Selective justice for Lacson, Garcia
BY AMADO P. MACASAET
Reproductive health views
A.G ROMUALDEZ JR., M.D
‘In the reproductive health bill debate, the differences are more semantic than real as well as simply a variation in emphasis.’
ANTI-REPRODUCTIVE health partisans favor authoritative arguments even when the specific point to be made requires scientific basis. As well, their arguments all miss the point and beg the question of whether government should have a policy that enables all Filipino couples to have only the number of children that they can responsibly raise.
The question of when life begins is irrelevant in the face of an absolute lack of evidence that any of the contraceptive methods currently in use acts at any point in time after the fertilization of the egg. The morality of engaging in sexual activity without intending pregnancy is an issue of individual conscience for the vast majority of individuals who believe that the physical expression of love between husband and wife is an important part of family life.
On the relationship between population and development, except for a few fringe doctrinaire pro-lifers, most development experts are convinced by the logic of improved social development resulting from a slower population growth rate. The bogeyman of demographic winters stalking low birth rate countries is debunked by the obvious differentials in levels of suffering between rich and poor population groups.
On the other hand, pro-reproductive health groups argue with each other on the primacy of government’s social development responsibilities over its obligations to protect the rights of women and children who are unfairly exposed to higher morbidities and mortalities associated with unregulated fertility. The fact is that the differences are more semantic than real as well as simply a variation in emphasis.
It is clear from surveys that if reproductive health information, goods, and services were readily available most families would have less than three children resulting in significant reductions in population growth rate. As a result, government would be more economically capable of providing for the social development needs of all, including the poor – thus enabling their rights to health and education. Population-based arguments for reproductive health are in fact supportive of and complementary to the rights-based points of view favored my many RH advocates.
Last week’s issue of the New England Journal of Medicine (NEJM, one of the most prestigious of American medical journals) featured in its health policy section a discussion that has been raging since the passage of President Barack Obama’s health reform legislation known as the Affordable Care Act (ACA).
Academic Medical Centers (AMCs) are institutions, usually connected with medical schools, whose functions include research and training in addition to provision of health care. Because of this, these centers are perceived to be capable of delivering high-end health interventions based on cutting-edge medical science. Although research grants of consultant academic staff are a major funding source, Medicare (federally funded insurance) has also become an important major financing source for many of them because of their need for high patient loads
In order to adequately respond to the ACA, one of the journal articles suggests that AMCs will need to adopt "new care and payment models such as accountable care organizations (ACOs) – provider-based delivery systems that offer payment incentives for providing high-quality, coordinated care."
The reports describe formidable cultural and organizational barriers to the formation of ACOs within institutions that value their discipline-oriented structures and where service provision is generally of lower priority than research and other academic pursuits. It is estimated for instance that typical senior staff spend 80% of their time on research and teaching and only 20% on provision of clinical services – leaving relatively junior staff to deal with most patient concerns.
Although the situation of American academic medicine is very different from the Philippine situation, the way the address issues related to universal health care will heavily influence health reforms here for two reasons. One reason is that most influential Filipino medical practitioners are schooled in the ways of American medicine and are therefore likely to react to change as if they were in the American environment. Secondly, the fundamentalist free enterprise thinking that drives the American health system is also deeply rooted among the dominant elites that control health care delivery in this country.
The World Health Organization (WHO) recently published its "Global Recommendations on Physical Activity for Health" for three age groups: 5–17 years old, 18–64 years old and 65 years old and above. These were based on available scientific evidence relevant to the prevention of non-communicable diseases through physical activity.
While most people are familiar with the relationship of exercise to cardiovascular and pulmonary problems, it is noteworthy that the evidence indicates that risks for all non-communicable diseases including cancer can be reduced by optimal physical activity.
The recommended level of activity for individuals 65 years and over is at least 150 minutes of "moderate intensity aerobic physical activity throughout the week." Even those with limited mobility related to their health status are urged to engage in the maximum level of physical activity that their condition will allow.
Email: alberto.romualdez@ gmail.com