Aquino’s dilemma on preventive and curative medicines

I have lauded in previous columns the Aquino health agenda. What used to be a utopian dream of “health for all” now appears to be within reach.

I feel happy when indigent patients tell me that their PhilHealth coverage took care of all, if not a big part, of their hospital bills. I thought that this was a good indicator of “inclusive growth,” with the country’s economic gains trickling down to the “poorest of the poor.”

I’ve always said in my talks that, for me, President Aquino is the most health-oriented president we ever had. But his recent statements suggesting his health priorities made me wonder about his concept of Public Health and what preventive medicine entails.

There are speculations on why Health Secretary Ike Ona has gone on leave for four weeks to prepare answers to President Aquino’s questions on the mass vaccination campaigns of the Department of Health. If I had read between the lines correctly, I think P-Noy is wondering why we have to spend so much money on upgrading government hospitals instead of concentrating on preventive strategies like immunization.

Gov’t focus

I think there can be no disagreement that the government must focus on preventive strategies. I’m sure Aquino gets that kind of advice from everyone. The so-called New Public Health, or NPH, is defined as one which puts emphasis on preventive medicine. But probably it was not explained to the President that prevention does not only entail immunization or other primary preventive interventions.

When we speak of preventive medicine, we’re actually referring to three levels of prevention—primary, secondary and tertiary.

Primary prevention means implementing programs and services to prevent diseases such as mass immunization, and promoting the reduced usage of tobacco products and other harmful substances. Basically equipped and adequately manned primary health units should be able to handle these.

Secondary and tertiary prevention may require more well-equipped healthcare facilities.

Secondary prevention aims for early diagnosis of a disease when one has no symptoms yet. There are diseases, like high blood pressure, that may well be diagnosed in primary healthcare facilities; but others, like diabetes, cholesterol problems, early cancers, lung and liver diseases, may have to be referred to secondary or tertiary hospitals for a more thorough evaluation, early diagnosis and treatment to stop the worsening of these and prevent complications.

The same is true for tertiary prevention, which means that there is already symptomatic disease; and treatment is geared toward stabilizing the disease process, prevention of long-term disabilities such as after a stroke. This also involves physical and functional rehabilitation to enable the patient to be able to live a normal life as possible.

So all of these are in the scope of preventive medicine and healthcare facilities with relatively updated equipment and manned by adequately trained healthcare professionals are required.

Public Health requires a broad and holistic range of evidence-based scientific, technological and management systems implementing measures for both prevention and cure. No matter how excellent we are with our primary preventive strategies, we can never prevent diseases to an extent that we can remarkably minimize curative medicine. The reason for this is we’re living in a disease-prone world due to nonmodifiable and modifiable, or manmade, factors.

Nonmodifiable factors include the aging process. There’s no such thing as a fountain of youth. It’s a myth that got buried with Juan Ponce de Leon who spent all his life looking for it and probably died from physical exhaustion, obsessed with the non-existent fountain. People marketing anti-aging products and treatments like stem cell medicine may make one’s skin look younger, but everything else underneath remains old. And with aging comes all sorts of diseases due to wear-and-tear, or the so-called degenerative diseases.

Another nonmodifiable disease factor are our genes. Some simply have the genetic flaws that make them prone to develop a disease in their lifetime.

Modifiable factors is due to manmade folly, like smoking, excessive drinking, unhealthy diet and environmental pollution. We have to face reality that although it’s well established that tobacco products, excessive alcohol, gasoline-caused air pollution are disease-producing, there’s no way they can be outlawed.

So why should we wonder why we can’t just concentrate on primary preventive strategies and believe we can keep everyone hale and hearty by doing so?

Public Health necessarily involves a balance of preventive and curative strategies. There must be facilities and resources for both disease control and the promotion of preventive measures to fend off existing and potential health threats and risks.

Complex undertaking

Safeguarding Public Health is a complex undertaking and health officials must be able to manage a prudent and socially responsible distribution of available resources.

Universal health coverage or Kalusugang Pangkalahatan involves a proper balance of health services with the needed facilities to go with them. It’s judicious to have an emphasis on primary care and preventive health services, but there must be provision for a comprehensive healthcare system that can handle disease control at various stages.

After having said all of the above, the truth is that achieving a good balance between preventive and curative services, and judicious resource allocation sound much easier when spoken of and written about than when actually being implemented. What would make it more difficult is when tradeoffs and prioritization that are often politically challenging have to be factored in.

Hence, it makes one feel sad that the aim of reducing the health burdens of the poor and the underserved may have to take a back seat when political exigencies come into play.