The triple burden of DOH
The unceremonious rejection of Dr. Paulyn Ubial as health secretary by the Commission on Appointments is unfortunate, especially given the flimsy reasons for it, such as Manny Pacquiao citing Ubial’s son for criticizing his behavior as a senator. Though lacking the charisma of Johnny Flavier or the visionary spirit of Quasi Romualdez, Ubial has brought compassionate leadership to the Department of Health and I hope she will continue her public health work.
Even so, the work at the DOH continues. As Francisco Duque III makes a comeback as health secretary (he served under President Gloria Arroyo in 2005-2010), it is a worthwhile exercise to look at the challenges facing our healthcare system today.
Helpfully, the DOH’s own Philippine Health Agenda 2016-2022 articulates these concerns neatly under the “triple burden of illness.” In the first place, we have communicable diseases. Today’s elephant in the room is HIV/AIDS, which, despite spreading at rates not currently seen anywhere else in the world, is not receiving the commensurate attention and action it urgently needs. Moreover, despite the rightful concern over emergent infections like HIV and MERS-CoV, persistent ones like tuberculosis and malaria continue to claim thousands of Filipino lives yearly, with antimicrobial resistance complicating efforts to address them.
Secondly, we have noncommunicable diseases (NCDs), which include hypertension, diabetes and cancer. Taken together, NCDs actually constitute the biggest cause of illness and death in the country, but they’re grossly overlooked and understudied. To its credit, the DOH has formed various programs for NCDs, but much more needs to be done in addressing barriers to NCD care and its many social determinants.
The third category is described by the DOH as “diseases of rapid urbanization and industrialization,” which include mental health and substance abuse. This is another area where the department can make a big difference. For instance, by doubling down (and acting) on the fact that drug (ab)use is a “public health problem,” the DOH can redeem the government’s antidrug campaign by channeling it into rehabilitative and preventive — not punitive — measures.
Beyond the “triple burden of disease,” I see the DOH as having its own “triple burden” — areas of concern that the new leadership will hopefully work on.
The first is its inability to maximize legislative gains throughout the years. The Sin Tax Law, which was passed in 2012, has generated a lot of revenue for healthcare, but the DOH’s “absorptive capacity” remains limited. The long-overdue Reproductive Health Law has yet to take full effect; the same can be said of laws regulating pharmaceuticals, infant formula, hospitals, and medical practice itself. Here, Duque’s political savvy is needed to defend various laws from being watered down—and for their most progressive provisions to be finally and fully be implemented.
The second burden is a lack (and mismatch) of human resources. Though we are thankfully long past the time when doctors were becoming nurses, doctors remain heavily concentrated on urban areas; many areas remain doctorless; many agencies — i.e., the Food and Drug Administration — remain understaffed. In the long run, the key component here is making medical education affordable and equitable across the regions. But even now, more career guidance, mentoring opportunities, and financial support are required if public health is to be a viable option for young health professionals, such as the physicians in the Doctors to the Barrios program.
The third and final burden is a lack of effective communications. Social media has emerged as the main medium of communication for many Filipinos, but the DOH has not really come apace with this trend, still preferring Flavier-era TV commercials. Instead, it is the likes of Dr. Willie Ong — 6 million followers in tow — who reach the public more effectively on Facebook. Even the DOH website needs a makeover, and would be much more useful if it has educational materials written in simple and understandable language. Needless to say, an informed public can make a big difference in dealing with our most pressing health challenges.
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