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DOH CONCERNS 2010
BOARD REVIEW NOTES
Dr. Theresita R. Lariosa
NATIONAL HIV SUMMIT
• With increasing cases of HIV seen and reported
especially in the last three years in the Philippines, it has
now become imperative for the government to conduct
an HIV Summit to urge leaders from all sectors of society
to jointly scale-up a national response to address the
disease.
• “It is very timely and appropriate that we hold a one-day
National HIV Summit in order to inform leaders on the
current state of HIV in the Philippines and the need for
urgent action towards meeting the Millennium
Development Goal 6, particularly Target 9 on HIV and
AIDS,” Health Secretary Esperanza Cabral announced.
INCIDENTS COMMAND SYSTEM
(ICS)
• Participants to the ASEAN Workshop on Managing
Public Health Emergencies and Pandemics Using the
Incidents Command System (ICS), led by National
Center for Disease Prevention and Control Director Dr.
Eduardo Janairo, recently met to construct a regional
overview of achievements and gaps in the use of ICS
in managing public health emergencies. The said
workshop also aims to develop common understanding
and highlight the importance of ICS for muliti-sectoral
response, especially in facilitating continuity of
operations and services during a severe pandemic.
TURKISH FLOUR
• The Department of Health (DOH) disclosed that samples of flour
imported from Turkey are undergoing stringent analysis by the Food
and Drug Administration (FDA) following media reports that these
are potentially harmful to the health of consumers.
• It was recently reported that substandard flour from Turkey that
contain toxic substances are being dumped in the Philippines and
used to make food products such as noodles and bread.
• The DOH, through the FDA’s Laboratory Services Division,
immediately moved to test samples for the presence of mycotoxins,
particularly Ochratoxin A and Aflatoxin, using the Enzyme-linked
Immunosorbent Assay (ELISA) method. Mycotoxins are toxic
secondary metabolites produced by certain species of fungi.
HIV IN THE CURRICULA
• In order to implement a more effective campaign
against HIV and AIDS in the country, the
Department of Health (DOH) strongly urged that
information on the modes of transmission,
prevention and control of this disease be
integrated in the curricula of all institutions of
learning. The country’s HIV and AIDS situation
has reached alarming proportions as it is now
described as “expanding and growing”, from
the previous “low and slow” and “hidden and
growing” phases.
HIV PROGRAM IN THE
WORKPLACE
• The Department of Health (DOH) revealed that the Philippines
witnessed a sharp increase in the number of diagnosed HIV (human
immunodeficiency virus) cases in the last three years. Majority of
these recorded cases belong to the economically-productive age
group.
• “In 2000, an average of one new case is diagnosed
every three days. In 2007, it rose to one new case per
day. Last year, there were two new cases diagnosed
in a day,”
• Due to the rising trend and because most infections can be found
among economically-productive individuals, Cabral explained that
the business sector is in a position to help curb the rising trend in
HIV infections by setting up policies and programs in the
workplace. This program is also in consonance to provisions in
Republic Act 8504 or the AIDS Prevention and Control Act of 1998.
GLOBAL PLAN ON TB
• The Department of Health (DOH) revealed that the current year
2010 is the halfway mark of the 2006-2015 Global Plan to stop
Tuberculosis, or TB. This year’s theme, “On the Move Against TB,
Innovate to Accelerate Action”, speaks of the need for new ways
to make anti-TB services even more accessible and efficient.
• The Philippines has itself made great strides in combating TB. From
a high mortality rate of 38.2 deaths per 100,000 population in 1990,
the Philippine Health Statistics reported a lower rate of 31/100,000.
• While the Philippines is still included in the World Health
Organization (WHO) watchlist of 22 high-burden countries, it has
lowered its ranking in TB prevalence from 7th to 9th. TB also
remains the 6th leading cause of morbidity and mortality in the
country, but experts have observed a decreasing trend
SURVEY ON TOBACCO (GATS)
• The Department of Health (DOH) disclosed that almost half of the
Filipinos surveyed in the first Philippine Global Adult Tobacco Survey
(GATS) revealed that they live in homes where smoking is allowed.
• In coordination with the National Statistics Office, a total of 9,705
individuals in rural and urban areas of the country 15 years of age
and older (to represent 61.3 million Filipinos) were selected and
interviewed in 2009. Of this number, 28.3% were current tobacco
smokers, representing 17.3 million Filipinos and 22.5% or
approximately 13.8 million Filipinos smoke every day. The average
age of initiation for daily smokers 18-34 years old was 17.4 years
old.
• The GATS data revealed that almost half (48.8% or 29.8 million)
of Filipinos are exposed to cigarette smoke in their homes and
54% (32.9 million) reported that someone smokes at least monthly
in their homes.
SMOKING
• The Philippine League of Government and Private Midwives Inc.
(PLGPMI) raised the alarm on the effects of smoking and
secondhand smoke on maternal and child health and urged the
Department of Health to implement stricter tobacco control policies.
• Reduction in Maternal mortality ratio (MMR) may be jeopardized by
the current rate of tobacco use and secondhand smoke exposure of
women of reproductive age.
• Smoking and exposure to other people’s cigarette smoke pose a
variety of reproductive health risks on women even before she
conceives, during her pregnancy and delivery as well as on her
baby’s health and well-being. These are issues that affect maternal
and child deaths.
• Medical studies have shown that female smokers take longer to
conceive and may even actually result in a depletion of ova and
cause infertility.
SMOKING
• The Department of Health (DOH) strongly urged all
government agencies to refrain from establishing
partnerships with and accepting donations from tobacco
manufacturers as this goes against the country’s
commitment to the World Health Organization (WHO)
Framework Convention on Tobacco Control.
• “These donations and partnerships are packaged as
corporate social responsibility (CSR) programs of the
tobacco industry”, explained Health Secretary Esperanza
Cabral. She stressed that under Republic Act 9211 or
the Tobacco Regulation Act of 2003, such CSR
activities which involve the indiscriminate display of
the tobacco manufacturer’s name or brand name may
constitute a prohibited form of advertising.
SMOKING
• Noynoy Aquino is a smoker like 17 million other Filipinos. Like
others who were born in the 1960's, he grew up in an environment
where smoking was the norm -- even among role models like
priests, doctors, businessmen, scientists, scholars, actors, athletes.
• Nevertheless, from his public statements it seems that Mr Aquino is
aware that he is not only damaging his own health but is setting a
poor example to his fellow-countrymen and fellow-countrywomen
and has expressed a desire to quit.
• Few families in the Philippines have been spared the effects of
tobacco use and smoke exposure. Based on the Global Adult
Tobacco Survey in 2009, 49% of Filipinos report that smoking is
allowed inside the home. More than 50% of youth aged 13-15 years
of age report that they are exposed to cigarette smoke at home
daily. Filipinos endure multiple daily exposures to tobacco smoke
public transportation, restaurants, malls and even health facilities.
• Smoking kills 10 Filipinos every hour.
SMOKING
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The reasons for the high burden and prevalence of smoking are straightforward.
Cigarettes are cheap and accessible. A pack costs less than a dollar. Individual sticks
are sold on the street, including to children. Smoking, until lately, was allowed
everywhere and many people still smoke in enclosed spaces including their homes.
Information and services for quitting are not readily available.
Smoking is the most important preventable risk factor for the leading cause of death
in the Philippines today: cardiovascular disease. It also causes immeasurable
suffering among families that are afflicted by cancers and other tobacco-related
diseases.
The Aquino family was not spared from this -- Ninoy Aquino suffered a heart attack.
Cory Aquino had colorectal cancer. Both of these conditions have been linked to
cigarette smoke exposure.
With the coming into force of the WHO Framework Convention on Tobacco
Control (WHO FCTC) in 2005, anti-smoking programmes have changed
dramatically. In the past, smoking and quitting was left to the individual
smoker. Today, because of the WHO FCTC, it is also government's responsibility
and mandate to control tobacco use.
Smokers have a right to the best information and the best available services to quit in
order to protect their health and the health of their loved ones.
But at the same time, every patient's right to privacy in dealing with quitting needs to
be respected. This is as true of Noynoy Aquino as it is of everyone else
SMOKING
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Scientific understanding of smoking and treatment of tobacco dependence
has advanced in recent years. "Treating Tobacco Use and Dependence:
Clinical Practice Guidelines, 2008" published by the US Public Health
Service is recognized as an authoritative resource for evidence-based
practice in cessation. Applied to the Philippines, the following
recommendations from the Guidelines are relevant:
1) tobacco dependence should be viewed as a chronic disease that
requires multiple interventions and sometimes many quit attempts are
needed;
2) clinicians and health care workers need to identify and treat every
tobacco user;
3) practical counselling (problem solving and skills training) and social
support are important parts of treatment;
4) brief advice, rather than constant reminders, is effective;
5) nicotine replacement therapy (patches, gums, lozenges, inhalers and
sprays) as well as bupropion and varenicline are effective drugs of choice
for treatment; and
6) counselling and medication are effective by themselves but are more
effective in combination
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Recent public statements made in the Philippines regarding the efficacy of
acupuncture as a treatment needs to be scrutinized. The Guidelines state
unequivocally that there is no evidence to show that acupuncture is effective in
tobacco use treatment. Based on a separate meta-analysis conducted in 2000 to
evaluate effectiveness, the "actual" vs. "control" acupuncture groups showed no
difference in effectiveness in the two types of procedures. These results suggest that
any effect of acupuncture might be produced by other factors such as positive
expectations about the procedure.
It took 17 years (from 1987) when the first bill on anti-smoking was introduced in the
Philippines for it to be passed into law. There is a huge unfinished agenda for the
Philippine government to comply with the WHO Framework Convention on Tobacco
Control. This agenda includes raising prices and taxes of cigarettes, requiring
graphic health warnings on cigarette packs, strictly enforcing 100% indoor smoking in
public places, preventing single cigarette stick sale, banning point of sale advertising,
preventing the influence and lobby of the tobacco industry in policy-making,
legislation and enforcement, protecting all citizens from exposure to second hand
smoke and last but not least, ensuring that every smoker, like Senator Noynoy Aquino
has scientific information, the best available services and respect for a patient's right
to privacy.
EMERGING AND RE-EMERGING
DISEASES
• Emerging infectious diseases are newly identified or previously
unknown infections while re-emerging infections are secondary to
the reappearance of a previously eliminated infection or an
unexpected increase in the number of a previously known
infectious disease. Both types can cause serious public health
problems if not contained as close as possible to its source.
• National agencies and LGUs in the Philippines are able to respond
appropriately to threats and incidences of emerging and re-emerging
infections through the institutionalized systems for disease
surveillance, epidemiological investigation and epidemic response in
the DOH and the long-established interagency disaster response
mechanisms. Protocols for surveillance, case investigation, outbreak
investigation, contact tracing and response have been defined.
CHEAPER MEDICINE LAW
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Republic Act No. 9502, or the "Universally Accessible Cheaper and Quality
Medicines Act of 2008", is a measure intended to enhance access to generic drugs
that will provide cheaper but quality medicines to Filipinos. The law amended
Republic Act No. 6675 or the Generics Act of 1988, Republic Act No. 8293 or the
Intellectual Property Code, and Republic Act No. 5921 or the Pharmacy Law.
The law was signed by President Gloria Macapagal-Arroyo on 6 June 2008.
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The law allows the parallel importation of patented medicines from other countries
where they are more affordable. It also bars the grant of new patents based only on
newly-discovered uses of an ingredient of an existing drug. Generics firms will be
allowed to test, produce, and register their versions of patented drugs.
The President of the Philippines is also empowered to "impose price ceilings on
various drugs upon the recommendation of the Health Secretary" of the Department
of Health (DOH). Drug outlets will be required to carry a variety of medicine brands,
which include those sourced through parallel importation -- giving consumers more
choices.
The Law also creates a congressional oversight committee, such as the Quality
Affordable Medicines Oversight Committee, to monitor the implementation of the
"Cheaper and Quality Medicines Act."
INTERNATIONAL HEALTH
REGULATION
• The International Health Regulations or IHR is a set of
international laws which help countries work together to
agree on the same rules in covering public health
emergency of international concern (PHEIC), preventing
international spread of diseases and other health risks.
• The IHR was revised as the IHR 2005 (the first IHR was
implemented by the WHO member States in 1969), as a
result of the 48th World Health Assembly in 1995.
Representatives of the World Health Organization
(WHO) member nations observed the onslaught of the
resurgence of cholera in Africa, the plague in India, the
emergence of new infectious agents such as Ebola in
the 1990s and thus, called for the revision of the IHR
1969.
PHEIC
• For an event to be classified as a PHEIC
the following criteria should be satisfied:
• seriousness of the public health impact
of the event;
• unusual or unexpected nature of the
event;
• potential for the event to spread
internationally; and/or
• the risk that restrictions to travel or
trade may result because of the event.
INTERNATIONAL HEALTH
REGULATION
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The National Epidemiology Center (NEC) was named as the National IHR
Focal Point in the Philippines. The IHR requires that the NEC will be
responsible for the following activities, 24 hours a day, 7 days a week:
– respond to requests for verification of information regarding events that may
constitute a public health emergency of international concern;
– respond to public health risks which may spread internationally;
– develop, strengthen and maintain the capacity to detect, report and respond
to public health events;
– provide routine facilities, services, inspections and control activities at
designated international airports, ports and ground crossings to prevent the
international spread of disease;
– report to WHO evidence of a public health risk identified outside their territory
which may cause international disease spread, manifested by exported/imported
human cases, vectors carrying infection or contamination, contaminated goods;
– respond appropriately to WHO-recommended measures; and
– collaborate with other States Parties and with WHO on IHR (2005)
implementation.