Showing posts with label Tony Leachon. Show all posts

Monday, June 02, 2014

Pork Barrel 10: Bloated Budget, Wasteful Government

A physician friend, Doc Tony Leachon, posted this poster in his fb wall and asked, “Do you agree? Yes or No?”

ALL the first 26 comments have answered Yes, directly or indirectly. And the succeeding many other comments also said Yes. Not one said No. Coming from mostly physician-friends of Dr. Leachon.

I also briefly commented, "Yes. The main purpose of government is often to expand the government. So many taxes, fees, royalties, other revenues and still not enough. They keep borrowing and borrowing and borrowing. Both the Executive and Legislative branches are wasteful.

There were three notable comments there:

1. Mark: The problem is that power corrupts. You may not be corrupt when you enter politics but you are at very high risk of bring corrupt when in power and exposed to all that money flowing around.

2. Ruby: Yes. Grabe ang laki ng taxes. Lalo na sa salaries na automatic ang deduction. 1/3 agad ang bawas sa perang pinaghirapan mo. Paano mababago ang sistema kung same people ang nasa government? Tapos di mo makita or maramdaman saan napunta ang perang binawas sau... walang pagbabago.

3. A former DOH official: “frustrated working on the DOH budget. ‘bondat na bondat na ang DOH sa dami ng Pera..di na Kayang nguyain.’ The problem is, the success of the department is measured on how much budget you can get. DBM introduced performance-based budgeting but the problem is beyond planning and spending...it's on the capacity to implement, existing infrastructure of the local government, procurement policy and process. Mahigpit sa gumagawa ng tama pero sa mga katulad ni Napoles walang existing system!

“We need to develop a very good monitoring system on where the money went, how it was used and it's impact based on the objectives. There has to be a very very clear indicators on how to use the funds Hindi lang where and what.”

Take note of this: "We need to develop a very good monitoring system on where the money went, how it was used and it's impact based on the objectives."

That is exactly the role of Congress -- have oversight functions over the money that it authorized and appropriated for the Executive Branch. Congress is not doing its job. The Executive is wasteful, the Legislative tolerates its wastefulness, in exchange for pork barrel. That is why the pork barrel system can never be abolished or eliminated. Its size is directly proportional to the wastefulness of government in general, it is a bribe by the Executive to the Legislative so that the former can continue with its wasteful, living beyond its means, philosophy and practices.

Even if income tax is 50 percent of personal and corporate incomes, it will never be enough. All that government will do is to keep expanding like amoeba. Both national and local governments. B

Doc Tony asked me, “where do we start now ? The people are waiting for the execution of the plan. With the PDAF investigation , the senate and congress are all busy.”

Well, my quick modest and doable proposals are as follows:

1. Have a flat budget. 2014 budget is P2.27 trillion, the 2015 budget should be P2.27 trillion too, if not lower.

2. No new borrowings, have zero budget deficit for 2015, government to live within its means. If projected total revenue is P2.2 trillion, then spending should be only P2.2 trillion, not P2.5 trillion because government will borrow P300 billion.

3. For every new welfare program (cash transfer for the poor, condoms and pills for the poor, soon iPad for the poor), one or more old welfare program/s should be shrunk or discontinued.

The public debt stock is rising by around P400 billion a year, with or without a crisis, it just keeps rising and expanding like amoeba. Thus, annual interest payment alone remains high, around P330 billion a year.

I am not suggesting drastically shrinking government to only one-half or one-third of its current size and spending (not doable) nor the abolition of government (anarchist argument, not doable either). I am suggesting modest and doable action programs. Once government and its various bureaucracies and personnel see that they can still exist with “less” resources and no need for borrowings and fiscal irresponsibility, personal and official responsibility can trickle again back to government consciousness.

And the public, the NGOs and media, academics and consultants, politicians and their supporters, should realize again and again that “A government that is BIG enough to give everything you want is also BIG enough to take everything you’ve got.” If the people will ask for freebies and subsidies left and right, government will also impose taxes and fees left and right, borrow left and right.

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Monday, February 10, 2014

UHC 22: Shortage of Doctors in the Philippines

A friend, Dr. Tony Leachon of UP College of Medicine, also practicing at Manila Doctors Hospital, posted this article in his fb wall last week, and it attracted lots of healthy and useful comments from his fellow physicians. I believe more people should be able to read this useful exchange. This is long, ~~4,600~~+ 7,300+ words, 10 16 pages, enjoy.
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Tony Leachon
PMA warns of worsening shortage of doctors. http://www.abs-cbnnews.com/nation/01/30/14/pma-warns-worsening-shortage-doctors

Emmanuel 3D- Dispersal, Diffusion, Dedication

Daniel Most patients in the provinces can't afford doctors. The government thought universal healthcare through the PHIC will solve it. It just solved half the problem.

PHIC doesn't even pay for OPD consults. What, wait for these patients to be sick enough to be admitted for insurance to start paying for it? By then the healthcare cost could already skyrocket.

Ted The ratio should be 1 physician per 1000 persons. If we are 95million and we have 130,000 licensed isnt 1.3 doctors per 9,500 population? We definitely need more doctors! I believe PPP will be a major solution as many of the doctors are in the private sectir.

Iris Hopefully UPCM Return Service will help and that these new MDs will be encouraged to stay.

Minerva This issue definitely needs a comprehensive analysis that considers demographics, changing practice patterns and healthcare access. Most existing estimates of the shortage of physicians are based on simple ratios. These estimates do not consider the impact of such ratios on patients’ ability to get timely access to care and do not quantify the impact of changing patient demographics on the demand side and alternative methods of delivering care on the supply side. We are at the threshold of collaborative practice which could be expanded to include the use of healthcare teams of physicians, nurses, midwives. Telehealth is another option to address timely access to care in remote areas. Improving allocations for physicians in government, both national and local as well as improvement in facilities through local government emphasis on health agenda is a must while we review the Local Government Code.

As an educator engaged in organized medicine, I believe we should also shift some of our focus in teaching medicine and include health informatics, leadership and management of change, medical socio-anthropology and immersion in public health issues in research, in elective rotations and as part of case scenarios in medical subjects so that medical students will have a grasp of the real world that they will face after medical school.

Ted If each private doctor accepted or was assigned few poor families in consult and treatment under their care and Philhealth paid for their servicrs, would that lessen the problem?

Daniel PHIC calls it capitation but its only paid to the RHU doctors, which in most cases, the poor patients won't even find in their clinics.

Adrian It might be time to consider Dr Domingo's proposal for a national matching system. That will ensure a career for doctors, while addressing distribution issues.

UHC 21: The PGH, Manila City Government and Civil Society

An official of the University of the Philippines (UP) Manila, where the College of Medicine and the Philippine General Hospital (PGH) is based, Dr. Tony Leachon who is also a friend, posted in his facebook wall about the need to raise the budget of the PGH.

This year, the UP System (UPS) total budget is P9.53 billion of which P2 billion goes to PGH alone. Next year, UPS total budget will be P8.1 billion, and again, P2 billion of which will go to PGH alone. This year too, UPS’ capital outlay (CO) is P1.45 billion but zero for next year.

(See http://www.dbm.gov.ph/wp.../uploads/NEP2014/VIII/VIII.pdf)

Those in UP Manila estimate that PGH needs P4 billion a year to run smoothly, a “Harvard like institution” and at least P1 billion is for CO alone to improve or replace many of its dilapidated facilities.

There are two moves being proposed. One is to double PGH annual budget and two, PGH should have a separate budget from UPS budget.

I suggested that there should be similar effort to pressure the Manila City government to contribute to PGH regular funding. I think it is safe to assume that about one-fifth of PGH’s patients, confined and outpatient, are residents of Manila City.

The City of Manila government does not feel it has any responsibility over PGH funding as it also finances about six city-owned hospitals, like Ospital ng Maynila , Ospital ng Sampaloc, Tondo General Hospital, Sta. Ana Hospital.

This is not correct. The city government has "no responsibility" but "has privilege" or "has right" to use PGH for its residents. Right without responsibility is a good formula for free riding and citizen irresponsibility.

A better option for the city government would be to sell or privatize one or two of its six (?) city hospitals, get the money and contribute to PGH regular funding.

This practice by national government agencies to subsidize Manila-based facilities and give Manila-based residents various subsidized or free services contribute to more congestion of Metro Manila. People in the Visayas, Mindanao, Bicol or Ilocos regions have no PGH but they contribute to the annual budget of PGH. They do not have MRT or LRT but they contribute to the annual subsidy of LRT and MRT. So many people from the provinces jump to Manila, partly to enjoy these freebies that are not available in their provinces and cities.

If the Manila City government will not contribute to PGH funding, PGH should NOT get budget increase from Congress. Instead, Congress-appropriated budgetary hike for healthcare should go to existing big DOH hospitals in Mindanao, Cebu or Iloilo, Bicol, Ilocos, Cagayan regions. Make these region-based hospitals become more modern, in infrastructure and health professionals’ training and specialized services. This way, the old practice of national agencies (UP, DOH) favoring Manila-based residents and contribute to further Manila congestion will be corrected.

Someone suggested that my above proposal does not and should not apply because of health insurance portability principle, that national taxes should apply to everyone. If we are to follow this logic, then it should be fine to have 3 or 5 more PGH in Manila City alone, and if funds for healthcare in other cities and provinces are not sufficient, public hospitals there can be closed down, anyway the people can go to the many PGH system in the city of Manila alone.

Any increase in public health should go to one regional or big island hospital -- in the Visayas, Mindanao, Bicol, Ilocos, or Cagayan region. Any significant increase in PGH funding should come from the Manila City government and from private donation, what Atty. JB Baylon is doing to raise funds for the PGH Medical Foundation through the "I am a Person Giving Hope (PGH)" campaign. Many showbiz, basketball stars and corporate individuals are supporting this cool initiative.

There should be more civil society and corporate involvement in increasing PGH funding, it should not rely on more national funding. Once again, the Manila City government must contribute to PGH annual funding as the hospital is serving many of its residents and voters.

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Thursday, June 27, 2013

UHC 15: On DOH Plan to Recentralize Healthcare

The quest for government-initiated and centralized universal health care (UHC) can be dizzying for all sectors -- patients/public, private healthcare professionals and providers, government health agencies, the legislature and everyone else. This is because when government centralizes or almost monopolize healthcare, competition, price differentiation, market segmentation and service innovation is often sacrificed or killed.

A famous physician, expert and consultant on UHC and NCDs, also a friend, Dr. Tony Leachon, posted this story from GMA News the other day, in his fb wall,

PNoy to push for less controversial health programs in last half of his term

In a speech during the Department of Health's (DOH) 115th anniversary celebration, Aquino said his administration is determined to attain its goal of universal healthcare for all Filipinos by 2016….

"Last year mayroon tayong Sin Tax, mayroon tayong Responsible Parenthood, ngayon naman ho ay pakikiugnayan ng mas hindi masalimuot ang ating pakay," he added. Aquino, in his speech, said his government was able to enroll some 20 million more Filipinos to the national health insurance program during his first three years in office.

He also boasted of his administration's efforts to expand benefit packages for Filipinos suffering from heart diseases, aside from those with "catastrophic diseases" such as breast cancer, prostate cancer and acute leukemia.

The president likewise pledged to build more new health facilities in far-flung regions of the country, and the rehabilitate old hospitals.

"Hindi tayo titigil hangga’t may mga kababayan pa rin tayong ni hindi nakakakita ng espesyalista sa tanang-buhay nila. Kaya naman sa huling dalawang taon ng ating administrasyon—binawasan ho ako ng isang taon, siguro ‘yong writer ko po ay gusto na ring lumipat ng trabaho—target nating i-upgrade at gawing mas moderno ang 7,325 na mga ospital, klinika, at pagamutan," he said. DOH Secretary Enrique Ona, meanwhile, said his department will propose a law that will facilitate the efficient delivery of health services to distant towns in the country.

"Kami ay nahirapan nang husto na ipaabot sa ating local health units 'yung tulong ng DOH kasi devolved ang ating health system down to the towns. Sabi namin, pag-aralan on how we can improve the devolution of healthcare," he said in an interview after the event.

He likewise said he wants a legislation that will "improve the governance" of public hospitals under the DOH.

Among the comments raised by Doc Tony's friends were the following:

(a) Do not neglect the human resource aspect of modernizing health facilities, otherwise we willl have ghosts running our hospitals.

(b) Maldistribution and unemployment of healthcare professionals are serious issues.

(c) There is an over-supply of nurses and there is maldistribution of doctors, maybe even an under-supply of physicians.

(d) Start an Advanced Practice Nursing/ Nurse Practitioner program. Can be piloted with a very good nursing program. It will provide job security and provide additional primary care providers especially in underserved areas.

(e) "Hindi tayo titigil hangga’t may mga kababayan pa rin tayong ni hindi nakakakita ng espesyalista sa tanang-buhay nila." -- Why do the people need to see a specialist? Specialist in what? Why can't they be seen by primary care physicians or nurses? If nurses are trained to render primary care... agree ako jan.

I commented that the move now by the DOH is towards more nationalization and recentralization of public healthcare. But centralized programs often result in centralized expectations and centralized disappointment. Then I asked Doc Tony since he has worked in both private and public hospitals and other healthcare facilities, what are the efficient incentive systems that encourage HC professionals to provide really caring service to patients, so they get well and become economically productive.

Doc Tony replied that HC professionals should be compensated well to stay with a well planned career plan.

That is precisely my point. Very often in government hospitals and HC facilities, the doctors are paid flat rate, whether they see 20 or 200 patients a day, the pay is the same. So the tendency is to provide quickie prescription, little or no patient counselling, then call the next patients after 3 or 5 minutes. When government centralizes, nationalizes and monopolizes healthcare, service differentiation, market segmentation and service innovation is often sacrificed or killed. Government service is meant to uniformize, harmonize and monotonize the public, and sub-optimal health outcome is the result.

In the food sector, there is zero government carinderia or restaurant, zero government supermarket or talipapa, zero or little government farms, and yet people are eating. There are various products for various people with various budget and needs. Service innovation, price differentiation and market segmentation allows the various food producers/sellers to meet with certain food consumers.

In contrast in the health sector, (1) there are tens of thousands of government rural and barangay health centers, (2) tens of thousands of government-sponsored botika, (3)hundreds of government hospitals (DOH, LGUs, PGH, AFPMC, etc.), (4) there are free medicines and entitlement programs for the poor, (5) drug price control policy, (6) mandatory price discounts to senior citizens and persons with disabilities (PWDs), (7) government health insurance monopoly, and health problems are not declining but rising. Expectations rise, disappointment and discontent rise. Centralization and monopolization is wrong.

In another thread, there are good experiences in private-provided healthcare like the case of Dr. Meo Santos-Cao. She said,

when I had my practice here in Laguna (up to 2006). I did not even register as provider with PhilHealth. I always made sure that this fact was clear to my patients. They paid me directly, usually before discharge from the hospital, but sometimes upon post-hospitalization check-up in my clinic if they had difficulty raising money. And since I didn't have to wait for 3-6 months for PhilHealth to pay me, I always charged much lower than other MDs here.

I practiced general med. I did minor surgeries, checked on pregnant women and assisted normal deliveries. While it's customary for those services to be provided by specialists (surgeons and OB-Gyne), I had no qualms doing those because I was capable, had training and licensed to practice. In so doing, I gave patients an alternative to expensive services of specialists. In 2005, OBs charged 15k for a normal vaginal delivery, part was paid for by PhilHealth and the bulk out-of-pocket. Whereas, I charged only 6k for the same service, all out of patient's pocket. Malaki pa rin ang natipid ng pasyente. The important point here is that patients must know that they have options and that they cannot be held hostage by the prevailing system. Bottom line pa rin, as Marco pointed out, patient and provider must agree on the service and its cost.

I like the stories that Doc Meo shared, it's about private contract between a service provider (her as a physician) and service consumer (the patients) with no tertiary or external intervention (the state like PhilHealth, especially). The result is fine. If the patients are not happy, no need to rally or demonstrate in the streets to demand that the state should regulate Dr. Meo Cao or whoever. They simply refuse to come back, tell their friends that Dr. Cao is a lousy doctor. But this did not happen, they keep coming back, meaning they are happy with the services provided by Dr. Meo Cao.

Another physician friend also shared that "...with unjust compensation, doctors would opt not to operate lalo na kung difficult cases, the new Philhealth scheme doesnt take into account case difficulty. Di ka na properly compensated, mas malaki pa risk sa license mo, pagod ka pa. I dont think this is in the best interest of the patient. It takes forever for Philhealth to pay the MD and hospital, and only an instant to disqualify patients na may minor delinquencies sa continuity ng payment."
http://funwithgovernment.blogspot.com/2011/10/philhealth-watch-9-physicians-talk.html

On another note, I changed the subject of this thread from "Socailized Healthcare" to simply UHC. See also:

Socialized Healthcare 11: Private Health Insurance and HC Vouchers, November 16, 2012

Socialized Healthcare 12: Nurses, Doctors and Other Resources, March 03, 2013

Socialized Healthcare 13: On Inequality and Inclusive Business in HC, March 19, 2012

Socialized Healthcare 14: Over-extending Government Role in Health, May 22, 2013

Tuesday, May 07, 2013

Election Watch 5: Sin Tax Law, Hospital Over-regulation and Senatoriables

The Senatorial and local elections are just six days away. Yesterday and today, two groups in the health sector released their own separate statements endorsing certain Senatorial candidates with their respective reasons.

I got this today from the President of the Private Hospitals Association of the Philippines, Inc. (PHAPI) and a friend, Dr. Rustico "Rusty"Jimenez. This is a joint statement of PHAPI and the mostly government hospitals association, the PHA.

They also endorsed four party list (PL) groups, but am skipping those. Am not interested in any of those groups, I am boycotting the PL system. Here now are the reasons why the two hospital associations have endorsed the nine Senatorial candidates above. Note the last item -- overregulation of private hospitals by various government bureaucracies, local and national.

The ugly habit and corrupt nature of many government bureaucrats would show up just anywhere.

Meanwhile, here's another statement from another group of health groups. The main coordinator, Dr. Tony Leachon, is another friend of mine. They endorsed only four candidates, but mentioned eight candidates that voters should never support, based on the criteria they laid out.

Only Koko Pimentel and Sonny Trillanes are the common candidates of the two groups.
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Doctors Prescribe: Go Out and Vote for Health

Manila, Philippines (6 May 2013). Trust your doctor. Doctors and health advocates called on their patients and colleagues to go out and vote for health on May 13. “Exercising your right to vote is good for your health,” said Dr. Tony Leachon, Secretary of Philippine College of Physicians, “This is a powerful opportunity for us to flex our muscles to put true health champions in Senate, who will fight for health.”

“Six out of 10 Filipinos die without ever seeing a doctor,” added Dr. Tony Dans, President of Philippine Society of General Internal Medicine (PSGIM), “The high cost of health care in the country prevents people from accessing life-saving services, and drowns families further into poverty.”

In 2010, Filipino families spent more than half of the country’s annual health expenditure according to the National Statistical Coordination Board. “Mahal magkasakit. Mabuti kung may bulsa na puwede paghugutan, kung wala mamatay ka na lang?” added May-i Fabros from WomanHealth Philippines, “Enshrined in our Constitution is our right to health, which is why we need to ensure that those who we elect into power will push for health reform policies that will make access to health services equitable for all, regardless if you have money or not.”

Sin Tax Law as Criteria in Voting for Health

“Although health is just one of the considerations when choosing candidates, its impact in our lives resonate, we need a health criteria to help us vote for true champions for health,” said Jo-Ann Latuja, Senior Economist of policy think tank, Action for Economic Reforms. “We can use their position on the Sin Tax Law as a proxy measure for health and societal reform since it addresses the issues on health financing, universal health care, governance, corruption, economic reform, and vested interests, among others.”

The Sin Tax Law or Republic Act 10351 was one of the critical and highly controversial health reform measures that passed into law before the end of 2012, amidst the strong tobacco industry lobby. "Words are cheap, what we need are true champions for health who will battle it out with vested interests in the halls of congress," said Dr. Maricar Limpin, Executive Director of Framework Convention on Tobacco Control Alliance Philippines (FCAP), one of the first tobacco control groups who fought against the anti-health Sin Tax Law of 2004, or Republic Act 9334, which maintained the status quo and kept tax rates pegged at 1996 prices. "We will vote for legislators who will fight for health, and reject those who will most likely fight against health."

"What we are presenting are Pro-Health and Anti-Health candidates based on our critical appraisal of their health position particularly on Sin Tax," continued Latuja, "With health as our criterion, we encourage the public to assess the track record of the candidates for local and national positions, particularly those who have the obligation to pass national policies that will health our health system.

The doctors, economists and health advocates presented their review process of the 33 senatorial candidates. First, they identified the incumbent candidates who had the chance to vote for what they referred to as the effective and pro-health Sin Tax Law of 2012 or the defective and anti-health Sin Tax Law of 2004. After which they assessed the most recent statements on RA 10351 of the candidates, whether they are for or against it.

Combining these two they identified only four (4) Pro-Health candidates - Risa Hontiveros, Jamby Madrigal, Koko Pimentel, and Sonny Trillanes, but were able to identify eight (8) Anti-Health candidates - Gringo Honasan, Chiz Escudero, Jack Enrile, Migz Zubiri, Ernie Maceda, Mitos Magsaysay, Teddy Casiño, and Christian Señeres.

The group led by the Philippine College of Physicians, Philippine Society for General Internal Medicine, Philippine College of Chest Physicians, and civil society sin tax advocates, Action for Economic Reforms, WomanHealth Philippines, and FCAP held the press conference during the 60th Anniversary of PCP and its 43rd Annual Convention to inform the public of the pro-health and anti-health stance of the 33 Senatorial Candidates.

Tony Leachon,MD

Consultant of the Department of Health on Noncommunicable Diseases

Director,University of the Philippines Manila,Information,Publications & Public Affairs

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See also:
Election Watch 1: Anti Epal Photos, June 29, 2012
Election Watch 2: On Celebrities as Politicians, August 19, 2012
Election Watch 3: Defining Celebrities, Politicians and the State, August 30, 2012
Election Watch 4: Senatoriables on Healthcare, March 08, 2013

Monday, March 05, 2012

Lifestyle Diseases 18: Addressing NCDs via Preventive Healthcare

Mainly lifestyle-related non-communicable diseases (NCDs) can be addressed via change in lifestyle and hence, preventive healthcare, not curative. Preventive approach shifts the burden of healthcare from the government to the individuals themselves, their households and civil society organizations (health and wellness groups, sports clubs, medical and nutrition associations, etc.). Whereas curative approach is mainly throwing more money, ie tax money, to problems that are more often than not, self-inflicted.

My cardiologist friend, Dr. Tony Leachon, has written several articles about NCDs posted in this blog. See for instance,

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

Lifestyle Diseases 15: Preventing Metabolic Syndrome, January 27, 2012

Lifestyle Diseases 16: On Smoking and NCDs, February 16, 2012.

Below are some powerpoint slides he had made and presented in his talks. These are good supplementary materials and visuals to the DOH Presentation on smoking and tobacco tax hike, Tobacco Tax 7: DOH on NCDs and Tax Hike. A number of his slides were also used in the said DOH presentation.

I like the title, Shifting to Preventive Healthcare. The three risk factors are obviously lifestyle related -- high tobacco use, low intake of fruits and vegetables (more fried meat, etc.) and less physical activity (more couch potato in front of a computer or tv, etc.).

Many Asian economies are indeed getting wealthier. The rising problem of the people is that they are eating more expensive, more sweet and more fatty food and drinks like more soda, more ice cream. The result is more diabetes, more obesity. People work hard and they eat and party hard too.

My beef about these analysis by Dr. Antonio Dans, DOH, WHO and other known health analysts is that there is little or zero mention about personal responsibility aspect of healthcare. It is very often easy to blame the tobacco companies, the soda/softdrink/beer companies, the junk food manufacturers, the fastfood shops, the heavy ads in tv of these products, and so on. But somehow we have to look inwards and see what we individuals, parents and guardians do, to prevent children not to get addicted to junk food, softdrinks and sedentary life too early.

Articles like these by Dr. Leachon and Dr. Dans, campaigns by the DOH and WHO, the various health professional organizations, are helpful in reminding people again and again, good healthcare rests first and foremost in their own hands, not in government. They do not need the DOH and WHO to realize that having a clean house, a clean environment, washing hands properly before eating, drinking plenty of water and other liquid, having more vegetables and/or fruits everyday, among others, are simple but highly effective steps towards better health. More than cheaper or free medicines, more than cheaper hospitalization and free PhilHealth card.

Cheaper or free medicines are effective for infectious and communicable diseases, for pediatric diseases, for genetic and hereditary diseases. And even if those cheaper medicines -- will the government abolish taxes on medicines please? -- are made available for these illnesses, preventive healthcare still play a big and important role, at least not to exacerbate existing diseases.
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See also:
Lifestyle Diseases 1: Obesity, February 04, 2011
Lifestyle Diseases 2: Killer diseases in the Philippines, March 16, 2011
Lifestyle Diseases 3: Causes of Mortality in the Philippines, August 10, 2011
Lifestyle Diseases 4: The UN on NCDs, September 24, 2011
Lifestyle Diseases 5: NCDs Global Picture, September 30, 2011

Lifestyle Diseases 17: On Cancer, COPD and NCD Risk Factors, March 05, 2012

Thursday, February 16, 2012

Lifestyle Diseases 16: On Smoking and NCDs

Here's another paper from a cardiologist friend, Doc Tony Leachon. After his article, an article from Inquirer columnist Rina David, where she quoted Tony.
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Things You didn't know about Smoking and Lifestyle-Related diseases

Anthony C. Leachon, MD

1. Consultant of the Department of Health on Noncommunicable or Lifestyle Diseases
2. Regent, Philippine College of Physicians
3. Cardiologist Internist, Department of Medicine, Manila Doctors Hospital

According to the World Health Organization (WHO), non-communicable diseases (NCDs) or lifestyle diseases are the leading cause of deaths worldwide. In 2008, of the 57 million deaths, 36 million people died due to NCDs. Deaths were attributed to cardiovascular diseases (48%), cancers (21%), chronic respiratory diseases (12%), and diabetes (3%).

1. Lifestyle - related disease is not a disease of affluence.The WHO Global Status Report (GSR) on NCDs for 2011 revealed that poorer countries are more susceptible to NCDs. High-income countries have 13% prevalence, upper-middle-income countries have 25% prevalence, while lower-middle-income countries like the Philippines have 28% prevalence. Low-income countries have 41% prevalence of premature deaths among citizens below 60 years of age. This is three times higher than the proportion of the high-income countries. Death rates from stroke, heart disease, COPD and cancer) is highest among poorer countries in the ASEAN region (Dans et al , Lancet 2010). One reason for greater death rate in the poor is that the poor smoke much for than the rich. The study likewise shows that smoking rates are highest among the poor in the ASEAN region including the Philippines, Malaysia, Vietnam,Laos, and Myanmar while rich countries like Singapore and Brunei have lower NCD death rate.

Prof Antonio Dans of the University of the Philippines College of Medicine said that Southeast Asia is facing the epidemic of chronic non-communicable diseases. Based on 2008 figures, 60% of all deaths in Southeast Asia are attributed to NCDs. Dr. Dans stressed that NCDs are not diseases of affluence but diseases of poverty.

In the Philippines, about 200,000 Filipinos die annually because of NCDs. “This is larger than any epidemic we have ever seen in the country,” said Dr. Dans.

2. Traditionally, NCDs are viewed as the diseases of the elderly, “therefore unavoidable.” However, based on studies, NCDs are now affecting even the productive age group from 15 to 59 years old. “Sixty percent of the disability causes in this age group are NCDs. This situation is greatly affecting the productivity and economy of countries,” said Dr. Dans. He further stressed that this figure is projected to increase to 75 % by 2030 if nothing is done.

While death or disability results to productivity and income losses, it also brings expenditures for medical care on families affected, leading to serious consequences, not only at the household level, but at the national level as well.

3. Based on National Nutrition and Health Survey ( NNHes) 2008, smoking does not just cause cancer and lung diseases, it is also the number one cause of stroke and heart attack ( 50,000 deaths per year). In fact, smoking causes more stroke and heart attack than diabetes, hypertension , obesity and high cholesterol.

“The prevailing risk factors varied among a country’s income groups,” said Dr. Dans. Physical inactivity among women is the prevailing risk factor in high-income countries, while smoking or tobacco use is the prevailing NCD risk factor among middle-income group countries like the Philippines.

4. We are challenging that lifestyle is a choice. “It is not, because we live according to what the environment provides us.” The medical profession has been unsuccessful in improving lifestyle despite decades of trying. Even medical professionals , with all their knowledge , find it hard to live a healthy lifestyle. Lifestyle is shaped by the environment. If food is expensive , people will eat unhealthy cheap food. If tobacco is cheap, people will smoke.

Prof Dans cited the strong connection between poverty and NCDs as an example. “

1. People in the lower socio-economic class have less access to disease prevention. Therefore, they have unhealthy lifestyles and have higher risk factors.

2. They have no access to treatment when they have heart diseases, lung cancer and other NCDs.”

3. Likewise, poor families do not have the money to finance treatments which leads to higher mortality rates.

Dr. Dans proposed several measures to promote healthy lifestyle: 1) legislative advocacy on proper food labeling (emphasizing food health risks and benefits), 2) implementation of sin taxes, and 3) legislation on healthy urbanization or creating infrastructure for healthy lifestyle in school, in workplace and the community.

Rather than begging individuals to live healthy, we should level-up our agenda towards a healthy environment and help promote healthy lifestyle in our society.

We make our goals in life. We define our own successes. We don't get to choose where we start in life ; however, we do get to choose the kind of people we become.
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http://opinion.inquirer.net/22431/breaking-out-of-denial

Breaking out of denial

By: Rina Jimenez-David
Philippine Daily Inquirer

9:52 pm | Saturday, February 4th, 2012

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While the Department of Health currently operates on an annual budget of P40 billion, the total annual expenditure for smoking-related illnesses (cancers, lung diseases and cardio-vascular complications, not to mention lower productivity, absenteeism and fires caused by cigarettes) total P400 billion.

Should Congress pass the “sin taxes” law, which would impose higher taxes on cigarettes, among other things, the government would be able to raise an additional P60 billion in revenues, money which could go a long way towards battling smoking-related ailments.

As they say: “You do the math.”

Dr. Tony Leachon, a consultant on non-communicable diseases (NCDs) with the DOH, presents these figures as part of his advocacy to raise awareness about the need to move from a mentality of “treatment and cure” to one of “prevention,” which in the long run is cheaper and more effective.

“We are currently facing an epidemic of NCDs, with six out of every 10 deaths in the country attributable to stroke, cardiac arrest, chronic respiratory disease, Type 2 diabetes and cancer,” Leachon said, speaking at the conclusion of “Moving as One,” a conference billed as “A Global Call to Action for a Public-Private Partnership for Cancer Care and Control.”

NCD’s are also called “lifestyle diseases,” and apart from an unhealthy diet and lack of exercise, Leachon singles out smoking as a culprit. Science has already determined the link between smoking and a number of diseases, but as Leachon points out: “We know it’s bad for our health and yet smokers allow themselves to suffer and die prematurely – this is really absurd.”

The sin taxes would, in theory, impose higher taxes on cigarettes and make them more expensive, putting tobacco out of reach of the young and the poor, the population most vulnerable to NCDs in both the short and long term. Another pending piece of legislation, which would require the use of “graphic” warnings on the health risks of smoking in cigarette packs – already in place in neighboring countries – could also help bring down the number of smokers and prevent more young people from taking up smoking....

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Government and Taxes

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