Embracing a Healthy Lifestyle
Disclosures :
• Internist -Cardiologist, Manila Doctors Hospital
• Retired Medical Director of Pfizer Philippines (19932011)
• Director of Information, Publications, and Public
Affairs,University of the Philippines, Manila
• One Peso Consultant , DOH on Noncommunicable
Diseases
• Secretary, Philippine College of Physicians
• Preventive Health Advocate
MY HEROES
Dr. Jose Rizal
June 19, 1861 – Dec. 30, 1896
National Hero
Pilar Cueto Leachon
(Jan. 25, 1935 – Sept. 22, 2003)
Marita Leachon
Ramirez
(June 7, 1962 – June
11, 2011 )
Flow of Presentation
• Background on NCDs
• What 5 Shocking Lessons we have learned
about NCDs/lifestyle diseases
• Reasons why we fail in our Health Goals
• 3 DOH Pillars to address NCDs
• What else can we do to step up NCD efforts ?
• Summary
MORTALITY
Infectious
Disease
Lifestyle/NCDs
Omran et al 1970.
DEVELOPMENT
Common Risk Factors for NCDs
Deaths from 4 chronic diseases
Tobacco
Poor diet
Lack of exercice
3 risk factors
Deaths from all other causes
60% of all deaths
Cardiovascular
Chronic respiratory disease
4 chronic diseases
Type 2 diabetes
Cancer
Oxford Health Alliance 2003
2005 DOH Data
Top 10 Causes of Morbidity and Mortality
Philippines July 2010
10 Leading Causes of Morbidity in the
Philippines (DOH)
10 Leading Causes of Mortality in the
Philippines (DOH)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
1.
2.
3.
4.
Pneumonia
Acute Watery Diarrhea
Malaria
Typhoid & Paratyphoid Fever
Schistosomiasis
Measles
Acute Bloody Diarrhea
Dengue Hemorrhagic Fever
Hepatitis
Leprosy
*All Preventable with Education
and public health infrastructure
(DOH 2010)
Diseases of the heart
Strokes
Cancer
Chronic Obstructive Pulmonary
Diseases
5. Road Accidents and Injuries
6. Diabetes
7. Dengue Fever
8. Maternal Deaths
9. Kidney Failure
10. Perinatal conditions
Top 4 & #6: NCDs
Accidents: 50 % drunk driving
SEA: Epidemic of chronic non-communicable diseases  60% of
mortality rates in the region
 Environmental factors: promotion of tobacco use, unhealthy diet &
physical inactivity
 Disadvantaged sector is most affected
 Health care systems should be redesigned to deliver chronic care
founded on primary health care facilities, but supported by good referral
systems
Surveillance of key modifiable risk factors (monitor magnitude of
problem & study effects of interventions)
Involvement of government & society sectors to establish healthy
environment
Lesson # 1 Silent EPIDEMIC
300,000 deaths in Philippines
800 deaths/day !
Dans, et al Lancet
2011 and DOH data
2.5 MILLION
NCD DEATHS
IN 2005
NCD deaths per
100 thousand
population
900
Dans et al (Lancet 2011)
800
700
600
500
400
Myan
Camb
Viet
Phil
Indo
Thai
Brun
Sing
Mal
Laos
0
5
10
20
30
40 50 60 70 80
Gross National Income (International Dollars x 103)
2.HIGHER
NCD RISK
Globalization
Smoking
Urbanization
Unhealthy Diet
Poverty
Phys. Inactivity
Low Education
Stress
Blood Sugar
Blood Pressure
Cholesterol
BMI
1.NO ACCESS TO
PREVENTION
Predisposing Behavioral
EnvironmentRisk Factors
MORE Expenses &
IMPOVERISHMENT
Biologic
Risk factors
3.NO ACCESS TO
TREATMENT
Heart Disease
Stroke
Cancer
Chronic Lung Ds
4.HIGHER
MORTALITY
Chronic NCD
Morbidity/Mortality
LIMITED RESERVES
Lesson #2
NCDs: Diseases of the POOR
Lesson #2 The poor suffer the most
Prevalence (%)
The poor smoke more than the rich. In ASEAN, the
lowest quintile of the population suffer more deaths due
to smoking.
Poorest
Wealthiest
From DANS, ET. AL,
LANCET 2010)
Tobacco use > Food 
Tobacco and Food Expenditure Ratio, 2008
Poorest
Poor
Middle
Rich
Richest
Total
2006
0.029
0.031
0.030
0.024
0.018
0.026
2009
0.027
0.027
0.025
0.021
0.015
0.023
Valerie Gilbert T. Ulep
Philippine Institute for Development Studies
The Situation
Lesson # 3 : Disease of the Young
Of the users of tobacco products:
(highest in South East Asia)
17.5%
Girls
28.3%
Boys
SOURCE: WHO Report on global tobacco epidemic:Implementing smoke free
environment.Geneva,Switzerland.WHO, 2009
Non-communicable Diseases: At a Glance
Share of premature deaths, Philippines, 2008
100%
90%
Premature deaths
80%
70%
60%
50%
45
51
40%
66
73
30%
20%
10%
0%
49
55
34
27
Cancer
Diabetes
CVD
CLRD
Pre-mature
Mature
Valerie Gilbert T. Ulep
Philippine Institute for Development Studies
Estimated deaths from heart attack
and stroke (all risk factors)
Smoking is the #1 preventable risk factor.
Risk Factor
Heart Attack Deaths
CVD Deaths
Total Deaths
Smoking
19,315
29,184
48,499
Cholesterol
8,799
4,053
12,852
Obesity
HPN
Diabetes
Lesson # 4
14,840
Smoking
is PH’s20,207
top
killer;obesity
3rd
15,559
25,401
3,326
6,864
35,047
40,960
10,190
Smoking does NOT just cause cancer and lung diseases, it is also the number 1
cause of stroke and heart attack (~50,000 deaths per year). In fact it causes more
stroke and heart attacks than diabetes, hypertension, obesity and high
cholesterol - National Nutrition and Health Survey, 2008
Counseling or Education for
Risk Factor Modification
Ebrahim et al, Cochrane 2011
>
>
>
>
>
>
>
>
Lesson # 5
55 Clinical Trials
Education for general
163, 471 patients studied
population is not
Did not affect longevity
effective
.
Did not prevent heart disease
Did
Did
Did
Did
not
not
not
not
prevent stroke
reduce cholesterol
lower BP
lower smoking rates
Why do we fail at what we set out to do ?
3 reasons why we fail
1. Ignorance : we may err
because science has given
us only partial
understanding ; Education
is key ( not quite)
2. Ineptitude : knowledge
exists, yet we fail to apply
it correctly.
Gorovitz and MacIntyre, 1970
Smoking
Unhealthy Diet
Phys. Inactivity
Behavioral
Risk Factors
Blood Disease
Sugar
Heart
Blood Pressure
Stroke
Cholesterol
Cancer
BMI
Chronic
Lung Ds
Biologic
Chronic
NCD
Risk factors
Upstream
GlobalizationBlood Sugar
Smoking
Urbanization Blood Pressure
Unhealthy Diet
Poverty
Cholesterol
Phys. Inactivity
Low Education
BMI
Stress
Downstream
Heart Disease
Stroke
Cancer
Chronic Lung Ds
Biologic
Behavioral
Predisposing
Chronic NCD
Risk factors
Risk Factors
Environment
LIFESTYLE DISEASES : 3 DOH Action Pillars
Dec 2011
Tobacco
Learning
1.
2.
LGU action
Legislation
•
Healthy Diet
Exercise
Health Education curriculum in schools; workplace
wellness programs
Public Awareness Campaign for targeted
populations through media, academe, and NGOs
Local ordinances eg smoke free environment,
food label, exercise facilities
Sin Tax Increase on
tobacco and
alcohol – now at
approved- Dec
20,2012
Food Certification
Front -of -pack Calorie
counter Dec 2012
(FDA – DOH
approved); Belly gud,
Food plate
Infrastructure
eg
recreational
facilities
Goals of Excise Tax Law
(in order of priority)
1.
2.
3.
Reduce the number of
smokers among the YOUNG
(<18 years old)
Reduce the number of
smokers among the POOR
Reduce the consumption
of cigarettes among current
smokers
***Equally important as the
health objectives is the
revenue gained from the
excise tax.
Health is Wealth:
Universal Health Care Realization
•
•
•
•
DOH annual budget
Excise Tax
Tobacco revenue
Smoking related
expenditures
1.
2.
Indirectly, through loss of
productivity and income
Directly, household spending on
chronic medical care, often of
catastrophic proportions
•
•
•
•
Php 54 Billion
Php 35 Billion
Php 26 Billion
Php 177 Billion (Dans et al
2012)
1.
2.
3.
4.
Hospitals and other infrastructures
Health Information technology
Human resources
Health promotions and research
initiatives
Sec Ona with Med Org
Leading the Way in Sin
Tax Lobbying
Sin Tax on tobacco & alcohol
Approval at Malacanan
Dec 20, 2012
Sin Tax Law Passage and DBM
• Dec 20, 2012 : Victory
party after signing of
the sin tax law by Pres.
Benigno Simeon
Aquino III
• With DBM Sec.
Florencio Abad and Dr.
Antonio Dans of UPCM
• Vital role in the IRR of
the sin tax law
Who took the space?
Filipinos gaining weight 
• 26.6 per cent of Filipino
adults were overweight in
2008 (5.2 per cent are
obese), a marked
increase from 16.6 per
cent in 1993.
• Overweight is also rising
among children aged 5–
10 (up from 5.8 per cent
in 2003 to 6.6 per cent
in 2008).
Source National Statistics Coordination Board
(NSCB)
Nov 2011.
Obesity in Young Filipinos rising
Sept 23, 2010 Manila Bulletin
• MANILA, Philippines — Obesity is now on the rise among Filipino adults
ages 20 and up, and threatens to increase the number of people having
degenerative diseases like heart disease, hypertension and diabetes
mellitus, as study conducted by the Department of Science and Technology
(DoST) showed.
• The increase was discovered in 2008 when it registered a trend in the study
conducted by the DoST’s Food and Nutrition Research Institute.
V. Ulep, 2012 Phil Institute for Development Studies
Physical exercise
Phil Institute for Development Studies,2008
30
Prevalence of adult population with adequate exercise, Philippines,
2008
27.9
26.9
24.8
25
22.5 22
23.5 23.1
22.4 22.7 22.9
24.3
22.8
21.3
20.8
Prevalence (%)
20
15
10
5
0
Total
Male
Poorest
Poor
Middle
Female
Rich
Richest
24.9
2103 DOH programs : Unhealthy Diet
• 1. Calorie counter – Front of Package
(Dec 2012)
• 2.Food labeling – mandatory to declare
salt, sugar, trans fats in addition; Legislation
is needed for the long term ( July 2013)
• 3. Belly GUD – DOH Executives’ weight
reduction , biggest loser type of program (Jan
–July 2013)
• 4. Pinggan ni Pinoy – Filipino Food plate
(to be launched with DOST- FNRI)
Target Calories in a Day
Calories per day for Males
Calories for Females
 1,800 – 2000
 1,200-1,500
calories per day
Note: One pound
of body mass
represents 3,500
calories.
calories per day
Calorie Checklist
Eat Low Calorie Foods
(50-100 calories)
Avoid High Calorie Foods
(300-800 calories )
• Fish
• French fries
• Fruits
• Burgers
• Vegetables
• Pork & beef
• Chicken without skin
• Ice cream
• Cereals
• Doughnuts
• Oatmeal
• Processed foods
• Water
• Ice tea & softdrinks
How sweet is it ?
Bloomberg now wants all of New York state to
ban big soft drinks
March 2, 2013
• New York City Mayor
Michael Bloomberg wants
to trim waistlines by
expanding the Big Apple’s
upcoming ban on big soft
drinks.
• "Kids, once they get obese,
they will be obese as
adults. And this year, for
the first time in the world,
in the history of humanity,
more people will die from
overeating than from
under-eating."
Burger King : Calorie Count in Korea
Dec 2010
Burger King in Korea :
Calories disclosed 
South Korea
Global Update Summary Feb 2013
• South Korea was the first Asian country to press ahead with
recommendations for voluntary traffic light labels on children’s food
starting 1 January 2011.
• On 25 May 2012, the Prime Minister’s Office announced its intention to
progressively introduce mandatory traffic light labelling to snacks and
beverages starting in 2013, making South Korea the first country globally
to mandate traffic light labelling. Since then, two draft bills have been
submitted to the Korean National Assembly.
• One bill recommends mandatory traffic light labelling on foods preferred by
children, including chips, snacks and beverages (e.g. carbonated soft drinks,
juices).
• The second bill recommends both a mandatory traffic light system and
mandatory reference daily intake labelling with a colour coding system. This
move could potentially have implications for other countries in the AsiaPacific region.
Global Food Labelling
• Violet : Mandatory
• Yellow: Voluntary
• White: Information not found