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Changing dynamics in dengue cases in the Philippines, partially caused by increasing temperatures, have left more people vulnerable to the disease.Changing dynamics in dengue cases in the Philippines, partially caused by increasing temperatures, have left more people vulnerable to the disease.

The term “climate change” evokes images of destruction brought by typhoons and droughts in the minds of most Filipinos. However, the public needs to take notice of how it also affects their health and well-being, even without these extreme events.

“Before your typhoons and tsunamis come, you are already preparing people so whenever it comes, their vulnerabilities are already low. It’s the same principle when it comes to health,” said Dr. Fely Marilyn Lorenzo of the Commission on Higher Education (CHED).

A hotspot for diseases

“What we have found in the recent past is that climate change exacerbates the conditions that make it more favorable for diseases to set in,” Lorenzo said. “For example, in dengue, the vectors can multiply faster and become fiercer. Even if you have a lot of mosquitoes, if there is no source of infection, there will be very few cases.”

The Philippines has been a dengue hotspot in recent years. Dengue cases in 2015 saw a 64.8 percent increase from the previous year, with a Department of Health (DOH) official attributing it to climate change. While the nationwide tally for the first half of 2017 has decreased by 36.8 percent from the year prior, Metro Manila experienced a 24.9 percent increase in dengue victims.

This spike is linked to the high population density of Metro Manila, which is ideal for transmitting diseases. This is especially evident in poor communities, which suffer from poor hygiene and stagnant water occasionally brought by flooding episodes.

“Before, dengue was only before during the rainy season. But now it isn’t because the water fluctuation in the urban areas is so bad. When there’s stagnant water, then there are more breeding places. Floods bring on leptospirosis, which could be fatal,” she added.

Climate-related health issues become more critical in rural areas, which lack infrastructures and services common in urban areas such as water distribution systems. For instance, the spread of cholera and typhoid fever can be worsened by poor water quality, lack of electricity access, and improper sanitation. In Tacloban, the storm surge due to typhoon Yolanda led to saltwater infiltration of groundwater resource, exposing its inhabitants to water-borne in the chaotic aftermath.

The storm destroyed all but one of the hospitals in the city, paralyzing health care services in already one of the poorest regions in the country. Most of the city’s inhabitants and refugees from nearby towns also get crammed in evacuation centers, creating a favorable environment for the transmission of diseases.

“They have to go to evacuation centers, amassing people in one place for hours and producing a lot of waste,” Lorenzo said. “If you bring people to evacuation centers, there’s a chance that you have some tuberculosis cases there that might spread. Because the healthcare services were decommissioned, for a while, they had a problem with the implementation of other programs.”

Make it “sexy”

Lorenzo identified two key priority areas to increase climate resilience and improve public health: water and sanitation. Due to the complex links surrounding these issues, the national and local government units (LGUs) need to take the lead in a multi-sectoral approach to resolving the health implications of climate change.

“When it comes to health impacts, it’s really the contribution of all of government and all of society. You have to keep the environment safe, that’s DPWH and DENR. You have to provide good water; that’s the role of the water management system officials. You have to give the citizens good income and basic necessities so they won’t get sick,” she remarked.

She also emphasized the need of LGUs, in partnership with the private sector and civil society groups, to increase resilience by implementing adaptation programs, especially for their vulnerable constituencies. “So as much as possible, we don’t want people to go to evacuation centers because it brings up more vulnerabilities for people to get diseases. You need to decrease the vulnerability. Don’t allow them to build houses near shorelines or rivers anymore,” she added.

Reinforcing this preventive approach is strengthening primary health care in the Philippines. Improving the services provided by barangay health centers and municipal hospitals should help ease the load on public hospitals, especially in the provinces.

The administration of Benigno Aquino III was criticized for focusing too much on infrastructure building when the country is also in need of medical personnel on the community level. This lack of investment in human resources is a mistake President Rodrigo Duterte must avoid making for the well-being of all Filipinos.

“If you look at Vietnam, Thailand, and other ASEAN countries, they really improve their primary health care services. If people get sick in the Philippines, especially in urban areas, we immediately go to hospitals. That should not be because you’re clogging up the hospitals and it is too expensive. Other diseases can be treated at the lower levels,” Lorenzo said.

Advocates are pushing for the passage of the Universal Health Coverage bill, which aims to provide access to health care and insurance for all Filipinos. The bill passed through the House of Representatives on September 6 by a vote of 222-7.

Lorenzo also expressed the need for “green hospitals”, or health facilities equipped to deal with environmental factors. “The health centres should already take the variables of temperature and humidity into consideration as they plan health programs. In some of our studies, we found that you can predict the onset of dengue if you keep track of rainfall and temperature patterns,” she said.

She noted that health professionals operate under the belief that “there is no relationship between climate change and health in terms of planning health programs. Right now, we don’t have any system in the health sector that links our epidemiologic statistics to climate factors. It’s going to be easy to track diseases if we’re able to track meteorological parameters and relate the number of certain cases to that.”

Lorenzo also called for perception of climate change and public health to be made “sexy”, or attractive to the public. She remarked that people either do not see its direct link to public health or believe they are powerless to stop it. Improving the network of information between experts and communities can help alter this mentality, noting that “advocacy and getting the information out there is very critical” in effective communication to localities.

In the communal level, she emphasized the importance of neighbors taking a leading role in keeping their areas clean and assisting those prone to diseases. Removing potential sources of diseases should further improve community resilience to both climate hazards and diseases and prevent unnecessary expenses.

“If you take care of them and all of you are well, the probability of getting sick is very low. That is what we have to work for. So those saying that we don’t care about their neighbors is not even selfish; that’s being foolish. Nobody’s really looking at it that way. That’s why we have to take care of the vulnerable,” Lorenzo added.

Source: Huff Post | 22 September 2017

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