Cardiovascular diseases (CVD) greatly threaten Filipinos today.

  The Filipino faces the risk of

CVD throughout his life.  At birth, congenital heart diseases (CHD) and vascular malformations
are possible.   In early childhood, the risk of rheumatic fever and rheumatic heart disease
(RF/RHD) starts, peaking in adolescence.  Atherosclerotic changes in the blood vessels may set
in early adulthood and progress to hypertension (HPN), coronary artery diseases  (CAD) or
ischemic heart disease, resulting in heart attacks, common in middle age groups particularly in
males.  In the elderly, the common complication of hypertension is cerebrovascular
accident(CVA) or stroke.

     CVDs have varied causes and risk factors, ranging from infectious agents to environmental
and constitutional causes- some inherited and some acquired.  Conginital heart dieseases may
arise out of genetic causes and maternal infections, diseases or drug intake.  Rheumatic fever
and rheumatic heart disease arise from frequent stretococcal sorethroat.  Essential
hypertension is asssociated with heredity and high salt intake.  CAD is linked with smoking,
obesity, HPN, stress, hyperlipidemia, diabetes mellitus and a sedentary lifestyle.

     Of all risk factores to CVD, smoking has the highest prevalence (46%).  Hypertension (i.e.
systolic blood pressure greater thant 140mm Hg or diastolic blood pressure greater than 90 mm
Hg) was found in 22% of the population, with greater prevalence in males and among the poor
(FNRI 1993).  THe problem of HPN control appears rooted in low perceived risk, non-compliance
to medications or the prescribed lifestyle modifications, poor monitoring and control of blood
pressure.  About 37% of hypertensive patients in one survey have high cholesterol levels. 
Family history of hypertension is also one of the predominant risk factores among Filipinos.

     Morbidity and mortality trends for cardiovascular diseases have been rising for the past
several decades.  The morbidity rate is 206.3 cases per 100,000 population while the mortality
rate is 73.7 deaths per 100,000 population is 1994.  CVD is now the number one cause of death
and the seventh leading cause of morbidity in the country.  The region with the highest
morbidity for CVD is REgion 7, followed by Regions 1, CAR, 2 and 6.

     The Philippines has the highest death rate for hypertension in the region, second to
Indonesia in mortality for rheumatic heart dieases, fourth to Singapore for CAD, and third to
Japan for stroke (WHO 1990).  Atherosclerotic diseases rank as first leading death among
Filipinos.  Overall, deaths due to CVD comprise 25 percent of total deaths in 1995 (PHS 1995).  
The rise of CVD deaths is due to hypertension, CAD and cerebrovascular accidents, all of which
have more than doubled during the period 1965-90 (Facts and Figures, CVD in the Philippines). 
The prevalence of congenital heart disease at birth is 5 per 1,000 livebirths.   It declines rapidly
as many of the cases die.  At five years of age, the rate is about 1.5 per 1,000 and remains at 1.2
per 1,000 at age eight and onwards.

     Applying appropriate measures at different stages of the disease must be done to prevent
CVD.  The first step of prevention is to apply measures before the illness begins.  It is a
significant step as most CVDs are permanent once they set in.  The second step is protection
through early diagnosis and prompt treatment.  This is important in disease prevention and
control so that illness may not progress and lead to disability or death.  Rehabilitation to limit
disability and prevent early death is the third level of CVD prevention.

PROGRAM THRUSTS FOR 2001-2004

1.  Intensification of health promotion campaigns towards behavioral change and lifestyle
modification.

2.  Establishment of infrastructure (standards, treatment protocols/guidelines, implementation

guidelines, capability building, provision of strategic logistcs) for proper management of
cardiovascular diseases.

LEGAL MANDATE

1.  Proclamation No. 973 Declaring Cardiovascular Disease Prevention and Control as Priority
Program of Government.  In line with this proclamation, all government agencies shall
collaborate with the Department of Health and the Department of Interior and Local
Governemtn and give full support to all the activities under the National Cardiovascular Disease
PRevention and Control Program.

2.  Memorandum Order No. 416 Providing for the Nationawide Implementation of the
Cardiovascular Disease Prevention and Control Program

PROGRAM POLICIES

1.  The prevention and control of cardiovascular diseases shall be a priority program of the
Department of Health.

2. The program shall be community based, comprehensive in scope and relevant to the existing
local situation.

3.  Considering the etiopathogenesis of cardiovascular diseases, primordial and primary

prevention shall be the priority strategies of the program.

4.  All levels of the health care delivery system shall be involved in the delivery of services to
prevent and control cardiovascular diseases.

5.  The program shall utilize operational strategies which are appropriate and responsive to
local needs and situation.

6.  The program shall be integrated with the existing health care delivery system utilizing the
primary health care approach.
7.  Collaboration with GOs, as well as participation of NGOs and the private sector, shall be
maximized in the pimplementation of the program.

8. CVD prevention and control shall utilized the mass based population  approach.

SUB-PROGRAMS

1.  Sub-program for Hypertension and stroke.

2.  Sub-program for Rheumatic Fever/Rheumatic Heart Disease.

KEY AREAS FOR PROGRAM IMPLEMENTATION

1.  Primordial prevention or prevention of the risk factors in the place by intensive health
promotion campaigns towards behavior change and lifestyle modification.

2.  Establishment of infrastructure to provide for the proper screening, diagnosis, treatment
and rehavilitation of patient such as standards of care, treatment guidelines or protocol,
training of personnel, guidelines for implementation and provision of strategic logistics.

3.  Creating an enabling environment for the implementation of the program by passing
legislations/regulations on anti-smoking, food labelling and exercise lanes.

RESPONSIBILITY/ROLE OF EACH LEVEL OF HEALTH SERVICE DELIVERY IN PROGRAM

IMPLEMENTATION

A. Central Office Level:

1.  Formulates/issues policies/guidelines for program implementation.

2.  Develops/issues relevant treatment guidelines/standards of care for cardiovascular patients.

3.  Provides technical assistance to Centers for Health Development and other stakeholders on
matters pertaining to cardiovascular prevention and control programs.

4.  Provides strategic logistc support for program implementation.

B.  Centers for Health Development:

1.  Provides technical assistance to the local government units in matters pertinent to the
implementation of the program.

2.  Monitors/evaluates the implementation of the program.

3.  Provides strategic logistic support for program implementation.

C.  Regional Hospital/Medical Centers

1.  Provides all possible cardiology services except cardiac surgery.

2.  Provides training on cardiology for lower level hospitals.

D. Provincial Health Office

1.  Convenes the Provincial Intersectoral CVD Task Force composed of various stakeholders
based on the province which would be tasked to:

     1.1 Plan and oversee the implementation of the CVD program in the province.

     1.2 Network with other stakeholders on matters pertaining to program.

     1.3 Supervision, monitoring and evaluation of the program.

     1.4 Conducts training on matters pertaining to program.

     1.5 Provides logistical support to program implementation.

E. Provincial Hospital

1.  Serves as referral center for the province on cardiovascular disease management.  

G.  Municipal Health Office

1.  Plan/implement CVD program for the municipality

2.  Conduct case finding activities
3.  Manage Patients properly
4.  Refer patients properly
5.  Do health education, advocacy and patient education
6.  Train BHWs on program
HL to the MAX
The Healthy Lifestyle campaign will be revitalized and repackaged to focus
on the prevention of risk factors that give rise to the incidence the four main
chronic diseases that affect all members of the family - from the newborn to
the elderly.  Thus, the Healthy Lifestyle is the main message and it will
highlight on the following seven major vital healthy practices:

NO SMOKING (Huwag Manigarilyo)

DON'T DRINK ALCOHOL (Iwas Alak)
NO TO ILLEGAL DRUGS (Talo Ka sa Droga)
EAT LOW-FAT, LOW SALT, HIGH FIBER DIET (Wastong Pagkain)
PREVENT HYPERTENSION (Bantay Presyon)
DO PHYSICAL ACTIVITY (Katawang Aktibo)
MANAGE STRESS (Bawas Stress)

NATIONAL HEALTHY LIFESTYLE PROGRAM

INTRODUCTION

Situationer:

The rapid rise of non-communicable diseases represents one of the major health challenges to global development in
the coming century. This growing challenge threatens economic and social development as well as the lives and
health of millions of people.

In 1998 alone, non-communicable diseases are estimated to have contributed to almost 60% of deaths in the world
and 43% of the global burden of disease. Based on current trends, by the year 2020 these diseases are expected to
account for 73% of deaths and 60% of the disease burden.

Low and middle income countries suffer the greatest impact of non-communicable diseases. The rapid increase in
these diseases is sometimes seen disproportionately in poor and disadvantaged population and is contributing to
widening health gaps between and within countries. For example, in 1998, of the total number of deaths attributable
to non-communicable diseases, 77% occurred in developing countries, and the disease burden they represent, 85%
was borne by low and middle income countries.

Philippine Data

In the Philippines, increasing life expectancy, urbanization and lifestyle changes have brought about a considerable
change on the health status of the country. Globalization and social change has influenced the spread of non-
communicable or lifestyle/degenerative diseases by increasing exposure to risk. As the country's per capita income
increases, the social and economic conditions necessary for the widespread adoption of risky behaviors gradually
emerge. This in turn has brought a considerable challenge to the country's health policy and health system to address
emerging lifestyle/degenerative diseases amidst the unfinished agenda of communicable health.
Recent statistics have sounded out the alarm. The life expectancy of Filipinos in 1999 has gone up to 69 years. The
process of aging brings out myriad  health problems which are degenerative by nature. Mortality statistics in 1997
shows that 7 out of 10 leading causes of deaths in the country are diseases which are lifestyle related (diseases of the
heart and the vascular system, cancers, chronic obstructive pulmonary diseases, accidents, diabetes, kidney
problems). Morbidity statistics show that diseases of the heart ranks 6th as the leading cause of illness in the country.

In a study conducted by FNRI in 1998, it was found out that 2 in every 10 Filipino adults, 20 years and over, or 21%
of the population, are hypertensives and is increasing in prevalence after age 40 years. Four percent (4%)  of the
population have blood glucose levels of 125 mg/dl and above, and an increasing prevalence of hyperglycemia after
the age 40 years. The proportion of adults with total cholesterol 240 mg/dl and above is 4% with prevalence of
hypercolesterolemia peaking at age 40 years. Adults with total triglyceride levels ³400 mg/dl is 0.8 shown to be
highest among the age group of 40-59 years old.

     In the same FNRI study, it was found out that among pre-school age children (0-5 years old) 9 ub every 1000 are
overweight for their height; 1 in every 100 children 1 year old is overweight; and 2 in every 100 children, less than 1
year old, are overweight for their height. Among children 6-10 years of age, prevalence of overweight is negligible
among 6-9 year old children while 2 in every 1000 children 10 years old are overweight. Among adolescents, 11-19
years old, the female adolescents are more at risk to overweight and obesity (4.7%) than their male counterpart
(1.2%).

Prevalence of obesity (BMI ³ 30 or 2nd and 3rd  obese) among adults is 3.3% with female adults having higher
prevalence (4.4%) than their male counterparts (2.1). The 40-59 year old adults are the most at risk to being obese.
Adults classified to be overweight (BMI 25 - <30) is 16.9% (male- 14.9%; female- 18.9%). Overweight and obesity
among adults has a prevalence of 20.2%

High waist circumference show high risk to becoming obese which predisposes individuals to hypertension, heart
disease, diabetes and others. In this study, it was found out that high waist  circumference is more prevalent among
the female adults (10.7%) than among the male adults (2.7%).

Prevalence rate of android obesity (high waist hip ratio) is consistently higher among the female than the male
adults. Among the male adults, almost 8% have android obesity; among the female adults, it is about 40%.

In a recent study by Tiglao et al, (2000) 32.2% are ever smokers or having smoked at one point in their lives.
Current smokers are 23.5% (73.1% of the ever smokers) 78.5% are males while 21.4% are females. Among the
current smokers 13.6% began smoking at the age of 6-14 years old; 51.4% began at the age of 15-19 years old;
19.6% 20-24 years; 6.8% 25-29 and 8.5% 30-70 years old. A study done by NDHS in 1998 revealed that 60% of the
households nationwide have at least one smoker.

In the same study by Tiglao et al, 38.9% of the sample population are alcohol drinkers, with recorded age of
initiation at 6 - 71 years old. Half of the drinkers (50.3%) started drinking at ages 15-19, the teenage years; while
8.5% started at less than 14 years. More than half (58.1%) are light drinkers, meaning they usually take less than
four drinks; about 37% are moderate drinkers (4-12 drinks) while a small proportion (5.9%) are heavy drinkers (>12
drinks). Number of drinks is equivalent to 1 glass of wine, 1 shot of liquor, or 1 cocktail.

Again, in the same study, 79.1% of the respondents claim that they have some form of exercise or engage in some
physical activities. More than half (54.4%) engages in low to moderate physical activities - walking, jogging,
bending, stretching, yoga, exercise for pregnant women, weaving, sewing, gardening. Thirty one percent (31.1%)
engages in sustained physical activity - household chores, peddling, farming, carpentry, fishing, serving. Only
14.6% participates in vigorous forms of physical activities - brisk walking, push up, weightlifting, PE class, taebo,
sports. Most popular form of physical activity is walking followed by household chores.

Looking at the weekly consumption of fruits and vegetables, Tiglao et al's study revealed that a big majority (81.3%)
of the respondents claim to eat fruits and vegetables four or more times a week; 10.7% thrice a week; 3.9% twice a
week; 3.4% once a week; while 0.7% admitted they don't eat fruits and vegetables.
Rationale of the Program 

Four of the most prominent non-communicable diseases are linked by common preventable risk factors related to
lifestyle. These are cardiovascular disease, cancer, chronic obstructive pulmonary disease and diabetes. The risk
factors involved are tobacco use, unhealthy diet and physical inactivity. Action to prevent these diseases should
therefore focus on controlling s in an integrated manner. Intervention at  the level of family and community is
essential for prevention because the causal risk factors are deeply entrenched in the social and cultural framework of
the society. Addressing the major risk factors should be given the highest priority in the global strategy for the
prevention and control of lifestyle related diseases.

The mandate of the Department of Health is to promote and protect health lifestyles. For common understanding,
healthy lifestyle has been operationally defined as a way of life that promotes and protects health and well being.
This would include practices that promotes health such as healthy diet and nutrition, regular and adequate physical
activity and leisure, avoidance of substances that can be abused such as tobacco, alcohol and other addicting
substances, adequate stress management and relaxation; and practices that offer protection from health risks such as
safe sex and responsible parenthood.

Our goal is to reduce the toll of morbidity, disability and premature deaths due to lifestyle related diseases. One of
the components of the major strategies employed will be health promotion, across the life course and prevention of
the emergence of the risk factors in the first place. This is where a serious campaign on healthy lifestyle would be
most relevant. Thus the development and installation of the National Healthy Lifestyle Program in the Department
of Health

GOAL

Reduce prevalence of lifestyle diseases particularly cardiovascular diseases, cancers, diabetes and chronic
obstructive pulmonary diseases.

OBJECTIVES

General

Reduce prevalence of major risk factors specifically smoking, physical inactivity and unhealthy diet and nutrition.

Specific

1. Develop the program components of the National Healthy Lifestyle Program

a. Tobacco Control Program
b. Lifestyle Physical Activity Program
c. Healthy Diet and Weight Control Program
d. Stress Management Program
e. Control of Alcohol Use Program
2. Launch a Comprehensive Healthy Lifestyle Advocacy and Health Promotion Campaign:
     Key Messages:
a. Exercise regularly
b. Eat a healthy diet everyday
c. Watch your weight / Weight control
d. Don't smoke
e. Manage stress
f. Have a regular health check-up
3. Institutionalize the promotion of healthy lifestyle in local government units.
4. Quality assurance through Sentrong Sigla.
5. Support research on behavior change and best practice on the promotion of healthy lifestyle.
STRATEGIES

1. PROGRAM, POLICY AND STANDARDS DEVELOPMENT

a. Creation of Task Forces for each program component.
b. Pilot implementation of the Integrated Community Based Non-Communicable Disease Prevention
and Control Project (WHO Demonstration Project - Guimaras and Pateros).
c. Inclusion of healthy lifestyle promotion in the Sentrong Sigla standards.
d. Issuance of an administrative order to mandate the mandatory inclusion of nutrition
facts/information on prepackaged food labels.
e. Issuance of guidelines in the promotion of healthy lifestyle.
f. Formulation of an integrated and comprehensive national policy on issues relating to healthy
lifestyle (nutrition, environmental/urban planning, transportation, etc.).
2. INSTITUTIONALIZATION AND CAPABILITY BUILDING
a. Implementation of the National Healthy Lifestyle Program nationwide through local government
units.
b. Training health workers on the promotion of healthy lifestyles.
c. Technical assistance in the development of local policies/resolutions relative to healthy lifestyles.
d. Establishment of Wellness Centers in health facilities across the country.
3. ADVOCACY AND HEALTH PROMOTION
a. Development and Launching of a Comprehensive Health Lifestyle Advocacy and Health
Promotion Campaign.
b. Organization of a Healthy Lifestyle Coalition among various stakeholders.
c. Development/production/distribution of advocacy/IEC materials.
d. Observance of Healthy Lifestyle as a common theme during conventions, meetings, congresses of
various groups being represented in the coalition during the year 2003 and beyond.
e. Highlighting periodically a year round thematic advocacy/IEC campaigns on specific healthy
lifestyle messages.
 January - Regular health check up
 February - Exercise regularly
 May/June - Don't smoke
 July - Eat a healthy diet
 October - manage stress
 December - Watch your weight / Weight control
4. RESEARCH DEVELOPMENT
a. Behavior change and best practice on healthy lifestyle promotion.
5. MONITORING AND EVALUATION