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Key Issues In International Health: Cardiovascular Diseases And Tuberculosis In The Philipinnes

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Communicable diseases (CDs) were the main cause of death globally for several decades (Boutayeb, 2006). These diseases include “tuberculosis (TB), cholera, meningitis, hepatitis, malaria, dengue, yellow fever, AIDS, Ebola, and SARS”. Hence, recent years the occurrences of non-communicable disease (NCDs) become relatively high, this happened because of world’s demographic shift, industrialization and change of habits. According to the data by World Health Organization, NCDs is responsible for approximately 70% death worldwide, the major NCDs include; cardiovascular diseases, cancer, chronic respiratory diseases and diabetes. Cardiovascular diseases (CVDs) are cumulative of disorders that affect heart and blood vessels. CVDs are prominent factor of death globally, for example, in 2015, 17. 7 million people died with CVDs as underlying caused, this contributes approximately 31% of death worldwide. By 2030 there is an assumption that occurrence of death caused by CVDs will increase continuously to 35% worldwide, which projected to be approximately 23. 4 million deaths.

Tuberculosis (TB) is a transmitted disease, this disease caused by bacteria named Mycobacterium tuberculosis, this bacterium mainly attacks the respiratory tract system, which occur around 85% in lungs, Tuberculosis is marked as the 9th in the top 10 causes of death globally in 2015, this contributed 1. 37 million deaths (WHO, 2017c). Recently, several countries facing a huge challenge for disease trend shifting from communicable to non-communicable disease, this happened both in high-income and lower-income countries, which often called as the double burden diseases. The Philippines is indicated as lower-middle-income country with GDP approximately 3, 000 dollars per capita, while its population in 2015 were 100. 98 million. Recently, the Philippines deal with both communicable and non-communicable disease, especially with tuberculosis and cardiovascular disease cases. This essay will focus on cardiovascular disease as the NCDs and tuberculosis as CDs. This essay aims to give in-depth explanations on the impacts of double burden disease in terms of mortality, morbidity, and social and economic consequence to the chosen country. Secondly, this essay will also identify the key determinants of each disease and elaborate specifically two determinants for each disease. Lastly, it will address the key actor’s roles, which influence the policies and health system strategies in the Philippines.

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Cardiovascular Diseases

Number one chronic problem worldwide is cardiovascular diseases, whereas the majority occurrences of it happened in low and middle-income countries, this contribute more than three fourth of the world populations. In Southeast Asia, the estimation of people having heart failure is around 9 million in 2015. From database published by WHO in 2014, approximately 571, 000 Filipinos died, with the estimation of 33 per cent caused by cardiovascular diseases cases. The poor lifestyle and diet might be the main reason contributed to accelerate the risk factors of cardiovascular diseases, this risk factors include “coronary artery disease (CAD), hypertension and diabetes mellitus”.

Based on study of Lam et al. , in 2016, it was found that the prevalence of risk factors in Southeast Asia were the highest among other Asian regions. This contributed high possibility in mortality and morbidity rate. To look further, Filipino had highest hypertension cases number compare with other ethnicity, while in terms of CAD and diabetes the prevalence risk of Filipino relatively in the same level with other ethics.

In terms of social impacts, for those who suffered from cardiovascular disease, the person would not be able to have normal daily activity; there might be limitations (based on writer’s personal knowledge). For instance, the person suffered from cardiovascular diseases could not fully participate sports activity that needs extra work for heart muscles, such as sprint. The cost of medications and hospitalizations become the primary factor for people to prolonged patient’s life while having heart diseases. In low-middle-income countries, approximately 50% heart diseases happened to people before their age of retirement. This disease affects household budgeting and the possibility of overall country’s income. Based on data, the treatment’s cost of cardiovascular disease was 60 million U. S. dollars in 2007, and the said amount was forgone from the Philippines GDP, by 2015 the cumulative GDP loss is projected to be loss approximately 62 millions U. S. dollars. From the writer’s perspective, this is a huge financial loss for Philippines government.


Tuberculosis is an infectious disease affects almost one third of the world’s population; moreover, the probability of infection among Asians is 29 times higher than Americans. The occurrence of tuberculosis reached 10. 4 million globally and 1. 8 million deaths were found out with tuberculosis as the underlying cause in 2015. In the Philippines, the occurrence of tuberculosis in 2015 were indicated 286, 544 cases and with 276, 672 cases as new and relapse cases. Even though the rate and cases of tuberculosis in the Philippines counted lower than other Southeast Asia countries, yet the Philippines still become a part of 20 high TB burden countries based on the number of incident cases.

According to tuberculosis report 2016 by WHO, the mortality rate of tuberculosis in the Philippines relatively declined from 2000 to 2015, which contributes approximately 0. 44 thousand deaths per 100, 000 populations. The prolonged use and quantity of medications influence household budget of the patient Filipinos spend more than 45% of their finance for their own health facilities (WHO, 2016). Through online news sourced by USAID it is indicated that the total lost finance of Filipinos reached $180. 7 million a year for tuberculosis medications and treatments purposes.

Analysis of determinants

Framework on key determinants of each disease created to help better understanding (Figure 5), in some part in this section; writer put personal experiences to give clear picture of health condition in the Philippines. Overall the key determinants will be based on Dahlgren and Whitehead framework, 1991. This framework is modified by writer to add specific example in chosen country. Furthermore, two out of five determinants will elaborate in this section.

  1. Cardiovascular Diseases
    1. Living and working conditions
    2. The availability of nutritious food is one of key determinant to have healthy life. According to collaborative report entitled Cardiovascular Risk in the Filipino Community by National Heart, Lung, and Blood Institute, and other organizations in California, Filipinos source of diets is relative different with western cuisine, this often include spices and complimentary ingredients such as, shrimp paste and fish sauce. In general Filipino cuisine likely include high amount of salt intake, Filipinos are aware of high salt intake could make a contribution to high blood pressure, yet they still use high amount of salt as daily intake. Philippines traditional food contains “vinegar, coconut milk, tamarind, garlic, ginger, onion, and pepper as key ingredients”. And lastly the Filipino’s dessert contains high amount of sugar and starch often eat regularly. Based on experience, the writer observed every meal that Filipino order in the restaurant mostly cooked with high amount of oil. For an example, during lunch time in one restaurant called Inasal, they serve big thigh portion of roasted chicken with greasy appearance, while they serve it with addition vinegar, fish oil and soy sauce. The most interesting part, in this restaurant every customer could make unlimited additional rice order without extra charge in their bills, which makes Filipino more prone to obesity. Innutritious, high carbohydrate, high salt and sugar serving contribute Filipino to high susceptibility to cardiovascular diseases.

    3. Lifestyle Factors
    4. The lifestyle factor will elaborate together with tuberculosis in the next section.

  2. Tuberculosis
    1. General socio-economic, cultural and environmental condition
    2. The poverty, pollutant amount and overcrowded living condition become important key determinant in spreading the infectious tuberculosis agent. The infectious agent of tuberculosis transmits easily through airborne by cough of positive tuberculosis patient to the next host. Based on population census 2015, the living condition in Philippines especially in National Capital Region were overcrowded, which comprises of 12. 88 million people, which 1. 78 million located in Manila and approximately 3. 0 million live in Quezon City. Based on writer’s experience, the environment living condition in National Capital Region is huge contribution to Philippines’ health crisis, most high Filipino salary-man tend to use private vehicle for their daily activity. On the other side, for the low-income citizen, they tend to provide transportation services like motorcycle (tricycle) driver or jeepney (public transportation) driver. This urbanized activity accelerates amount of air pollutant. The fact that the Philippines is tropical country and said living condition make the infectious agent such for M. tuberculosis easily to spread among household and families.

    3. Lifestyle Factors
    4. It is interesting to note that lifestyle factor of Filipinos specifically smoking is key determinant for both cardiovascular diseases and tuberculosis. Based on collaborative report entitled Cardiovascular Risk in the Filipino Community, the social perspective of Filipino said that, smoking is stress reliever and it is a growing up process form adolescence to adult, this make smoking as an acceptable activity in the Filipino community. Smoking reduces the ability of body to detoxify the free radicals inside the body, or more likely called oxidative stress inducer. It also increases the insulin resistant which become huge factor in several cardiovascular diseases risk factors such as “obesity, hypertension, glucose intolerance, and dyslipidaemias”. While for tuberculosis, the main chemical agent in tobacco, which is nicotine is the major key role compare to other 4, 500 compounds. The nicotine increases the susceptibility of tuberculosis patient to the infectious agent, it rendering to higher rate of survival and multiplication of M. tuberculosis.

Analysis of Actors

In International level, World Health Organisation takes a crucial part both in cardiovascular diseases and tuberculosis. In regard of cardiovascular diseases WHO launched several package programs to reduce the burden of growing cardiovascular diseases case, especially in terms of cardiovascular diseases prevention and management, this include “MPOWER for tobacco control, SHAKE for salt reduction and HEARTS for the strengthening of CVD management in primary health care”. These programs were launched on September 2016 as “Global Hearts Initiative”. This program is collaboration between “WHO, United States Centers for Disease Control and Prevention, and other partners; World Heart Federation and World Stroke Organization, the International Society of Hypertension and World Hypertension League”. In addition, World Health Organization also concerns in eradication or tuberculosis, and take a global action. In 2014, WHO launched “End TB Strategy which the aimed to reduce 95% deaths occurred by TB and reduce 90% the incident of TB by 2035”. This program aimed to make an “accessible prevention, treatment and elaborate the future innovations and diminished the tuberculosis occurrence globally”.

Department of Health of The Philippines is the main actor in creating health and healthcare system and policy in the Philippines. Department of Health Philippines launched specific program to achieve Sustainable Development Goals targets. In regard of cardiovascular diseases, Department of Health launched crucial program for prevention of cardiovascular diseases, which “aims to reduce mortality and morbidity and reduce the burden and of individual, family, and community economic status”. These could be achieved and implemented though different settings such as, through health care provider, education institutions, community and industrial settings. There are several actions that Department of Health Philippines already done, which include promoting healthy lifestyle and helping people to stop smoking habit.

Regarding of eradication of tuberculosis, Department of Health launched the Tuberculosis control program named “The 2017-2022 Philippine Strategic TB Elimination Plan (PhilSTEP)”, this program “aimed to end the TB in the Philippines by 2022”. The fact that Philippines is archipelago country, Department of Health set up a provincial health offices and city health offices to actively contribute help to this program. The PhilSTEP is a collaboration of work and program between Department of Health with several agencies and organization. It is known that Philippines indicated as lower-middle income country, the fund and help through other bilateral organization contribute huge impact to Philippines’s healthcare system development. One of bilateral organization that continuously supports Philippine is United States Agency International Development (USAID). Over 5 decades United States helps Philippines through various ways, such as in agricultural sector, training and teaching strategies, building infrastructure and management in environmental progress. Started on 2012, USAID made an official partnership with Philippines which focusing on works through “economic development, governance, health and education”.

The awareness and contribution of Philippines citizens as the implementer and number one actor that could manage cardiovascular disease and tuberculosis in the very first place. The knowledge of individual, family and community take a big part to noticing the sign and symptoms of each disease. Cardiovascular disease risks could be minimized by lifestyle changing through healthy diet, smoking cessation and routine exercise (based on writer’s knowledge). The transmission of tuberculosis agent could be minimized if individual and community work together if community realized the right things to do, such as continuing the medication of tuberculosis and finish the treatment on schedule so that the relapse of tuberculosis would not be happened.


The shifting trend of communicable disease and non-communicable disease globally took special concern in the field of health sciences. The double burden disease that occurs worldwide especially in low and middle-income country become a huge concern to meet Sustainable Development Goals target. One of the specific example low-middle income countries facing these double burden diseases is the Philippines. Whereas this include high percentage occurrences of cardiovascular disease, new and relapse cases of tuberculosis. These double burden diseases make a huge impact on the rate of mortality, morbidity and social economic status of every Filipinos suffering from these diseases. These diseases are preventable if the key determinants examine closely, by lifestyle changing and make better environmental and living conditions are the steps toward prevention of those diseases. The key determinant itself could not stand as solid determinant, which means that each determinant is connected to one another and make great impact for better health outcome. In addition, to reduce cardiovascular diseases rate and end the occurrences also relapse of tuberculosis, there is a need of balance actors’ collaboration from international level organization, bilateral partnerships, cooperation of several ministries in the country, up-to the smallest part in society, which is the individual citizen. In the end, if every aspect run implemented the SDG is not impossible to achieve.


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