Social determinants of health are defined as non-medical agents that influence the individual’s overall health (Daniel et al., 2018). In the Philippines, the Department of Health (n. d.) defines social determinants of health as “those critical characteristics of societies and communities in which people live that have an impact on their health." This includes income and poverty, education, food production and security, human rights, civil society and good governance.
Income and Poverty
Income and poverty both show the economic status of a community. Following the definition of health by the WHO (1946) as a “state of complete physical, mental and social well-being,” the economic condition of a group of people has wide implications for their health. For example, the poor are unable to spend for their basic needs such as food and housing (Sachs & McArthur, 2005). Even in countries with the highest economies, the upper class have longer lifespans and fewer illnesses than the indigent (WHO, 1998). Concurrently, improving health can be an important factor in reducing poverty (Peña & Bacallao, 2002).
Poverty in the Philippines (Source: Pinterest)
In Brgy. Guripan, Deofrecil Duyar, the wife of the Brgy. Captain, specified that some people in the community do not have adequate financial capacity. In fact, there is a place called Pyrites that the locals term “Little Africa” because of the poverty of the people living in the area and the unsuitable environment where they live. According to the teachers from Guripan Elementary School, many people dwell there and have been ordered to leave. Yet, they refuse to transfer to another area, possibly due to poverty. Historically, according to Wilmar Librea, one of the local people, Pyrites was the area where the mining wastes were processed and dumped before. The community people say that when it rains, the water that flows from Pyrites go to the rivers and kill the fish. When it’s hot in the afternoon, the sulphuric vapour rises from the soil and can irritate your respiratory tract. During the students’ purok 5 ocular survey, they visited the area. It was there that they observed the true condition of Pyrites: multiple houses and people in a place with many yellow and white-colored soil (presumably sulphur and silver wastes), trash everywhere on the ground, and a little comfort room with a bowl that has no septic tank. Many of the student doctors who visited this area experienced multiple illnesses after being there for only a few minutes.
Trash can be seen littered on the soil of Pyrites
A small comfort room with no septic tank at Pyrites
Education
Education is one of the key factors needed for sustainable development. This is evidenced by the fact that dropping out early from schools is one of the conditions causing health inequalities globally (WHO, 2019).
Preschoolers at Guripan Elementary School
In Barangay Guripan, Wenceslao Ponce, the GES GPTA President and Livelihood and Development Coordinator, said that many of the young people in this community do not finish school and then opt to enrol in Alternative Learning System (ALS) afterwards. He has also been very passionate in his commitment to health and sanitation. In their Senior Citizen meeting he emphasized, “Nevermind the fact that we are poor, at least we are clean.”
Guripan Elementary School GPTA President Wenceslao Ponce
Additionally, there may be a health education problem in the community. The president of Purok 6, Sixto Bugas, expressed his concern that the people in the upper puroks need to be educated about health sanitation. Since the water flows from the upper parts of the barangay (where the deep wells are found) to the lower ones, he reports of seeing diapers and wastes coming from the water flowing down to them. Also, one of the people who recently died was a master sergeant who, upon knowing he had cancer, went to the faith healer first. By the time he went to the doctor for medical assistance, the disease had already become too far advanced. This is according to Hon. Alfredo L. Duyar, the barangay captain of the community.
Tube with continuously flowing water at Purok 1
In terms of drugs, Brgy. Guripan has been declared “drug-cleared” as of 2019. It is also a “moderately affected barangay” because of the presence of pushers in the area. According to Lenie Bacaling, a patrolwoman of the Police Community Relation in Mahayag Police Station, they continue to monitor 57 Persons who used drugs, 53 users, and 4 pushers. They do this by conducting monthly meetings with these people and having various activities pertaining to drug education and the like.
Within the community, there are also two places for childhood education: Guripan Elementary School in Purok 4 and Guripan Daycare Center in Purok 5.
Guripan Elementary School Entrance Sign
Food Production and Security
Food security is rooted in the three dimensions of; food availability, access to food, and food utilisation. There is food availability when there is enough, safe and nutritious food consistently available to people. There is access to food when individuals and families have sufficient resources to obtain proper food for a healthy diet. Food utilisation is the appropriate use of food, which requires food choices with adequate energy and essential nutrients, drinkable water and sanitation (Sassi, 2018). According to Thomas & Frankenberg (2002), nutritional deficiency, especially of iron, reduces work capacity and output. This is detrimental to the workforce of communities, especially those who labor in rural areas.
For Brgy. Guripan, malnourishment of children has been one of the identified problems. According to the data from the Municipal Nutrition Action Officer, there have been many cases of children with overweight and underweight weight-for-age status, stunted height-for-age status, and wasted as well as severely wasted weight-for-height status.
Medical students serving food during Guripan Elementary School Feeding and Deworming
Greater than other problems, the community prioritized the lack of adequate and clean water as their main concern. According to Wenceslao Ponce, who is also the Senior Citizen President, there is improper distribution of water across the mountainous barangay. The ones who live in the upper puroks (Puroks 1 to 3) waste too much water. Worse, some of them illegally intercept the water tube from the deep wells above, thereby decreasing the amount of water for those below. He also accompanied the students as they documented the water tubes that had been unlawfully tampered by these community people during the Purok 1 and 2 ocular surveys. Their complaint is that they are unable to plant crops due to the lack of water (aggravated by the dry season). Sir Ponce said that one of the possible solutions is the condemning of these locals who interfere with the water system. Thus, the water is only available to them from 11 pm to 3 am. Aside from insufficient supply, the water may not be completely safe for drinking. During the Women’s Meeting, the people verbalized that their water came from both an unclean reservoir and tube. They also report of experiencing “kalibanga” or diarrhea.
Flowing water contaminated with mining wastes at Purok 1
Human Rights
According to Chapman (2010), multiple social determinants of health are considered human rights with a moral obligation. There is a social and political mandate when it comes to making health a priority.
For the health facilities of the community, the Barangay Health Station was finished last 2016. The committee chairman for health is Hon. Babele L. Lepiten. For the local health workers, they have one midwife, one barangay health worker and one barangay nutrition scholar. They also have a nurse (NDP) focused on Barangay Guripan. Together, they make the healthcare accessible to the families, especially those living in distant areas.
Civil Society
Community participation continues to prove a great benefit to health system development (Haldane et al., 2019). There are better health results when the local people become more involved in planning, implementing, and evaluating programs. For example, social mobilization has been a strategic part of the initiative for eradicating polio (Obregon & Waisbord, 2010).
There are also multiple organizations that contribute to the overall well-being of Barangay Guripan. They have the Women’s Organization, Senior Citizen’s Organization and the Guripan Mamatyan Organization (GuMO). The organization for PWDs is still being organized, as stated by the Mahayag PWD President Regie Baclaan. These organizations have been actively pushing towards better quality of life.
Sir Ponce at the Senior Citizen's Meeting
One of the interesting groups in this barangay is the Guripan Mamatyan Organization or GuMO. It’s an original organization composed of individuals in the community who gather every time someone is deceased. When someone dies in the community, each of them contributes a certain amount to lighten the financial burden of the grieving family. Moreover, during the grieving period, they have committees assigned for entertaining guests, preparing food, washing dishes, and even transportation. This is evidence of the close-knit supportiveness of the people of Guripan towards each other.
Good Governance
Governance is the systematic management of decisions and implementation of policies (Greer et al., 2016). Since politicians have greater influence on overall health than healthcare workers, the political aspect of health must not be neglected (Rose, 2008).
Currently, the political climate in the barangay seems to be relatively stable. When Hon. Duyar became a Barangay Councilor (and later the barangay captain), he immediately began strengthening the peace and order in the community. In the past, this place had many active NPAs yet today there are hardly any. According to Sir Ponce, many of the NPAs before have already been living peacefully for years. One of them is the CVO who accompanied the students during one of the ocular surveys, Dominador or “Tata” as they call him.
References:
Chapman, A. (2009). Globalization, Human Rights, and the Social Determinants of health. Bioethics, 23(2), 97-111. doi: 10.1111/j.1467-8519.2008.00716.x
Daniel, H., Bornstein, S., & Kane, G. (2018). Addressing Social Determinants to Improve Patient Care and Promote Health Equity: An American College of Physicians Position Paper. Annals Of Internal Medicine, 168(8), 577. doi: 10.7326/m17-2441
Department of Health. What are social determinants of health? | Department of Health website. Retrieved 4 February 2020, from https://www.doh.gov.ph/node/1407
Greer, S., Wismar, M., & Figueras, J. (2016). Strengthening health governance. Maidenhead: Open University Press.
Haldane, V., Chuah, F., Srivastava, A., Singh, S., Koh, G., Seng, C., & Legido-Quigley, H. (2019). Community participation in health services development, implementation, and evaluation: A systematic review of empowerment, health, community, and process outcomes. PLOS ONE, 14(5), e0216112. doi: 10.1371/journal.pone.0216112
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Peña, M., & Bacallao, J. (2002). MALNUTRITION ANDPOVERTY. Annual Review Of Nutrition, 22(1), 241-253. doi: 10.1146/annurev.nutr.22.120701.141104
Rose, G. (2008). Rose's Strategy of Preventive Medicine. Oxford: OUP Oxford.
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Sassi, M. (2018). Understanding Food Insecurity. Gewerbestrasse: Springer.
Thomas, D., & Frankenberg, E. (2002). Health, nutrition and prosperity: a microeconomic perspective. Bull World Health Organ, 80(2), 106-13.
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