The term Baby Boomer describes the generation born between the 40s and 60s. But if there was any time that the population is really booming, it’s now. As of the last count, we are 103,830,000, growing at an average rate of about 1.55% or by more than a million Filipinos every year.
21.3 million Filipinos occupy the Philippine’s National Capital Region during the day, resulting in a population density of 42,800 people per sq. km. While this huge workforce fuels our economic engine, can our healthcare system keep up with the growing numbers of health problems caused by rapid urbanization and brought about by the population explosion?
This urbanization contributes largely to slum development and consequently overburdens basic services that we all rely on. Among the most vital are health and sanitation which are the constant major issues for city dwellers. Crowded, poverty-stricken living conditions in urban areas also increase the likelihood and spread of diseases, both the communicable and non-communicable variety.
Time has become quite an expensive commodity in today’s urban jungle. As traffic and waiting in long lines continue to eat away at everyone’s 24 hours, there is increasingly less time for life’s basics like food preparation and sitting down to a home-cooked meal. As if in response to this demand, fast food and street food provide quick, filling, but ultimately deficient meals with choices ranging from either oily or starchy grubs to sodium-heavy processed foods such as instant noodles and canned food.
Poor parents are at a disadvantage because most of them do not have the basic knowledge in proper nutrition with their households suffering as a result. A study of the Food and Nutrition Research Institute reveals that 26% of children up to two years old suffer from chronic malnutrition, the highest in the past 10 years. Undernutrition, described as the deprivation of proper nutrition from day 1 to 1000 of a child, is prevalent in poor families and causes stunting among young children. As many as 1.5 million Filipino children go through entire days without having a single, proper meal.
Stunting does not only result in smaller children but it also affects brain development, as well as a delay in motor and cognitive skills necessary for academic performance. Undernutrition is seen as among the major factors that contribute to high dropout rates in basic education. Left unaddressed, these children with poor cognitive development become the future parents who lack basic knowledge in nutrition, perpetuating the cycle.
The Health and Nutrition Center of the Department of Education believes that this trend will bite us in the end as dropouts will not be able to take advantage of better employment opportunities which require higher education. This will ultimately hurt the country economically because of the critical role our workforce plays to drive economic progress.
The dismal state of our modern urban diet is not limited to the poor. The ready availability of fast food coupled with a fast-paced but sedentary nature of city work results in a perfect storm of conditions for lifestyle-related diseases, such as hypertension and diabetes, among the middle to upper middle classes.
Still, in the Philippines wealth as a determinant of health, seems accurate. Money buys better living conditions — away from crowding and pollution — and access to personalized health services such as family physicians, as well as nutrition and fitness instruction. The rich can also afford a proper education, which includes information on proper health, nutrition, and reproductive health. For example, studies have shown that the poor have an average of six children per family whereas the rich maintain about two.
There is a high correlation observed between maternal health and health of the children and a correlation between maternal health and the number of children she gives birth to. Not only are the rich better off financially to begin with, but having fewer children allows the parents to give their adequate parental and financial support to assure better overall development.
Dealing with the population, definitely, is no panacea and reducing birthrates alone will not suddenly solve everything. But any sensible healthcare management strategy should address these issues. Full implementation of the RH Law is a start, which is not simply a matter of distributing condoms as its detractors oversimplify it, but a holistic approach including education, information dissemination, and contraception.
As another consequence of urban growth, increased exposure to vehicle exhaust and cigarette smoking, all present in the daily commute increases the risks for Non-Communicable Diseases or NCDs with respiratory problems being the obvious consequence. But traveling in enclosed vehicles like trains and air-conditioned buses are not necessarily helpful as they make the transfer of airborne pathogens a lot easier among passengers.
It is tempting to think that going to the provinces for fresh air, and where life is less stressful would be best. However, decongestion by migration is simply displacement not reduction, and what it makes up for in a better environment is offset by the lack of health professionals.
The Department of Health (DOH) with its Philippine Health Agenda aims for the improved implementation of the country’s healthcare system. DOH’s TSEK AP or Tamang Serbisyo sa Kalusugan ng Pamilya promised to give free medical consultation for 20 million Filipinos. But it was not realized as no additional Barangay Health Stations (BHS) was established in the necessary barangays in the country.
At present 26,000 barangays are without BHS. And among those barangays that do have BHS, some are dilapidated and unequipped. Without these basic services, we will continue with the trend of 75,000 children dying before the age of five due to lack of pre and postnatal care, pediatric assistance, or even having complete immunizations as evidenced by the measles outbreak from a few years back.
Even if facilities would be constructed immediately, the imbalance in the distribution of health care providers presents another problem. Less than 20% of the active medical professionals in the country are employed in public facilities while responding to nearly 70% of the health care needs of the population. The problem is compounded by the fact that a majority of health center workers are stationed in urban areas and very few serve in rural and depressed communities.
This lack of personnel restricts DOH programs like the, “No Home Birthing Policy” which was expected to reduce childbirth complications. And so while the “No Home Birthing Policy” aimed to reduce Maternal Mortality Rates or MMR to 52 in every 100,000 as far back as 2015, the lack of health care professionals to address the massive need resulted to the figures rising to 221 in every 100,000.
In a Special Feature in the 2016 April-June issue of the Philippine Journal of Internal Medicine, Dr. Esperanza Cabral, reveals that “a majority of Filipinos and most of the poor seek medical care in public health facilities, but of the 66,000 physicians, 500,000 nurses and 74,000 midwives who are actively practicing their profession, only 3,000, 5,000 and 17,000 respectively, work in a public national facility as of 2013. This translates to less than one physician, less than one nurse and less than two midwives per 10,000 population doing public health work in the DOH.”
A healthy population is directly linked to our economic prosperity and efficient and widely available health care cannot take a backseat in that pursuit. The World Health Organization sets a minimum standard of 24 medical practitioners to 10,000 people, based on the figures above we have achieved 1/10th of that. A million more Filipinos every year will not better those odds. There is only so much more our health care system can take and only so much even the best programs can mitigate.
The luring of doctors from the cities and more BHSs would require more funding from the government. While it is easy to criticize, it is much harder to operationalize. But what we can work on is education. Education empowers people to manage their own health.
The discrepancy between rich and poor can be managed with proper education. What are the nutritional equivalents of expensive food? How can you balance macro and micronutrients on a poverty budget? Just discussing, Go, grow, and glow one week every July is not enough. Students should be equipped with practical knowledge that can be brought home.
Education empowers our youth on reproductive health and family planning. They would understand why spacing would be good for them physically, and economically. Education would give them options on how to accomplish these goals later on.
And the simplest of discussions would empower them to understand that BHSs were built for their benefit, that they can avail of free vaccinations, vitamins, and consultations. And that affordable health care is within reach and they should not be hesitant to take full advantage of these opportunities.