What public health needs: Disease prevention, early diagnosis and treatment
Next week, I’m honored to be participating in the first International Conference on Health Risk Reduction in Africa, to be held in Marrakech, Morocco, under the auspices of the Moroccan Ministry of Health. My role is to discuss programs that could help reduce the incidence of cardiovascular disease in their region.
The international conference brings together diverse Moroccan, African and other experts from all over the world, to discuss various aspects of health that could guide policy makers. The conference aims to address not only health issues but also political, socioeconomic, cultural and other factors impacting African public health.
Culture, poverty level and education are definitely equally important determinants of public health as medical risk factors. The economy is a major driver of the quality of healthcare any country could have. Although some African countries, especially those in the northern part, are relatively economically self-sufficient, there are several countries in Sub-Saharan Africa which have unfavorable economic conditions, which account for the high incidence of premature deaths. In several countries, the life expectancy is less than 55 years, compared to the global life expectancy of 73 years.
Our main recommendation is to allocate more resources for health promotion and disease prevention programs. Most underdeveloped and developing countries face the same problem of focusing more on curative rather than preventive health programs. A cardinal rule in public health is that it costs a lot less to prevent a disease than to treat it.
Early risk factors
It’s also important to detect risk factors early on and treat them before they develop into a complicated disease. This is where public screening programs for risk factors like high blood pressure (BP), diabetes and high cholesterol play an important role. It only takes a few minutes to check if one has high BP, and in screening programs, many so-called “walking time bombs,” whose BPs are at critically high levels, have been diagnosed. Many of them claim they feel no symptoms, though they may have BPs high enough to burst an artery in the brain.
Our own government must pursue its programs on early detection of risk factors and asymptomatic disease. We recall that in 2016, then Health Secretary Paulyn Jean B. Rosell-Ubial launched the Duterte Health Agenda, which consisted of health promotion and preventive medicine programs. One of the three major goals was to provide mandatory basic checkups to 20 million poorest Filipinos within 100 days. It would be good to pursue and sustain such an agenda.
Our countrymen, particularly those in the lowest quintile of society, should avail of this important benefit, which may serve as a screening procedure to detect diseases at an early stage. This has been a perennial problem in our country. We probably take care of our cars or other devices more than we take care of our health. We send our cars for regular oil changes and tuneups, but when it comes to our health, we rarely go for checkups if we don’t feel anything.
We only see our family doctor when we have symptoms, and we’re obviously afflicted with a disease. In many instances, it might be too late because the disease is already in an advanced stage.
We should also have an intentional agenda to shift from a curative type of healthcare to a preventive strategy—to prevent diseases, or catch them at an early stage so as to prevent complications.
It may be easier said than done, though. There were already similar efforts in the past, but sometimes, the problem is how to execute the strategy and achieve this goal. We need to convince the public, especially the poor sectors, to avail themselves of this benefit regardless of whether they have symptoms or not.
Change of mindset
Going back to high BP, only around 50 percent of the hypertensive population of the country is aware that they have high BP. The 50 percent who are not aware never bothered to have their BP checked simply because they don’t have any symptom attributable to hypertension.
Some who don’t want to have their checkups are simply foolhardy. They would reason that their doctors would just tell them to quit smoking, reduce their alcohol intake and avoid eating fatty foods, but they don’t offer them alternatives that can at least reduce their risk. Practically all risk factors are lifestyle-related, and once they are established, it’s difficult to correct them because the habit or vice is already deeply rooted in one’s psyche.
Realistically, we cannot hope to lick the habit completely, but we can offer alternatives like diet cola instead of regular soft drinks, salt substitutes to maintain the taste of food, meat substitutes like vegetarian burgers, and alternative tobacco products to get them off combustible tobacco products, which are the main source of health risks from smoking.
The road to good health really starts with a change of mindset. Again, it sounds simple enough, but it’s easier said than done. The Department of Health really has to exert effort through the local government units to make sure that health promotion programs, like the mandatory annual checkup, is availed of by our poor countrymen.
The public should be made to realize that many of the country’s prevalent diseases like high BP, heart disease, diabetes, lung diseases and cancer are not associated with any symptom during the early stage, but over time, serious damage to the body organs develop. When one waits until symptoms are present, the organ damage might be too advanced already and treatment may not be of much help.
When we say basic checkup, it does not mean simply taking blood, urine and stool specimens and doing a chest X-ray.
An important and truly cost-effective basic component in a basic checkup is good medical history-taking and physical examination (PE). We always tell our young doctors that by just a complete history and thorough PE, one can already come up with a reasonable assessment of the patient in 85 percent of cases.
‘Clinical eye’
We need the results of our laboratory examinations to validate what we already suspected by history or PE; in 10 to 12 percent of cases, the labs are necessary to point us in the right direction for the diagnosis. In about 3 to 5 percent of cases, despite a thorough checkup including sophisticated laboratory procedures, the right diagnosis may still be elusive.
So our DOH teams should not dispense with the history-taking and PE in the checkup. Our doctors of old didn’t have any of the laboratory tests we have now, but they apparently did well in treating their patients. Perhaps, as a form of compensation, they developed their so-called “clinical eye,” such that they already had a good sense of what was wrong with their patients the moment they finished talking to them and examining them.
This is what we seem to be gradually losing with modern medicine. The reliance on sophisticated laboratory procedures has increased so much that some don’t even bother to examine their patients, and would just wait for the laboratory results to arrive. When the labs come, one can now search from some downloaded apps the suggested treatment guidelines are for the identified problem.
However, the astute physician correlates carefully what he/she has noted in history and PE with the results of laboratory tests. When there is a disagreement between the two findings, the physician opts to verify further before prescribing anything, but in most instances, it’s more prudent to treat the patient rather than the lab results.
We remember a case wherein a patient was treated with anti-diabetic medications for lab results showing high blood sugar. Several days later, the patient was rushed to the emergency room due to severe hypoglycemia or markedly low blood sugar levels. It turned out that the lab result upon which the initial diagnosis of diabetes was based was erroneous.
The lab tests were apparently done together with hundreds as a promotional offer of the village laboratory clinic. There might have been some lapses in the quality control. This is what the DOH should ensure with whatever laboratory they assign to do the labs for the annual checkup of more than 20 million Filipinos.
Our government doctors manning our primary health centers must be retrained on how to develop their “clinical eye” further. We may be a little conservative and traditional, but we still go for the good, old-fashioned way of medicine when the “clinical eye” can actually guide one on how to treat a patient, better than a whole battery of tests.
In low-resource settings like what we have in our country, we should harness our government doctors’ clinical eye more, rather than the lenses of sophisticated microscopes, scanners and X-rays.INQ
We only see our doctor when we have symptoms. In many instances, it might be too late because the disease is already in an advanced stage