By Cassandra Sunga
In December 2015, the Philippines announced that it would be the first country to launch Sanofi Pasteur’s brand new dengue vaccine Dengvaxia. As dengue infects 200,000 Philippine citizens per year and treatment for the disease costs about 18,000 pesos per patient, this intervention has the potential to save hundreds of thousands of dollars and several lives across the equator. Although this medical feat is one that should be celebrated, one fundamental question remains on its delivery however: who will ultimately be able to obtain this vaccine in the Philippines?
According to a report made by the Philippine Statistics Authority in 2013, poor households are 18.2% less likely than non-poor households to obtain their mandatory first dose of the Hepatitis B vaccine. Furthermore, the World Health Organization (WHO) in 2011 reported that only 55.5% of households in the lowest income bracket were able to obtain a full round of mandatory, WHO EPI vaccines in comparison to 83% of households in the highest income bracket. While the cyclical nature of income disparity and health is a constant in most countries across the globe, the poor in the Philippines are especially susceptible to the consequences as there is essentially no public safety net to ensure that they receive quality health care when needed. Although current President Benigno Aquino has overseen a number of positive reforms in healthcare policy since assuming office in 2010 (e.g. the expansion of their national health insurance program Phil Health and the appropriation of birth control to the public), differential access to quality health care amongst various income groups is still a major issue.
Even though the country’s situation seems bleak for the poor and geographically isolated, one NGO has risen above the rest to find a valid solution to the problem. Gawad Kalinga (GK), which means, “to give care” in English, aims to “end the poverty of 5 million poor families by 2024”. The organization started by building quality housing structures and communities for poor families in the early 1990’s, and has since launched about 2,000 different communities across the country. To make each community economically sustainable, GK also partners with business schools and entrepreneurs around the world to empower Philippine citizens with viable livelihoods based on their working skills and what’s naturally available in the environment around them.
In 2010, Center for Disease Control (CDC) head Dr. Thomas Frieden published an article in the American Journal of Public Health on his 5-tier intervention pyramid. The pyramid creates a framework for understanding how impactful public health interventions will be depending on what factors they target. The idea is that if you have an intervention that targets broader segments closer to the bottom of the pyramid (i.e. socioeconomic factors), you will thereby have a broader impact on society. Although simple on the surface, the idea does come with a catch; targets listed towards the bottom are often times the most difficult areas to address or change in public health. Thus, the obstacles and difficulties that ultimately lie in changing the bottom of the pyramid are what largely deter interventions from aiming to make socioeconomic factors a main target.
As Dr. Frieden elaborates within his article, previous models and current interventions often times fail to address infrastructure in health systems. However, this framework is exactly what makes GK’s model so fascinating and exciting! Rather than using interventions that are too focused on the individual or are largely non-preventative, GK is trying to solve health disparity in the country by attacking the root of the problem: income disparity. While GK will most likely be unable to provide all of the people living in its communities with the dengue vaccine, they are providing them with something that is arguably just as essential for community health: hope. By finally creating the quality, sustainable infrastructure this country has needed for the poor, GK has laid down the groundwork for improved population health in the country. They took a leap of faith and started at the bottom of Dr. Frieden’s pyramid. Now, all they simply have to do is continue climbing upwards.
- Frieden, Thomas R. “A Framework for Public Health Action: The Health Impact Pyramid.” American Journal of Public Health 100.4 (2010): 590–595. PMC. Web. 26 Feb. 2016.
- “Breastfeeding, Immunization, and Child Mortality.” Philippine Statistics Authority. Philippine Statistics Authority, Oct. 2013. Web. 26 Feb. 2016.
- “World’s First Dengue Vaccine Now Available in PH.” CNN Philippines. CNN, 12 Feb. 2016. Web. 26 Feb. 2016.
- “Welcome to Gawad Kalinga.” Welcome to Gawad Kalinga. Gawad Kalinga, n.d. Web. 26 Feb. 2016.
- In the Philippines. Digital image. Gawad Kalinga. Gawad Kalinga, n.d. Web. 26 Feb. 2016.