Public health challenges for 2020 (Part II)

Last week, I discussed three public health challenges for the coming year: vaccine-preventable diseases, tuberculosis and dengue, as well as HIV/AIDS. In what follows, I discuss three more — with the caveat that there are many others I hope to also highlight in the future.

Malnutrition. According to the 2018 National Nutrition Survey (NNS), stunting prevalence remains high among Filipino children, with the 30.3 percent figure essentially unchanged from 2013. Meanwhile, overnutrition is rising, with the prevalence of overweight jumping from 10.6 percent to 14.7 percent among 9-10-year-olds and obesity increasing from 7.2 percent to 9.6 percent among adults.

Beyond the physical appearance of shortness, stunting has been documented to lead to poor educational, health and social outcomes; in my own research on height, I found that short stature deprives young people of employment opportunities in part because of institutionalized physical discrimination. As for obesity, it is a major risk factor for noncommunicable diseases, which I will discuss later. Passed late last year, Republic Act No. 11148 or the Kalusugan at Nutrisyon ng Mag-Nanay Act, seeks to combat malnutrition by institutionalizing various interventions, including supplementary feeding and breastfeeding support. However, stronger measures are required, such as promoting health literacy and addressing the social and corporate determinants of nutrition, mindful that for many Filipinos, food is not a matter of choice.Noncommunicable diseases (NCDs). The 2018 NNS offers further worrisome statistics: 1 out of 5 adult Filipinos have elevated blood pressure, while 6.7 percent of all adults have high fasting blood sugar — a great increase from 4.7 percent in 2013. Although these survey results don’t necessarily equate to hypertension and diabetes, they nonetheless suggest worryingly high rates for two diseases responsible for some of the leading causes of deaths in the country.

In many ways, the rise of NCDs speaks of poor nutrition and lifestyle choices, as well as lay perceptions of illness. For instance, in the Respond Study — a collaborative research between the University of the Philippines Manila and the London School of Hygiene and Tropical Medicine — my colleagues and I are learning that many patients do not consider “high blood” a “chronic” condition and consequently take maintenance medications only for symptomatic relief.

Beyond these individual factors, there are also structural and health care system-related constraints that serve as barriers to NCD care. For instance, even if people want to exercise, there are very few public spaces in our cities to do so. The irregularity of medical doctors and medicines in health centers, as well as the limited clinic hours, discourage many from seeking consultation.

Mental health. The eminent child psychiatrist Dr. Cornelio Banaag recently warned that we are in the midst of a “mental health crisis”; ominously, he added: “I have been in practice for over half a century — that’s how old I am—and I have never seen anything like this.”

Policymakers have not been blind to this phenomenon, as evidenced by the welcome enactment of the Mental Health Law (RA 11036). Crucial to the success of these efforts, however, will be augmenting the shortage in human resources, from psychiatrists to guidance counselors, as well as strengthening social support in schools, for instance, through mentoring opportunities.

Just as important, we also need to look at the stressors — financial, educational, social — that young people face today, beyond the rightful, but sometimes disproportionate, ascription of responsibility on smartphones and the internet. While social media can engender feelings of loneliness and inferiority — and serve as venue for cyberbullying and online shaming—it can also be a platform for self-expression, community-building and other therapeutic possibilities.

Fortunately, we have dedicated professionals and advocates who are working hard to overcome these and other health challenges. They will need all the support, cooperation and political commitment the country can give them if they are to succeed — and if 2020 will bring us closer to “health for all Filipinos.”Merry Christmas and Happy New Year to everyone.

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