Lecture 1_20240606.pdf

“Health as a Social Phenomenon” Module 1: Introduction to the Course ‘Comparative Health Policies in the ASEAN’(SEAS 103i) Photo Credits: AC Nadate Dennis B. Batangan, M.D, M.Sc. (H...

“Health as a Social Phenomenon” Module 1: Introduction to the Course ‘Comparative Health Policies in the ASEAN’(SEAS 103i) Photo Credits: AC Nadate Dennis B. Batangan, M.D, M.Sc. (Heid) School of Social Sciences Institute of Philippine Culture Ateneo Initiative for South East Asian Studies School of Government Ateneo de Manila University  Parts of the Lecture 1. Tolak angin, Herb Inhalers and Activated Charcoal: Popularizing ASEAN Herbal Medicines* 1. How it started: the SEAS 103i story 2. “Health as a social phenomenon” (main lecture) *https://opinion.inquirer.net/124486/tolak-angin  Institutional Partnerships for HATID ASEAN: CPHS, Chulalongkorn University, Thailand; AdMU-IPC Philippines and NIHRD, MOH Indonesia ➔ 2012 EU-SEA Net “Ambient Intelligence Course” in Budapest Hungary ➔ 2013 WHO Proposal for HATID ASEAN ➔ 2015 October- “Learning Interaction on eHealth Technologies” LIT 1 ASEAN, CPHS Chulalongkorn University, Bangkok, Thailand ➔ 2016 April - Technical meeting hosted by NIHRD, MOH in Jakarta Indonesia ➔ 2016 October- Approval of HATID ASEAN proposal by the ASEAN Committee on Science Technology and Innovation (COSTI) ➔ 2017 February and December– LIT 2 ASEAN and the ASEAN eHealth Conf ➔ 2018 ASTIF Approval of HIIGIT ASEAN Project ➔ 2019 AUN Health Promotion Conf in Manila and LIT 3 ASEAN in Bangkok ➔ 2020 Webinars hosted by Ateneo-IPC as part of LIT 4 ASEAN  First LEARNING INTERACTION ON eHEALTH TECHNOLOGIES IN ASEAN LIT 1 ASEAN  Second LEARNING INTERACTION ON eHEALTH TECHNOLOGIES IN ASEAN LIT 2 ASEAN  3rd LEARNING INTERACTION ON eHEALTH TECHNOLOGIES IN ASEAN ( LIT 3 ASEAN) Introducing the HATID ASEAN and HIIGIT ASEAN Projects Within An Evolving ASEAN eHealth and Data Governance Nexus Dennis B. Batangan, M.D., M.Sc. (Heidelberg) Institute of Philippine Culture Ateneo de Manila University, Philippines 30 September 2019 3rd Learning Interaction on eHealth Technologies (LIT3) College of Public Health Sciences, Chulalongkorn University Bangkok Thaailand LIT 4 ASEAN HATID ASEAN Data Governance in eHealth Programs: Understanding the Interaction of Health Technologies and Decision-making in the HATID ASEAN projects of the Philippines, Thailand and Indonesia (HATID GOV) MICRO-credentials for life-long learning and employability: Building Capacities for Developing Agile Educational Interventions in Southeast Asian Universities “Health as a Social Phenomenon” Module 1: Introduction to the Course ‘Comparative Health Policies in the ASEAN’(SEAS 103i) Photo Credits: AC Nadate Dennis B. Batangan, M.D, M.Sc. (Heid) School of Social Sciences Institute of Philippine Culture Ateneo Initiative for South East Asian Studies School of Government Ateneo de Manila University  Disclosures Faculty- Ateneo Initatives for South East Asian Studies, School of Social Sciences and Ateneo School of Government; Lecturer in UP Diliman, UP Manila and MSU IIT_Iligan City Research scientist -Ateneo de Manila University-Institute of Philippine Culture -One Utility Model registration and one pending Patent Application with Intellectual Property Philippines;2018 - Social Innovation in Health Award -2021 Gawad Manuel Goyena, National Inventors Week Bronze Prize for a pending patent -2021 Gawad DAGISIK Recognition(Dakilang Ambag sa Imbensyon at Syensiyang pang-Kalusugan) and Gawad Technicom People’s Choice Award Data Protection Officer –ACE Level 1 Certification by the National Privacy Commission (NPC) ASEAN level engagements: PHL Delegation to ASEAN eHealthCare Services Working Group led by DOH; ASEAN Committee on Science, Technology and Innovation; eTSI NOVuS project with UK Philippine Post/British Embassy Manila; EU ERASMUS+ MICROCASA -PHL Partner External appointments with World Health Organization (WHO) as Health Financing Consultant, Chunbuk National University, South Korea (public health specialist), DG Research and Innovation European Commission, Belgium (independent expert); Asia Commission , Belgium Inter-University Council (VLIR UOS Belgium); Implementation Science Consultant of the Balance Clinical Trial of DLSU PHL_University College London_University of Capetown-SA No conflict of interest in this presentation  Learning Objective For students to understand and trace the interrelationships of health systems and health policies and its direct implications for delivering basic health services.  Outline of Presentation 1. The Right to ‘Health’ 2. Social Determinants of Health 3. Understanding the Building Blocks of a Health System 4. Health Policies as Determinants of Health  Right to Health In order to protect, respect, and fulfill the “right to health”, we need to know what it is, what it entails, and whom it is. Image Credits: AdMU IPC, 3CPNET  1987 Philippine Constitution “The State shall protect and promote the right to health of the people.”1 “The States … recognize the right of everyone to the enjoyment of the highest attainable standard of […] 2 health.” 1 Philippine Constitution, art. II, §15. 2 International Covenant on Economic, Social and Cultural Rights, art. 12(1).  ‘Intent of the Framers’, 1986 Philippine Constitutional Commission From proponent, Commissioner Minda Luz Quesada: “We want a very strong declaration of principle as far as health is concerned.” “[H]ere is actually a thrust to make health care become more preventive in orientation rather than having to wait for people to seek medical care when they are already sick Records of the 1986 Constitutional Commission.  ‘Intent of the Framers’, 1986 Philippine Constitutional Commission Ms. NIEVA: “So, the thrust is just an awareness then[?]” Ms. QUESADA: It is not just an awareness. I do not want to put the words “CRITICAL CONSCIOUSNESS,” but it is actually not just knowing the facts about why one needs to brush his teeth and all that. […] a consciousness that makes people behave and put into practice what they know about their health; so that they stop smoking, they exercise, they avoid certain foods because they now have this consciousness. So, it is a consciousness that makes people act on what they know. Records of the 1986 Constitutional Commission, vol. IV, p. 906 ‘Intent of the Framers’, 1986 Philippine Constitutional Commission From Commissioner Blas Ople: “I think the committee is right in wanting to focus on fostering health consciousness among the people as a declaration of principles because a nation that has risen to a state of consciousness for itself and the health of its members will make so many hospitals and so many expensive outlays on social services in the field of health unnecessary.” Records of the 1986 Constitutional Commission Health as a Fundamental Right Health is a fundamental human right indispensable for the exercise of other human rights.”1 “The right to health is closely related to and dependent upon the 2 realization of other human rights.” 1 UN OHCHR, CESCR General Comment No. 14 (2000), ¶1 2 Id., ¶3. Social Determinants of Health The conditions in which people are born, grow, work, and age: these include socio-economic aspects, the state of the environment, the design of cities, and opportunities to access and use health services.  Health Equity The opportunity for everyone to attain his or her full health potential No one is disadvantaged from achieving this potential because of his or her social position or other socially determined circumstance. Reference: Whitehead M. et al  Health Inequities WHO -“Health inequities flow from patterns of social stratification — that is, from the systematically unequal distribution of power, prestige and resources among groups in society” Systematic and unjust distribution of social, economic, and environmental conditions needed for health Unequal access to quality education, healthcare, housing, transportation, other resources (e.g.information, social benefits) Unequal employment opportunities and pay/income Discrimination based upon social status/other factors  Health Disparities Differences in the incidence and prevalence of health conditions and health status between groups, based on: Race/ethnicity Socioeconomic status Sexual orientation Gender Disability status Geographic location Combination of these  MayamanHealth na probinsya inequity slide Mahirap na probinsya Haba ng buhay > 80 Haba ng buhay < 60 Sanggol na namamatay Sanggol na namamatay < 10 > 90 Namamatay sa Namamatay sa panganganak panganganak < 15 >150 health inequities UHC Study Group, NIH Manila Comparing Health Development Index (HDI) and Life Expectancy at Birth Comparing Health Development Index (HDI) and Life Expectancy at Birth Mortality Rates of Selected Diseases - Vietnam, Indonesia and Philipppines Health outcomes lagging behind our Asean Neighbors Life Expectancy at Birth, Total (Years) From: “Reconfigurin g Primary Health Care Study” From: “Reconfiguring Primary Health Care Study” Pre-PHC PHC Adoption Devolution HSRA Fourmula1 KP & Expansion Source: The World Bank (2015). Life expectancy at birth, total (years) [Data file]. Retrieved from http://api.worldbank.org/v2/en/indicator/sp.dyn.le00.in?downloadformat=excel Health outcomes lagging behind our Asean Neighbors Life Expectancy at Birth, Total (Years) From: “Reconfigurin g Primary Health Care Study” From: “Reconfiguring Primary Health Care Study” Pre-PHC PHC Adoption Devolution HSRA Fourmula1 KP & Expansion Source: The World Bank (2015). Life expectancy at birth, total (years) [Data file]. Retrieved from http://api.worldbank.org/v2/en/indicator/sp.dyn.le00.in?downloadformat=excel Declining Immunization Rates Compared with our Asean Neighbors From 88 percent in 2013, coverage declined to 73 percent in 2017. It moved further down to less than 70 percent in 2018. (UNICEF,2019)  COVID-19 Vaccination Rates among the ASEAN Member States (AMS) https://www.reportingasean.net/in-numbers-covi d-19-vaccination-in-southeast-asia/  COVID-19 Vaccination Rates among the ASEAN Member States (AMS) https://www.reportingasean.net/in-numbers-covi d-19-vaccination-in-southeast-asia/ Evolution of Health Sector Reforms in the Philippines 1980-1986: Primary Health Care 1986 – 1992: Health Financing Reforms 1992 – 1998: Public Health Campaigns 1998 – 2004: Health Sector Reform Agenda 2004 – 2010: Fourmula One/HSRA 2010 – 2018: Kalusugan Pangkalahatan (UHC) 2019 -Universal Health Care Law  Health System Infrastructure ( Sanchez et.al, 1993,Adopted from WHO,1987) MANAGEMENT 1 Health Planning 2. Administration 3. Regulation DELIVERY OF SERVICES ORGANIZATIONL STRUCTURE 1. Health in the Hands of the People 1. Hierarchy of Health Services RESOURCE 2. Community Health Workers 2. Integration of Public Health and Medical PRODUCTION 3. Professional and Care 1. HHR Paraprofessional 3. Roles of Different Sectors 2. Health Care Facilities Health Personnel 4. Indigenous Medicine 3. Commodities 4. People Oriented Programs 4. Science and Technology ECONOMIC SUPPORT 1. Public Health Activities 2. Medical Care Services 3. HHR Production 4. Research Precursor of the Health System Building Blocks Functions of a Health System and its Building Blocks WHO (http://www.who.int/whr/2000/en/) Scope of Universal Health Care Department of Health, Philippines Universal Health Care as a Health System Approach Universal Health Care Every Filipino has access to quality, affordable health services, when and where they need them, without ever falling into financial hardship when these services are availed of. “Ensured generation and use of evidence in health policy development, decision-making, and program planning and implementation.” Department of Health, Philippines Department of Health, Philippines DOST 2017 The PHL Local Health Systems Provisions of the UHC Law Department of Health, Philippines UHC Health Care Provider Networks (HCPN) X-ray Laboratory Service Pharmacy Delivery and RHU Capacity Polycl Private Building via inic clinic eHealth BHS Apex Philhealth Community Hospital Department of Health, Philippines  2019 2020 2021 2022 2023 2024 2025 COHORT 1 MANAGERIAL FINANCIAL SELECTION INTEGRATION INTEGRATION COHORT 2 MANAGERIAL FINANCIAL SELECTION INTEGRATION INTEGRATION COHORT 3 MANAGERIAL FINANCIAL SELECTION INTEGRATION INTEGRATION Department of Health, Philippines The Philippined Devolved and Fragmented Public Healthcare System 51 Source: Thinkwell cf. Dayrit et al (2018); Capuno et al 2018 Non-Communicable Diseases (NCDs) are on the rise, even as some infectious diseases are declining… Source: Global Burden of Disease Study (2019) Source: Global Burden of Disease Study (2019) 53  The Philippine economy and public health sector have grown significantly in the last decade… Source: Worldeconomics.com, Index: 1996 = 100 Source: DOH 54 Numbers of Human Resource for Health (HRH) professionals have been maldistributed and in shortage… Source: DOH (2020) Source: DOH (2020) 55 … while chronic inequalities in health remain entrenched Region Percent Unattended PHILIPPINES 41.2 NCR 27.7 CALABARZON 28.2 MIMAROPA 52.3 Central Visayas 52.4 Eastern Visayas 56.6 Source: Philippine Human Development Network Davao Region 55.4 56 Source: PSA Vital Statistics Report 2019 SOCCSKSARG Decentralization has fragmented the health system, and spurred central-local tensions… Source: Juco et al (2023) Source: Capuno (2013) 57 Private and Out of Pocket (OOP) spending has stayed high, while primary/preventive health remains deprioritized … Source: PSA National Health Accounts 58  Health inequity slide Life Expectancy at Birth Life Expectancy at Birth > 80 < 60 Infant Mortality Rate Infant Mortality Rate < 10 > 90 Maternal Mortality Rate Maternal Morality Rate < 15 >150 health inequities UHC Study Group, NIH Manila Opportunities for Philippine Healthcare System Reforms I. Capacity-building of health workers at different levels and the Local Health Boards (LHB) II. Local Public Financial Management and health: leverage provisions in the UHC law to strengthen oversight of LGUs’ health funds III. Primary care resources: build on and refine, rather than oppose, community-level and informal primary care provision initiatives IV. Financing: ensuring benefits delivery through payment provider methods and strategic purchasing for UHC V. Stakeholding : Civil Society and Sectoral representation in Local Health Boards and national government agency boards/councils 60 “Health as a Social Phenomenon” Module 1: Introduction to the Course ‘Comparative Health Policies in the ASEAN’(SEAS 103i) Photo Credits: AC Nadate Dennis B. Batangan, M.D, M.Sc. (Heid) School of Social Sciences Institute of Philippine Culture Ateneo Initiative for South East Asian Studies School of Government Ateneo de Manila University  References The Constitution of the Republic of the Philippines. https://www.officialgazette.gov.ph/constitutions/1987-constitution/ International Covenant on Economic, Social and Cultural Rights. https://treaties.un.org/pages/ViewDetails.aspx?src=IND&mtdsg_no=IV-3&chapter=4&clang=_en Department of Health. National Health Sector Meeting , 6-12 December 2019, Novotel Cubao, Quezon City Panelo, Solon, Herrin and Ramos. Securig a Continuum of Care: The Challentes of a Fragmented Health Sector. UP Press Record of the 1986 Philippine Constitutional Commission. – https://archive.org/stream/record-of-constitutional-commission-volume-1/fullRecordOfTheConstitu tionalCommissionVolumeI_djvu.txt Whitehead and Dahlgren. Concepts and Principles in Tackling Social Inequities in Health. https://www.euro.who.int/__data/assets/pdf_file/0010/74737/E89383.pdf World Health Organization. (2010). A Conceptual Framework for Action on the Social Determinants of Health. Geneva: World Health Organization. From https://apps.who.int/iris/bitstream/handle/10665/44489/9789241500852_eng.pdf?sequence=1 World Health Organization. (2010). Monitoring the Building Blocks of Health Systems: a handbook of indicators and their measurement strategies. World Health Organizations. From https://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf?ua=1