Proponents: Canazares, Torre, and Tabasa
RECOMMENDATIONS: POSSIBLE INTERVENTIONS IN ADDRESSING THE THREE HIGH’S IN THE FOLLOWING
GENRES:
CNU COMMUNITY
● Coupon and Reward-Redeem Systems: For
every participation in health-promoting school
activities, students and staff will be given
coupons to avail discounts, even free goods,
and services, from the school canteen,
library, and other affiliated institutions, if any.
In addition, students and the staff should be
rewarded with rewards points, which they can
redeem, for every healthy choice they make,
such as choosing a healthy meal from the
school canteen or participating in recreational
activities in or outside the campus with friends
and family. This can be monitored by
providing them with checklist cards, which
should be checked weekly.
● Youth Health and Wellbeing Training
● De-Stress Day/Hour: Allowing students and
staff to enjoy a stress-free day every week/
de-stress hour every day. Activities can
include free consultations and counseling, as
needed, by the students and staff. Everyone
should be allowed to exercise their freedom in
choosing a recreational activity according to
their preference, such as reading books in the
library, listening to music, etc. at school.
● Indicating which foods are high in sugar or
fats. This is done so that the students would
be aware of the foods that they will purchase.
● Weekly Zumba. A short Zumba Program for
the students and staff once a week. Different
schedules will be made for different groups.
This is done so that the participants can be
monitored.
● Daily Meditation. Relaxation can help with
stress and can lower blood pressure.
CEBU COMMUNITY
● Plantita/Plantito Project: →Establish a
Herb Planting Day and encourage the community
to have one herb garden every barangay and
every resident to have a small herb garden at
home
→Introduce the herbal plants approved by
the DOH and their respective benefits
● Herbal Medicine Training: Residents are taught
how to properly prepare the different herbal
medicines at home.
● Zumba Community: A free Zumba Program
offered specifically to each age group: Different
schedule for each age group and one schedule
for all ages (can be considered as a grand event
where all ages can support one another and
bond)
● Tabang para Maluwas, Tabang para sa
Panglawas (Help to Save; Help for Health):
A healthier approach in helping those affected by
disasters (storms, fire, pandemics, and etc) and a
healthier way of sharing generosity. The main
focus of this movement is to offer healthier ayuda
and healthier community pantries for those who
are in need.
● Coupon and Reward-Redeem Systems For
every participation in health-promoting
community activities, the residents will be given
coupons to avail discounts, even-free goods, and
services, in affiliated grocery stores, botika
(pharmacy) local restaurants, and recreational
sites.
● Improve the implementation of Botika ng
Barangay in the Community: Aside from
government-initiated funds, community leaders
can work with the community residents and
private sectors to open fundraising activities in
order to secure enough supplies of medicines in
the BNB.
● Nutrition and Healthy-Eating (Courses)
Training and Seminar for
Karenderya/Restaurant/Food Stall Owners in
Cebu: Idea: Kalendarya/Restaurant/Food Stalls
in Cebu City should not be allowed to operate
without certificates from Nutrition and Healthy-
 Eating Trainings and Seminars.
● Making Recreational Sites more Accessible to
Everyone: Improving community/public parks to
make them more friendly for exercise and
recreation.
● Enhancing Neighborhood Walkability

Why are 3 Highs increasing at Community Level?

● CULTURAL CONSIDERATIONS
⮚ Lay conceptions of Hypertension among Filipinos
For Filipinos, especially those of low-income families and with poor health literacy, hypertension, having high
cholesterol, and diabetes are conceptualized as conditions that are “Namamana” or “Nasa dugo” or inherited.
This refers to hypertension being a familial disease, which is a fact. However, there are certain gaps in this Filipino
conception of hypertension, having high cholesterol, and diabetes as it leads some to think that once these
diseases become prevalent within the family, they can no longer be prevented, they can only be managed.
⮚ Social Function of Food in Filipino Cultural/Traditional Activities: Cebuano Traditional Dishes, and most
Filipino traditional dishes, are mostly high in fat, cholesterol, and sodium. In addition, Cebuano’s love for fiestas,
holidays, and special occasions also contribute to the increasing rates of the 3 Highs at the Community Level. To
note, the same is true for most Filipinos all over the country.

TRADITIONAL DISHES DESCRIPTION

USUALLY FOUND
DURING “HANDAAN”

LECHON Roasted pig

HUMBA Pork cooked and boiled with carbonated drinks, vinegar, and sugar

BAM-I Sautéed vegetables, shredded chicken, shrimp, and rice noodles

BUWAD Dried fish, usually fried or roasted, and very high in sodium content

SINUGBA Roasted pork meat, can be beef or chicken

LUMPIA Ground beef or pork with mixed vegetables

DINOGOAN Pork blood, pork, tripe, onions, garlic, and peppers

CRISPY PATA Deep fried pork leg

CHICHARON Pork rinds served with vinegar and chili

ADOBO Onions, garlic, pork or chicken, soy sauce, and vinegar

● GENETICS AND FAMILY HISTORY

⮚ Family History
Aside from Genetic and biological factors that run in the family, Cebuanos are highly family-oriented and mostly
share meals and food with the family.
⮚ Genetics
 Hypertension tends to run in families. Individuals whose parents have hypertension have an elevated risk of
developing the condition, particularly if both parents are affected. However, the inheritance pattern is
unknown. Rare, genetic forms of hypertension follow the inheritance pattern of the individual condition.

● ENVIRONMENTAL FACTORS
⮚ Chronic Exposure to Stress

● INDIVIDUAL CHARACTERISTICS AND BEHAVIOR

⮚ Lifestyle
⮚ Dietary Pattern
⮚ Mental Health
⮚ Filipino Mentality
⮚ Low Illness Perception

● Globalization

● SOCIAL FACTORS
⮚ Urbanization
⮚ Education

● TECHNOLOGICAL ADVANCEMENT

● ECONOMIC CONSIDERATIONS
⮚ Economic Growth
⮚ Marketing Factors
: The rise of milktea stores, eat-all-you-can/unli-restaurants, and bottomless drinks in the Phillippines has
increased Filipino’s risk to acquiring the three hyper-conditions
● NATIONAL DISASTER AND PANDEMIC RESPONSE
➢ Ayuda
: Most of the ayuda being given are processed foods, because they are cheaper and easier to procure.
➢ Community Pantry

Current Practices in Addressing the 3 Highs in Cebu, Philippines

HYPERLIPIDEMIA

Government Policies/ Programs

1. Clinical Practice Guidelines for the Management of Dyslipidemia in the Philippines
· Spearheaded by the Philippine Heart Association (PHA) Council on Preventive Cardiology and in collaboration with the
International Clinical Epidemiology Network (INCLEN) to formulate national dyslipidemia clinical practice guidelines to
improve decision-making and clinical performance.
· Contains 12 statements that present all the management recommendations formulated.
o STATEMENTS
1. To reduce overall cardiovascular (CV) risk, all patients, regardless of their present morbid condition or
risk profile, should be advised on the need for the following:
a. Smoking cessation
b. Weight management
c. Regular physical activity and
d. Adequate blood pressure monitoring and control
2. For patients at any level of CV risk, especially those with established atherosclerosis, a low-fat, low-
cholesterol diet is recommended for life.
3. In poorly nourished and elderly patients, correction of nutritional deficiencies can be achieved even with
a low-fat, low-cholesterol diet.
4. For low-risk patients without evidence of atherosclerosis, drug therapy is not recommended, regardless
of lipid levels.
 5. And more

2. Proclamation No. 1096, s. 1973 “Philippine Heart Month”

● For raising awareness and attending with urgency to the growing prevalence of heart cases among Filipinos
which include the tackling of risk factors such as high cholesterol levels.
3. Philippine Plan of Action for Nutrition 2017–2022 - Addresses stunting, overweight, and obesity
4. National tobacco control strategy
5. Tobacco and Alcohol taxation
6. STOPSMOKE Mobile Health Programme
7. Quit-line and smoking-cessation clinics
8. Great Filipino Workout - Preventive physical fitness programme adopted by all government agencies
9. FDA’s removal of Partially Hydrogenated Oils (PHO from “Generally Recognized as Safe” category.
· This force disables food manufacturers from adding PHO’s into processed food.

Medication Availability
1. Botika ng Barangay Program
· Drug outlets managed by a legitimate community organization (CO)/non- government organization (NGO) and/or the
Local Government Unit (LGU), with a trained operator and a supervising pharmacist that sell primary, non-prescription
generic drugs listed in the Philippine National Drug Formulary (PNDF) and selected prescription drugs.

2. DOH Complete Treatment Pack Program

· Initiated in December 2008, this program aims to widen people’s access to prepackaged generic drugs with an
affordability limit with the intention to encourage patients to take the full course of their drug treatment regimen (i.e.,
improve compliance), instead of patients buying them in individual tablets or capsules which end up being more expensive
and often leads to discontinuance once the patient feels well enough.

3. Tax Reform for Acceleration and Inclusion (TRAIN) Law

· The sales of drugs prescribed for diabetes, high cholesterol, and hypertension are exempted from value added tax.

Diet Modification Practices

1. Pinggang Pinoy for Adults
· a food plate guide to help Filipinos determine the kind of food and the proportion to be consumed per meal
2. Consumption of foods that can naturally lower cholesterol
o Garlic
o Fiber-rich foods
o Phytosterol-rich foods
o Red Yeast Rice
o Certain Herbs and Spices
o Soybean
o Orange Juice

HYPERTENSION

Government Policies / Programs

1. Executive Summary of the 2020 Clinical Practice Guidelines for the Management of Hypertension in the
Philippines
o Groups collaborated to develop the 2020 Philippine Clinical Practice Guidelines of hypertension arising for the need
to come up with a comprehensive local practice guideline for the diagnosis, treatment and follow up of persons
with hypertension.
o A tecThis guideline also includes recommendations for the specific management of hypertensionhnical working
group ts.
o Goal: to aid Filipino healthcare professionals to provide evidence based care for persons with hypertension and
help those with hypertension adequately control their blood pressure and reduce their cardiovascular risk
2. Philippine Society of Hypertension Inc. (PSH)
o Goal: Control hypertension using a total quality management approach, which involves reciprocal communication
between providers and clients facilitated by paramedical representatives and the media.
o Mission: We reduce the prevalence, risks, and complications of hypertension through multidisciplinary action.
o Vision: We are an internationally esteemed organization harnessing shared commitments and concerted efforts
towards the prevention and control of hypertension.

Vision Mission (philippinesocietyofhypertension.org.ph)

3. Cardiovascular Risk Assessment and Management Initiative (2019)

o This is a joint project initiative between the Department of Health (DOH) and the Philippine Society of Hypertension
(DOH) aimed at addressing the increasing prevalence of hypertension and non-communicable diseases (NCDs)
in Cavite Province, Philippines. DOH-4A (Calabarzon) Director Dr. Eduardo C. Janairo emphasized that “greater
progress in addressing cardiovascular diseases can be achieved through the cooperation of different sectors.
o Strategic Approach: Due to the high cost of diagnosis and treatment of hypertension and NCDs, this relies on
early detection and care using cost-effective and sustainable health care interventions that are integrated in the
primary health care facilities, such as the barangay health stations, rural health and other community health
centers.
o Vision: Focus more on prevention, especially on the four modifiable behavioral risk factors – unhealthy diet,
physical inactivity, harmful use of alcohol, and tobacco use. More Filipinos are being assessed, screened and
diagnosed early to prevent debilitating and sometimes fatal complications.
o Goal: Decrease the diseases' prevalence by 3 percent in the next five years.

DOH, PSH launch program to curb hypertension prevalence | Philippine News Agency (pna.gov.ph)

4. RA 11223 (Universal Health Care Act)

● Mandates the institutionalization of health technology assessment (HTA) as a fair and transparent priority setting
mechanism that shall be recommendatory to the DOH and PhilHealth for the development of policies and programs,
regulation, and the determination of a range of entitlements such as drugs, medicines, pharmaceutical products, other
devices, procedures and services.
● UHC means all Filipinos are guaranteed equitable access to quality and affordable health care goods and
services, and protected against financial risk. President Duterte signed R.A. 11223 or the Universal Health Care Act
into law last February 20, 2019.
● The UHC Act contains comprehensive and progressive reforms that will ensure every Filipino is healthy, protected
from health hazards and risks, and has access to affordable, quality, and readily available health service that is
suitable to their needs.
● Universal Health Care (UHC), also referred to as Kalusugan Pangkalahatan (KP), is the “provision to every Filipino of
the highest possible quality of health care that is accessible, efficient, equitably distributed, adequately funded, fairly
financed, and appropriately used by an informed and empowered public”.
● 3 Strategic Thrust:
○ 1) Financial risk protection through expansion in enrollment and benefit delivery of the National Health
Insurance Program (NHIP);
○ 2) Improved access to quality hospitals and health care facilities; and
○ 3) Attainment of health-related Millennium Development Goals (MDGs).
● Financial efforts shall be provided to allow immediate rehabilitation and construction of critical health facilities. In
addition to that, treatment packs for hypertension and diabetes shall be obtained and distributed to RHUs.

Universal Health Care | Department of Health website (doh.gov.ph)

5. Medicines Access Program

● Implemented by DOH To supplement the supply of medicines procured by municipalities for their health
centres which does bulk procurement and nationwide distribution of essential medicines
 6. National Policy on Strengthening the Prevention and Control of Chronic Lifestyle Related Non Communicable
Diseases (Administrative Order No. 2011-0003 dated April 14 2011)
o prescribes the strategy or comprehensive approach the country has adopted in reducing the morbidity, mortality and
disability rates due to chronic lifestyle-related non communicable diseases (NCDs)
o The Phil PEN Protocol on the Integrated Management of Hypertension and Diabetes shall be used in all primary
health care facilities in the country, i.e. barangay health stations, rural health centers, community health centers,
and the like.
A DOH Document

7. Proclamation No. 1761, s. 2009

● Signed on May 1, 2009
● May = “Hypertension Awareness Month”
● WHEREAS, the Philippine Society of Hypertension composed of multidisciplinary medical and allied professionals was
organized in 1993 to help address the prevention, treatment and control of hypertension in the Philippines;
● WHEREAS, nearly eight million adult Filipinos suffer from hypertension and its cardiovascular complications and tens
of thousands are unnecessarily disabled and/or die prematurely from it;
● WHEREAS, the impact of premature death and disability is counted not only in the loss that: families bear but also on
the negative effects on our national productivity and socio-economic development;
● WHEREAS, it is urgent that the different strategies in the prevention, treatment and control of hypertension be actively
pursued to reduce hypertension-related deaths and disability.

DIABETES

Government Policies / Programs

1. Free Diabetes Risk Screening
● Barangay health stations, rural health units / health centers, public hospitals, and other government health facilities.
2. World Diabetes Day
● An annual event that the government hosts in any way possible (some include convention and scientific sessions,
exhibitions, and fairs)
● ·During the event, DOH and NGOs urge the Filipino public to mount early preventive actions against diabetes.
● Activities during this day include a parade / walk around the Quezon Memorial Circle, free diabetes screening, and a
lay forum.
3. Diabetes Awareness Week
● Every 4th week of July as proclaimed by late President Ramos in the year 1993.
● For the year 2021 → the theme was “Wastong Impormasyon mahalaga, aksyon laban sa diabetes ay itama”
or “Spread facts, correct misconceptions”
1. DOH Partnership with the Philippine Society of Endocrinology, Diabetes, and Metabolism (PSEDM)
· Empower and build capacity among primary healthcare workers in diabetic management and
to enhance health service delivery.
· More than 1,700 health care providers across the country were already trained.
1. Barangay Nutrition Scholar Program
human resource development strategy of the Philippine Plan of Action for Nutrition, which involves
the recruitment, training, deployment and supervision of volunteer workers or barangay nutrition
scholars (BNS)

● Medication Availability

1. DOH Insulin Access Program

· Provision of free medications (e.g. oral anti-diabetes medicines and insulin to Filipino
patients diagnosed with diabetes) or (around PHP 500)
· Partner pharmaceutical companies participate through provision of affordable insulin
products through the consignment system.
· Started in 2009
· Can be assessed through Vicente Sotto Memorial Medical Center (VSMMC) [CEBU]
Individual Level
 ● Diet Modification Practices
1. Pinggang Pinoy for Adults
· Recommended by the Food and Nutrition Research Institute (FNRI). It focuses more on
variety of dietary intake emphasizing on prevention of diseases via a healthy Filipino diet.

1. DASH Diet
· Saturated fat intake should be <10% of total calories
· Dietary cholesterol intake should be <300 mg/day
1. Shifting Rice to Mais (corn rice)
→ lower glycemic index; lower rate of glucose absorption; rich in dietary fiber

● Lifestyle Modification Practices

1. Zumba Sessions (hosted by public and private orgs) (JesChan, 2014)
· Gyms offer zumba sessions with reasonable fees ranging from Php 40 - Php 150 per hour.
· Free zumba sessions are available in malls, local government gymnasiums, and open courts.
· Sometimes the LGU provides a schedule for exercises.
1. Daily Monitoring of fasting blood glucose every day

Recommendations:

Improving Current Practices in Addressing the 3 Highs (Three Hyper Conditions)

National Level:

● Policy-Making: Reward and Punishment System when Availing Goods and Services in UNLI and Eat-All-You-
Can Restaurants
● Policy-Making: Increasing Price Rates of Cigarettes and UNLI and Eat-All-You-Can Restaurants
● Policy-Making: Limiting TV and Social Media Advertisements of UNLI and Eat-All-You-Can Restaurants
● Policy-Making: Adopting Healthier Option Practices from other countries in Grocery Stores and Local
Restaurants
● Policy-Making: Make Recreational Activity Program a National Celebration

Community Level

● Creating Health-Specific Disaster Response and Charity Practices

○ Healthier Ayuda
○ Healthier Community Pantry
● Making Recreational Sites more Accessible to Everyone
● Community Walks

Individual Level
● Journalling and Self-Care Rewards
● Regular Workout
● Daily Walks

School Level
● Offer healthier options in School Canteen/Cafeterias
● Indicate which foods are high in sugars and fats
RECOMMENDATIONS: POSSIBLE INTERVENTIONS IN ADDRESSING THE THREE HIGH’S IN THE FOLLOWING
GENRES:
RP COMMUNITY SINGAPORE COMMUNITY
● ●
●