This column analyzed the possible differences between the two candidates for United States presidency back in September last year. Then, an Obama presidency was predicted to be liberal and more sympathetic to the plight of developing countries. The nomination of Hillary Clinton to the post of Secretary of State basically confirms this. Thus, it is expected that family planning programs that allow abortion will no longer be blacklisted from US assistance, for example. Also, the substantial PEPFAR (the Presidential Emergency Program for AIDS Relief) will finally include condoms. In terms of overall health development, it is anticipated that actions addressing inequity issues – which tend to be oriented along socialistic approaches – will receive more genuine attention.

While it did not receive quite the same attention as the American presidential elections, the release of the report of WHO’s Commission on the Social Determinants of Health also merits mention among the top international health stories of 2008. The emphasis that the report has given to inequality and maldistribution of health resources should guide future health policies for years. The WHO Secretariat under Director General Margaret Chan has already initiated a response to this report in the form of the revitalization of Primary Health Care as the basic approach to national health development in poor underdeveloped countries.

At the regional level, drawing even less media attention was a significant change in leadership at WHO’s Western Pacific Regional Office (WPRO). After ten years at the helm of WHO’s Manila-based regional headquarters, Dr. Omi, an infectious disease expert, will step down at the end of this month. Omi’s stewardship was marked by very impressive achievements in communicable disease control during trying times – he began with the eradication of polio, the successful implementation of DOTS for tuberculosis control, as well as SARS and avian influenza containment. He had also led in the development of an analytical framework placing people at the center of health policy making. This last endeavor could guide Western Pacific countries in their efforts to revitalize primary health care approaches.

Omi will be replaced by a Korean, Dr. Young Soo Shin, a health systems and finance expert who played a role in Korea’s successful rollout of its national health insurance scheme. Given this expertise, WHO attention in the Western Pacific may be expected to begin to focus on health policies and systems development. This adjustment may be appropriate considering the fact that based on the recommendations of the Global Commission on the Social Determinants of Health, addressing health inequalities through fundamental structural changes in health systems will become a high priority for health development in the region.

Here at home, the first half of the year was dominated by debates on a Cheaper Medicines Bill that was eventually passed and signed into law. The Department of Health, after an agonizingly long process, has issued implementing rules and regulations for the law. While it was expected that this would improve access to cheaper medicines by poor Filipino patients, health experts are not holding their breath on this. That DOH and its technical agencies like the Bureau of Food and Drugs have the capacity to enforce the law is yet to be demonstrated; the fact is that BFAD is awaiting passage of another bill that will strengthen this capacity. As well, on other issues DOH has not demonstrated the political will to change the way things are done in the health sector and there is no reason to expect it to do so on the issue of pharmaceutical prices.

The Reproductive Health Bill also known as House Bill 5043 was the main topic of health discussions during the second half of the year. As expected, there was strong opposition from conservative elements of the Roman Catholic Church, who are obsessed with the notion that contraception is equivalent to abortion. Not surprisingly, the Macapagal-Arroyo administration has sided with the Catholic hierarchy on this issue. This despite the fact that several surveys have shown that a clear majority of the Filipino people support the measure which would require government at all levels to support free services and information on family planning for all Filipinos who need them.

Despite the fact that the Philippines health sector has so far failed to meet the health needs of its population, the present government continued to promote the notion of "medical tourism" as a tool of economic development. Even as the DOH continues to be dependent on foreign assistance to carry out most of its priority reform activities, the medical tourism program aims at diverting resources from important public health and poverty-related programs. The most serious of these initiatives is the attempt by some elements of the kidney transplantation community to encourage commercial kidney donation for foreign victims of end-stage renal disease. For a while, internet advertisements for kidney transplantation in the Philippines were put up by some of these groups. Fortunately, this time, the DOH acted swiftly and with determination to nip this attempt in the bud.

During the last quarter of 2008, melamine-tainted milk from China exploded into the health scene. Even as in China thousands of children were made ill by the product defect , some of them seriously – including some deaths – revelations were made that melamine had tainted many other food products. International and national agencies acted quickly and with apparent good effects as melamine-related health problems were averted.

Even as 2008 ended with fireworks injuries again on an apparent rise, politics is now looming as the major concern of all sectors including health. Of course, major attention will be given to the presidential election of 2010. Nevertheless, debates on health will continue to be a major item as politically sensitive issues such as pharmaceuticals and reproductive health are still on the agenda. The fact that the incumbent Secretary of Health is rumored to be among the "senatoriables" should make the topic of health even more interesting material for politics.

Unfortunately for the majority of Filipinos who are almost totally dependent on government services for their health needs, the combination of politics and the global economic crisis will mean that health services will not improve much in 2009. On the other hand, the situation may well be taken as an opportunity to fully discuss real reform in the health sector that can be introduced by whoever takes power after the elections of 2010.