MODULE 1: OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES

LESSON 1
Global and National
Health Situations

O VERVIEW

The world is facing multiple health challenges. These range from

outbreaks of vaccine-preventable diseases like measles and diphtheria,
increasing reports of drug-resistant pathogens, growing rates of obesity and
physical inactivity to the health impacts of environmental pollution and
climate change and multiple humanitarian crises. 

In our present lifetime, we are experiencing a pandemic of CoVid-19

which pose a great challenge not only for us as individuals but to the health
care system in general and the nursing profession is particular.

As we go through the discussion in Module 1, you will see graphical

presentations about the global health situations as we correlate them to the
national position. This will cover current issues that affect the global and
national health state – the demographic profile and leading causes of
morbidity and mortality.

L EARNING O BJECTIVES

1. Define key terminologies.

2. Discuss the global and national health situations in terms of

commonly used measurement to describe a population’s health.

3. Compare the provincial (Northern Samar) health situation with that of

the national.

4. Assess the provincial (Northern Samar) with the local (municipality)

health situation.

5. Draw implications from the health situations presented from the

global and national perspectives.

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L EARNING P LAN

INTRODUCTION

Good health is essential to human welfare and to sustained economic

and social development. Countries around the globe set themselves target to
develop their financing systems to ensure that all people can use health
services.

Topic 1.0 GLOBAL HEALTH SITUATION

Currently, the world is

facing a fundamental
dilemma. There has been
actual deterioration in health
status in many developing
countries, largely as a result
of HIV/AIDS but also because
of a resurgence in other
infectious diseases like Ebola
and a growing burden of
noncommunicable1 diseases.
Worst is the emerging
communicable disease, like
the CoVid-19 which become
pandemic as pronounced last March 11, 2020 by the World Health
Organization. The impact of this health situation resulted to the global
economic deterioration which eventually affects the people.

“The coronavirus disease (COVID-19) pandemic has caused significant

loss of lives, disrupted livelihoods and undermined well-being throughout
the world. The COVID-19 crises have underscored how unprepared most
health systems were and the negative impact this can have towards
achieving the Sustainable Development Goal (SDGs). These is an urgency to
invest in health systems, services and workforce”, says Dr Tedros Adhanom
Ghebreyesus, Director-General of the World Health Organization.

The impact of this health situation resulted to the global economic

deterioration and eventually affected the peoples.

But before we go further in our discussion, let us first define some key
terminologies which will help you in understanding the subject matter.

Key Terminologies:
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Child Mortality Rate - is the number of deaths of children under five

years of age in a given year per one thousand children in this age
group. 

Infant Mortality Rate - is the number of infants dying before reaching

one year of age, per 1,000 live births in a given year.

Life Expectancy - estimate of the average number of additional years that

a person of a given age can expect to live.

Live birth -  refers to the complete expulsion or extraction from its mother
of a product of conception, irrespective of the duration of the
pregnancy, which, after such separation, breathes or shows any
other evidence of life - e.g. beating of the heart, pulsation of the
umbilical cord or definite movement of voluntary muscles - whether
or not the umbilical cord has been cut or the placenta is attached.
Each product of such a birth is considered live born.

Maternal Mortality Rate - is the death of a woman while pregnant or

within 42 days of termination of pregnancy, irrespective of the
duration and site of the pregnancy, from any cause related to or
aggravated by the pregnancy or its management but not from
accidental or incidental causes.

World Health Organization - A specialized agency of the U.N., WHO has

as its directive "to act as the directing and coordinating authority
on international health work. The mandate is to establish global
standards and to give strong advice to countries regarding rational
public health measures and to provide countries with science-
based recommendations for health policy.

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LIFE EXPECTANCY

Life expectancy is the most commonly used measure used to describe

a population’s health. Historical data shows that global life expectancy has
increased drastically over the last couple of centuries, with substantial long-
run improvements in all countries around the world. In fact, recent life
expectancy gains in developing countries have been particularly important.
However, despite recent progress towards long-run cross-country
convergence, there are still huge differences that have to be addressed: in
several countries in Sub-Saharan Africa for example, the average life
expectancy is still less than 60 years, compared to more than 80 years in
countries in Europe or in Japan.

Source: https://www.worldlifeexpectancy.com

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A ctivity 1
Study the graph on the Life Expectancy of the World Population
from 3 different years found in page 4. Answer the following
questions:
1. What are the top 5 countries that have the longest life
expectancy?
2. Compare the progress of each country for the years 1800,
1950 and 1912.

1. Search on the Life Expectancy of the World Population for

the year 2019. Compare the status of same countries with
the above graph.

2. Search on the Life Expectancy in Asia for the year 2019.

Identify top 10 countries with the longest and shortest life
expectancy.

Historical reductions in child mortality and maternal mortality have

been crucial to improving life expectancy around the world. But also for
these two measures of health we observe large remaining inequalities: low-
income countries still have, on average, child mortality rates that are more
than ten times higher than those in high-income countries. We show that
similarly large gaps remain for other measures of health, including recent
burden-of-disease estimates.

CHILD/INFANT MORTALITY

In 2017, 4.1 million (75% of all under-five deaths) occurred within the
first year of life. The risk of a child dying before completing the first year of
age was highest in the WHO African Region (51 per 1000 live births), over six
times higher than that in the WHO European Region (8 per 1000 live births).

Globally, the infant mortality rate has decreased from an estimated

rate of 65 deaths per 1000 live births in 1990 to 29 deaths per 1000 live
births in 2017. Annual infant deaths have declined from 8.8 million in 1990
to 4.1 million in 2017.

The graph below presents the global child and neonatal mortality
between the years 2000 and 2018. It shows that the under-five mortality
rate fell from 76 [75–78]1 per 1000 live births to 39 [37–42], and the

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neonatal mortality rate declined from 31 [30–31] per 1000 live births to 18
[17–19]. This represented an estimated 5.3 [5.1–5.7] million under-five
deaths and 2.5 [2.4–2.7] million neonatal deaths in 2018.

A ctivity 2
Look for the Infant Mortality Rate (IMR) in Asia for the year
2019. Identify the (1) top 5 countries with the highest
IMR, and (2) countries the lowest IMR. Analyze data in
relation to the economic status of each country.

The World Health Organization reported that in the year 2007, nearly
9 million children under the age of five die every year. Around 70% of these
early child deaths are due to conditions that could be prevented or treated
with access to simple, affordable interventions. The leading causes of death
in this age group are pneumonia, diarrhea and health problems during the
first month of life and of all child deaths, over one third are linked to
malnutrition. The report further stated that children in developing countries
are ten times more likely to die before the age of five than children in
developed countries.
MATERNAL MORTALITY

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Similarly to child mortality, maternal mortality provides important

information regarding the level of health in a country.

In 2015, an estimated 303,000 women died during pregnancy and

childbirth. In 2016, maternal mortality was the second leading cause of
death for women of reproductive age, after HIV/AIDS, and was the leading
cause among women aged 15–29 years (Fig. 2.1). Almost all maternal deaths
(95%) occurred in low-income and lower-middle-income countries, and
almost two thirds (65%) occurred in the World Health Organization (WHO)
African Region. The risk of dying from maternal causes is related to the risk
of getting pregnant and to the obstetric risk of developing a complication and
dying while pregnant, during childbirth or within 42 days postpartum. In
resource-poor settings, fertility rates are higher and the risks of dying in
labor are greater (10), so the lifetime risk of dying from maternal causes is
greatly amplified; in 2015, one woman in 41 in low-income countries died
from maternal causes.

For the maternal mortality status the WHO reported that women die
as a result of complications during and following pregnancy and childbirth.
Most of these complications develop during pregnancy and most are
preventable or treatable. Other complications may exist before pregnancy
but are worsened during pregnancy, especially if not managed as part of the
woman’s care. The major complications that account for nearly 75% of all
maternal deaths are (4):

 severe bleeding (mostly bleeding after childbirth)

 infections (usually after childbirth)
 high blood pressure during pregnancy (pre-eclampsia and eclampsia)
 complications from delivery
 unsafe abortion.

The overall picture of the global health situation is reflected in the

2019 world health statistics report. The key findings that has improved are
as follows:

 Global life expectancy increased by 5.5 years to 72.0 years

between 2000 and 2016, and healthy life expectancy increased by
4.8 years to 63.3 years.
 More births are attended by skilled health personnel, and women
are less likely to die in childbirth. Global targets to reduce
neonatal deaths and deaths in children aged under 5 years are on
track, and childhood stunting is in decline.
 Vaccination coverage rates have increased while incidence rates
for several infectious diseases, prevalence of tobacco smoking,
exposure to environmental risks and premature NCD mortality
have decreased at global level.
However, in the same report the WHO mentioned disparities in
health outcomes. These are:

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 Life expectancy at birth in low-income countries is 18.1 years

lower than in high-income countries. Much of this difference is
attributable to preventable and treatable conditions.
 In low-income countries, one in 41 women die from maternal
causes. Such deaths rarely occur in upper middle and high-income
countries. Maternal deaths contribute more to differences in life
expectancy in low-income countries between men and women than
any other single cause.
 In low-income countries, more than a third of children are stunted
(short for their age), reflecting long- term nutritional deprivation,
and one child out of every 14 born will die before his or her fifth
birthday.
 In 2016, life expectancy in men was 4.4 years lower than for
women, with higher death rates for multiple causes, especially
cardiovascular diseases, road injuries, lung cancer, chronic
obstructive pulmonary disease and stroke. Men are generally
exposed to increased occupational risks, and have higher
prevalence of tobacco use and higher per capita consumption of
alcohol. In many settings, men use health services less than
women, even after taking into account reproductive-related
consultations. The health gap between men and women is widest
in high-income countries.

A ctivity 3
Read : World Health Organization List of Top 10 Threats to
Global Health. Compare & analyze the health situation with
your own locality.

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topic 2.0 NATIONAL HEALTH SITUATION

Let us now have an overview of the health status of the Philippines.

The Philippines is in
the Western Pacific and
belongs to the lower-middle
income according to the
World Bank. It has a
population of 110 million.
The life expectancy for women
is 72 and 65.3 for the male.

As a developing
country, the Philippines has
made significant investments
and advances in health in
recent years.

The graph below shows

the live births registered in
2018 which has a total of
1,668,120 a
crude rate equivalent to 15.8 or 16 births per thousand population.
The graph also showed a decreasing trend in the number of registered
live from 2012 to 2018. The decrease in the last six years was 6.8 percent,
from 1,790,367 live births in 2012 to 1,668,120 recorded births in 2018.

On the average, there were about 4,570 babies born daily or about
190 babies born per hour or approximately three babies born per minute.

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INFANT MORTALITY RATE

The infant mortality rate for Philippines in 2019 was 19.239

deaths per 1000 live births, a 2.16% decline from 2018. (Source: World
Bank ). The current infant mortality rate for Philippines in 2020 is
18.815 deaths  per 1000 live births, a 2.2% decline from 2019.

Below you will see data on mortality rates for this year (2020) as
reported by the Philippine Statistics Authority. As shown, the Infant
Mortality Rate is higher in males with 16.77/1,000 births than females with
12.54/1,000 births. You will also notice that there is the same trend in 1-4
years age group and under age 5 years old with males having the highest
mortality.

Deaths Per 1000 4.85 Per 1,000

Infant Mortality Rate 14.71 Per 1,000 Births

· Female 12.54 Per 1,000 Births
· Male 16.77 Per 1,000 Birth

Mortality Rate - Age 1-4 5.06 Per 1,000 Births

· Female 4.32 Per 1,000 Births
· Male 5.76 Per 1,000 Births

Mortality Rate - Under Age 5 19.69 Per 1,000 Births

· Female 16.81 Per 1,000 Births
· Male 22.43 Per 1,000 Births

MATERNAL MORTALITY RATE (PER 100,000 LIVE BIRTHS)

Complications during pregnancy and childbirth are a leading cause

of death and disability among women of reproductive age in developing
countries. The maternal mortality ratio represents the risk associated
with each pregnancy, i.e. the obstetric risk. The United Nations reported
that thousands of Filipino women continue to die due to complications
related to childbirth. But that was in 2009.

The Philippines Maternal Mortality Rate (MMR) for 2017 was 121.00,

a 2.42% decline from 2016.  For 2016 it was 124.00, a 2.36% decline from
2015 and in 2015 was 127.00, a 3.05% decline from 2014. The downward
trend in the MMR suggests an improving maternal health services like pre-,
peri-, post- natal, vaccination, early referral system and follow-up care.

The overall view of the health status of our country, the Philippines,
shows that Filipinos live longer and healthier in this current times, except
that there is an increase in the morbidity and mortality rates due to the
CoViD-19 pandemic.

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To back tract, the health status of the Philippines prior to the

pandemic, and as presented in the Global Health Observatory report dated
May 2017, there was a rapid economic growth and strong country
capacity that have contributed to Filipinos living longer and healthier.
However, not all benefits of this growth have reached the most vulnerable
groups, and the health system remains fragmented. The following findings
were included in the report:

 Health insurance now covers 92% of the population.

 Maternal and child health services have improved, with more
children living beyond infancy, a higher number of women
delivering at health facilities and more births being attended by
professional service providers than ever before.
 Access to and provision of preventive, diagnostic and treatment
services for communicable diseases have improved, while there are
several initiatives to reduce illness and death due to non-
communicable diseases (NCDs).

Despite substantial progress in improving the lives and health of

people in the Philippines, challenges remain because of inequities that
persist between regions, rich and the poor, and different population groups.

 Many Filipinos continue to die or suffer from illnesses that have

well-proven, cost-effective interventions, such tuberculosis, HIV
and dengue, or diseases affecting mothers and children.
 Many people lack sufficient knowledge to make informed decisions
about their own health.
 Rapid economic development, urbanization, escalating climate
change, and widening exposure to diseases and pathogens in an
increasingly global world increase the risks associated with
disasters, environmental threats, and emerging and re-emerging
infections.

We are done with Module 1. Congratulations for finishing all the

activities! However, you still have to answer some exercises. You will be
graded or scored based on the rubric presented. GOODLUCK!

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A ctivity 4

1. Discuss the 2019 health status of the Province of Northern

Samar in terms of the following criteria: (a) life expectancy, (b)
infant mortality rate and (3) maternal mortality rate.
Compare 2019 data with that from the past 5 years (2014-
2018).

2. Compare the 2019 Provincial data (from #1) with that from
your own municipality of the same year. Include the
economic factor in your discussion.

3. How do the Top 10 global threats listed by the WHO affected

the health status of your municipality?

4. What is the relevance of knowing the global and national

health situation to you as future nurse?

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RUBRICS

CRITERIA MINIMAL FAIR GOOD EXEMPLARY

1 2 3 4
OBSERV- Makes a very Offers only a Describes most Thoroughly
ATION brief or basic description of the criteria of and
erroneous of the required the sources accurately
attempts at criteria of the correctly. describes
identifying the sources and may criteria of the
required include errors. findings.
criteria of the
sources.
INTERPRET- Is not able to Offers 1 example Explains & Explains &
ATION place any of in which criteria gives examples gives
the criteria of of the sources is of the meaning examples of
the sources in placed in a & usefulness of the meaning
a broader broader context. more than 1 & usefulness
context. but not all of of all of the
the sources sources &
placing them in placing them
a broader in a broad
context. context.
EVALUATION/ Does not offer Asks questions Able to ask Able to ask
CRITICAL any additional about 1 criteria questions questions
THINKING information of the sources about more about all of
about the regarding its than 1 but not the criteria of
criteria besides validity, all of the the sources
what is already limitations, & criteria of the regarding
provided. strengths sources their validity,
regarding their limitations, &
validity, strengths
limitations, &
strengths
RESEARCH Shows no Demonstrates Shows some Exhibits
SKILLS awareness of limited awareness of ability to look
how to find knowledge of additional for new
additional where to look for resources both sources and
resources. Was additional primary & recognize the
not able to resources. secondary. existence of
come up with Shows limited Demonstrates the additional
new sources. ability to look for some ability to resources
new sources. look for new both primary
sources. & secondary.

F EEDBACK:

How did you find the activities of the lessons? Did you find it relevant
and appropriate? How about the pacing of our lesson against the targeted
deadline of submission?

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S OURCES:

WHO Director-General's opening remarks at the media briefing on COVID19

- 11 March 2020

World Health Statistics Overview 2019, Monitoring Health For The

ustainable Development Goals (SDGs)

https://www.who.int/gho/child_health/mortality/neonatal_infant_text/en/

https://www.who.int/pmnch/media/press_materials/fs/
fs_mdg4_childmortality/en/

https://www.britannica.com/science/life-expectancy

https://www.who.int/healthinfo/statistics/indmaternalmortality/en/

https://psa.gov.ph/content/births-philippines-2018

https://www.npr.org/sections/goatsandsoda/2020/04/28/847453237/
what-is-who-and-what-does-it-do

https://www.who.int/pmnch/media/press_materials/fs/
fs_mdg4_childmortality/en/

https://www.who.int/news-room/feature-stories/ten-threats-to-global-health-in-
2019

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