DOH CONCERNS 2010

1. DOH CONCERNS 2010 BOARD REVIEW NOTES Dr. Theresita R. Lariosa

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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

8. 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.

9. 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.

10. 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.       

11. 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.

12. SMOKING • 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

13. SMOKING • 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

14. 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.

15. 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 knowninfectious 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.

16. CHEAPER MEDICINE LAW • 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. • 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."

17. 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.

18. 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.

19. INTERNATIONAL HEALTH REGULATION • 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.