The Global Burden of Disease and Some Implications to Health Policy in the Philippines

The Global Burden of Diseases Study (GBD) is a collaborative project of about 500 researchers in 50 countries led by the University of Washington Institute for Health Metrics and Evaluation (IHME). It is the world’s largest systematic, scientific inquiry that quantifies the levels and trends of health loss by determining the prevalence, morbidity and mortality for hundreds of diseases, injuries, and risk factors that are of global significance. The results of the GBD show how socioeconomic development has generated many health achievements but also emerging challenges in both national and global contexts. Over the years, it has been extensively used to inform evidence-based policy and health systems design.


In the Philippines, the observed Filipino life expectancies increased by almost 2 years: females 73.1 (versus 71.4 in 1990), males 66.6 (versus 64.6 in 1990). We also saw a significant decline in the trend of child mortality between 1990 and 2017 (Under-5: 56.0, 26.6; Under-1: 36.0, 19.9). These numbers provide us a snapshot of how our current policies positively impact the health of the Filipino people.


As with many other low- and middle-income countries, the Philippines is still facing a double burden of disease. While the country continues to battle with the problem of infectious diseases, it is also experiencing a rapid increase in chronic NCDs at the same time. This double burden of disease places a great toll on the health system and the economy. Non-communicable diseases (NCDs) and lifestyle-related diseases like ischemic heart disease and stroke have remained in the top primary causes of death. In fact, six of the ten leading causes of death are non-communicable diseases (ischemic heart disease, stroke, chronic kidney diseases, diabetes, hypertensive heart disease and COPD). Lower respiratory tract infection and tuberculosis remain as the third and fifth leading causes of death, respectively.


Disability burden on Filipinos such as low back pain, headache disorders, diabetes, mental health problems, vision and hearing loss, and other chronic diseases, has significantly risen. The Philippines’ greatest risk factors driving the most death and disability come from a combination of metabolic (high fasting plasma glucose, high blood pressure, high BMI, high LDL, impaired kidney function), environmental (air pollution), and behavioral risks (dietary risks, malnutrition, tobacco, alcohol use).


According to the Financing Global Health Database (2017), the Philippine government spent $98 on health per person in 2015. Majority of health care spending came from out-of-pocket payments which was estimated to be $178 per person in 2015. The same database projected that in 2040, even when the government increases its health expenditure, the bulk of health care spending in the Philippines will still come from out-of-pocket payments. The expected OOP spending will rise to a staggering $590 per person or more than P30,000 in today’s exchange rate (US$1 = PhP52.15).

In summary, the study found that although people are living longer, we are spending more time and money in illness. These findings inform decision-making by providing policy makers with accurate, up-to-date information to identify vulnerable populations, conduct disease surveillance, and evaluate the efficacy and cost-effectiveness of current health interventions.


These findings also indicate that health issues can vary from country to country. Perhaps, we can expect that the same is true at the local level. Health issues will vary within the country especially when examined through our geopolitical divisions. People in the urban areas have greater access to health care services compared to those living in rural areas. However, urban areas also concentrate new risks and hazards for health. As such, the Philippines should address not only inequities in health care but also emerging threats brought about by rapid urbanization and globalization.


Data and information from GBD can assist the government in understanding the drivers/promoters of the observed trends. The government can effectively use data from the GBD to examine emerging challenges and explore opportunities for action. Future policies should extend across multiple sectors to include environment, urban planning, social insurance, education, and even transportation. There is a growing trend that emphasizes the need to strengthen (and maybe improve) current health interventions on infectious diseases. However, the country’s health system should now shift its focus from a highly curative system to one that is preventive and health promotive. Or maybe, at least be prepared in reducing health risks and hazards that are highly modifiable or preventable.


Ultimately, the GBD proved that development drives, but does not necessarily determine, the health status of the people. We must keep in mind, therefore, that health conditions exist in the same continuum which reflect underlying social conditions such as poverty and inequity. Given the nature of health conditions, the growing burden of disease reinforces the need for an integrated, multi-sectoral approach at the national and subnational levels that address health system functions (health promotion & prevention, cure, and rehabilitation) rather than disease categories by instituting cost-effective interventions that improve health beyond the health system.


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