The United Nations Inter-Agency Task Force on the Prevention and Control of NCDs (UNIATF) conducted a one week joint mission to the Philippines, 7-11 May 2018.
Ten UN system agencies participated in the mission, with the objective to advocate a whole-of-government and whole-of-society response to NCDs. The joint UNIATF mission also aimed to enhance the support of UN agencies, individually and through the UN Country Team, to the Government of Philippines to scale up the national multisectoral response to NCDs, in line with the WHO Global NCD Action Plan 2013-2020 and the Regional Action Plan.
From 7 to 11 May 2018, three interrelated international missions took place in Philippines to support the country’s efforts to beat NCDs:
- The Joint United Nations Task Force for the Prevention and Control of NCDs
- The needs assessment for the implementation of the Framework Convention for Tobacco Control (FCTC)
- The NCD investment case mission
Joint Programming Mission of the United Nations Interagency Task Force on the Prevention and Control of NCDs
During the visit, the Task Force met with high-level officials from a number of ministries across the government in order to explain how NCDs present a challenge to their sector and the national development agenda and to identify concrete steps that can be taken in their sector to tackle NCDs. The Task Force also met with parliamentarians as well as development partners and representatives of civil society.
An additional objective of this mission was to collect the necessary economic data and undertake an institutional context assessment in Philippines in order to develop the case for investing in NCDs. The investment case will quantify the costs of NCDs in Philippines – both to the health sector and the economy at large – and the benefits of scaled up action, thus providing the Department of Health with evidence-based, compelling arguments to advocate for more investments in the prevention and control of NCDs.
The Task Force Secretariat expresses gratitude to the Government of Japan for financial support of the Joint mission and to the Government of Russian Federation for supporting NCD investment case mission.
NCDs in Philippines: A growing social and economic threat
In the Philippines as well as worldwide, NCDs (principally cardiovascular diseases [CVDs], diabetes, cancer, and chronic respiratory disease) are the leading cause of death. These diseases kill over 450,000 Filipinos annually, accounting for 68% of all deaths. Even more worryingly, there is a 29% chance of dying prematurely (between the age of 30 and 70) due to one of these diseases. Most premature deaths are associated with the main avoidable risk factors for NCDs, namely unhealthy diets, physical inactivity, harmful use of alcohol and tobacco use.
In spite of progress in implementing stronger tobacco control legislation, 43% of Filipino men are smokers and the prevalence of the other NCD risk factors among the entire population is equally alarming. More than one fifth of Filipino adults are hypertensive and the prevalence of adult overweight and obesity has doubled in the last 20 years from 14.5% in 1993 to 31.1% in 2013. A dramatic increase in obesity among children and adolescents has been observed as well.
“To beat NCDs, we need urgent action taken at various levels of the government and engagement of all relevant stakeholders,” said Dr. Gundo Weiler, WHO Representative in the Philippines. “The participation of different sectors during this joint mission clearly demonstrates that progress in NCD prevention and control requires coordinated action by many sectors, such as finance, trade and industry, budget and management, parliamentarians, justice, education, labour and employment, agriculture, local government and others.”
NCDs are imposing an ever greater health and socioeconomic burden on the country coping with the rising cost of treatment, and on families through loss of income and high health care costs. There is also growing recognition that failing to control NCDs could threaten the attainment of national health targets and the Sustainable Development Goals (SDGs). To reach the goal of reducing the number of premature deaths by one third by 2030, the multisectoral approach is essential, as well as coherence across economic, social and environmental policy areas to promote healthy lifestyles and address NCDs.
Country progress
The Task Force noted that there is high-level of recognition and understanding of NCDs and its adverse impact on health and development. The Philippines is committed to tackling NCDs and is already demonstrating significant commitment to action.
The UN Task Force reviewed multiple strategies and plans and legislation in the area of tobacco control, harmful use of alcohol, unhealthy diets and physical activity. The Mission witnessed the achievements of the Government of Philippines in developing national whole-of-government and whole-of-society responses to NCDs, including the recently updated Multisectoral NCD Action Plan 2015-2025 that gathers approximately 14 different government departments, resident UN agencies and civil society and notable achievements in the taxing tobacco and sugary sweetened beverages.
The Mission was made aware of the recently updated national tobacco control strategy, Philippine Package of Essential NCD Interventions Management of hypertension and diabetes for primary health care facilities (PhilPEN), policies on palliative and hospice care, cancer and management of obesity, as well as the established STOPSMOKE mobile health programme together with quit line and smoking cessation clinics.
The Mission was also presented with notable examples of good policies and plans on NCDs at municipal and city level, in particular from the Manila Metro area and Valenzuela city who have implemented successful anti-smoking campaigns in line with FCTC provisions.
“NCDs are not only a threat to individual health, they jeopardize the social fabric and economic development of the Philippines” said Nick Banatvala, Head of the UN Task Force Secretariat. “We were impressed by the commitment of the government, and the UN stands ready to provide the necessary assistance to translate this commitment into effective programme for the population”.
Despite the active efforts to halt the rise in NCDs, the Mission was concerned that avoidable risk factors associated with NCDs are still problematically high. Approximately one third of adults smoke cigarettes, and over half of men and women above 20 years old engaged in binge drinking. Furthermore, almost half of the population do not meet sufficient levels of physical and almost 90% of Filipino adults do not consume enough fruits and vegetables. All of these risk factors are associated with the increased risk of developing CVDs, cancer or diabetes and a higher chance of premature mortality.
The Joint Mission provided a set of recommendations to the government, resident UN Country Team, and civil society aiming to help scale up whole-of-government, whole-of-society and whole-of-UN response to NCDs in the Philippines ahead of the Third High-level Meeting on NCDs in September 2018 and beyond.
FCTC needs assessment mission
During this week an international team led by the Secretariat of the Framework Convention on Tobacco Control and composed of colleagues from Department of Health and WHO country and regional offices worked together to identify the main needs and barriers in the full implementation of the WHO FCTC and thus contributing to the achievement of Target 3.A of the SDGs.
The team met and discussed with different government and non-government stakeholders how the different sectors can contribute to accelerate the implementation of the treaty.
The Philippines has made great progress in combating the tobacco epidemic and this is well reflected in the latest national surveys which show a decrease in tobacco use both in Filipino men and women. We believe that in great part this is due to the increase in taxes through the sin tax law. The team encouraged the Department of Finance to continue their efforts to further increase this tax which has shown to be a win-win measure.
It has been made clear from the discussions that a functional national multisectoral coordinating mechanism is needed so that all government sectors move in the same direction, protecting the health and wellbeing of the population and preventing the interference from the tobacco industry. The team encouraged the Civil Servant Commission to continue reporting and prosecuting cases of tobacco industry interference though civil servants.
It is also evident that support to the local government units (LGUs) is essential so that national laws can be enforced at all LGU levels in a coordinated manner so that no Filipino is left behind.
Finally, the team advocated for the passing of a number of bills presented to the Parliament in line with the obligations to the FCTC and the accession to the Protocol to Eliminate Illicit trade in tobacco products.
At the end of the week, the team agreed on a number of recommendations which were presented to the Secretary of Health as well as the UN country team. A full report will be submitted to the government in the near future.
NCD investment case
A NCD investment case is a quantitative analysis outlining how cardiovascular diseases, diabetes, respiratory diseases and cancers hold back a national economy by escalating budget costs and lost productive capacities from people unable to work, or working less effectively.
The investment case provides evidence on how governments can avoid these losses by implementing a set of proven cost-effective policies between now and 2030. Philippines’ investment case is being developed under the UNDP-WHO Joint Global Programme on NCD Governance, with the financial support of the Government of the Russian Federation. It will detail how premature death, illness and disability from NCDs impacts socio-economic development of the Philippines, including direct costs to the national budget and indirect (hidden) costs from lost productivity. It is also expected to estimate the return on investment in certain cost-effective NCD measures, and the expected impact from implementing these interventions on the country’s health and economy.