Wednesday, May 02, 2012

Socialized Healthcare 4: On Health for All

One of the recurring and never-ending discussions in public policy is Universal Healthcare or Health for all. I have no question with this, I even support this initiative. What is being discussed and debated upon  is how to attain this, via (a) More government intervention, in pricing, supply and distribution of drugs and related health requirements, or (b) less government interventiom and more competition among various industry players.

Below are three recent articles by the head of PHAP, Mr. Rainer Cooler, on this subject. It is a good perspective from the innovator drugs sector. Enjoy! 

(1) Health for all

Reiner W. Gloor, April 20, 2012

Against the backdrop of political and economic uncertainties, health inequities between developed and developing countries and within countries have widened to such a degree that people found “politically, socially and economically unacceptable”.

With the growing concern on health disparities, the World Health Assembly (WHA) proposed in 1977 a major social goal for governments to achieve by the year 2000 a level of health that would permit them to lead a socially and economically productive life. Towards this end, the WHA unanimously endorsed a Global Strategy of Health for All in 1981 that ushered in the “Health for All” movement.

This strategy was reinforced at the 51st WHA in 1998, where world leaders signed the World Health Declaration, in which the “Health for All in the 21st Century” policy was adopted to carry forward the vision of HFA as stated in the Alma-Ata Declaration of 1978.

“Health for All” emphasized the attainment of the highest possible level of health by societies as a basic human right, and where health policies and strategies are guided by principles of equity and solidarity.

The World Health Organization (WHO) explained that “Health for All” does not mean the eradication of disease and disability, or that health professionals such as doctors and nurses will care for everyone. HFA means that resources for health are evenly distributed and that essential health care is accessible to everyone.

The goal of HFA is the achievement of full health potential for all. This can be attained through the promotion and protection of people’s health throughout their lives and the reduction in the incidence of major diseases and injuries while alleviating the suffering they cause.

The global strategy of a “Health for All” is equally important in a country where, according to the National Housing Targeting System (NHTS), about 5.2 million families or approximately 26 million of Filipinos live below poverty line. These are the individuals, who by standards of the World Bank, earn merely USD1 a day.

Using the social determinants of health approach, social and economic conditions and their effects on people’s lives determine their risk of illness and the actions taken to prevent them becoming ill or treat illness when it occurs. For instance, evidence shows that the poorest of the poor have the worst health. In general, health turns from bad to worse as the socioeconomic condition of a person goes lower.

The social determinants of health are the conditions in which people are born, grow, live, work and age, as well as the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices.Social determinants of health are mostly responsible for health inequities or the unfair and avoidable differences in health status seen within and between countries, the WHO explained.

Health inequities are evident in various health indicators in the country which varies, depending on the social and economic conditions of the household. The National Demographic and Health Survey (NDHS) of 2008 revealed inequities in mortality rates by reason of residence with high poverty incidence.

For example, the under-five mortality rate for the in urban areas is 28 per 1,000 live births compared to 46 in rural areas. Under-five mortality is also highest in Autonomous Region in Muslim Mindanao or ARMM (94 deaths) and Eastern Visayas (64 deaths) and lowest in the National Capital Region (24 deaths).

The NDHS also showed that childhood mortality decreases with mother’s education and household wealth. There are only 17 under-five deaths per 1,000 live births in the wealthiest households compared with 59 deaths per 1,000 live births in the poorest households.

While vaccination coverage is above 70% in all regions, only 31% of children between 12 and 23 months in ARMM received all the recommended vaccinations to include one dose each of BCG, measles and three doses each of DPT and polio.

Furthermore, majority of Filipino women receive at least some antenatal care (ANC) from a skilled provider, most commonly from a midwife (51%) or doctor (39%). With the exception of ARMM, more than 85% of women in all regions received some ANC. However, the NDHS said that only 47% of women in ARMM received ANC.

In addressing health inequities, the Philippines is on its way to implementing universal health care, which is defined by the Universal Health Care Study Group as provision to every Filipino of the highest possible quality of health care that is accessible, efficient, equitably distributed, adequately funded, fairly financed and appropriately used by an informed, empowered public. Universal health care will ensure health as a right, regardless of social determinants -- particularly one’s ability to pay.

(2)  Health indicators

Reiiner W. Gloor

April 13, 2012 

Enjoyment of the highest attainable standard of health is one of our fundamental rights, regardless of race, religion, political belief, and economic or social condition.

Health is defined by the World Health Organization (WHO) as the state of complete physical, mental and social well-being and, therefore, not merely the absence of disease or infirmity.

In 1984, WHO further described health as the “extent to which an individual or group is able to realize aspirations and satisfy needs and to change or cope with the environment.” It added that health is a resource for everyday life and not the objective of living.

While limited, measuring health has become possible with the establishment of health indicators that describes some of the aspects of health of an individual or population. These indicators are observable and measurable characteristics that help quantify the achievement of a health goal.

The power of health indicators is on their ability to define public health concerns at a given time, geographic areas and groups of people. They can, likewise, track changes and trends in the level of health of a population, group or individual. Health indicators are very relevant in providing needed attention on the most important domains of health. Furthermore, indicators can measure performance of health systems that at the moment emphasize on the role of increased health care spending.

The US National Institutes of Health said that indicators are powerful tools for monitoring and communicating critical information about health. They can be used to support planning like in identifying priorities and benchmarks as well as track progress toward broad community objectives. Health indicators can also prompt engagement of partners towards a collaborative action. Based on indicators, stakeholders can work together to generate awareness on health concerns and formulate interventions in the form of policies and programs.

Indicators are also tools in informing governments and nongovernment agencies about the current health status and in establishing accountability among those concerned. Moreover, indicators help identify similarities and differences in the health of given populations. At present, indicators highlight persistent disparities in health as well as their correlation with a nation’s wealth and even priorities.

One of the most common indicators is life expectancy at birth which is the average number of years that a newborn is expected to live if current mortality rates continue to apply.

In relating global life expectancy with wealth, people in low-income countries can expect to live on the average of 59 years, while those in lower middle income (69 years), upper middle income (75 years) and high income (83 years). Given the life expectancy indicators, people in high-income countries can expect 24 years longer than those low income countries.

In terms of life expectancy in Southeast Asia, people from Singapore (82), Brunei Darussalam (77), Malaysia (73), Vietnam (72) will live longer than those in the Philippines and Thailand (both at 70 years), Indonesia (68), Myanmar (64) and Cambodia (61).

Available data also showed that infant mortality per 1,000 live births is lowest in Singapore (2.3), followed by Malaysia (14.9), Thailand (16.5), the Philippines (19.9), Vietnam (21.5) and Indonesia (289).
Globally, records indicated that 70 out of 1,000 infants will die in lower income groups, 42 in lower middle income, 19 in upper middle income, and six in high income countries.Taking a look at this indicator indicate that 64 infants more will die in lower-income countries compared with those living in high-income countries.

Indicators also help measure the performance of health systems.Health financing, being a critical component of health systems, is being measured by indicators like total expenditure on health as percentage of gross domestic product (GDP).

WHO defined total expenditure on health as the sum of general government health expenditure and private health expenditure in a given year, calculated in national currency units in current prices.

In 2008, only Vietnam (5.7%) and Cambodia (5.7%) had total expenditure on health in ASEAN which reached the reported WHO recommendation of spending 5% of the GDP for health. Malaysia spent 4.3%, followed by Thailand (4.1%), Lao PDR (4%), the Philippines (3.7%) and Singapore (3.3%).Globally, low income countries spent an average of 5.4% of GDP while high-income countries spent 11.1%.

Several other health indicators are available to help us get a glimpse of a nation’s state of health vis-à-vis economic and social conditions. Indicators continue to reflect deep and widening disparities in health.On the other hand, they also show that there are increasing opportunities for nations to invest further in health to improve outcomes.

(3) Poverty at the core of health issues

Reiner W. Gloor, March 30, 2012

A Social Weather Stations (SWS) survey in 2010 revealed that Filipinos agree that health is a basic constitutional right. As such, almost nine out of 10 respondents believe that it is the duty of the government to provide health care for all, including those who cannot afford to pay for it.

However, the sad reality remains that a number of Filipinos die without even having seen a doctor. Mothers mostly from poor provinces in the Visayas and Mindanao continue to perish as they give birth in this day and age of modernity.

Official statistics, likewise, disclosed that 25 children per 1,000 live births die before reaching their first birthday. Overall, 34 children per 1,000 live births perish before reaching the age of five. Such incidences are highest in the Autonomous Region in Muslim Mindanao (ARMM) and Eastern Visayas and lowest in the National Capital Region (NCR).

Evidence leads us to the relationship of poverty and infant and under-five mortality. Records show that there are only 17 under-five deaths per 1,000 live births in the wealthiest households compared with 59 deaths per 1,000 live births in the poorest households.

The disparities in health outcomes can be explained by the inequities in access and utilization of health services as a result of the socioeconomic conditions of the majority.

The latest official poverty data from the National Statistical Coordinating Board (NSCB), released in 2009, indicate that a Filipino needs P974 to meet his or her monthly food requirements and P1,403 to stay out of poverty. This leaves a Filipino P429 for his other expenses.

Consequently, a Filipino family of five needs P4,869 monthly income to meet the basic food needs and P7,017 to stay out of poverty, leaving the family another P2,148 for all their other expenses.

On the other hand, the NSCB observed that a sole breadwinner in a five-member family residing in Metro Manila is expected to find it difficult to bring the entire family above the poverty line if he or she earns less than P317 per day.

Shortly before the NSCB survey, the Department of Labor and Employment Regional Tripartite Wages and Productivity Board-NCR issued Wage Order No. 14-NCR which stipulated that in 2008 to 2009, daily minimum wage for Metro Manila workers ranged from P345 to P382 for those in the manufacturing, retail, service, agricultural and non-agricultural sectors and industries.

If a breadwinner earned P345 in 2009, his wages were just P28 more than what was then required to keep his family right above the poverty line.

The National Household Targeting System for Poverty Reduction, which identifies who and where the poor are in the country, estimates that 5.2 million families earns P3,460 a month while the second poorest quintile, consisting of 4.1 million families, has a monthly income of P6,073. If we add up the poorest and second poorest quintiles, we are talking about 46,500,000 poor individuals or about half of the Filipino population.

In the 2009 Family Income and Expenditure Survey (FIES), families in the bottom 30% income group, which may be considered as poor families, had yearly earnings at an average of P62,000 or P5,200 monthly.

The 2009 FIES also disclosed that poor families spent P64,000, on the average, which is P2,000 more than their average annual income. Furthermore, the income gap between families in the bottom 30% income group and families in the upper 70% income group barely changed. It was observed that the average annual income of families in the upper 70% income group was four times that of the families in the bottom 30% income group.

Across regions, families in the National Capital Region had the highest average annual family income at P356,000. Families in ARMM had the lowest average annual family income at P113,000.

Results of the NSCB and FIES demonstrated that majority of Filipinos barely have enough for food and other important household expenses. And if forced to choose among all needs, food will be the top priority.

Filipinos spent a mere 2.9% of their income on health care, having almost along the same priority as spending for special family occasions and furniture and equipment, which are both at 2.7%.

The bottom poor spent even lesser for health care at 1.7% while the upper 30% of the population spent 3% for their health.

In the same SWS survey, majority of the people expressed optimism that it is possible for the government to provide quality health care to everyone, whether rich or poor. I hope that the government, our legislators and other stakeholders will take this unique opportunity to realize universal health care as the more comprehensive approach to achieve quality health for all, especially the poor.

For more information, consult your doctor or you may log on to Join us on E-mail the author

See also:
Socialized Healthcare 1: More Government = Less Health Care, March 29, 2006
Socialized Healthcare 2: Discussions in Facebook, September 04, 2009
Socialized Healthcare 3: Free Market and Better Health, September 22, 2010

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