations millions of years ago indicate, in our opinion, that the 200- year solar cycle exerted a strong influence on climate parameters at those time intervals as well.”

6. Climate patterns in north central China during the last 1800 yr and their possible driving force; Tan et al, 2011, see abstract here.

Solar activity may be the dominant force that drove the same-phase variations of the temperature and precipitation in north central China.

7. Multifractal Detrended Cross-Correlation Analysis of sunspot numbers and river flow fluctuations; Hajian, 2010, see abstract here.

Our results show that there exists a long-range cross-correlation between the sunspot numbers and the underlying streamflow records.”

Doesn’t Hajian work for the Iranian gas and oil industry?
---------

Other independent scientists, the astrophysicists especially, even if they are also skeptical of AGW hypothesis, are not that convinced of Dr. Archibald's analysis. But the difference among them are relatively minor, compared to those scientists and environmental groups who totally disregard the role of the Sun and are too focused on regulating and taxing human activities and energy use.

* See also:
Climate Tricks 1: 4.5 Billion People to Die This Year, January 03, 2012
Climate Stupidity 25: Wetter or Drier, We Send them More Money, December 29, 2011
Climate Stupidity 24: Environmental NGOs as Climate Saviours, December 13, 2011

Drug Price Control 24: Forcing Drug Firms to Report Payment to Doctors

2012-01-24T18:11:00.000+08:00

The US government is planning to force American drug firms to be transparent in their payment and gifts to physicians. Now this is not exactly or directly a government price control policy. This more of an indirect one -- using the government's regulatory and penalty powers to bring down certain costs of marketing and trading, and hoping that in the process, prices of medicines will go down further. Here's the NYT report:

http://www.nytimes.com/2012/01/17/health/policy/us-to-tell-drug-makers-to-disclose-payments-to-doctors.html?_r=1&emc=eta1

U.S. to Force Drug Firms to Report Money Paid to Doctors

By ROBERT PEAR

Published: January 16, 2012

WASHINGTON — To head off medical conflicts of interest, the Obama administration is poised to require drug companies to disclose the payments they make to doctors for research, consulting, speaking, travel and entertainment.

Many researchers have found evidence that such payments can influence doctors’ treatment decisions and contribute to higher costs by encouraging the use of more expensive drugs and medical devices.

Consumer advocates and members of Congress say patients may benefit from the new standards, being issued by the government under the new health care law. Officials said the disclosures increased the likelihood that doctors would make decisions in the best interests of patients, without regard to the doctors’ financial interests.

Large numbers of doctors receive payments from drug and device companies every year — sometimes into the hundreds of thousands or millions of dollars — in exchange for providing advice and giving lectures. Analyses by The New York Times and others have found that about a quarter of doctors take cash payments from drug or device makers and that nearly two-thirds accept routine gifts of food, including lunch for staff members and dinner for themselves.

The Times has found that doctors who take money from drug makers often practice medicine differently from those who do not and that they are more willing to prescribe drugs in risky and unapproved ways, such as prescribing powerful antipsychotic medicines for children.

Under the new standards, if a company has just one product covered by Medicare orMedicaid, it will have to disclose all its payments to doctors other than its own employees. The federal government will post the payment data on a Web site where it will be available to the public.

Manufacturers of prescription drugs and devices will have to report if they pay a doctor to help develop, assess and promote new products — or if, for example, a pharmaceutical sales agent delivers $25 worth of bagels and coffee to a doctor’s office for a meeting. Royalty payments to doctors, for inventions or discoveries, and payments to teaching hospitals for research or other activities will also have to be reported.

The Obama administration estimates that more than 1,100 drug, device and medical supply companies will have to file reports, generating “large amounts of new data.” Federal officials said they would inspect and audit drug company records to make sure the reports were accurate and complete.

Companies will be subject to a penalty up to $10,000 for each payment they fail to report. A company that knowingly fails to report payments will be subject to a penalty up to $100,000 for each violation, up to a total of $1 million a year.

Top executives are potentially liable because a senior official of each company — the chief executive, chief financial officer or chief compliance officer — must attest to the accuracy of each report.

The new requirements, or something very similar, will take effect soon; in fact, they are overdue. Under the new health care law, the administration was supposed to establish payment-reporting procedures by Oct. 1, 2011. The public will have until Feb. 17 to comment on the proposals, which are broadly consistent with the expectations of industry and consumer groups. After considering the comments, Medicare officials will issue final rules with the force of law.

Consumer advocates have long demanded details of the financial ties between doctors and drug and device companies.

Allan J. Coukell, a pharmacist and consumer advocate at the Pew Charitable Trusts, said: “Patients want to know they are getting treatment based on medical evidence, not a lunch or a financial relationship. They want to know if their doctor has a financial relationship with a pharmaceutical company, but they are often uncomfortable asking the doctor directly.”

In an introduction to the proposed rules, the Obama administration says that patients can benefit when doctors and the industry work together to develop life-saving drugs and devices. But, it said, these relationships can also “lead to conflicts of interests that may affect clinical decision-making” and “threaten the underlying integrity of the health care system”....

I think this is good news. Both innovator and generic manufacturers should be subjected to transparency pressure, not only in the US but also in the Philippines, elsewhere. In the US as of 2008, 69 percent of total pharma market by volume was accounted for by generic manufacturers, although these producers account for only 13 percent by value, see data and graph here, Generic Drugs Asia 3: FDAs and the Consumers, November 25, 2011.

About two years ago, the Pharmaceutical and Healthcare Association of the Philippines (PHAP) sponsored a social dialogue with member-NGOs of the Coalition for Health Advocacy and Transparency (CHAT) of which MG Thinkers is a member. Among the topics discussed, PHAP discussed their Code of Ethics, which explicitly limits and restricts their member pharma companies' gifts and payment to physicians and the latter's non-medical activities like a sports/touring event. Many CHAT and MeTA leaders expressed surprise at their strict code, including CHAT Chairman, former Gov. Obet Pagdanganan.

I know that the Philippine Chamber of Pharmaceutical Industry (PCPI) does not have a code of ethics imposed on its members, like limiting or restricting their member pharma companies' gifts to physicians. I hope they will have one too someday, I know the PCPI leaders, they are good gentlemen and good friends of mine.

About 60 percent (or more) of total Philippine pharma market is accounted for by the national and local generic companies. United Laboratories (Unilab) alone corners about 24 percent of total pharma market, larger than the combined sales of the 2nd, 3rd and 4th (GSK, Pfizer and Roche or MSD, am not sure of the 4th).

So any government policy and pressure towards transparency should apply to all players -- innovator pharma, generic pharma, importer pharma, both multinationals and local. I think some innovator pharma give gifts to physicians so that the latter will prescribe their more expensive drugs. The local generic pharma also give gifts to physicians so that the latter will endorse/prescribe their lesser known drugs. The importer pharma also do for the same reason.

One problem with this policy should it be applied here, is that this will be another job that will require additional monitoring by the DOH and/or FDA. The DOH cannot even properly monitor if the money they give to DOH-attached hospitals, or the money they give to Botika ng Barangay (BnB), or money spent on other programs, are properly utilized and not wasted or stolen.
--------

See also:
Drug Price Control 23: Greece's Pharmacy Nightmares, January 13, 2011
Drug Price Control 22: Comparing Prices of Drugs, Diagnostic Tests, PFs, December 24, 2011.

Decentralization 10: Devolution, Federalism and Subsidiarity

2012-01-21T15:05:00.000+08:00

I posted my paper, Decentralization 9: Ben Diokno Says Recentralize, in the CORRECT Movement (Constitutional Reform & Rectification for Economic Competitiveness & Transformation Movement) group in facebook because that group is advocating "evolving federalism" plus two other issues, economic liberalization and Parliamentary form of government. The exchange has expanded into a long discourse.

Below are the exchanges -- with explicit permission from Carlos Tapang and implicitly from Paul Alli (Paul is a friend way back in the 80s in UP, Carlos I have met 2 years ago) -- minus the comments from Orion Perez, the main convenor of CORRECT Movement. He does not want his comments to be publicized.

Nonoy Oplas

The subsidiarity principle is very radical, it says that if the smallest social unit can do a task, no need to give it to the higher social or political unit. The smallest social unit in society is the individual, then the household. If an individual can do a task by himself, like taking care of his/her body and health, then there will be no or little need for govt healthcare program, especially for non-communicable diseases (NCDs).

22 hours ago ·
Paul Alli There is a much more cogent reason why decentralization is necessary- the unequal development of regions.
21 hours ago · · 1
Nonoy Oplas But that is why Ben Diokno shot down in his presentation, he said that decentralization is a failure in reducing inequity bet and among regions and LGU localities, that is why he is arguing that the natl govt should do that job, not the LGUs themselves.
20 hours ago ·
Paul Alli Because of corruption among LGU officials. There should be a check and balance bet natl govt and local govt. One sad case is Samar.
20 hours ago ·
Nonoy Oplas

Yes, corruption is endemic in both national and local governments. That is why I argued in my paper that we need less and small government, both at the national and local levels. Government should focus on stamping out criminality, protect private property rights and the citizens from killers and other criminals. But government, both national and local, veered into so many sectors and areas, because that's where corruption and extortion can be maximized, like controlling "illegal gambling", "Illegal drugs", "Illegal prostitution", etc.

19 hours ago · · 2
Carlos C Tapang

This is very good discussion. I think we should think of government power in terms of points being allocated instead of "areas of responsibility". The problem with thinking in terms of area of responsibility is that those in the national government can claim that because the whole country is their responsibility, it is OK for them to meddle in local affairs. This is the part of centralization that is bad, in my opinion. If we think in terms of power points to be allocated, there should be not so many points allocated to the central government, because otherwise there would be no points left to each of the regions or provinces. Allocate only 10% of the power points to the central government, and give 90% to the LGUs. What this means in practice, with regards to taxation, for example, is that the central government should collect only as much as 10% of the total tax revenue. For each taxpayer, the local government can tax say 9% max, and the national government only 1%.

15 hours ago · · 1
Carlos C Tapang

Our situation in Pinas is the opposite of what is desirable: 90% of the power points is concentrated in the central government, 9% to local governments, and 1% to each individual.

We experience this power on a daily basis. Observe how even the lowest government official behave towards citizens. Go to the local SSS office and see how many people line up for service at any one time. When you finally reach the end of the long line and are finally able to talk to a clerk, observe how the clerk feels more important than you are. Compare that to the behavior of a bank teller in a well-run bank. The government clerk feels no compunction to demand a requirement that you forgot to do, like filling up another form, or getting the signature of somebody else. It does not matter how minor the missing paper is, it must be with you; if not, you either go fill that silly piece of paper and go back to the other end of the line, or worse, come back some other time.

We have to deal with the central government in most that we do. If we want to buy land, the title gets registered all the way to Manila. If we want to start a business, our corporation papers gets filed with the central government and not the local government. The central government is like a bad CEO who doesn't know how to delegate, who can't trust anybody else to do something well, so he does everything himself, to the detriment of the whole company.

14 hours ago ·
Nonoy Oplas

I think local govts are more notorious in imposing stupidity than the central or national govt. Take makati city. So many NOs, Donts, Prohibitions. Buendia and its long blocks is now "No Jaywalking". They say they want people to commute and walk, to leave their cars at home to reduce traffic, but they make crossing streets hard and bureaucratic, penalty is P200 and you have to get your ID at a far out office. Ayala ave is "No loading here, walk to the next block" and "No unloading here, walk to the next block" (about 250 meters away).

These may seem trivial but if you are subjected to these types of inanities and stupidity every day, you won't be happy. I don't think a central govt would think of this type of stupidity, but a local govt can. That's why I'm never a fan of decentralization or devolution or even federalism/autonomy if such will mean worse bureaucracies at the local levels.

12 hours ago ·
Carlos C Tapang

Let's look at this more closely. At some point, yes, we can say that some traffic rules are just silly. The question is whether you prefer such silly traffic rules to come from the central government (in which case all traffic rules in Pinas would be uniformly silly), or from the local government (in which case there is no uniformity and one locality can have silly rules and people disobey them all the time and get a away with it, while another locality has simple rules and people seem tame enough).

Here's one reason why you want it local and non-uniform: the word is competition. As Orion has just written about, competitition is what will slowly drive local laws and ordinances to parity. I took a taxi once from Pasay to Cubao, and the driver asked permission, before we got started, to avoid Makati roads. I asked why, and the answer was because of the silly traffic rules that you mentioned. People will avoid localities with silly rules and very high local taxes. Businesses, when locating their branches, certainly look at how rational local governments are, among other things.

The funny thing about local autonomy and uniformity is that, the more local autonomy we have, the more the LGUs tend towards uniformity, because of competition. Here in the US there is variety in certain local ordinances: there are subtle differences among cities, and glaring differences among states. But there are certain things like how easy it is to set up a corporation that trends towards uniformity: there is clearly competition on which state it is easiest to setup a corporation. It used to be that Delaware was the easiest state to setup a corp. Now most states have changed their laws to make it even easier to setup shop. Here in Washington I can setup a corp in less than a day, and less than $200, without ever going to a state government office (I just visit the secretary of state website).

Of course, there are certain things that will always be different among localities, and this then is what would give them their own character. Our ideal should be not one color for all of Pinas, but rather an array of bold colors to start with, which would gradually dissolve naturally into pastel colors, with each locality having its own natural color.

11 hours ago · · 2
Carlos C Tapang

Instead of micro-managing the different localities, the central government should be limited in what it can do. The central government should be limited, as much as possible, to only enforcing simple rules on local government, rules that should be written in the constitution. For example, the Bill of Rights should be uniformly applicable everywhere, and there can be no local ordinance or rule that can contradict any section of the Bill of Rights. Another example of a simple rule that the central government can and should enforce on all localities is a lmit on taxation: the constitution should limit local income taxes to a maximum of, say, 10% or less. Of course, the same constitution should also limit what the central government can collect, which should even be less (as a percentage of individual income, but not necessarily as a percentage of total govt revenues) than what the LGUs are allowed to collect.

11 hours ago · · 3
Paul Alli

Decentralization, federalism and local autonomy are concepts meant to free up the potential of local regions to develop itself without much assistance from the national govt. In fact, by virtue of local autonomy parts now of Mindanao, esp ARRM, is moving on its own. But despite this, there is still glaring poverty in the area because of warlordism. We have to recognize the fact that Philippines have unequal development brought forth by colonialism and feudalism. The structures of feudalism still prevails in some areas, and some has been masked by corporatism- or stock distribution e.g hacienda luisita- in order to circumvent modernization of regions. If we really need to get Free Market principles going, federalism shouldl be implemented on a nation-wide scale making regions or LGUs compete among themselves by enticing investors, tourists, transient class, and businessmen to locate or relocate or even travel to better places, be it under a Parliamentary form or Presidential form. I am reminded of my 7 year stay in America. I can always choose to locate in different states offering the best opportunities in life. I moved around from coast to coast searching for the American dream. I ended up now working out here in Samar to develop the coconut industry.

4 hours ago · · 1
Nonoy Oplas It's unfortunate that Orion equates disagreement or agnosticism with federalism aka region-based decentralization as "extremist and knee-jerkishly dogmatic and narrow-minded interpretation...".

My concept of subsidiarity is that if things can be done by the individual and households, them as the smallest social and political unit in society, then don't give it to higher political units -- barangay, city, province or federal governments. Take healthcare, do we need any local or national govt to remind people that over-drinking, over-smoking, over-eating is bad for one's health? Preventive healthcare in this case won't need govt, local or national, autonomous or federal, it purely falls on the level of the individual, the household and civil society. Even healthcare financing can be done at the personal and household or enterprise level too, people getting their private health insurance. To insist that we still need govt even in simple cases like preventive healthcare, local or national, for me is wrong. Privatization of certain functions, not just decentralization or devolution, is more economical as this will enhance more personal and parental/guardian responsibility.

I left the CORRECT Movement fb group today. Below is my last comment to the group before I clicked "Leave Group". Nonetheless, I thank Orion for the opportunity to exchange notes with him and many of his followers in the said movement.

Orion, a few months ago, I already asked you if you will accommodate people here who only believe in free market, and is/are indifferent on the 2 others -- federalism and parliamentarism. You said fine, so I stayed. Until now, I remain indifferent and agnostic -- someone who neither believes or disbelieves on something, simply indifferent -- about those federalism and parliamentarism. I don't agree with your defiinition of agnosticism of "does not know". For me, neither believe nor disbelieve. Sa tagalog, wala akong paki, ang paki ko lang ay economic liberalization and less government.

From your points above, there is clear message of your intolerance to agnosticism to the 2 other programs of CORRECT, like repeated use of "knee jerkish dogmatism". Fine. If being in this movement means obedience to all 3 advocacies so as not to be labelled as knee-jerk dogmatism, then this group is not for me. Thank you.
--------

See also:

Decentralization 1: It's Still More Government, July 25, 2007

Decentralization 2: From Local Government to Civil Society, August 30, 2008

Decentralization 3: Challenges to Local Government, November 18, 2008

Weekend Fun 27: Physics Jokes

2012-01-21T07:00:00.042+08:00

I have posted here Weekend fun 15: Political jokes, Weekend fun 21: Humor in global financial turmoil, Math jokes - Weekend fun 22: Functions and equations, and Weekend fun 23: Economist Jokes, it's now time for physics jokes.

1. A hydrogen atom lost its electron and went to the police station to file a missing electron report.
Police: "Haven't you just misplaced it somewhere? Are you sure that your electron is really lost?"
Atom: "I'm positive."

2. A seminar on time travel will be held 2 weeks ago.

3. A rocket explorer named Wright
Once traveled much faster than light.
He sat out one day
In a relative way,
And returned on the previous night.

4. Gravity was discovered by Sir Isaac Newton. It is chiefly noticeable in the autumn, when the apples are falling off the trees.

5. You can listen to thunder after lightning and tell how close you came to getting hit. If you don't hear it, you got hit, so never mind.

6. When people run around and around in circles, we say they are crazy. When planets do it, we say they are orbiting.

7. The tides are a fight between the Earth and moon. All water tends towards the moon, because there is no water in the moon, and nature abhors a vacuum.

8. To remove air from a flask, fill it with water, tip the water out, and put the cork in quick before the air can get back in.

9. Isn't it meaningless to speak of a 45 degrees angle unless you specify Fahrenheit or Celcius?

10. An object at rest will always be in the wrong place. An object in motion will always be headed in the wrong direction.

11. For every action, there is an equal and opposite criticism.

12. Doppler effect is the tendency of stupid ideas to seem smarter when you come at them rapidly.

13. Lenz's Law: Everything you start works against you.
-------

Meanwhile, here are some cheesy pick up lines, gathered from facebook, some I have invented myself (#s 4 to 10).

1. Facebook ka ba? Bakit? Kasi...LIKE kita eh.

2. Google ka ba? Bakit? Kasi...nasa sa iyo LAHAT NANG HINAHANAP ko.

3. Email ka ba? Bakit? Kasi ...gusto kong ma-ATTACH sa iyo.

4. Youtube ka ba? Bakit? Kasi gusto kitang panoorin palagi.

5. Twitter ka ba? Bakit? Kasi gusto kitang ma tweet tweet palagi.

6. Yahoo ka ba? Bakit? Kasi gusto kong sumigaw sa tuwa pag nakikita kita.

7. Hotmail ka ba? Bakit? Kasi I feel hot tuwing nakikita kita.

8. Linkedin ka ba? Bakit? Kasi gusto ko ma-link sa yo.

9. Wordpress ka ba? Bakit? Kasi I'm lost of words to say or press pag nakikita kita.

10. Google+ ka ba? Bakit? Kasi gusto kong magaya sa inyo ni Nonoy 0+.‎
------

From Philip Baguisa:

Bangko (Bank) ka ba? Bakit? Kasi gusto kitang pasukin.

GMA 7 ka ba? Bakit? Kasi KAPUSO na kita

ABS-CBN 2 ka ba? Bakit? Kasi gusto kitang KAPAMILYA.

Girl: TV 5 ka ba? Suitor: Bakit? Kasi KAPATID lang ang tingin ko sa'yo (hehehe, BUSTED)
-------

See also:
Weekend fun 10: Gadhafi fashion, February 19, 2011
Weekend fun 11: More Gadhafi fashion, February 25, 2011
Weekend fun 12: Marcos corruption, February 25, 2011
Weekend fun 13: Economics of stimulus package, March 05, 2011
Weekend fun 14: Ghadafi's women bodyguards, March 05, 2011
Weekend fun 15: Political jokes, March 12, 2011
Weekend fun 16: Gaddafi cartoons, March 19, 2011
Weekend fun 17: Political jokes, May 15, 2011

Welfarism 13: Decriminalize Prostitution

2012-01-20T17:36:00.000+08:00

Many governments have the habit of declaring many human acts as illegal and prohibited. Thus, there are thousands of law, rules and regulations that say, NO, DON'T, PROHIBITED ACTS, RESTRICTIONS, and so on. Since these are prohibitions, there are fines and penalties for violating them. This way, governments collect more revenues aside from the existing taxes that they impose.

In short, more prohibitions, more revenues to the government, more power to government officials and administrators to create more restrictions and prohibitions.

Prostitution and sex trade is among the oldest professions in the world, and many governments have the hypocrisy to declare it as "illegal" and prohibited, even if such practice is happening in many corners and crannies of their economy. They key there is to have double standard. Prostitution -- and illegal gambling, illegal drugs, etc. -- are prohibited for certain people and entrepreneurs, but allowed for other businessmen and political friends of the administration in power. There is a fee of course, both formal and informal, that

Here's a report from Business Insider the other day,

There Are 42 Million Prostitutes In The World, And Here's Where They Live

Gus Lubin | Jan. 17, 2012, 1:55 PM | 10,848 | 20

Global prostitution may be a bigger industry than you think.

There are 40 to 42 million prostitutes in the world, according to a report from Fondation Scelles (via Le Figaro). Three quarters of them are between the ages of 13 and 25, and 80% of them are female.

An estimated 1 million prostitutes live in the U.S., even though it's legal only in Nevada.

In the U.S. and elsewhere most prostitution is unregulated and many workers are forced into prostitution.

The report isn't available online, but here's a map published by the foundation in 2010, which shows the estimated number of prostitutes in various countries as well as number per 1,000 people (data was not available then for countries in green).

www.fondationscelles.org

One good thing about Netherlands, there are fewer crimes and criminals, so they have few prisoners. Prostitution is not a crime, it's legal, but government-regulated and taxes are collected.

(Bombay prostitutes, photo from My Opera/My India) Prostitution should not be made illegal, only human trafficking for sex and prostitution. If people, men and women, want to become prostitutes for money, and there are demand and consumers for their services, so be it. Government should focus its resources on running after human traffickers, those who force people into prostitution (or drug dealers or hired killers, etc.) against their will. For those who enter prostitution voluntarily, government should allow them, regulate them only for public health reason like controlling the spread of infectious sexually-transmitted diseases (STDs).

(Photo from The red light district of angeles) Currently, prostitution is clearly existing, in many areas in Metro Manila and other big cities. Spread of STDs is not properly monitored because sex workers are not regularly checked by local authorities. Sex workers will not voluntarily go to those authorities because of the "illegal" nature of their work.

If the demand is there, and especially if the demand is high (customers would rather pay someone for a service rather than kidnap women and rape them, a big and serious crime), no amount of prohibitions and restrictions will stop a service. Especially if the implementors and administrators of the law -- government and police officials -- are also among the customers of prostitution.
-------

See also:
Welfarism 7: Squatters in the Univ. of the Philippines (UP), February 23, 2009
Welfarism 8: Send All Monthly Salary to UK Govt First, September 21, 2010
Welfarism 9: Conditional Cash Transfer (CCT), November 12, 2010
Welfarism 10: Spanish Problem, the Euro or the State?, December 01, 2010
Welfarism 11: Bureaucratizing Entrepreneurs, April 12, 2011

PhilHealth Watch 11: Hospital Bill Deductions (b)

2012-01-19T17:50:00.001+08:00

The son of a staff of my sister's accounting firm was hospitalized last December. The patient, 2 years old Joziah Enzo Villante Villacillo (the mother, Gerlie, gave me permission to give her son's name) was rushed to the hospital ER due to high fever and flu.

The patient was later confined at the UHBI-Paranaque Doctor's Hospital last December 26, 2011. They stayed in the ward, 4 beds in a room, P650 per day per patient. After 1 1/2 days of confinement, the boy's condition has improved and was discharged. Here is their total bill.

	Actual charges	PhilHealth coverage	Due from patient
Hospital Charges
Laboratory	1568	500	968
Central supplies	1069	500	569
Room accommodation	975	500	475
Medicine	610	210	400
Emergency room	490		490
Sub-Total	4,712	1,810	2,902

Professional Fee (PF) pedia	3,600	500	3,100

Total, Pesos	6,312	2,310	4,002

Here, PhilHealth shouldered 36.6 percent or more than 1/3 of the total bill. The PF of the attending pediatrician bloated the patient's bill, PhilHealth paid only P500 out of the P3,600 PF. Since PhilHealth pays P500 per day for the specialists, they should have paid 2 days or P1,000 instead of P500, in order to reduce the costs to the patient's family.

The patient's mother, the PhilHealth member, is paying P300 per month (P150 employer, P150 employee) to PhilHealth or P3,600 per year.

In my case when my daughter was also hospitalized in Iloilo Mission Hospital also last December, PhilHealth shouldered 46 percent of the total bill. PhilHealth did not contribute to the PF's P2,400 charge, see my notes, PhilHealth Watch 10: Hospital Bill Deductions, December 24, 2011.

Moving away from PhilHealth, check the share of medicines to the total bill: P610 / P6,312 = 9.7 percent. This belies again the common notion that "drugs and medicines are the single biggest cost to hospitalization and healthcare." In my daughter's hospitalization, drugs and medicines comprised 26 percent of the total bill. The bigger items, as usual, are the PF and the hospital room, especially if one will stay in a private room, not the ward.
-------

See also:
PhilHealth Watch 8: Alternatives to PhilSick Monopoly, October 13, 2011
PhilHealth Watch 9: Physicians talk about PHIC, October 16, 2011

Decentralization 9: Ben Diokno Says Recentralize

2012-01-19T01:42:00.006+08:00

I attended the PIPER forum on "Fiscal Decentralization After 20 Years" last Monday, January 16, at Crowne Plaza Galleria Hotel, Ortigas Center. It was a whole day forum and many known personalities in the academe, Philippine government and foreign aid involved in decentralization were there.

Session one was a presentation by Dr. Benjamin "Ben" Diokno (sitting 3rd from right) of UPSE, also former DBM Secretary, and consultant to the WB, ADB, EC, USAID, among the biggest foreign aid institutions advocating more and bigger governments, more taxation and social redistribution.

The 3 scheduled reactors to his presentation were former DOF UnderSecretary Milwida "Nene" Guevarra, DILG UnderSec. Austere Panadero, and NAPC UnderSec. Jude Esguerra. Hah, the Institute for Popular Democracy (IPD) guys Joel Rocamora and Jude Esguerra, among others, have joined the government big time. Well, they have been advocating reformed but big government for many years now, so their position fits with their advocacies.

Jude did not arrive though, also USec Panadero, but he sent one of his senior staff to read his reaction paper. Then open forum started. I wanted to ask a question, but I saw some more popular personalities raising their hands, I said I better listen to them and ask my questions later, perhaps in the next session or panel.

Prof. Ben Diokno, my teacher twice at UPSE (undergrad in 1983 or '84, then PDE in 1998) used these slides as the theoretical framework in analyzing decentralization. The two benefits and advantages of decentralization, vs. its costs and disadvantages.

The texts in the presentation here are readable enough, readers can see them, nice. To see the texts better, just click on them to see larger images.

He noted that the Local Government Code (LGC) of 1991 was the most sweeping law changing intergovernmental structure and fiscal rules in the Philippines.

As seen in the graph here, the internal revenue allotment (IRA) given by the national government to the local government units (LGUs) have drastically increased since 1991. Unit on the vertical axis is percentage, not money. The table below explains why -- before the LGC, LGUs' share to internal taxes was only 20 percent, increased to 40 percent after the LGC. Besides, there has been considerable economic growth in the 90s, temporarily slowed down by the Asian financial crisis of 1997-98, and growth has slowly picked up, resulting in more internal tax revenues by the government, which leads to more IRA for LGUs.

These two tables are helpful and self explanatory. The biggest gainer among the four types of LGUs in the country were the barangays or villages, from only 10 percent to 20 percent of total IRA share. There are now more than 42,000 barangays nationwide.

The number of cities has drastically increased as more progressive and more populous municipalities have been converted into cities. Cities have higher tax rates than municipalities so the city government were earning higher than municipal governments. More revenues are supposed to make things lighter for city governments, but it seems that all of them, no exception, are saying that they need more money -- from their local residents, from the national government, and from foreign aid through more borrowings.

This is something new to me: "creeping recentralization" of certain agencies, especially the DOH and the DSWD. But the recent huge increases in the budget of these two agencies would prove correct the term used by Ben Diokno.

The CCT seems to be the single biggest program of the DSWD. The WB and ADB pitched in huge money for this program, they expect huge interest income from those loans too in the coming years. I am not a fan of the CCT program. Old programs are education and health for the poor, housing and credit for the poor, agrarian reform and irrigation for the poor, etc., not enough they say. So they added cash transfer for the poor, and soon, more condoms and pills for the poor. My longer discussion about the CCT, Welfarism 9: Conditional Cash Transfer (CCT), November 12, 2010.

The DSWD is the "outlier" here among the agencies which devolved their functions after 1991. From only 0.58 percent of total expenditures net of interest payment before the LGC, to 2.46 percent last year, such a big jump. The UN and its partner foreign aid banks, namely the WB and ADB, are hurrying the Philippines to reach its MDG targets which are supposed to be attained by 2015 or just three years from now. The DSWD plus the DOH are the main agencies that they see will greatly expand government and state welfarism.

The big drop in the number of employees in DA and DOH means big increase in the number of employees among LGUs doing agricultural extension work and healthcare services.

Here now are the major messages of Prof. Ben Diokno: decentralization was a failure in reducing disparities among communities and LGUs, and the big transfer of resources from the national government via IRA made many LGUs become lazy in raising their own local revenues.

Twenty years after the LGC and fiscal decentralization, some 75 percent of provincial governments' total revenues were coming from IRA. For municipal governments, it's slightly higher at nearly 79 percent of their total revenues. It's only the cities, especially those in Metro Manila, that were more creative, and sometimes more extortionist, in raising local taxes. Big cities like Makati, Manila and Quezon are I think only about 10 percent dependent on IRA. These cities have invented dozens upon dozens of local taxes, fees and fines slapped on residents, business locators, and non-residents but do business in their cities. For instance, there are cradle to grave fees to pay: birth certificate fee, residence fee, marriage certificate fee, death certificate fee, etc.

Prof. Diokno is saying further that decentralization was a failure in arresting high poverty incidence in the country. Thus, there is need to recentralize this function, more jobs for the national government. So back to central planning at the national level via national government agencies (NGAs) like NEDA, DOF-DBM, DOH, DSWD, DA, DENR, etc.

Being a non-fan of bigger local governments, I will not shed big tears for his proposal. My problem is that since many LGUs will oppose his proposal, we ordinary mortals, aka the taxpayers in the private sector, will be caught in the crossfire of fight between LGUs and NGAs for more taxes, more fees, more fines -- from our pockets. Let us remember that the government, national or local, is a penniless institution that becomes very powerful and very rich only by getting lots of money from our income, from our savings, from our investments, from our hard work and self-reliance.

Clear message from him, once again: Centralization, not decentralization, is the answer to poverty reduction and other social and political goals of the government.

I am no fan of centralization of powers to the NGAs and bureaucracies, I am no fan of decentralization either that results in ever-expanding LGUs with their ever-expanding rules of more restrictions, more regulations and prohibitions, and ever-expanding taxes and fees. Personal and parental responsibility is becoming an increasingly alien topic for them as they think that many if not all things should be government responsibility.

In her reaction, Nini Guevarra countered that decentralization has also produced many outstanding LGU leaders in the country. She cited some of them who were in that conference -- former Bulacan Governor Roberto "Obet" Pagdanganan, Albay Governor Joey Salceda, and Valenzuela Mayor Sherwin Gatchalian. But she recognized that many LGUs really lack accountability, so DILG Sec. Robrero has imposed a performance indicator system for LGUs which can be one of the new basis for the release of the IRA. She observed that while CCT has encouraged more children from poor families to attend schools, there is also lack of classrooms and teachers in poorer villages and municipalities. She thinks that there are bad LGU leaders because they don't have enough good role models.

During the open forum, Ms. Amina Rasul, a leader of a Mindanao-based NGO, lamented that autonomy of certain regions has not been given enough attention both by the presenter and the reactors. That autonomy, more than ordinary decentralization, is what is needed by more LGUs. Nini Guevarra argued that there is bad governance in the ARMM (Autonomous Region of Muslim Mindanao) due to bad politics by the national government (NG), but she added that there are a few good LGU leaders there.

Former NEDA chief and UPSE Dean Felipe Medalla asked how can we have good LGUs when we have lousy NG leaders. He also cited the claim of Cong. Mandanas of Batangas, that the NG owes LGUs some P500 billion in additional IRA because the IRA is based on total internal revenues of the NG, and about 80 percent of Bureau of Customs (BOC) collections are actually internal, not external taxes. And the NG has been using internal tax collections by the BIR only and excluded BOC internal tax collections.

I believe we simply need small and limited government, both at the national and local levels. The government should focus on promulgating the rule of law -- the laws against killing, murder, stealing, plunder, rape, extortion, carnapping, kidnapping, and many other criminal acts. It's a big and very important function but there is obvious government failure there. All malls, all private schools and universities, all villages and condo buildings, all churches, all big shops and restaurants, all banks, etc. are using private security guards to protect their property and customers from criminals. This is one clear and glaring example of distrust by the citizens and entrepreneurs of government failure, of both NG and LGUs in stamping out criminality in society.

Government, both national and local, should step back in heavy intervention, regulation and taxation in entrepreneurship and job creation by the private sector. The latter can take care of that. It is in the promulgation of the rule of law, of the protection of private property rights, protection of citizens against criminal elements, both private and government, that is sorely lacking.

I will discuss in the next paper, Prof. Gilbert Llanto's presentation on the assignment of functions and inter-government fiscal relations.
---------

See also:

Decentralization 1: It's Still More Government, July 25, 2007

Decentralization 2: From Local Government to Civil Society, August 30, 2008

Decentralization 3: Challenges to Local Government, November 18, 2008

Decentralization 6: Local Fees and LGUs' Independence from NG, September 20, 2010

Lifestyle Diseases 14: Transformative Education on Health

2012-01-18T05:03:00.001+08:00

This is the 3rd paper that Dr. Tony Leachon, a free and volunteer consultant to the Department of Health (DOH) on non-communicable diseases (NCDs), sent me. Thanks again, Tony.
-------------

Universal Health Care needs Transformative Education of all Filipinos on Health

Anthony C . Leachon MD
Philippine College of Physicians

The great Filipino thinker, entrepreneur, and philanthropist , Washington Sycip said that "Education is the greatest equalizer in life."

And why is this so?

Well, education empowers people; education provides equity; and education is more cost effective. A Filipino college graduate has a fighting chance to secure a stable job than one who's not.

Thus, an educated populace is perhaps an answer to our anemic economic progress. According to DepEd, only 2 out 10 students will finish collegiate education and health and poverty are predominant reasons for the gripping data. DepEd Sec. Armin Luistro has been championing K to 12 since he said that we are the only country in Asia lagging behind in educational curriculum. Sec. Luistro is a major proponent of the K+12 Basic Education Program in the Philippines. The program seeks to add two years to the current 10-year basic education curriculum.

Now the 64 dollar question looms in the horizon: are our students, teachers, educators, and healthcare professionals ready and equipped to face this constantly changing environment? Seventy percent of the country 's population is below the poverty line. This segment is highly considered the economic workforce of a third world country like the Philippines.

Recently, in a high level meeting of some of the great minds in health education convened in Cebu 3 months ago and addressed this disturbing finding. The Philippines' information, educational system and workforce are not ready to confront this social epidemic in a dangerous era of climate change , rapid population growth, and globalization.

Prof . Julio Frenk MD et al in their thought provoking Lancet article last year, said that the world will need a new breed of Health professionals with a different skills set for the new century utilizing education to strengthen health systems in an interdependent world. In 1970 , Omran et al theorized that globalization, improvement in science and technology eg vaccines and new antibiotics , and urbanization will reduce infections or communicable diseases. He boldly predicted though that with economic progress , noncommunicable diseases ( NCDs ) will increase and reach epidemic proportions. Now , this is a hard reality and without us knowing it.

Today , believe it or not , NCDs namely strokes, cancers, chronic respiratory diseases, cancers and diabetes , are not the domain of the affluent rich in their 60's. We have seen the unstoppable surge of NCDs almost of epidemic proportions across all social classes and across the globe ; however , the glaring reality , based on the Lancet article of top epidemiologist Prof. Antonio Dans last February 2010 ,NCDs are common now in younger and poorer patients in Southeast Asian countries and threaten the middle and low economic countries where the people are not ready to face this social epidemic.

Through integration of modern science into the curricula at university-based schools, the reforms equipped health professionals with the knowledge that contributed to the doubling of life span during the 20th century.
By the beginning of the 21st century, however, all is not well.

Glaring gaps and inequities in health persist both within and between countries.

Professional education has not kept pace with these challenges, largely because of fragmented, outdated, and static curricula that produce ill-equipped graduates, basically in preventive health education and in public health.

The problems are systemic: mismatch of competencies to patient and population needs; poor teamwork; persistent gender stratification of professional status; narrow technical focus without broader contextual understanding; episodic encounters rather than continuous care; predominant hospital orientation at the expense of primary care; quantitative and qualitative imbalances in the professional labour market; and weak leadership to improve health-system performance. Laudable efforts to address these deficiencies have mostly floundered, partly because of the so-called tribalism of the professions—ie, the tendency of the various professions to act in isolation from or even in competition with each other.

To advance third-generation reforms, the authors forward a vision: all health professionals in all countries should be educated to mobilise knowledge and to engage in critical reasoning and ethical conduct so that they are competent to participate in patient and population-centred health systems as members of locally responsive and globally connected teams.

The ultimate purpose is to assure universal coverage of the high-quality comprehensive services that are essential to advance opportunity for health equity within and between countries.

Realisation of this vision will require a series of instructional and institutional reforms, which should be guided by two proposed outcomes: transformative learning and interdependence in education.

We regard transformative learning as the highest of three successive levels, moving from informative to formative to transformative learning.

1.Informative learning is about acquiring knowledge and skills; its purpose is to produce experts.

2.Formative learning is about socialising students around values; its purpose is to produce professionals.

3.Transformative learning is about developing leadership attributes; its purpose is to produce enlightened change agents.

Effective education builds each level on the previous one. As a valued outcome, transformative learning involves three fundamental shifts: from fact memorisation to searching, analysis, and synthesis of information for decision making; from seeking professional credentials to achieving core competencies for effective teamwork in health systems; and from non-critical adoption of educational models to creative adaptation of global resources to address local priorities.

Interdependence is a key element in a complex environment. As a starter, if there are 3 major behavioral risk factors namely : tobacco use, unhealthy dietary lifestyle and physical inactivity that have shaped the destiny of patients in a globalized and technological world , then we need to design our educational curriculum from grade school to high school and even to collegiate levels . Thinking and behaving to be healthy should be a way of life and that the government should be responsible to provide the necessary infrastructure to complement with the changes in the educational system.

Health is wealth. A nation's health is a nation's wealth. The human capital is composed of a healthy and educated populace. A strong and solid human capital is the bedrock of the country ' s economic progress.
--------

See also:
Lifestyle Diseases 11: Obesity and Cancer, January 08, 2012
Lifestyle Diseases 12: On Fat Filipinos, January 17, 2012
Lifestyle Diseases 13: Curbing and Preventing NCDs, January 17, 2012