Introduction

In recent years, the NCD Prevention and Control Program of DOH has achieved significant milestones in addressing the public health problem on lifestyle-related diseases. One of the most notable innovations is the implementationof the integrated approach to reduce mortality, morbidity, and disability from NCDs. This is done through the promotion of healthy lifestyle with focus on addressing the common risk factors leading to NCDs. Demonstration projects and local experiences in implementing and managing NCD interventions and activities in local government units (LGUs) have likewise shown successes, and have helped enriched the program to what it is now.

1. Burden of Disease and Death of Non Communicable Diseases

Noncommunicable diseases (NCDs) are considered a major public health concern worldwide. They account for 60 percent of total deaths globally (with 40 million deaths estimated occurring annually), and contributes to 40 percent of universal disease burden annually. It is projected that if no action is done in the present, these rates would increase to as high as 73 percent to total deaths and 60 percent to disease burden respectively by 2020 (WHO, 2005).

The Philippines, like other developing countries, exhibits similar increasing trend of NCDs. More than half (58%) of total deaths in the country in 2003 were caused by NCDs. Diseases of the heart and vascular system made up almost one-third (30.2%) of all deaths (Philippine Health Statistics, 2003). Other NCDs in the top listinclude malignant neoplasm, chronic obstructive pulmonary diseases (COPD) and diabetes mellitus. NCDs have replaced the positions of infectious diseases particularly pneumonia and tuberculosis as top-most common causes of deaths.

Majority of these NCDs are linked by common preventable risk factors which include tobacco use, unhealthy diet, physical inactivity, and alcohol use. The 2003 Food and Nutrition Research (FNRI) Study showed that 90 percent Filipinos have at least one or more of NCD risk factors. Prevalence of risk factors among Filipino adults are as follows: smoking (34.8%), hypertension (22.5%), overweight (20.0%) and obesity (4.9%), high blood sugar (4.6%) and abnormal cholesterol levels (8.0%). It is also estimated that about two thirds (60%) of adults are physically inactive. More than half of adult males (56%) and 12 percent of adult females are current smokers.

The NCD risk factors are not only prevalent among adults. Alarmingly, younger children are already showing the propensity to becoming overweight at an early age Prevalence of overweight among adolescents 9-11 years old had increased two folds from 2.4% in 1993 to 4.8% in 2005. Similarly, the prevalence rate of overweight for children 6-10 years old doubled from 0.8% in 2001 to 1.6% in 2005 (Philippine Nutrition Facts and Figures, 2005). Numerous studies have shown a tendency for obese children to remain obese in adulthood.

Twenty two (22) per cent of teenagers currently smoke cigarettes (Philippines Global Youth Tobacco Survey, 2007). About 30% are physically inactive, spending three or more hours per day sitting and watching television, playing computer games, talking with friends, or doing other sitting activities. (Source: Philippines Global School-based Student Health Survey, 2007

Non-communicable diseases causes people to fall into poverty and create a downward spiral of worsening poverty and illness. They also undermine a country’s economic development.

The cost of care for chronic diseases is often high, to the detriment of the poor. A study by Higuchi (2009) on costs, availability, and affordability of diabetes care in the Philippines indicate thatthe median out-of-pocket expenditures for out-patient care is PhP 687 and hospitalizationis PhP 8,580. Median daily cost of maintenance medicines is PHP 25/day. Medicines too in general are more expensive compared with other Asian countries. Not surprisingly among diabetics, only 69% are able to sustain regular consultations, 76% maintain regular medication, and 40% maintain regular laboratory tests. Social health insurance covers 79% of those in the formal sector, but lowest at 15% among the informal sector.

2. Causes and Risk Factors of the Major NCDs

Causes of major NCDs can be traced to a number of underlying determinants, common risk factors and intermediated risk factors. Globalization, urbanization and population ageing are global scenarios that leads to common risk factors such as unhealthy diet, physical inactivity, tobacco and alcohol use to be on the rise in the population. These common risk factors give rise to intermediate risk factors such as high blood pressure, elevated blood glucose, abnormal lipid profiles and overweight/obesity. These intermediate risk factors then predispose individuals to the “fatal four” – cardiovascular diseases, cancer, chronic respiratory diseases and diabetes mellitus.

Causation Pathway of Major Non Communicable Diseases

Among the common risk factors cited, age and heredity are the only ones that cannot be prevented nor modified. However, an estimated 80% of premature heart disease, stroke, and type-2 diabetes, and 40% of cancer, could be avoided through healthy diet, regular physical

activity, and avoidance of tobacco use.

Another way of looking at the common risk factors and intermediate risk factors and how they are related to the major NCDs is presented in Table 1.9. In this table, it is clearly seen how the different major NCDs share common risk factors and intermediate factors. A comparison of the prevalence of selected risk factors showed a steady increase from 1998 to 2003 and 2008 as seen on the table below.