‘Health for All’ (replay)

We’ve been described as the “sick man (and woman) of Asia,” which we rarely link to the poor health, literally, of our citizens.

The specter of infectious diseases, from the age-old problem of tuberculosis to diseases that had emerged more recently such as HIV/AIDS, is all too real, even as noncommunicable diseases—cardiovascular problems, diabetes, cancers—are also on the rise, associated with lifestyle factors like under- and overnutrition. We shouldn’t forget, too, that accidents and homicides are listed among the country’s leading causes of death.

Sunday is World Health Day, with the World Health Organization (WHO) calling for more attention to health care. But looking at its key messages, I couldn’t help but feel a sense of déjà vu.

The messages revolve around the idea of “Health for All,” which is a recycled message from the WHO Alma-Ata Conference way back in 1978. At that time, the message was “Health for All by the Year 2000.”

Other key messages for World Health Day this year emphasize primary health care—programs that mobilize community health workers and the communities themselves—as the way toward health for all. Again, this is an old message associated with the

 Alma-Ata Conference.

Back then, there was much excitement about primary health care. In the Philippines, nongovernment organizations (NGOs), even before Alma-Ata, had taken the lead producing community health workers, with government getting on the bandwagon later to train barangay health workers.

The nongovernment programs tended to have stronger community organizing efforts, getting communities to mobilize not just for health services but also for other inputs necessary for good health—for example, safe water. The more radical community health programs even included mobilizations for land reform and decent wages and working conditions.

Primary health care had its risks. Programs with community organizing were often tagged as subversive. Community health workers were harassed, arrested, even killed. Dr. Bobby de la Paz, a physician who was involved in community health, was assassinated in 1982 by the military while serving in Samar.

By the 1990s, it was becoming clear all over the world that we were going to miss the target of “Health for All by the Year 2000.” But community-based health programs continued, and today, we see very dedicated community and barangay health workers manning (or womanning) frontline health care services in many parts of the country, together with midwives, nurses and, occasionally, brave physicians willing to serve in the Doctor to the Barrios program started by the late health secretary Juan Flavier in 1993.

This year’s World Health Day also has messages about health being a human right, and on the need for universal health coverage or UHC, with the catchy line “for everyone, everywhere.”

Again, UHC is “old” stuff, adopted as national policy in many European countries, members of the British Commonwealth (e.g., nearby Malaysia) and, in recent years, our neighbor Thailand.

Unfortunately, we followed the US model of dual health care systems: a strong private sector where health care depends on the ability to pay, and an underfunded, understaffed, underequipped public sector for lower- and middle-income households.

The results have been disastrous. Health education, the responsibility of government, is ineffective, especially compared to the large budgets private companies have to promote unhealthy foods and lifestyles through advertising and marketing. I was appalled when two NGOs, Southeast Asia Tobacco Control Alliance and Health Justice Philippines, alerted UP officials to job fairs in Diliman and Los Baños where two companies, using the initials PMI and JTI, had managed to worm their way in for co-sponsorship, using student organizations.

The initials stand for Philip Morris International and Japan Tobacco International, and their sponsorship was a violation of international agreements signed by several governments, including our own, to heavily restrict, if not ban, tobacco advertising and sponsorship.

When major illnesses strike, including those induced by tobacco, alcohol and junk foods, even middle-class households run the risk of their savings being wiped out with a major illness in the family. A physician friend who himself suffered from such bills described it this way: “The bills come like water out of a faucet.” (He said this before the Manila Water fiasco.)

Given all these problems and a situation where “health for a few” seems to be the norm, a universal health care bill signed into law last February offers some hope. The new law is not very well publicized, perhaps because its implementing rules and regulations are still being drafted, but mass media and nongovernment offices should be on the alert to ensure that this law brings us closer to the long overdue “health for all” goal.

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