Tuesday, January 30, 2007

OPINION: “Burdens of Disease” by Juan Mercado

“Health is the second blessing we mortals are capable of,” Izaak Walton once wrote.

I can’t recall the first. But fear of falling ill haunts all, specially the poor. That concern stems from their experience with government’s inadequate health systems. At local drugstores, some medicines are priced 5 to 18 times more than in other countries.

Those lusting for election exploit this anxiety. Cebu City mayor Tomas Osmena, for example, gave PhilHealth cards, valid for a year, to 35,000 beneficiaries (aka voters). Could this be misconstrued as politicking? “It’s not misconstrued,” he scoffed. “It is what it is.”

It is, in fact, far more. Health cards lapse after the votes are tallied. But many candidates ignore a critical issue: The “epidemiological transition” that is sweeping through Asian countries.

Harvard University and World Health Organization report that patterns of illnesses and deaths are drastically changing in poor countries like the Philippines – and straining health systems.

Where maladies of the poor once dominated, ailments of the affluent are emerging with a vengeance, Harvard and WHO note in their study: “The Global Burden of Disease” Tuberculosis, diarrhea, pneumonia, measles, dengue, infant malnutrition are being rapidly overtaken by stroke, diabetes, obesity, etc.

Only the very poorest countries have not started this transition to Western type diseases, University of Sydney’s Dr Bruce Neal writes in “Far Eastern Economic Review”.

Large scale studies, for example, found: “One in eight of those aged over 30 had diabetes. And an equal number showed prediabetes”. Strokes were spiraling. “Obsolete” diseases still ravage slums and uplands, of the Philippines, Indonesia, Nepal or Sudan.

But in affluent and urbanized Singapore, Germany, Korea or Hong Kong, as well as the “gated enclaves” of the rich here, fat-saturated diets, sedentary life styles, obesity boost incidence of chronic diseases. Cheek-by-jowl, the overfed and ill-nourished suffer their differing ailments.

“Potentates goodly in girth” popularized fat-reducing Xenia. But chronic hunger stunts 32 out of every 100 kids, “Philippine Human Development Report 2006” points out. And 20 percent of infants are puny under weights. In Cebu, 28 out of every 100 lack access to safe potable water.

Scientists have crafted new “burden-of-disease” indicators to track this transition’s effects.
Used since the mid-1990s, this new gauge adds up “life years lost due to diseases” and early graves, i.e. years wasted by pre-mature deaths, explain University of Ulster’s S.R. Osmani and A. Bhargaya from Houston University.

The novel tape measure is known as “Dalys” --shorthand for “disability adjusted life-years per thousand of population”. Among other things, “Daly’s” found that : Every one thousand Filipinos – like the 3.6 billion men, women and children who live in Asia today – lose the equivalent of 259 years from illness-linked disabilities and premature deaths.

Total life years lost, on the other hand, amounted to 259 years per 1,000 populations. Losses of such magnitude can beggar a nation. But political trapos do not factor such issues into their agendas. Hence, they are blind to implications of the Asian Development Bank warning: The two phases of this “transition in this burden of disease” do not follow in sequence, In fact, they interlock.

As a result, richer and poorer countries “share a common predicament: that of an overlapping health transition,” Dab’s Review points out. Nations like the Philippines do not have the option of solving one crisis at a time.

Instead, “they must tackle simultaneously problems the western world had the privilege of tackling sequentially. Emerging Asia will not have this “luxury” But problems spill far beyond casting of the ballot. Health will be costlier in the future, as populations’ age, ADB cautions.

Articulate groups, in cities, will seek to skew limited budgets towards treatment of their chronic diseases. “This will perpetuate disadvantage to the poor.” Indeed, needy countries should not “emulate Western style physician-driven programs,” adds Dr. Bryce Neal.

“(They) provide a high-cost solution for the wealthy few”. We allocate the equivalent of $174 per capita for health, Ump’s Human Development Report notes. The comparative figure for Malaysians is $374 and $1,074 for Koreans.

Over-worked, under supplied and underpaid municipal health workers close the health gap for most Filipinos, on a daily basis, in 81 provinces and 117 cities. They tap into the rich trove of traditional medicinal plants: from lagundi for coughs to amplaya for diabetes.

It’s an uphill fight. As an Inquirer “Talk of the Town” feature asked: Were multinational drug lobbies, with a few susceptible doctors, behind downgrading of ampalaya (momordica charantia), long listed as a scientifically validated medicinal plant?

That move bankrupted thousands of small ampalaya farmers. And it stripped municipal health workers of a tool in their kits. Now, Health Secretary Francisco Toque has dusted off scientific studies on ampalaya that were shoved under the rug.

He could reinstate the plant – and turn attention to the next 10 medicinal plants that health workers could use.“San Carlos University studies, in Cebu’s mountains, over 200 found medicinal plants,” Dr Franz Siedenchwarz reported. “But only one has been commercially exploited – marijuana.”

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