Blackmailing P-Noy
BY AMADO P. MACASAET
Mental and dental health:
Orphaned programs
A.G ROMUALDEZ JR., M.D
‘A strong oral health component should be a critically important component of the country’s overall health program.’
RECENT surveys show that up to 40 per thousand Filipino adults and children suffer from some form of mental disorder ranging from anxiety, to panic reaction, to frank psychoses and severe depression. As well, dental caries, premature loss of teeth, and other dental problems also afflict a large majority of the Philippine population in all age groups.
Ironically, the two areas that have suffered from relative neglect during the recent decade of health systems reform led by the Department of Health are those of dental and mental health.
The fact is that poor dental health is also both a result of and a contributory factor to the myriad nutritional issues that adversely affect the nutritional status of the majority of mainly poor Filipinos. For these reasons, a strong oral health component should be a critically important component of the country’s overall health program.
Until just over two decades ago, public health dentistry was prominent in the DOH agenda for health service development - with its own Bureau of Dental Health Services. Over the last two decades, however, a series of reorganization initiatives have serially downgraded the infrastructure for policy, planning, standards, and service delivery for oral health - first to the level of a division then to the status of a mere program. Each time, the oral health program has receded further down in the priorities for health. The Health Sector Reform Agenda, introduced in 1999, did not even mention this important area.
Recently, the Department of Community Dentistry of the UP College of Dentistry has taken the initiative and put forward a proposal to revitalize the country’s oral health programs. The proposal comprises initiatives to attain four goals in the following areas: dental disease prevention, access to dental care, information and education on oral health, and public policy for oral health. Importantly, the proposal also begins to address the issues of "over-medicalization," over-dependence on high end technology, and excessive specialization that hamper the delivery of dental health services by encouraging the development of non-professional levels of dental health personnel such as "barangay dental aides".
It appears that this proposal was recently discussed at the highest levels of the Department of Health and it is hoped that sooner rather than later a viable robust oral health program can be integrated into the plans for universal health care. If carried out as envisioned, it is possible that inaccessibility of proper dental care services may be a thing of the past soon.
Unlike oral health programs that have seen a continuous decline in emphasis over the last two decades, mental health has had highs and lows over the same period. The National Mental Health Program evolved from a Task Force on Mental Health headed by the late Dr. Antonio Perlas during the first Aquino administration. The program continued to have robust support for some time thereafter but began a slow decline in the latter part of the Ramos presidency. Just like the case of oral health, there was little consideration given to mental health issues in the formulation of the health sector reform agenda in 1999.
In fact, all administrations have acknowledged the critical importance of mental health in the overall scheme of health in the country. As the authors of a 2002 book on the state of the nation’s mental health (entitled "Beyond the Physical") put it, "... mental health is, in fact, the matrix on which all health is built. A healthy body finds its sanctuary in the tranquility of a healthy state of mind." Unfortunately, the complexity of having to deal with more than physical issues has kept mental health from being fully understood. Consequently, despite recognizing their importance, health planners and policy-makers have generally not taken into account issues of mental health in the design of programs and approaches in general health.
In March of 2001, the mental health program received a boost with the issuance of DOH Administrative Order No. 8 Series of 2001 declaring a National Mental Health Policy that "applies to all sectors, disciplines, and institutions, non-government or private entities whose functions and activities contribute to the improvement of the state of mental health of the Filipinos."
The Order provided general and specific guidance to all levels of the DOH system to attain its vision of "Better Quality of Life through Total Health Care for All Filipinos". It spoke of a "rational and unified response to mental health" as a way to attain its goal of "quality mental health". Unfortunately, the lofty words and energizing phrases remained on paper for most of the rest of the last nine years.
Nevertheless, there is still hope of resuscitating the program. Most of the visionaries who helped to formulate the National Mental Health Program dating back to the late 80s are still around and eager to push for its stronger implementation. All that remains is for the DOH to pick up the challenge again and truly integrate mental health in its universal health care programs. While specific issues, such as financing by the National Health Insurance Program, may soon be addressed, a greater challenge involves ensuring that mental health aspects of total health be taken into account by all health service providers when delivering programs.
The fact that the two major issues of dental and mental health are being revisited by health policy-makers at the highest level bodes well for the rest of the health sector. There is reason for optimism that truly holistic and integrated approaches will be more than mere words in the search for a winning formula to achieve universal health care for all Filipinos by the end of this new administration.
On troubling fact is often overlooked by Catholic fundamentalists who espouse the most conservative positions on contraception. This is that the majority of Catholics all over the world (ranging from 70 percent in Chile and the Philippines to 85 percent in Mexico) disagree with the hierarchy’s opposition to "artificial" contraception. Most Catholic couples ignore their bishop’s strictures and use contraceptive methods that are most suitable to their circumstances - whether "natural" or artificial.
A panelist in one of the recent forums on RH and religion likened the Church position to that of parents who insist on imposing family rules that none of the children believe in or obey. "That is not good parenting," said the panelist.
The following is a paraphrase of the remarks of Professor Michael Marmot, Chair of the WHO Commission on the Social Determinants of Health, in his review of a recent book on global health by Nigel Crisp:
The most influential groups in the health sector have a reputation for being fearsomely clever, prodigiously well-informed, and impressively analytical; and for using this remarkable array of talents to show why it is quite unthinkable for things to be other than as they are. It is time to convince all health stake holders that we simply have to do things differently - if we are to achieve true universal health care.