The government's meager resources for health mean that more and more Filipinos will resort to self-diagnosis and medication. The poor will be at a disadvantage as they do not have access to health information and services. The wealthy, however, will be healthier.

by Jonathan A. Flavier

	Because government resources for health are dwindling, self-care and self-treatment of health conditions will be much more common in the next decade. [photos courtesy of Jose Enrique Soriano]

FILIPINOS HAVE long been prone to self-diagnosis and self-medication, but in the years to come, D.I.Y. health care may become even more pronounced. After all, when society does not assume enough of the burden of health care, individual responsibility and self-preservation become the norm.

Compared to its counterparts in neighboring countries, the Philippine government has not been spending enough for the health needs of its people. According to official reports, our government allocates only 0.9 percent of total spending on health. This is lower than Thailand (11.6 percent), Malaysia (6.5 percent), and Vietnam (6.1 percent), and even less than what the economically distressed nations of Indonesia (3.0 percent), Cambodia (16 percent), and Bangladesh (8.7 percent) allocate for the health of their peoples.

It is not clear whether our government has no money because it is spending on the wrong things or cannot raise more revenues. What is certain is this: because the national government scrimps on health care while local government resources for health are limited and health insurance, inadequate, households end up bearing the bulk of the burden of health spending. Because public spending is deficient, more private resources have to pay for health expenditures.

In the coming years, we can only expect more self-spending activity where families make more out-of-pocket payments for services. And while self-sustaining and self-financing of health care are already becoming extensive, more people will rely on their immediate circle of contacts for remedial measures. Self-care and self-treatment of health conditions will be much more common. In this do-it-yourself setting, we would not even have to go to hospitals or diagnostic laboratories. It would be more convenient and much faster to call on family and get test kits from the neighborhood pharmacies. In this information age, it is also much easier to surf the Internet and access medical-information websites.

For the wealthy, D.I.Y. health care would work. Health is wealth, and the wealthy will be even healthier in the next 10 years and even beyond because of more self-education and self-diagnosis, better self-care and self-treatment, and increasing self-sustenance and self-financing. For the poor, however, even the simplest health problem could deteriorate into a matter of life and death because of their lack of access to health information and services, which in turn could lead to improper self-diagnosis and medication.

Health is a luxury for the needy. For them, thinking about what they can expect 10 years from now may even be difficult, when all they can hope for is just another day. It is an arduous challenge to improve the well-being of the ailing because of the divide among social classes, the gap between the rich and poor, and the disparity among first-class and lower-class communities.

	Lower-income households see more abortions, unwanted pregnancies, and maternal deaths than those in the upper classes. This gap will continue in the future.

GOVERNMENT HEALTH indices suggest that over the last 15 years our overall health status has improved. Tuberculosis and other infectious diseases are no longer the top causes of death and illness in our country. Diarrhea and other problems associated with environmental sanitation have decreased with improved water distribution and supply. The family planning program has provided a wide range of family planning services to many women of reproductive age, around 47 percent of whom were reported to be using contraceptives in 2000.

Yet while major health improvements have been evident in the last few decades, their pace and scope are now at risk of being overwhelmed by a growing population, a constrained economy, and a major challenge in health and development-the yawning gap between the few people who have so much and the many who have so little.

The "improvement in the economy" reported at the macro level excludes the fact that the Philippines has one of the most unequal income distributions in the world. Although reduced in many parts of the world, inequity is becoming worse in this country. In 1994, the family income of the richest ten percent of our people was 19 times higher than that of the poorest ten percent. Since then, that same affluent group has continued to increase its share of family income while the family income share of the majority of Filipinos has decreased. Economic improvement without equity cannot contribute substantially to human health and development, but there is no indication the trend will change anytime soon.

The differences dividing social classes have rarely been minimal. There is not only an information divide where the rich have the best computers and the best sources of knowledge-the poor are not even provided enough teachers, classrooms, and school books for basic elementary and high school education. It is not only harder for the poor to receive health education, it has also become much harder for them to understand the scant health information that is available.

When it comes to the national government's approach to health, lack of money is only half the problem. Of the little that is set aside for health, just a pinch is allocated for public health and preventive-care services like family planning or reproductive health or even for diseases like malaria.

Even today, lower-income households see more abortions, unwanted pregnancies, and maternal deaths compared to those in the upper classes. Yet family planning and health information are focused in health centers and in messages placed in magazines that are not always accessible to the poor.

It is true that there is almost equal access across income classes for free family planning commodities like pills, condoms, and injectables. But only those who have money can avail themselves of the more reliable family planning services that have to be paid for, such as longer-term contraceptive methods like the intra-uterine device (IUD) or voluntary surgical contraception for males and females.

The poor are still ravaged by tuberculosis or TB and pneumonia. Although these diseases are no longer among the top three causes of death in our country, they are still in the top 10. The World Health Organization estimates that the Philippines has around 250,000 new cases of TB each year and the second highest number of tuberculosis cases in this region of Asia.

And while water supplies have improved, diarrhea is still the top cause of illness here, with one out of every 100 persons affected each year. It's easy enough to figure out who are likely to have it. The more expensive housing in upper-class villages and communities can boast of so much water that golf courses are always green and swimming pools are kept full of clean water. On the other side of the fence are rural villages and teeming slums with dirty water and pitiful environmental sanitation.

Jonathan David 'Jondi' A. Flavier is a medical doctor who specializes in health policy, planning, and management. He currently provides part-time technical assistance for health and development programs of the Department of Health, the Philippine Health Insurance Corporation, the Philippine Congress, as well as international and other private organizations.

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