Education for Sustainable Development

Sustainable Health Programs

Allison E. Gocotano, MDRaymond Francis R. Sarmiento, MD

Jaime Z. Galvez Tan, MD, MPH

RCE CebuU.P. Cebu Campus

RCE CebuU.P. Cebu Campus

Focal Projects: I-WARM-CEBU (Integrated Water and Resource

Management) – to catch and harvest rain water in response to the current and future water shortage problem

REPORMA (Regional Resource, Poverty, and Poverty Response Mapping) – to inventory all available resources in the region starting with Cebu

Construction of an ESD resource centre which would include a multimedia library, training and ICE (Information, Communication and Education) material production

RCE CebuU.P.Cebu Campus

Currently, promotion of ecotourism at the forest reserve of Camp 7 Minglanilla

Part of the showcase project ‘Promoting ESD through Conservation and Sustainable Use of Forest Resources and Empowerment’, implemented in partnership with the Institute for Global Environmental Strategies (IGES)-Asia Pacifi c Forum for Environment and Development (APFED)

RCE Cebu Partners - NGOs

Visayas Primary Health Care Services Inc.Community Based Health Programs in

Cebu City urban poor communitiesProvinces of Bohol and Negros Oriental rural

communitiesTraining of Community Volunteer Health WorkersPromotion and Use of Asian and Filipino Traditional

MedicineSpecial services for reproductive health and family

planning

A Conceptual Framework of Sustainable Health

Levels of Sustainable Health

PersonalFamily CommunityMunicipal/City/ProvincialNationalGlobal

Components of Sustainable Health: Personal Level

Personal:healthy lifestylepersonal hygienegood diet and nutritionemotional integritybody-mind-spirit integration

Sustainable Health: Personal Level: Barriers and Strategies Barriers

Healthy Lifestyle - regular exercise, family planning

Smoking, alcohol, dangerous drugs, physical inactivity

Personal Hygiene - safe sex, hand washing, use of toilet

High risk sex behavior, lack of safe water and sanitation

Good diet and nutrition - eating a variety of food daily and in moderation, plant based diets

Overconsumption, fast food & junk food, processed food, pesticide & organo-phosphate laden food

Emotional integrity Lack of personal security, lack of economic & educational opportunities, personal isolation

Body-mind-spirit integration -inner peace

Lack of personal security, lack of economic & educational opportunities, personal isolation

Strategies: Health Promotion; Personal Wellness & Health Scorecards; Risk-Reduction Counseling; Stress Management; Behavior Change Communication; Education Scholarships; Vocational and Technical Training for Job Creation; Tobacco Free Policies; Animal companionship

Components of Sustainable Health: Family Level

Familyfamily beliefsgeneticsgenealogyfamily interaction and harmonyhousehold economic well beingfamily food gardens, family food basketinter-generational learning;

Sustainable Health: Family Level: Barriers and Strategies Barriers

Family Beliefs Formal education at times contradictory to family belief systems

Genetics and Genealogy Lack of access to newborn screening and genetic screening; family “shame” for hereditary disabilities - tendency to hide disabled family member

Family Interaction and Harmony Absence of one parent due to overseas work or far from ancestral home;

Household Economic Well Being Lack of education and job opportunities

Family Food Gardens Massive advertisements of fast food, junk food & processed food; lack of indigenous seeds for local fruits & vegetables & nuts;

Family Food Basket Low cost prices of junk & processed foods versus naturally grown food

Inter-Generational Learning Extended households now becoming nuclear households due to rapid urbanization and population pressure

Strategies: Family Health Promotion; Family Wellness & Health Scorecards; Family Oriented Counseling; ; Family Behavior Change Communication; Education Scholarships; Vocational and Technical Training for Job Creation for Female Headed Households; Production of Family Medicine Practitioners; Family Kitchen Learning Demonstrations of Healthy Foods; Bio-Intensive Family Gardening Promotion.

Components of Sustainable Health: Community Level

Community Customs, norms, and traditions (indigenous

knowledge)Water, sanitation and environmental healthFood production and securityOccupational health and safetyAvailability, accessibility & affordability of health

careCommunity managed and community based health

programsTraditional medicine

Sustainable Health: Community Level Barriers and Strategies Barriers

Indigenous knowledge (customs, norms, traditions)

Lack of research resources for documentation of indigenous health knowledge and practices ; prejudice against indigenous peoples

Water, Sanitation & Environmental health

Lack of investments in safe drinking water systems, sanitary toilets with desludgeable septic tanks; lack of community action on solid waste management

Food Production and Food Security

Take over of production of traditional (bio diverse) foods by large scale mono crops and cash crops plantation

Occupational Safety and Health (OSH)

Failure to fully implement laws and regulations mandating companies to apply occupational safety and health (OSH)

Availability, accessibility & affordability of health care

Lack of health personnel at the village level ; lack of essential medicines at the village level; high cost of health care and essential medicines

Community Managed and Community Based Health Programs

Lack of investments in community based and community managed programs

Traditional Medicine Dominance of North American and European Medicine (allopathic); dominance of multi-national pharmaceutical companies and infant milk formula companies of the commercial health markets.

Strategies: Universities as loci for research in traditional indigenous knowledge and medicine; Community Led Water, Sanitation and Environmental Health Approaches; Public-private-community investments in water, sanitation and environmental health ; Promotion of community biodiversity; Continuing education and capability building of community volunteer health workers; Community organizing; Public policy recognition of traditional healers.

Components of Sustainable Health: Local Government Level

Municipality/City/Provincelocal policies, laws, ordinanceshealth systems developmentroad safetylocal health investmentsinter-sectoral linkagesmultidisciplinary and trans-disciplinary

partnershipshealth management information system

Sustainable Health: Local Government Level: Barriers and Strategies

Barriers

Local Policies, laws, ordinances There maybe enough laws and policies but these are not uniformly implemented and enforced

Health Systems Development Lack of Capacity of Local Governments to manage various aspects of health systems development

Road Safety Lack of enforcement of transportation and road safety laws and ordinances - seat belts, no drinking when driving, traffic rule enforcement etc

Local Health Investments Health not a major priority of local governments; health varied as an expenditure rather than an investment

Inter-sectoral linkages Turfing of government agencies and even NGOs; fear of partnerships on both sides, government and NGOs

Multidisciplinary & Trans disciplinary Partnerships

Fear of partnerships; Difficulty in integrating established curriculum

Health Management Information System

Insufficient documentation; Faulty data collection

Strategies: Political will to re-evaluate existing policies for proper implementation and perhaps improvement; Training of individuals for health systems management; Proper implementation of laws and ordinances; Prioritization of health in the local budget; Pilot partnerships with small scale projects to build up confidence in both parties (government and NGOs); Pilot curriculum for trans-disciplinary partnerships maintaining open-mindedness; Improvement of documentation and process evaluation of data collection

Components of Sustainable Health: National Level

Nationalhealth policy developmenthealth standards, regulations and licensingquality and equity in healthhealth human resource developmenthealth research and developmenthealth financing and social health insurancedemographics and population management national medicinal drug development national disease surveillance system

Barriers

Health policy development There may be sufficient policies but with improper implementation

Health standards, regulations, and licensing

Substandard health condition probably due to lack of sufficient budget

Quality and equity in health Geographical challenges in terms of service delivery

Health human resource development Substandard schools; Health profession perceived as a means of economic advancement

Health research and development There may be a lot of ongoing researches but there is lack in advocacy and support from local government

Health financing and social health insurance

Coverage is still for those who can afford; Highest share of reimbursement claims come from rich, private institutions

Demographics and population management

Population growth at a faster rate than economic progress

National medicinal drug development Lack of local capacity to produce the drugs

National disease surveillance system Improper documentation; Faulty data collection

Sustainable Health: National Level: Barriers and Strategies

Strategies: Political will to re-evaluate existing policies for proper implementation and perhaps improvement; Sufficient budget allocation for health; Commitment of LGUs in ensuring availability of health service to their locality, or sponsoring a local resident for health education with return of service; Continuing advocacy; Reproductive health education; Initiatives to attract investors for local drug manufacturing; Process evaluation for disease surveillance system and with focus on preventive care

Components of Sustainable Health: Global Level

Global health professional migrationclimate changeemerging diseases and pandemicsglobal terrorism and armed conflictsglobal health equity (MDGs)global food equitygender and developmentglobal health governance (W.H.O. and United

Nations multilateral mechanisms)

Barriers

Health professional migration Imbalanced migration leading to depletion in source countries; Lack of equitable policies

Climate change Natural as well as Manmade causes

Emerging diseases and pandemics

Unpredictability; Delay in rousing awareness and concern

Global terrorism and armed conflicts

Conflicting beliefs; Unyielding attitude

Global health equity (MDGs) Insufficient local political will

Global food equity Typhoons and natural calamities

Gender and development Oppression

Global health governance Cross cultural differences

Sustainable Health: Global Level: Barriers and Strategies

Strategies: Development of a win-win bilateral agreement/policy between source and receiving countries; Education and awareness raising with initiatives on research and development to address climate change; Level of preparation in order to handle unexpected diseases; Bilateral peace talks and a margin for open-mindedness; Advocacy to local government to strengthen political will in prioritizing health issues; Nationwide preparations for natural disasters, and prioritization in food production; Gender equality empowerment initiatives; Strengthening of WHO and UN multilateral mechanisms , research and development, and informed policy making

Six Dimensions of Sustainable Health, Wellness and Well-Being

Physical

Mental

Spiritual

Emotional

Social

Enviromental

Six Contexts of National & Global Sustainable Health, Wellness and Well-Being

Good Politics & Governance

Social & Cultural Accord

EconomicEquity

Education & Gender Equality

Biosphere Balance & Harmony

Security, Peace &Human Rights

Sustainable Healthis the state of complete

physical, spiritual, mental, emotional, social, and environmental well-being and not just the absence of infirmity and

disease at the personal, family and community levels, but within the context of local, national and global

economic equity, good politics and governance, cultural and social accords, gender and education equality, security, peace and human rights, and biosphere balance and harmony

RCE Cebu

University of the Philippines, Manila Campus: Citing an example of the Role of a

University in Sustainable Health

Organizational Structure

The University of the Philippines SystemUP Visayas

Cebu campus (Central Visayas - RCE Cebu Headquarters)

Iloilo campus (Western Visayas)Tacloban campus (Eastern Visayas)

UP Manila (Health Sciences Campus)UP Diliman (Main Campus)UP BaguioUP MindanaoUP Los Banos (Agriculture and Forestry Campus)

Organizational Structure

UP Manila (Health Sciences)UP College of Medicine

Department of Family and Community MedicineCommunity Oriented Medical Education

Rural (Batangas province) and Urban (Pasay city) poor Communities

Community-Based Health Development Program

(CBHDP)Province of Batangas

Municipality of Laurel (1993-1997)Municipality of Santo Tomas (1998-2005)Municipality of San Juan (2006-present)

5-7 year partnership agreement with local government

CBHDP

Multi-disciplinary moving to Trans-disciplinary approachUP College of Medicine UP College of Nursing UP College of Allied Medical Professions (Physical

Therapy and Occupational Therapy)UP College of DentistryUP College of PharmacyUP College of Arts and SciencesUP College of Social Work and Community

Development (UP Diliman)

CBHDP

Live with the communityParticipation in community diagnosis,

organizing, local barangay (village) governance,Community planning;Community ImplementationCommunity Monitoring and Evaluation

CBHDP

Team up with existing health system structure at the village levelTraditional healersMidwives

Linkages with the Municipal doctor and nurses, and district hospital

CBHDP

Mainly through Community Empowerment towards Sustainable HealthEducation and Capability BuildingDevelopment of Community Based

TechnologiesActive participation and Community

managementSupervision, Monitoring, and Evaluation

Given the conceptual framework of sustainable health, what are

the roles of universities in its promotion?

What will be the key objectives of RCE models for Sustainable Health?

Proposed Objectives for the RCE model/s

At the end of the summer program, the participants will be able to:

Enumerate roles by which a University can play to empower a community

Define sustainable health under the context of education for sustainable development

Illustrate/Propose an example of how they can apply the principle in their local community

Integration of Traditional Medicine into Basic Health Care Services and Health

Sciences Curricula

Integration of Traditional Medicine in Basic Health Care Services and Health

Sciences CurriculaResearch and Use of Medicinal Plants

for MDG 4 and MDG 5 (Child Health and Maternal Health) at the community level.

Integration of Sustainable Health in ESD in Health Sciences Curricula

ESD Higher Education and Sustainable Health

RCEs as monitor of international ethical recruitment guidelines of health professionals and “Migration Watch”

Participation of RCEs in the Country Panels for negotiation of bilateral win-win agreements in the ethical recruitment of international health professionals

Why Traditional Medicine and Integrative Medicine and

Complementary Medicine in Medical and Health Sciences

Education?

Why Study Traditional Medicine?

W.H.O. recommendation of integration of Traditional Medicine in Medical and Health Sciences Education and Primary Health Care since 1978

World Health Assembly resolutions since 1981 called upon member-states to integrate Traditional Medicine in their health care systems

Why Integrative and Complementary Medicine in the Medical and Health Sciences

Curricula?Evidence Based Medicine already being applied in

Complimentary and Alternative Medicine

NIH Bethesda actively promoting through the National Center for Complementary and Alternative Medicine

North American, European and Asian Medical and Health Sciences Schools already incorporating Integrative Medicine and Complementary and Alternative Medicine

Why Integrative and Complementary Medicine in the Medical and Health Sciences

Curricula?Evidence Based Medicine already being applied in

Complimentary and Alternative Medicine

UP College of Medicine offering elective courses in Traditional and Alternative Medicine during 4th year medical school

Masters Program in Integrative Medicine started in UERMMC (Phils.)

Challenges in the Philippines

Research Agenda in Filipino Traditional Medicine

Generation of Research QuestionsDevelopment of Research ProtocolsHerbal medicine researchAnimal and mineral medicine researchInventory/survey of Filipino healersBottom-up Code of Ethics or Standards of

Practice

Challenges to the Research Community

1. Majority of Philippine medicinal plants with centuries of ethnomedical history, remain untapped.

2. Evidence supporting Philippine traditional medicine practices is still in the early developmental stage and its potential has not been fully explored.

3. Lack of collaboration among research institutions, private sector and academe

More Challenges to the Research Community

4.Lack of investments in research and development, raw material production, post harvest processing and herbal manufacturing.

5.Low level of scientific technology in herbal medicine research and manufacture among small and medium enterprises.

6. Low support for traditional medicine research in the academic community.

More Challenges to the Research Community

7. Need for market and government incentives like the ones given to rice, corn, coconut, sugar, bananas, pineapples and mangoes.

8. Need for standardized procedures/ accreditation/recognition in Filipino traditional medicine practices.

Philippines - The Heart of AsiaPhilippines - Islands of Wellness and the Center of

Health and Wellness in Asia

Philippines - The Global Capital for Tropical Medicinal Plants

The Filipino Hilot Traditional Massage - a brand name in all spas of the world in the next 5 years

Philippine Health Care - the Best of Asia with the Best of Europe and North America

Terima Kasih!Arigato Gosaimas!

Maraming Salamat po!

Allison E. Gocotano, MDRaymond Francis R. Sarmiento, MD

Jaime Z. Galvez Tan, MD, MPH

HEALTH FUTURES FOUNDATION INC.