Health as capital

We think of health usually in terms of, well, feeling well, which in turn is not being sick. It’s only when we do get sick that we crave for good health.

By extension, for legislators and health bureaucrats, there’s a tendency to think of health care mainly as expenditures for the sick. It’s money out, and that’s it. Often, too, patients are blamed for not taking care of themselves and becoming a burden to society.

We fail to think of health care as an investment in people — at all levels, from the family to the nation. This, in fact, is the way the Philippine Development Plan (PDP) looks at health.

The Philippine Statistics Authority (PSA) recently released its StatDev, a kind of scorecard measuring the country’s progress toward development goals described in the PDP with targets for 2022, which is when President Duterte ends his term. The first time I looked at the scorecard, I couldn’t find health indicators. It turned out most of the health indicators were in a section called “human capital development,” together with many indicators related to education.

I thought that the classification actually made sense. The country’s development involves more than financial capital. Human capital is important, and developing that capital involves not just education but also health care.

When I looked at the indicators, it turned out we did well with those for education, mainly around enrollment rates for basic education and technical and vocation education.

The scorecard used emojis to indicate the likelihood of reaching PDP targets, and when it came to the 14 health indicators, only three had smiling faces, meaning a high likelihood of achieving targets. Three had neutral emojis to mean medium likelihood, and eight had scowling faces—yes, you guessed it, meaning low likelihood.

The three smiling faces were related to a reduction in the death rates for children aged below 5, the decrease in teenage pregnancy rate, and the births attended to by skilled health personnel.

I don’t want to depress you by listing all the indicators where progress has been slow except to say they deal mainly with children, and with the control of infectious diseases like tuberculosis and malaria. I do want to mention that stunting (low height or, in Filipino, “bansot”) is one of the indicators where we have medium likelihood of achieving targets. This is borne out by a study released three years ago by Imperial College London, analyzing improvements in height among 179 countries from 1896 to 1996. The Philippines was at the bottom of the list; in fact, for girls, we were the very last.

About a third of our children are stunted, an important indicator for health care in general, because stunting is due not just to poor nutrition but also to a child having repeated infections. Stunting has long-term health consequences, including an increased risk for degenerative diseases such as diabetes. Women who are short also have more difficulties when delivering their children.

Finally, in relation to human capital development, stunting means reduced cognitive development, which translates to poor performance in school, dropping out, and just not having opportunities to advance.

Some readers might be reacting: “I’m short but I’m doing well.”

So, yes, genetics plays a role, too. But short height among the poor is the result of both genetics and social deprivation, and the stunting creates a vicious cycle where the person has limited opportunities for social mobility.

I’ve followed the country’s statistics on illness and death since the 1970s and have seen how we seemed to be shifting away from infectious diseases toward so-called lifestyle illnesses such as heart disease and diabetes. But the statistics over the last decade suggest we now have a double burden: Old infectious diseases such as dengue and tuberculosis are on the rise, even as we deal with the noncommunicable diseases like the lifestyle illnesses, plus accidents and homicide.

There are too many ironies in the health indicators: stunting amid the proliferation of so-called growth-enhancing vitamin-mineral preparations; underweight children amid an increase in overweight children.

The greatest irony is that the infectious diseases, which are taking a heavy toll in lives, can be prevented, cured or, in the case of HIV/AIDS, managed. The anti-infectious drugs are, however, expensive, and because of self-medication and inadequate treatment, we are facing more and more antibiotic resistance, as in the case of TB.

What a waste of human resources it would be if we improve our educational system but condemn our children to a health care system that isn’t working.

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