It is now an accepted fact that the aggregated impacts of human population size and economic activity on various biophysical systems of the world has drastically contributed to widespread environmental changes. The most alarming and extensive of these environmental changes is anthropogenic climate change, with the hydrological and atmospheric systems of the planet exceeding their regenerative and repair capacities. It is apparent that the rapid economic expansionism of the 20th and 21st century created an unprecedented overload of Earth’s ecological systems that scientists have now concluded that “it is extremely likely that human influence has been the dominant cause of the observed warming since the mid-20th century” (IPCC, Working Group II 5th Assessment Report, 2014).
One impact of climate change is on a population’s health. Higher temperatures trigger the surge of diseases such as dengue, malaria, cholera and typhoid. Changing climate also brings in new health consequences “such as heat-related mortality in Europe, changes in infectious disease vectors in some areas, and allergenic pollen in Northern Hemisphere, high and mid-latitudes” (IPCC Synthesis Report, 2007). Increasingly frequent and intense disasters displace thousands of people in many communities and increases their vulnerability to health risks in evacuation centers. This unfamiliar situation of humankind overloading Earth’s carrying capacity presents a challenge to researchers in the field of Medical Anthropology: given the plausible future scenarios of climatic changes, how can one best estimate its consequences for human health at the same time approximate the adaptive capacities of individuals and communities? How to do these with utmost consideration to the intimate interplay of human systems (political, social and cultural)?
Understanding disease risks brought by a changing environment requires studying a larger contextual framework that will include social, economic, cultural and political structures (Martens and McMichael, 2002: 27). The recognition that there are complex underlying environmental, social, cultural and political systems which, when perturbed or changed, may alter the pattern of health outcomes, has been one of the contributions of Critical Medical Anthropology (CMA) in the field of Public Health Studies. CMA also recognizes that the fundamental problem of social inequality (e.g. unequal access to health services) expounds the impact of disease risks in vulnerable communities (Baer, et al., 2003: 3).
On the other hand, the prospect that climate change and other environmental changes will affect health poses radical challenges not only to researchers but also to policymakers. Given the uncertainty of the magnitude and extent of climate change impacts, policymakers most often adjust to working with incomplete information and with making “uncertainty based” policy decisions. Often, policymakers work with a “wait-and-see attitude,” falling for the false assumption that scientists can provide final and precise truths with regard to climate change. All the while, civil society organizations and the academe have been raising the concept of Precautionary Principle in order to minimize the chance of low probability but potentially devastating outcomes (Martens and McMichael, 2002: 27).
This paper approaches the climate change and health interplay by employing the critical medical anthropology perspective in the reading of different Philippine national and local legislations on climate change. It will try to dissect these policies to answer the questions: What effect does the global capitalist system have on how these policies were written? How do these policies define and describe how health resources be allocated and accessed? A progressive contextualization will also be utillized starting with the macro-level global economic context and then working towards the micro-level local context of South Cotabato’s policies on climate change and its impact on health resource allocation.
As an exercise in Critical Medical Anthropology, the bias is towards biomedicine as the medical health system referred to.
The Critical Theoretical Framework in Medical Anthropology
Critical theory springs from the neo-Marxist philosophy of the Frankfurt School, which was developed in Germany in the 1930s. It maintains that ideology is the principal obstacle to human liberation. Modern critical theory has been influenced by György Lukács and Antonio Gramsci, as well as the second generation Frankfurt School scholars, notably Jürgen Habermas. Contemporary critical theory studies the social “base and superstructure” concept formulated by Karl Marx. The critical approach in medical anthropology uses the critical theoretical framework with focus on the political economy of health and health care. Political economy, from an anthropological perspective, includes the study of producing and exchanging goods, and the influence of government policy and capitalism on all aspects of life. When applied to studying health and health care, the political economy of health may include ways in which health services are differentially allocated based on wealth, and ways in which policy impacts health and delivery of health services. Political economy of health is a central component of critical medical anthropology, and a critical approach to medical anthropology seeks to uncover hidden causes of poor health as they relate to capitalism and neoliberal economics while examining health structures on a macro and micro level. In other words, critical theory in medical anthropology seeks to find the social origin of disease (Baer, et al., 2003: 53)
Critical medical anthropology (CMA) has been strongly shaped by the medical anthropologist Merrill Singer. Singer promotes using CMA as an approach to researching health because of its applied focus, noting that medical anthropologists must critically question how situations for their research participants can be improve (Singer, 1989). CMA is therefore a theoretical lens to inspire action and engagement in what Singer terms “system-challenging praxis”; that is, actions undertaken in order to challenge larger structures with the goal of producing a meaningful social change. Engaging in system-challenging praxis involves “unmasking the origins of social inequity, and exposing the relationship between social inequity and living and working conditions (Singer, 1989). Work from this perspective understands societies as involving class conflict and sees the state apparatus and medical-health systems as mediating this conflict in favour of the ruling class in capitalist societies. The historical developments and political -economic conditions are viewed as primary, with value orientations and beliefs flowing from these fundamental conditions (Singer, 1989).
CMA is a critique and answer to the prior theoretical framework of interpretive medical anthropology where there there is an “obfuscation of restricted microlevel focus” (Singer, 1989). In Interpretive Medical Anthropology where there is focus on “the ritual and symbolic realm in culture, [while] the political and economic issues which affect the health and health behavior of populations [are] not widely considered.” CMA critiques the interpretive framework as reducing medical anthropology to an examination of the cultural determinants of illness, curing, and resistance to biomedicine with little consideration of “the importance of the social formations in which ‘cultural factors’ occur”. CMA further critiques the prior theoretical frameworks as giving no attention to institutional actors with major parts in the health field internationally, such as manufacturers of medical commodities, government health and development agencies, international lending institutions, professional medical associations, and private health foundations (Singer, 1989).
Nancy Scheper-Hughes is also an important figure in critical medical anthropology, arguing that “CMA combines the intersections of personal, social, and political bodies” (Singer, 1989). Scheper-Hughes notes the shortcomings in the work of some social anthropologists and argues that social anthropology fails to explore the meaning of the body beyond a symbol upon which social meaning is inscribed. Similarly, Scheper-Hughes claims that some theorists ignore individual perspectives about illness, highlighting Michel Foucault’s work on biopower – the inseparability of the body from the will of the political apparatus (the State). Scheper-Hughes argues that Foucault describes the body in a way that is “devoid of subjectivity,” or lacking in a description that encompasses individual perspectives (Singer, 1989). CMA, however, fills the voids left by earlier social anthropologists and cultural theorists by understanding that the body is the “terrain where social truths are forged and social contradictions played out, as well as the locus of personal resistance, activity, and struggle”. In other words, CMA understands that the body and the patient are impacted by larger, unseen social forces but that individuals also have a stake in their bodies, and are not simply agents to these larger social forces. Critical medical anthropology therefore “blends an understanding of how structural forces are acted upon the body with an acknowledgement of individual agency” (Singer, 1989).
Critical Medical Anthropology (CMA) takes a very different approach to looking at questions regarding health. CMA believes that there exists a hegemonic relationship (as per Gramsci’s use where a dominant practice results in a predictable and controllable social consciousness) between the ideology of the health care system and that of the dominant ideological and social patterns. More simply put, a political economy approach. CMA views disease as a social as well as a biological construct (Baer et. al., 1997:35-36). Critical Medical Anthropologists examines issues such as who have the power over certain social institutions, how and in what form is this power delegated, and how this power is expressed (Baer et. al. 1997:33-35). In effect, Critical Medical Anthropologists try to deconstruct the medical science and expose the fact that all science is influenced by cultural and historical conditions, much like the social constructionist approach.
Merrill Singer also delineated some of the concerns within CMA: Examination of the social origins of disease and ill health in light of the world economic system; Analysis of health policy, health resource allocation and the role of the State in Third World Nations; Re-thinking of the contemporary understanding of medical pluralism; Development of a critique of biomedical ideology, practice, and structure; Attending to the role of struggle in health and health care; Re-examination of the microlevel of the individual, including illness behavior and illness experience within the context of macro level structures, processes and relations; and Investigation of health and health programs in socialist-oriented countries (Singer, 1989).
A Brief Survey of National and Local Policies on Climate Change
This section outlines the historical development of Philippine policies on climate change culled from the study conducted by the Tebtebba Foundation (Magata, Helen, et. al. 2010: 224-225). This brief survey aims to describe the significant milestones of the Philippine government in responding to climate change through various participations in global agreements and conventions and by pushing for local policies and programs.
Inter-agency Committee on Climate Change (1991)
This committee was created to coordinate various climate change related activities, propose climate change policies and prepare the Philippine positions to the the United Nations Framework Convention on Climate Change (UNFCCC) and other issues relative to climate change.
Signing of the UNFCCC (1992)
The signing of the Republic of the Philippines to the UNFCCC committed the country to the UNFCCC provisions on non-Annex 1 (developing countries) parties. This led to a Greenhouse Gases inventory in 1994 that became the basis of the country’s initial national communication on Climate Change to the UNFCCC in 1999.
Clean Air Act (1999)
This Act outlines the government’s measures to reduce air pollution and incorporate environmental protection into its development plans. This led the government to partner with different organizations such as Partnerships for Clean Air and Clean Air Initiative for Asian Cities Center to do information and education campaign and workshops on air quality management and sustainable transport.
Signing of the Kyoto Protocol (2003)
This Protocol sets binding targets for 37 industrialized countries and the European community for reducing greenhouse gas emissions. These amount to an average of 5 percent against 1990 levels over the 5-year period between 2008-2012. This led to the setting up of a Designated National Authority for Clean Development Mechanism (CDM). As of 2005, waste management projects, renewable energy and afforestation and reforestation were on the CDM pipeline for the Philippines.
Biofuels Act (2006)
This Act seeks to reduce dependence on imported fuels with due regard to the protection of public health, the environment, and natural ecosystems consistent with the country’s sustainable growth that would expand opportunities for livelihood by mandating the use of biofuels. This led to oil companies submitting themselves to the mandatory use of biofuels in the Philippines.
Renewable Energy Act (2008)
This Act seeks to promote the development of renewable energy resources and its commercialization. It aims to achieve this by providing incentives to institutions that invest in the sector. A National Renewable Energy Board has been created to accelerate the setting up of mechanisms and incentives critical to the implementation of the law.
Climate Change Act (2009)
This Act created a Climate Change Commission that would formulate and implement plans for the country to better prepare for and respond to natural disasters and it also aims to attract foreign financing for adaptation and risk reduction projects.
Philippine Disaster Risk Reduction and Management Act (2010)
This law mandated a nationwide disaster-risk reduction and management policy that goes down to the barangay level. The law also created the National Disaster Risk Reduction and Management Council (NDRMC), an agency tasked with crafting and implementing disaster-risk reduction policies.These policies are implemented by local disaster-risk reduction and management councils with the NDRMC coordinating relief, recovery, and reconstruction operations.
People’s Survival Fund (Republic Act no. 10174 of 2012)
A People’s Survival Fund was legislated to be used in support of adaptation activities of local governments and communities such as: adaptation activities in the areas of water resources management, land management, agriculture and fisheries, health, infrastructure development, natural ecosystems; improvement of the monitoring of vector-borne diseased triggered by climate change, and in this context improving disease control and prevention; forecasting and early warning systems; supporting institutional development for local governments, in partnership with local communities and civil society groups for preventive measures, planning, preparedness and management of impacts relating to climate change, including contingency planning, in particular, for droughts and floods in areas prone to extreme climate events.
The various Philippine policies and programs responding to climate change have been heralded by different environmentalists and civil society organizations as serious efforts towards a clean and green environment, and mitigation of climate change impacts. The Renewable Energy Law, for example, has caused quite a stir among environmental activists. Even Greenpeace has praised the government for its passage (Magata, Helen, et. al. 2010: 232). Yet despite the passage of these laws, critics argue that they do nor really acknowledge the main roots of the crisis which is unsustainable and destructive global economy and production. The Philippine government has also yet to call for deep and drastic cuts of greenhouse gas emissions from developed counties and impose greater tariffs or stricter requirements, including only clean or climate proof foreign business investment in the country.
Another noteworthy apprehension in these laws is the lack of an explicit health-related provision on funding health resources that would address the perceived rise in climate change- related diseases. Although the RA 10174 provided for “improvement of the monitoring of vector-borne diseased triggered by climate change, and in this context improving disease control and prevention [italics provided],” it is noticeable that it only deals with monitoring of diseases and precludes any actions to the improvement of access.
Major National Legislations on Access to Health Resource
Mandatory Universal Accessible, Cheaper, and Quality Medicines Act (2008)
With regard to access to health resources, a law was also signed in 2008 to provide cheaper but quality medicines to Filipinos. Sen. Loren Legarda, senate committee chair on climate change, describes the health-climate connection in a privilege speech:
“In 1998, when the Philippines experienced the El Niño phenomenon, almost 40,000 dengue cases, 1,200 cholera cases and nearly 1,000 typhoid fever cases, were recoded nationwide. These sicknesses make our population more vulnerable, especially those who cannot afford health care, much less health insurance. We must strengthen our people’s health to make them resilient against diseases that the change in climate may bring. It is for this reason that I advocate the passage of the Mandatory Universal Accessible, Cheaper, and Quality Medicines Act, as well as a bill providing for the nutrition workers in every barangay.
These laws shall ensure that proper healthcare and accessible, cheaper and quality medicines and knowledgable nutrition workers will on hand to help our citizens, especially the poor, avoid diseases heightened by warmer temperatures. (Sen. Loren Legarda, “State of the Climate,” Privilege Speech given on August 10, 2010.)”
The law was signed in 2008 and it amended Republic Act No. 6675 or the Generics Act of 1988, Republic Act No. 8293 or the Intellectual Property Code, and Republic Act No. 5921 or the Pharmacy Law. The law allows the parallel importation of patented medicines from other countries where they are more affordable. It also bars the grant of new patents based only on newly-discovered uses of an ingredient of an existing drug. Generics firms will be allowed to test, produce, and register their versions of patented drugs. The law also empowered the President to “impose price ceilings on various drugs upon the recommendation of the Health Secretary” of the Department of Health (DOH). Drug outlets will be required to carry a variety of medicine brands, which include those sourced through parallel importation – giving consumers more choices. The Law also creates a congressional oversight committee, such as the Quality Affordable Medicines Oversight Committee, to monitor the implementation of the “Cheaper and Quality Medicines Act.”
National Health Insurance Act of 2013 (RA 7875 as amended by RA 9241 and 10606)
The National Health Insurance Program (NHIP) created under Republic Act 7875 implemented by the Philippine Health Insurance Corporation (PHIC or Philhealth) is the mandatory social health insurance program in the country. The purpose is for every Filipino to have social health insurance coverage and access to quality health care facilities.
The Philippine Health Insurance Corporation (PhilHealth) and Department of Social Welfare and Development (DSWD) formalized their partnership to provide and secure health care for the poor as they signed a Joint Order on November 6, 2012. The Joint Order will benefit more than five million poor household-beneficiaries of the Pantawid Pamilyang Pilipino Program (4Ps) to uplift their quality of life by not only providing financial assistance but also by extending the needed health care benefits should sicknesses come up among beneficiary families. Entitlements also apply to primary care benefits such as consultations, regular blood pressure monitoring, and promotive health education on breastfeeding and counselling on lifestyle modification and smoking cessation. Medicines for diseases like asthma and acute gastroenteritis with no or mild dehydration, upper respiratory tract infection/pneumonia and urinary tract infection are also provided for by accredited healthcare providers.
In South Cotabato, for instance, around 11,000 poor families have been enrolled by the provincial government under the sponsored health insurance program of Philhealth. Under the program, the province allocated P 1,800 each for the premium contribution of the enrolled indigent families. Philhealth has also implemented the expanded health insurance coverage scheme for their members in South Cotabato (Balita.ph, 12 March 2014).
South Cotabato’s Environment Code (Provincial Ordinance no. 4 s. 2010)
The Environment Code of South Cotabato mandates a local network that will promote and sustain relevant, efficient strategies and modern technologies for the protection of the environment and natural resources, as well as ensure ecologically sound and sustainable development in the province. It also establishes policies and mechanisms for the protection, preservation and management of the province’s natural resources, as well as ensuring the strict enforcement of environmental laws, regulations, policies and issuances. It provides provisions for the management and protection of forests and watershed systems in the jurisdiction of South Cotabato; management of air quality, water quality and noise pollution; and provides a framework and management plan for local climate change action. While the most popular provision in South Cotabato’s Environment Code is the ban on open-pit mining in the province, it actually covers an extensive repertoire of environmental conservation and protection which considers principles of “intergenerational responsibility,” “carrying capacity of an ecosystem,” “precautionary principle,” and “conservation ethic” among others.
What then are the drivers for these national and local legislations? How does the development of national and local laws connect with the patterns of global discussions on climate change? And how does the global economy affect the creation of such laws? To answer such questions, we go back to the general presupposition of Critical Medical Anthropology, that “there exists a hegemonic relationship between the ideology of the health care system and that of the dominant ideological and social patterns” (Baer et. al., 1997:35-36).
Economizing Climate, Impacting Public Health
Capitalism’s inherent tendency to expand serves to escalate commodity production, which necessitates the burning of fossil fuels to power the machinery of production. As this process unfolded historically, it served to disturbed the natural carbon sinks and generate an accumulation of carbon dioxide in the atmosphere. The accumulation of greenhouse gases in the atmosphere, such as carbon dioxide, resulted to drastic changes in the Earth’s climates which, in turn, forecasted impacts on health. The connection between capitalism, climate change and health has been observed by the IPCC in its 2007 report stating that “until mid century climate change will act mainly by exacerbating health problems that already exist.”
In the Philippines, capitalism with a strong neoliberal attitude first came in “the form of the structural adjustment program imposed by the World Bank in the early 1980’s, in the latter’s effort to strengthen the economy’s capacity to service its massive external debt” (Bello, 2009). Walden Bello in a paper presented to the National Conference of the Philippine Sociological Society said that the neoliberal perspective triumphed by default in the early 1980s due to the ascendancy of several high-powered activist intellectuals and technocrats close to the Aquino administration who had been greatly influenced by the Reagan and Thatcher free-market experiments in the United States and Britain. These included economist Bernie Villegas and Cory Aquino’s secretary of finance Jesus Estanislao. Bello also cited the emergent neoliberalism of the University of the Philippines School of Economics, which had drafted the extremely influential anti-Marcos White Paper on the Philippine economy in 1985. This rise of neoliberalism in the country was also complemented by four developments internationally: the collapse of centralized socialism in Eastern Europe, which seemed to deliver the coup d’grace to the socialist alternative; the crisis of the Swedish social democratic model; the seeming success of the Reagan and Thatcher Revolutions in revitalizing the American and British economies; and the rise of the East Asian newly industrializing countries. All four had an impact on the thinking of the middle class and the elites, which are, incidentally, called the “chattering classes” because of their central discursive role in legitimizing social and political perspectives. (Bello, 2009)
This neoliberal capitalist ideology is reflected in the National Economic Development Authority’s Development Plan for 2011-2016, with its seeming addiction to expansionism and growth: “ investment must continually rise for the economy to grow and absorb labor into productive jobs. Being a bet on the future, investment requires a stable and predictable market environment. Macroeconomic stability, supported by sound monetary and fiscal policy, a strong financial system, and healthy external sector, is thus essential to maintaining positive consumer and business expectations about the future” (NEDA, 2014: 6). With this growth fixation on the economy, it is no wonder that policies on climate change fail to “acknowledge the main roots of the crisis which is unsustainable and destructive global economy and production” (Magata, Helen, et. al. 2010: 232). The Philippine government’s disregard for deep and drastic cuts of greenhouse gas emissions from developed counties and calls for the imposition of greater tariffs or stricter requirements, including only clean or climate proof foreign business investment in the country, is palpable with the seduction of foreign investors to put up more coal-fired power plants and mining ventures in the country.
The global economy is also under this same neoliberal capitalist ideology especially with the growing globalization of the world economy and increased integration of regional economies such as the Association of Southeast and East Asian Nations (ASEAN)-Integration which will be on full blast in 2015 especially with its free trade regime that aims to lower tariffs and minimize government intervention in trade.
This is dramatically confounding because while there were several summits (UN Climate Change Conference, yearly since 1995) on the climate change and how best to address the crisis, the paramount economic ideology of neoliberalism and free trade, is a disconnect to these summits’ general call to decarbonize the economy. Growth, as perpetuated by neoliberalism, means vastly more energy (Pielke, 2010: 62), which would exacerbate climate (and correlatively – health) insecurities.
This economy-environment tradeoff is reflected in the degree of bias against adaptation rather than on mitigation, in most of the Philippine policies on climate change. The Disaster Risk Reduction Management Act and Climate Change Act “has no legally binding targets on greenhouse gas emissions and it has no targets on renewables” (Smith, 2012). For decades, the options available to deal with climate change have been clear: we can act to mitigate the future impacts of climate change by addressing the factors that cause changes in climate; and we can adapt to changes in climate by addressing the factors that influence societal and environmental vulnerabilities to the effects of the climate. Mitigation policies focus on either controlling the emissions of greenhouse gases or capturing and sequestering those emissions. Adaptation policies focus on taking steps to make social or environmental systems more resilient to the effect of climate. Effective climate policy will necessarily require a combination of mitigation and adaptation policies. However, climate policy such as the Climate Change Act of 2009 reflects this bias against adaptation. The People’s Survival Fund also ensures adaptation by focusing on funding mechanisms yet “fails to integrate adaptation with mitigation strategies, such as transitioning to renewable energy systems” ( gmanetwork.com, 5 April 2014).
Although the health impacts of climate change have been seen as a “foreseeable future,” there is some disagreement about the magnitude of those effects, when they will occur and what the right course of action is. Decisions and policies on public health has to work on a level of uncertainty in terms of what the main threats to health are, in the short, medium and long term.
Underpinning those disagreements in health effects is the acceptance of the fundamental structure of capitalism, with the differences being around whether climate change requires more immediate public policy and health professional intervention or whether capitalism will address the health issues though economic development. The debates run on whether more progress on economic growth and development will answer the health threats. The IPCC itself in its report also states that “rapid economic development will reduce health impacts on the poorest and least healthy groups, with further falls in mortality rates.” Alongside poverty alleviation and disaster preparedness, the most effective adaptation measures are: “basic public health measures such as the provision of clean water, sanitation and essential healthcare.” This has clear emphasis on economic development and poverty alleviation which accepts the basic tenets of growth capitalism and stressing the neoliberal attitude of the market able to fix social woes. The position taken by some conservatives is that humanity needs more capitalist economic and technological development even if that results in a warmer world. Some points out that we are living longer and healthier lives than ever before thanks to economic development and growth. Therefore, inductively, we need more growth, and that humanity should strive to achieve more in terms of economic development.
Hans Baer, on the other hand, stresses that indeed, the root cause of the climate crisis is capitalism, a global economic system that “systematically exploits human beings and the natural environment”. He concludes that we need “a vision of an alternative world system, one based on two cardinal principles – namely social equity and justice and environmental sustainability.” He adds that environmental destruction is inherent to capitalism because it thrives only on “profit-making” and “continued economic expansion”. Unable to jump off its “treadmill of production and consumption”, the system must continue to generate ever higher levels of waste and consumption, even though this threatens life on the planet in the long run. (Baer, 2012)
South Cotabato’s Environment Code, while it actively promotes for environmental protection and conservation, is still a product of this overarching neoliberal hegemony – which sees the environment as a resource, that is, for eventual exploitation. Provisions such “Forest Resource Management Framework,” “Resource Profiling,” “Genetic Resource Base,” and “Ecological Tourism” among others, suggests a framework that accommodates the overall “development” plan of the government which is inherently defined by a neoliberal ideology. South Cotabato is of course part of NEDA’s Development Framework for Mindanao 2010-2020, which banners the objective of “harnessing the full potential of Mindanao’s rich resources” (p 8). South Cotabato’s Agro-Industrial Zone, with its DOLE centerpiece in Tupi, is an intense drive towards resource-based industrialization which can only be characterized as neoliberal in practice and principle. Addressing the impacts of heavy industrialization and influx of foreign corporations in South Cotabato, the Environment Code sets up mechanisms for monitoring, cooperation between agencies, and penal provisions for violation of the code. Yet, the problem exists when in the same code, utilization and exploitation are coupled with protection and conservation. This may be because of the same schizophrenia which affects the very department that exploits and then protects the environment, that is, the Department of Environment and Natural Resources, which by its very name regards the environment as a resource. The website of the Provincial Government of South Cotabato itself, in its “General Information” button has a “Mineral Resources” item, enticing prospectors: “South Cotabato is rich in mineral resources especially in the mountainous areas of the municipality of Tampakan where Gold and Copper deposits are found. The municipality of T’boli is also a source of gold particularly in Brgy. Kematu” (http://www.southcotabato.gov.ph/mineral-resources/, October 30, 2014). The Code’s claim to environmental protection and conservation is placed under doubt.
Climate Change action in South Cotabato’s Environment Code is partnered with Disaster Risk Reduction with no explicit provision connecting health and climate. While it indeed adopts explicit measures with regard to protection and management of natural resources, its public health access provision is limited to that of sanitation, specifying that the “Provincial Government shall adopt appropriate measures to assist city/municipal governments improve environmental sanitation by expanding the use of sanitary toilets for waste disposal. Such assistance shall include direct investments in public health education and strict enforcement of the Building and Sanitation Code” (Article III, Section 36). This may be because of the single-subject rule in law which stipulates that legislation may deal with only one main issue, yet the emerging concern for the interplay between health and environmental changes must not be downplayed. As it turns out, local ordinances on health resource access are mere implementations of national policies (i.e. Mandatory Universal Accessible, Cheaper, and Quality Medicines Act), without the necessary connection to the drastic surges in diseases caused by anthropogenic environmental changes which could have been accommodated in the provincial code.
South Cotabato’s health profile is characterized by acute respiratory infections leading the cause of morbidity for all ages in the province. It reaches a total of 490 cases while cancer in all forms remain second, with a total of 314 cases. Other diseases, such as diarrhea, influenza, acute bronchitis and broncholitis, hypertensive and glomerular & renal diseases were also included in the top ten leading causes of morbidity. Lifeystyle related diseases, such as cardiovascular diseases, cancer in all forms and diabetes remain as the leading cause of death. Dengue and malaria cases likewise drastically increased. (Provincial Investment Plan for Health, 2010: 14)
In answer to the health needs of South Cotabato, the Provincial Investment Plan for Health (2010) of South Cotabato includes upgrading of facilities, improvement of primary health care service network, expansion of the drug revolving fund, and inclusion of user fees for health services in the local tax revenue code, among others. Implementation of the Plan costs about P 324 million over the five years. More than half was spent for service delivery, while more than 20 percent of the financing component was comprised of Philhealth premium contributions. More than 70 percent are for maintenance and operating expenses. The province was also a recipient of a grant from the European Commission for implementation of the plan.
Although South Cotabato’s Health Plan is being strengthened to provide basic health service, how much of these local health policies are integrated with the climate change framework? How adequate are these measures in addressing the foreseen effects of climate change to health? For instance, it’s been forecasted that climate change will enhance the spread of some diseases. This disease-causing agents or pathogens, can be transmitted through food, water, and animals such as bats, birds, mice, and insects. Climate change could affect all of these transmitters. Aside from the more known impacts of heat waves, extreme weather events, and reduced air quality, some climate change-related diseases are as follows (US Environmental Protection Agency, http://www.epa.gov/climatechange/impacts-adaptation/health.html):
- Higher air temperatures can increase cases of salmonella and other bacteria-related food poisoning because bacteria grow more rapidly in warm environments. These diseases can cause gastrointestinal distress and, in severe cases, death.
- Flooding and heavy rainfall can cause overflows from sewage treatment plants into fresh water sources. Overflows could contaminate certain food crops with pathogen-containing feces.
- Heavy rainfall or flooding can increase water-borne parasites such as Cryptosporidium and Giardia that are sometimes found in drinking water. These parasites can cause gastrointestinal distress and in severe cases, death.
- Heavy rainfall events cause stormwater runoff that may contaminate water bodies used for recreation (such as lakes and beaches) with other bacteria. The most common illness contracted from contamination at beaches is gastroenteritis, an inflammation of the stomach and the intestines that can cause symptoms such as vomiting, headaches, and fever. Other minor illnesses include ear, eye, nose, and throat infections.
- Mosquitoes favor warm, wet climates and can spread diseases such as West Nile virus, Dengue and Malaria.
- The geographic range of ticks that carry Lyme disease is limited by temperature. As air temperatures rise, the range of these ticks is likely to continue to expand northward. Typical symptoms of Lyme disease include fever, headache, fatigue, and a characteristic skin rash.
Few people are aware of the impact climate change may have on health even though the effects are serious and widespread. Disease, injury and death can result from climate-induced natural disasters, heat-related illness, pest- and waterborne diseases, air and water pollution and damage to crops and drinking water sources. Children, the poor, the elderly, and those with a weak or impaired immune system are especially vulnerable to climate change-related diseases. Public policy in the national and local levels have a spiralling impact on an individual’s and community’s health as structural (in this case, State) forces are acted upon the body.
As Critical Medical Anthropology asserts, the body is impacted by larger, unseen social forces. In this case, the neoliberal regime in the global economy impacts decision making in the national level, as in the bias towards adaptation rather than mitigation, then spiralling down to local decision making, as in South Cotabato’s resource framing of its Environment Code. This snowball effect has tremendous impact on the individual who might already be feeling the brunt of climate change-induced diseases.
This exercise in Critical Medical Anthropology proves that national policymakers exert powerful forces that influence how local, regional policies are also crafted, as well as greater global forces that exert their force on these national policymakers. The individual, right in the center of these powerful forces, becomes the locus of discourse, activity, and struggle
Yet individuals have a stake in their own bodies, and are not simply agents to these larger social forces. Active participation in government processes may be one way of asserting agency in an unjust system, but a serious level of behavioral change is also sought in adjusting to today’s world where the neoliberal attitude of acquisition is pervasive but resources are limited, and where resource exploitation can lead to further human exploitation, affecting not only the current generation but also future generations.
Balita.ph. 12 March 2014. “11000 poor families in South Cotabato enrolled with Philhealth in 2013.” Accessed in http://balita.ph/2014/03/12/11000-poor-families0in-south-cotabato-enrolled-with-philhealth-in-2013, retrieved on October 29, 2014.
Baer, Hans A., Merrill Singer, and Ida Susser. 2003. “Theoretical Perspectives in Medical Anthropology”. In Medical Anthropology & the World System, 31-54. Wesport Connecticut, and London: Praeger.
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