Philippines' Top Ten Causes of Mortality

Written by Dr. Emer

03 July 2007
http://emeritus.blogspot.com/2007/07/philippines-top-ten-causes-of-mortality.html

It is interesting to see what are the leading diseases and health conditions that kill Filipinos everyday and ponder why
they continue to do so. The chronology I have below came from the Department of Health's Health Statistics website
(now a dead link), and is said to have been updated sometime last January 2007.

Heart diseases are varied and may include coronary, ischemic, valvular, inflammatory,
hypertensive, hereditary, and infectious causes. Sadly, I can't find recent online data that
points specifically to the breakdown of specific heart diseases' contribution to the overall
mortality rate. The resources just say it is number one, and for the past several years
beginning in the early 90s, the complex group of heart diseases has been the Philippines' top
killer. From 1942 to the 1980s, infectious diseases used to be the Philippines' top killer. A 1984 study identifies
rheumatic heart disease, ischemic and hypertensive heart diseases as the major types involved. Another study
blames cigarette smoking, the easy accessibility of cigarettes even to adolescents, and the usual suspects of
increasing fat intake, increasing diabetes cases, and high cholesterol levels as predisposing factors.

Closely related to number 1 above, these are the diseases that affect the circulatory system
(blood vessels) and may include peripheral artery disease, all types of aneurysms and
dissections, atherosclerosis, Buerger’s Disease, Raynaud’s phenomenon, and arterial
embolism and thrombosis. A frequent diet of fatty and salty food, lack of exercise, no
periodic medical consultations, and increasing cost of hospitalization all contribute to the
existence of this number two killer.

In order of killing contribution, cancers of the lung, breast, cervix, liver, colon and rectum,
prostate, stomach, oral cavity, ovary and leukemia are the specific leading cancer killers in
the Philippines today. Why the lung? Because Filipinos love to smoke, the innocent and
unwary get to inhale all the second-hand smoke they can get, and the air pollution is
terrible especially in cities found in Metro Manila. Why breast cancer? Read this. Why the liver? Perhaps alcohol
consumption and unidentified but increasing incidence of both overt and subclinical hepatitis infections are to blame.
For the rest, feel free to share your theories. As with the heart and vascular diseases, there is low cancer prevention
consciousness. Currently, 75 percent of all cancers occur after age 50 years, and only about 3 percent occur at age
14 years and below. Also, cancer survival rates here are relatively low. Most Filipinos seek medical help only when
their cancer conditions are in the advanced stage. By that time, it is too late. They spend most of their money with
radio- and chemotherapy sessions just to extend their lives for a couple of months.

Safety and prevention are two of the frequently ignored concepts by most Filipinos. It is not
therefore surprising to find that accidents is the fourth killer. I am not talking about merely
driving accidents, but all types of accidents including occupational and otherwise. It is a
common sight seeing construction workers not wearing safety harnesses or hard hats. In fact, I
have not seen a worker operating a jack hammer wearing any ear protection --- only in the Philippines! Construction
in streets and roads are done with a scarcity of signs making both motorists and pedestrians suffer from accidents
like colliding with big blocks of stone and falling in open manholes. Also, since we are a disaster-prone country,
typhoons, landslides, flash-floods, volcanic eruptions, and earthquakes all contribute to the other causes of accidents
here.
 You would think that in the light of modern medical treatment and wide availability of
antibiotics, Pneumonia would no longer kill us, right? Wrong! For adults, this occurs mainly
as a complication of other chronic diseases like lung cancer, COPD, tuberculosis, and other
debilitating illnesses that leave them bedridden most of the time. For children, this remains to
be a major killer, either as a sole disease beginning with a respiratory infection, or as a complication of measles. This
recent study from Cebu City concludes that most physicians do not adhere to the local guidelines in treating
community-acquired pneumonia. Also, there's the other form of more fatal pneumonia --- the hospital-acquired type.
This is the pneumonia you get when your length of stay in the hospital is long, and the antibiotics used to treat are the
higher generations.

The joke is that you are not a Filipino if you do not have TB. It might sound amusing but it
gives you a glimpse of how prevalent this disease is. In the late 1990s, the Philippines was
fourth in the world for the number of cases of tuberculosis, and had the highest number of
cases per head in South East Asia. Today, there has been some improvement but a lot still
need to be done. Among the 22 countries in the world accounting for 80 percent of TB worldwide, the Philippines is
now ranked number 9. Almost 75 Filipinos die everyday because TB. Almost everyone gets vaccinated with BCG as
a child, and yet, this does not ensure that you will not develop TB later. Is the direct-observed treatment strategy
(DOTS) working? To a certain extent yes, and only if those with symptoms consult immediately. The problem is that
most Filipinos ignore their symptoms, continue to roam around and spread the infection, and consult only when there
is blood coming out when they cough. Also, over the years, no one has developed a better vaccine and a better class
of drugs against this infection. Meanwhile, the multi-drug resistance capability of the organism due to mutation
continues to progress.

This number 7 killer confuses me, and much as I have tried to research on it, I can't find
what are the specific details about it. What does this mean? Abnormal signs and
symptoms? Are these mysterious diseases? If NEC means necrotizing enterocolitis, then
this should be looked into and investigated more. In the UK, confirmed cases of necrotizing
enterocolitis occurred in three times as many infants who received no breast milk as in
those who received both breast milk and formula.

These are all smoking-related diseases and includes emphysema, chronic bronchitis, and
COPD. The Philippines has a law against smoking, but very few establishments and
people enforce and follow it.

Extrapolated prevalence figures show that there are more than 5 million Filipinos with
diabetes today. Central obesity, which means big and bigger tummies, predispose to
developing type 2 diabetes. The lack of physical activity and love of sugar-laden food and
beverages predispose to metabolic abnormalities which later on give rise to diabetes.
Most consultations are made because of symptoms arising from diabetic complications
like diabetic retinopathy (leading to vision loss and blindness), diabetic neuropathy (decreased sensation in the limbs,
fingers, often leading to diabetic foot and amputation), and diabetic nephropathy (kidney damage resulting in chronic
dialysis).

Infant mortality rate in the Philippines is higher compared to its southeast Asian neighbors.
Currently, the infant mortality rate is 22.12 deaths per 1,000 live births. Identified causes
include sepsis, prematurity, jaundice, entangled umbilical cord leading to asphyxia,
diarrhea, and congenital malformations. Improved prenatal care can possibly decrease the
mortality rates even more.