Running head: PHILIPPINES AND HYPERTENSION

The Philippines and Hypertension

PHILIPPINES AND HYPERTENSION

Hypertension is a significant health concern in the Philippines. Hypertension was the

fourth leading killer of Filipinos in 2009 (WHO, 2011, p. 339). Hypertension was the second
most common cause of maternal mortality, which is a significant factor in the Philippines (Say et
al., 2014, p. e327).
Physical Effects
The physical effects of hypertension are initially benign, but if untreated, hypertension
may progress to more noticeable effects. Hypertension is one of the characteristics of metabolic
syndrome, which is common in the adult Filipino population (Morales, Punzalan, PazPacheco, Sy, & Duante, 2008, p. 42). Hypertension leads to cardiovascular disease, including
arteriosclerosis, myocardial infarction and stroke.
Psychological Effects
Due to their strong belief in God, Filipinos may accept any symptoms of hypertension as
Gods will, and may not seek medical care (Vance, 2014, p. 414). Filipinos may experience
challenges with regimen compliance due to a fatalistic view of disease (Vance, 2014, p. 415).
Health-related fatalism may be characterized by the phrase Bahala na, which translates
roughly to Come what may, and may make the Filipino patient view treatment as useless
(Christine Castro, personal communication, September 29, 2014).
Nutrition, Ethnonutrition, and Ethnopharmacy
Filipino diets contribute to hypertension. Traditionally, Filipinos cook comfort foods
with high-sodium ingredients such as bagoong, patis and soy sauce (Dela Cruz & Galang, 2008,
p. 121). Celebrating with food is central to Filipino culture, and egg rolls (lumpia) and roast

PHILIPPINES AND HYPERTENSION

suckling pig (lechon) are common celebratory foods. As a result, Filipino diets contain a lot of
salt and fat, both of which are detrimental to cardiovascular health.
Traditional Filipino healers may treat hypertension with herbs that are part of the
pharmacopeia of their healing practice. Healers may ask their hypertensive patients to boil the
leaves of Cymbopogon citratus or Euphorbia hirta and drink the tea (Gruyal, del Roasario, &
Palmes, 2014, p.3). Chemical analysis of each of these plants reveals both diuretic and
vasodilative action that serves to lower blood pressure (Carbajal, Casaco, Arruzazabala,
Gonzalez, & Fuentes, 1991; Kumar, Malhotra & Kumar, 2010).
Current Cultural Address of Hypertension
Among Asians, Filipinos have the highest rate of hypertension (Vance, 2014, p. 417).
The website of the Philippine governments Department of Health displays a menu with health
promotion materials for health topics of national concern, but there are no materials that
specifically address hypertension amid the many broken hyperlinks (Department of Health,
2011a). While there is a section devoted to cardiovascular disease, the single page vaguely
references implementation of a nameless program (Department of Health, 2011b). In 2012, the
Philippine Department of Health issued a 156-page collection of Philippine Health Advisories;
hypertension merited one full page (Department of Health, 2012, p. 72).
Effectiveness of Cultural Address
Filipinos believe that good health is a result of a life in balance, which includes food
intake, exercise, rest, and work (Dela Cruz & Galang, 2008, p. 125). Filipinos are capable of
bearing great psychological stress in an effort not to upset the perception that they are agreeable
and hardworking (Dela Cruz & Galang, p. 122). Filipinos know that their health behaviors and

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food choices contribute to hypertension, but they continue to practice their less than optimal
habits because that is what they know, and they feel as though interventions would make no
difference (Dela Cruz & Galang, p. 121). The lack of a central, government-backed message
regarding hypertension may contribute to the perception that Filipinos can alter their behavior to
control their hypertension.
Recommendation
Hypertension is prevalent in the Filipino population, but it is not irreversible. A
comprehensive educational program to motivate Filipinos to examine their own risk of
hypertension should be undertaken. A needs assessment would be completed to determine, how
Filipinos perceive hypertension, what behavior change messages would be most effective, and
the best methods of delivering these messages and motivating the population. An appropriate
public health behavior change theory or model would be chosen based on data collected during
the needs assessment. The programs planning process would consult health authorities,
physicians and nurses, members of clergy, and traditional healers. Program planning
participation by these figures would increase social credibility and cultural competence of the
program, and would send the message that participation in the scientific evidence-based program
will not violate any beliefs.
Costs of the program would be offset by stakeholders, including the World Bank and
other international banks, the Philippine government, major employers, and tourist bureaus.
Funds would be allocated to develop a database to track participants blood pressure changes and
voluntary health data over the course of program participation. Mass media would be recruited
to promote participation in the program, publicize locations of publicly available blood pressure
measuring equipment, and to recognize individual success.

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Reflecting the bilingual nature of the Philippines, program materials would be available
in both Tagalog and English. The program would begin with a self-assessment quiz that the
person could take, with the risk assessment score explained to the person in non-scientific terms.
Registration in a nationally-administered cardiovascular health improvement program would be
offered. Participants would enter their blood pressure measurements and other health data into
the program database via a secured login accessed through an internet portal or via a cell phone
application.
Registration in the internet-based comprehensive behavior improvement would come
with rewards. Clients would accrue points based on participation in learning exercises and
quizzes related to reducing cardiovascular risk factors, improving nutrition, increasing physical
activity, and tracking of their blood pressure measurements. Proof of participation in charity
walks, local sports, and athletic competitions would contribute to point totals. In order to
increase social aspects of participation, points would be awarded for recruiting new participants,
and would be awarded periodically based on the recruits continued program participation.
Program sponsors would provide prizes or tokens of recognition for which participants could
redeem points; ideally, the prizes would serve to increase or maintain that sponsors customer
base. Media recognition of individual success stories would reinforce participation, and may
serve as a promoter of social status.
Evaluation of the effectiveness of the plan would be measured by drops in prevalence of
hypertension, as measured by the self-reported data. While this may not be a standardized
method of data collection, it would require trusting in participants ability to remember to enter
data, and to enter it correctly. Data would be able to be tracked by individual, as well as
aggregated for national reporting information.

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6
Conclusion

Hypertension is a slow, yet preventable method of death. Imagination and

resourcefulness may be coupled with evidence-based practice to yield realistic interventions with
achievable goals. Finding a health promotion message that resonates with hypertensive Filipinos
will allow them to take the steps they need to gain control of their condition. Convincing the
government to assume more of an active role and drafting specific, measurable health objectives
will demonstrate to Filipinos that their government is serious about keeping the people healthy
and alive.

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7
References

Carbajal, D., Casaco, A., Arruzazabala, L., Gonzalez, R., & Fuentes, V. (1991).
Pharmacological screening of plant decoctions commonly used in Cuban folk medicine.
Journal of Ethnopharmacology, 33(1), 21-24.
De la Cruz, F. A., & Galang, C. B. (2008). The illness beliefs, perceptions, and practices of
Filipino Americans with hypertension. Journal of the American Academy of Nurse
Practitioners, 20(3), 118-127. doi: 10.1111/j.1745-7599.2007.00301.x
Department of Health (2011a). Health Promotion Materials. Retrieved from
http://www.doh.gov.ph/health_promotion_materials.html
Department of Health (2011b). Cardiovascular Disease. Retrieved from
http://www.doh.gov.ph/content/cardiovascular-disease.html
Department of Health (2012). Philippine Health Advisories. Retrieved from
http://www.gov.ph/downloads/2014/05may/Philippine-Health-Advisories.pdf
Gruyal, G. A., del Roasario, R., & Palmes, N. D. (2014). Ethnomedicinal Plants Used by
Residents in Northern Surigao del Sur, Philippines. Natural Products Chemistry &
Research, 2, 140. doi: 10.4172/2329-6836.1000140
Kumar, S., Malhotra, R., & Kumar, D. (2010). Euphorbia hirta: Its chemistry, traditional and
medicinal uses, and pharmacological activities. Pharmacognosy Reviews, 4(7), 58. doi:
10.4103/0973-7847.65327
Morales, D. D., Punzalan, F. E. R., Paz-Pacheco, E., Sy, R. G., & Duante, C. A. (2008).
Metabolic syndrome in the Philippine general population: prevalence and risk for

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atherosclerotic cardiovascular disease and diabetes mellitus. Diabetes and Vascular
Disease Research, 5(1), 36-43.
Say, L., Chou, D., Gemmill, A., Tunalp, O., Moller, A.-B., Daniels, J., ... Alkema, L. (2014).
Global causes of maternal death: a WHO systematic analysis. Lancet Global Health, 2,
e323-333. doi:10.1016/S2214-109X(14)70227-X
Vance, A. R. (2014) Filipino Americans. In J. Giger (ed.), Transcultural nursing: Assessment
and intervention (pp. 403-425). St. Louis, MO: Elsevier Mosby.
World Health Organization (WHO) (2011). Philippines country profile. Retrieved from
http://www.wpro.who.int/countries/phl/26PHLpro2011_finaldraft.pdf