Global and Philippine Healthcare Systems and Trends

The Health Sector 8-Point Action Agenda in the Philippines

In the vision of Bagong Pilipinas, every life is considered valuable. The national health agenda is centered on ensuring that every Filipino, community, health worker, and institution is supported. The primary goals for every Filipino include being safe (Ligtas), experiencing quality and caring service (Dekalidad at mapagkalingang serbisyo), and utilizing technology for rapid service delivery (Teknolohiya para sa mabilis na serbisyo). The health system is designed to be crisis-ready (Handa sa Krisis).

The 8-point action agenda specifically targets several key areas of improvement: the prevention of diseases (Pag-iwas sa sakit), the comfort of mind and emotion (Ginhawa ng isip at damdamin), the welfare and rights of health workers (Kapakanan at karapatan ng health workers), and protection against any future pandemics (Proteksyon sa anumang pandemya).

Fundamentals of Global Healthcare

Global health involves the study, research, and practice of medicine aimed at improving health outcomes and achieving health equity for populations across the globe. This field is inherently multi-disciplinary, incorporating medical and non-medical disciplines such as Epidemiology, Sociology, Economic Disparities, Public and Environmental Factors, and Cultural Studies. The World Health Organization (WHO) serves as the primary international agency focused on advancing these global health initiatives.

Global health is crucial for both global security and the security of individual nations. The emergence or reemergence of infectious diseases and other health threats is often driven by international travel and commerce. According to the World Health Report ($2007$), since $1970$, new diseases have been identified at an average rate of one or more per year.

Cultural Patterns and Healthcare Disparities

Culture is defined as a set of patterns of human activity within a community or social group, encompassing customs, laws, manner of dressing, architectural styles, religious beliefs, and traditions. Within the healthcare context, health disparities represent a higher burden of illness, injury, disability, or mortality experienced by one group relative to another. Healthcare disparity specifically refers to differences between groups regarding health insurance coverage, access to care, use of care, and the quality of care received.

Well-documented disparities exist in healthcare and health outcomes between the majority population and racial, ethnic, minority, or underserved populations. The National Healthcare Disparities Report ($2012$) by the Agency for Healthcare Research and Quality identifies several reasons for these disparities: low socioeconomic status, specific health behaviors, limited access to healthcare due to poverty or disability, environmental factors, and both direct or indirect manifestations of discrimination within the healthcare system.

Chronic Illness and Associated Risk Behaviors

Chronic illness is defined as a long-lasting, persistent, and recurrent disease that lasts for more than $6$ months. The term "chronic" specifically refers to the course of the disease, including its onset and development. These conditions require ongoing medical attention or result in limitations to activities of daily living. Major examples of chronic diseases include heart disease, stroke, diabetes, lung disease, kidney disease, mental illness, and conditions resulting from substance use.

Chronic diseases are frequently associated with four key risk behaviors: tobacco use and exposure to secondhand smoke; poor nutrition, including diets low in fruits and vegetables or high in sodium and saturated fats; a lack of physical activity; and excessive alcohol use.

Principles of Culturally Competent Care

Culturally competent care is an individualized approach to nursing that demonstrates respect for the dignity, personal rights, preferences, beliefs, and practices of the individual receiving care. It requires healthcare providers to acknowledge their own biases and prevent them from interfering with care. Nurses must find meaningful healthcare delivery strategies based on an integration of knowledge, skills, and attitudes regarding a patient's cultural heritage. This involves complex assessment, decision-making, judgment, critical thinking, and evaluation.

There are five core principles of cultural competence. Equity focuses on balancing and justice. Diversity focuses on demographics and the identity of populations. Intercultural Competence involves the systems and processes to effectively build operational capacity for Diversity, Equity, and Inclusion (DEI). Inclusion focuses on outcomes and engagement. Belonging is centered on personal experiences and values.

Transcultural nursing is a distinct specialty that focuses on global cultures and comparative cultural caring, health, and nursing phenomena. The ultimate purpose of this specialty is to provide culturally congruent care by recognizing and appreciating cultural differences in healthcare values, beliefs, and customs.

The Philippine Healthcare Delivery System

The Philippine healthcare system features highly proficient doctors and nurses, but it faces limitations in public healthcare despite the implementation of Universal Healthcare. There is unequal access to medical care, and public healthcare staff are often strained by a large population. This strain has led to Western migration of staff, resulting in understaffing and delayed treatment. Public healthcare is administered by PHILHEALTH, a government-owned corporation that subsidizes treatments, patient care, and surgeries.

The delivery system is divided into Public and Private sectors. The Public sector is largely financed through a tax-based system and includes the National level (Department of Health or DOH, which manages specialty, regional, and retained hospitals and medical centers) and the Local level (Local Government Units or LGUs, which manage provincial and district hospitals, Rural Health Units or RHUs, and Barangay Health Stations or BHSs). The Private sector is market-oriented and includes Profit entities (commercial practitioners, clinics, and laboratories) and Non-profit entities (socio-civic groups, religious organizations, or foundations).

Disease Burden and Mortality in the Philippines

Based on preliminary data from $2022$ and $2023$ from the DOH-Epidemiology Bureau and Philippine Statistics Authority, the leading causes of morbidity and mortality have been identified. The ten leading causes of morbidity are: 1. Acute Respiratory Infection, 2. Hypertension, 3. Animal Bites, 4. Urinary Tract Infection, 5. Acute Lower Respiratory Tract Infection, 6. Skin Diseases, 7. Pneumonia, 8. Diseases of the Heart, 9. TB (all forms), and 10. Fever of Unknown Origin.

The ten leading causes of mortality in the Philippines are: 1. Ischaemic heart diseases ($I20-I25$), 2. Cerebrovascular diseases ($I60-I69$), 3. COVID-$19$ virus identified, 4. Neoplasms ($C00-C96$), 5. Diabetes mellitus ($E10-E14$), 6. Hypertensive diseases ($I10-I13$), 7. Pneumonia ($J12-J18$), 8. Chronic lower respiratory diseases ($J40-J47$), 9. Other heart diseases ($126-151$), and 10. Remainder of diseases of the genitourinary system ($N17-N98$).

Global Health Projections and Historical Data ($1955$-$2025$)

Between $1955$ and $2025$, the global health situation has seen massive shifts. In $1955$, the global population was $2.8$ billion; by $2025$, it is projected to reach $8$ billion, increasing by $80$ million people per year. Life expectancy has improved from an average of $48$ years in $1955$ to $65$ years in $1995$, with a projection of $73$ years by $2025$. The projected age structure of deaths for $2025$ indicates that $8\%$ of deaths will occur in children under $5$ years old, $3\%$ in those aged $5-19$, $27\%$ in those aged $20-64$, and $63\%$ in those over $65$ years old.

In $2025$, it is projected that $5$ million children under the age of $5$ will die, with $97\%$ of these deaths occurring in developing countries due to pneumonia. For older children and adolescents, primary health concerns include HIV, violence, delinquency, STDs, alcohol, and motor accidents. In adults, there is a prevalence of non-communicable diseases (NCDs) and infectious diseases in developing countries. Diabetes cases are expected to double to $300$ million by $2025$ due to dietary and lifestyle factors such as smoking, high-fat diets, obesity, and lack of exercise. Cancer remains a leading cause of death worldwide. For older adults, cancer and heart disease are primary concerns between ages $70-75$, while those over $75$ often face impairment of senses (vision, hearing), mobility, and mental function. Women over $60$ are at significant risk for dementia.

Six Prominent Global Health Issues

Pandemics and global disease outbreaks remain a constant threat, with newly emerging pandemic threats appearing every year. Addressing these requires health education, responsible agricultural practices, and managing the spread of viruses. Environmental factors, including climate change, air pollution, and water source contamination, lead to the displacement of people through floods and droughts. Solutions involve providing bottled water, sanitation technology, and health education.

Economic disparities and limited access to healthcare result in the persistence of STDs, high child mortality rates, and poor nutrition. Rural communities often lack personnel, a problem exacerbated by income inequality. Political factors such as conflicts between nations can destroy critical infrastructure for transportation and sanitation. Refugee migration increases the spread of disease, necessitates improved access to refugee healthcare, and requires policies to shorten response times.

Non-communicable diseases (NCDs) account for $70\%$ of deaths worldwide and are attributed to genetics, physiology, environment, and behavior. Education is key to changing lifestyles regarding poor diet, inactivity, tobacco, and alcohol. Finally, animal health, food sourcing, and supply are intertwined with human health. Agricultural practices such as pesticide use and waste management influence animal health, and pathogens from animals play a significant role in disease transmission, necessitating the inclusion of veterinary medicine in global health strategies.

Global Mortality Statistics ($2019$ Data)

In $2019$, out of $55$ million total deaths globally, $74\%$ were caused by non-communicable diseases. Cardiovascular diseases, including heart attacks and strokes, accounted for $33\%$ ($18.5$ million deaths per year or $50,850$ per day). Cancers accounted for $18\%$ ($10$ million deaths per year or $27,600$ per day). Other causes included infectious diseases ($14\%$), comprising pneumonia/lower respiratory diseases ($4.4\%$, $2.5$ million deaths/year), diarrheal diseases ($2.7\%$, $1.5$ million deaths/year), tuberculosis ($2\%$), HIV/AIDS ($1.5\%$), and malaria ($1.1\%$).

Additional global causes of death include chronic respiratory diseases ($7\%$), neurological diseases like Alzheimer's ($3.9\%$), digestive diseases ($4.5\%$), diabetes ($2.7\%$), neonatal deaths ($3.3\%$), transport accidents ($2.3\%$, $1.3$ million deaths/year), other accidents ($3.1\%$), and suicides/homicides ($1.3\%$). Communicable diseases involve infectious and parasitic diseases, as well as maternal, perinatal, and nutritional conditions. Non-communicable diseases are categorized as chronic diseases.

Emerging Global Health Issues and Trends

Developing countries are facing a "Dual Burden" as they must address both infectious diseases and increasing death rates from non-communicable diseases, mental health issues, and injuries. Emerging laws and policies affecting health now include road traffic safety and violence prevention. Expanding international trade has also introduced new health risks. The WHO proposes that both developed and developing countries must have appropriate surveillance and response capabilities. Prevention is recognized as the key to management, but because many factors lie outside personal control (e.g., environment, economics), a collective effort from a variety of disciplines is required.