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Embracing a Healthy Lifestyle. Disclosures : Internist -Cardiologist, Manila Doctors Hospital Retired Medical Director of Pfizer Philippines (1993- 2011)

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Presentation on theme: "Embracing a Healthy Lifestyle. Disclosures : Internist -Cardiologist, Manila Doctors Hospital Retired Medical Director of Pfizer Philippines (1993- 2011)"— Presentation transcript:

1 Embracing a Healthy Lifestyle

2 Disclosures : Internist -Cardiologist, Manila Doctors Hospital Retired Medical Director of Pfizer Philippines (1993- 2011) 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

3 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 )

4 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

5 DEVELOPMENT MORTALITY Lifestyle/NCDs Infectious Disease Omran et al 1970.

6 Common Risk Factors for NCDs Deaths from 4 chronic diseases Deaths from all other causes 60% of all deaths 3 risk factors Tobacco Poor diet Lack of exercice 4 chronic diseases Cancer Type 2 diabetes Chronic respiratory disease Cardiovascular Oxford Health Alliance 2003

7 10 Leading Causes of Morbidity in the Philippines (DOH) 1.Pneumonia 2.Acute Watery Diarrhea 3.Malaria 4.Typhoid & Paratyphoid Fever 5.Schistosomiasis 6.Measles 7.Acute Bloody Diarrhea 8.Dengue Hemorrhagic Fever 9.Hepatitis 10.Leprosy 10 Leading Causes of Mortality in the Philippines (DOH) 1.Diseases of the heart 2.Strokes 3.Cancer 4.Chronic Obstructive Pulmonary Diseases 5.Road Accidents and Injuries 6.Diabetes 7.Dengue Fever 8.Maternal Deaths 9.Kidney Failure 10.Perinatal conditions *All Preventable with Education and public health infrastructure (DOH 2010) 2005 DOH Data Top 10 Causes of Morbidity and Mortality Philippines July 2010 Top 4 & #6: NCDs Accidents: 50 % drunk driving

8  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

9 2.5 MILLION NCD DEATHS IN 2005 Lesson # 1 Silent EPIDEMIC 300,000 deaths in Philippines 800 deaths/day ! Dans, et al Lancet 2011 and DOH data

10 NCD deaths per 100 thousand population 051020304050607080 400 500 600 700 800 900 MyanCamb Laos Viet Indo Phil ThaiMalSing Brun Gross National Income (International Dollars x 10 3 ) Dans et al (Lancet 2011)

11 2.HIGHER NCD RISK 4.HIGHER MORTALITY 1.NO ACCESS TO PREVENTION 3.NO ACCESS TO TREATMENT LIMITED RESERVES MORE Expenses & IMPOVERISHMENT Heart Disease Stroke Cancer Chronic Lung Ds Biologic Risk factors Smoking Unhealthy Diet Phys. Inactivity Behavioral Risk Factors Blood Sugar Blood Pressure Cholesterol BMI Chronic NCD Morbidity/Mortality Lesson #2 NCDs: Diseases of the POOR Predisposing Environment Globalization Urbanization Poverty Low Education Stress

12 The poor smoke more than the rich. In ASEAN, the lowest quintile of the population suffer more deaths due to smoking. Lesson #2 The poor suffer the most PoorestWealthiest From DANS, ET. AL, LANCET 2010) Prevalence (%)

13 Tobacco use > Food  20062009 Poorest0.0290.027 Poor0.0310.027 Middle0.0300.025 Rich0.0240.021 Richest0.0180.015 Total0.0260.023 Tobacco and Food Expenditure Ratio, 2008 Valerie Gilbert T. Ulep Philippine Institute for Development Studies

14 SOURCE: WHO Report on global tobacco epidemic:Implementing smoke free environment.Geneva,Switzerland.WHO, 2009 Lesson # 3 : Disease of the Young The Situation 17.5% Girls 28.3% Boys Of the users of tobacco products: (highest in South East Asia)

15 Non-communicable Diseases: At a Glance Share of premature deaths, Philippines, 2008 Valerie Gilbert T. Ulep Philippine Institute for Development Studies

16 Estimated deaths from heart attack and stroke (all risk factors) Risk FactorHeart Attack DeathsCVD DeathsTotal Deaths Smoking19,31529,18448,499 Cholesterol8,7994,05312,852 Obesity14,84020,20735,047 HPN15,55925,40140,960 Diabetes3,3266,86410,190 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 Smoking is the #1 preventable risk factor. Lesson # 4 Smoking is PH’s top killer;obesity 3rd

17 Counseling or Education for Risk Factor Modification Ebrahim et al, Cochrane 2011 > 55 Clinical Trials > 163, 471 patients studied > Did not affect longevity > Did not prevent heart disease > Did not prevent stroke > Did not reduce cholesterol > Did not lower BP > Did not lower smoking rates Lesson # 5 Education for general population is not effective.

18 Why do we fail at what we set out to do ? 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 3 reasons why we fail

19 Smoking Unhealthy Diet Phys. Inactivity Behavioral Risk Factors Heart Disease Stroke Cancer Chronic Lung Ds Chronic NCDBiologic Risk factors Blood Sugar Blood Pressure Cholesterol BMI

20 Smoking Unhealthy Diet Phys. Inactivity Behavioral Risk Factors Heart Disease Stroke Cancer Chronic Lung Ds Chronic NCD Biologic Risk factors Blood Sugar Blood Pressure Cholesterol BMI Predisposing Environment Globalization Urbanization Poverty Low Education Stress Downstream Upstream

21 TobaccoHealthy DietExercise L earning 1. Health Education curriculum in schools; workplace wellness programs 2. Public Awareness Campaign for targeted populations through media, academe, and NGOs L GU action Local ordinances eg smoke free environment, food label, exercise facilities L egislation 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 LIFESTYLE DISEASES : 3 DOH Action Pillars Dec 2011

22 Goals of Excise Tax Law (in order of priority) 1. Reduce the number of smokers among the YOUNG (<18 years old) 2. Reduce the number of smokers among the POOR 3. Reduce the consumption of cigarettes among current smokers ***Equally important as the health objectives is the revenue gained from the excise tax.

23 Health is Wealth: Universal Health Care Realization DOH annual budget Excise Tax Tobacco revenue Smoking related expenditures 1.Indirectly, through loss of productivity and income 2.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.Hospitals and other infrastructures 2.Health Information technology 3.Human resources 4.Health promotions and research initiatives

24 Sec Ona with Med Org Leading the Way in Sin Tax Lobbying

25 Sin Tax on tobacco & alcohol Approval at Malacanan Dec 20, 2012

26 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

27 Who took the space?

28 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.

29 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.

30 V. Ulep, 2012 Phil Institute for Development Studies

31 Physical exercise Phil Institute for Development Studies,2008 Prevalence of adult population with adequate exercise, Philippines, 2008

32 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)

33 Calories per day for Males Calories for Females 1,800 – 2000 calories per day 1,200-1,500 calories per day Target Calories in a Day Note: One pound of body mass represents 3,500 calories.

34 Calorie Checklist Eat Low Calorie Foods (50-100 calories) Fish Fruits Vegetables Chicken without skin Cereals Oatmeal Water Avoid High Calorie Foods (300-800 calories ) French fries Burgers Pork & beef Ice cream Doughnuts Processed foods Ice tea & softdrinks

35 How sweet is it ?

36 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."

37 Burger King : Calorie Count in Korea Dec 2010

38 Burger King in Korea : Calories disclosed

39 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 Asia- Pacific region.

40 Global Food Labelling Violet : Mandatory Yellow: Voluntary White: Information not found

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