INTRODUCTION

The social determinants of health refer to an individual's social, political, and economic situation and environment, which can have an impact on their health. On the other hand, disability-adjusted life years (DALYs) reflect the mortalities and morbidities incurred due to disease and injury.

This study aims to analyze the social determinants of health indicators and their association with communicable, non-communicable, and injury-related DALYs and deaths.

Data from World Health Organization, World Bank, and International Labor Organization were used and considered for the 17 Social Determinants of Health categories. Logistic regression was used to determine the relationship of social determinants of health indicators with communicable, non-communicable, and injury-related DALYs and deaths.

Results show that an increase in the population, monetary poverty, adult illiteracy, and fine particulate matter increase IPNN DALYs. This study also found correlations of socioeconomic factors to NCD deaths and DALYs attributable to the environment. NCD DALYs and deaths are found to increase with the number of poor living with 3.10 dollars a day, while median daily per capita income, and increase in persons above retiring age receiving pension decrease NCD DALYs attributable to the environment. Focusing on injury DALYs and deaths, an increase in the number of poor living at 3.10 dollars a day, non-agricultural informal employment, and total average concentration of f ine particulate matter increases injury DALYs while the latter is observed to decrease when there is an increase in the medial daily per capita income, agricultural employment outside the formal sector, and vulnerable persons covered by social assistance.

Socio-economic factors such as income, employment, education, and social welfare program affect morbidity, disability, and mortality.

Introduction: Small-scale mining (SSM) has been in the Philippines since the early 1900s and significant contributor to the local economy. SSM has contributed 14% of the country's total Gross Domestic Product and has a revenue share of about 19 billion pesos (380 million USD). Objectives: This study aims to document mining occupational safety and health in SSM in the Philippines and identify best practices among miners and communities to reduce toxic chemical use in mining. It also aims to evolve laws and legislative measures on mining in the country as the basis for more aggressive policies and programs for SSM in the Philippines. Methods: The data were based on gray literature, peer-reviewed journals, databases, government statistics, and secondary literature. Data were analyzed through critical appraisal on the impacts of mining in terms of occupational safety, mining issues, hazards, and disasters, environmental and health impact, as well as documentation of best practices in mining to reduce the use of toxic chemicals, and the current laws and legislations on mining in the Philippines. Results: SSM or artisanal mining is categorized as part of the informal sector of the market economy. In the Philippines, the leading types of accidents in the mines are being hit by falling objects, suffocation from chemical fumes, and crushing injuries, exposure to intense heat, poor ventilation, vibration, dust, fumes, repetitive stress injury, intense noise, manual handling (e.g., lifting) of heavy machinery, and biological and chemical hazard. Occupational illnesses include skin diseases, emphysema, chronic obstructive lung disease, and hearing loss. Due to these risks, the Philippines has adopted mercury-free mining, cyanide reduction, and green and climate-smart mining. The use of borax in recovering gold from ore instead of mercury originated in the Philippines, which is now widely known as the mercury-free gravity-borax method adopted in Africa and Asia. The Philippines also has a plethora of laws covering mining as a whole. Developmental directives include enacting specific SSM laws and regulations, including a separate set of safety rules, and decentralizing the issue and control of SSM permits and licenses through local government units. Some noted legislative measures, Presidential Decrees, and Administrative Orders have been crafted to cover the safety net, equity, safety, and health for small-scale miners, among the most vulnerable working populations. Discussion: Hazards and risks have been documented in SSM in the Philippines. However, the policies, legislation, and protective measures on SSM warrant more comprehensive coverage, implementation, and provision of social safety nets. Conclusion The study concludes that mining in the Philippines continues to be a problem as it produces adverse effects on workers' health, the community, and the environment. It is crucial to ensure the health and safety of mining workers, and all players and stakeholders must fulfill their respective roles. Governments and communities need to perform their regulatory and monitoring functions dutifully to build up their capacities to benefit mining communities that contribute much to the local economy.
Occupational Injuries ; Mining

Introduction: Pesticides are widely used in the agricultural sector to increase production by cutting down costs and improving the quality of produce. However, these chemicals come with serious health effects when an individual is exposed to large quantities at once, or low quantities over time. Objectives: The objective of the study is to investigate the knowledge, attitude, and practices of farmers, as well as investigate the correlation among knowledge, attitude, and practice variables. Methods: This research study used a cross-sectional design. Samples were drawn based on a multistage sampling of 387 agricultural workers. The target site was in Southern Philippines and the sample was selected using multi-stage sampling from the identified municipalities. Survey questionnaires were given to the respondents to measure knowledge, attitude, and practices (KAP) on pesticide exposure among farmers. The data were encoded using SPSS 13.0. The statistics used were both descriptive and inferential. Correlation analysis was used to study the relationship among knowledge, attitudes, and practices. Results: The results showed that farmers used pesticides in their farms on an average of 2.31 days per week (SD 2.13). The respondents reported that they were exposed to pesticides for about 3.46 months per cropping season (SD: 2.76), as well as from 3.34 (SD 5.92) cropping seasons per year. The mean score of the respondents on the knowledge aspect of the questionnaire was 5.91 out of 10 items (SD 3.28). The average score on practices on pesticide use among respondents was 3.37 (SD 1.75) with 8 items to evaluate practices. Lastly, the mean score on attitude on pesticide use among respondents was 5.34 (SD 3.31) over 12 items. Analysis showed a moderate correlation between knowledge and attitude with Pearson’s r = 0.651 (P <0.0001), also a moderate correlation between knowledge and practices at r = 0.521 (P <0.0001), and a moderate correlation between practices and attitudes at r = 0.443 (P <0.0001). Factor analysis revealed three components for items within practices and attitudes and two for items within knowledge. Conclusion Pesticide use in the Philippines continues to present various challenges in terms of its safety to humans and the environment. Farmers do not have adequate knowledge of pesticides and their proper management from use to disposal. They need to improve knowledge, encourage a healthy and safe attitude and correct practices on the hazards from pesticides, as well as its proper usage and handling. It is recommended that capacity building and training for farmers are initiated to address inadequacies in their knowledge, attitudes and practices.
Knowledge ; Attitude ; Farmers

Introduction: Companies and hospitals in the healthcare industry, like other businesses, are not exempted from the rising labor costs and growing dissatisfaction among employees. The assessment and optimization of total rewards management (TRM) are important since TRM consists of monetary and non-monetary rewards given to employees in exchange for their time, talents, and efforts. Objective: This study assessed the TRM in Philippine healthcare companies. This study also looked into the organizational structure of various health-service companies and their TRM, and the difference between companies with TRM and without TRM in terms of pay, benefits, work-life balance, career development, and performance recognition. Method: A total of 74 human resource personnel were randomly sampled from healthcare companies in the Philippines. A survey questionnaire was administered with items on TRM philosophy divided into five parts – pay, benefits, work-life balance, career development, and performance recognition. High mean scores per TRM component correspond to higher levels of agreement to positive statements to the corresponding TRM component. Chi-square test was used to determine the association between various demographic variables and the existence of a TRM philosophy in a company. T-test was used to determine whether the differences in the mean scores per TRM component were statistically significant or not. Results: Less than half (44%) of the included companies have TRM and companies in Metro Manila were more likely to have an existing TRM philosophy. Companies in the healthcare sector usually disseminate information on TRM during town hall meetings, and not during onboarding. Employees in the healthcare companies had strict work schedules as most employers did not allow flexi-time arrangements. This may have contributed to burnout and stress that are common in most companies. Lastly, employees working in companies with a TRM philosophy do not experience significantly better pay, benefits, work-life balance, career development, and performance recognition than those working in companies without TRM. Conclusion These findings suggest that even companies with an established TRM philosophy need significant improvement in their TRM processes for TRM to translate to better pay, benefits, work-life balance, career development, and performance recognition.
Work-Life Balance

Introduction: In the Philippines, industries began to recognize the importance of workers’ health after occupational safety and health were introduced in the early 1900s. Ever since, several legal bases have existed to protect the people’s welfare. However, data regarding this matter is limited in the country. Objective: This paper aimed to develop a comprehensive review of occupational safety and health data, including hazard exposures and occupational diseases for various Filipino occupational groups. Methods: A comprehensive analysis of the latest records and statistics from various government agencies, non-government organizations, academe, and research institutions was done. Data analysis was completed through a critical appraisal of the Philippines' current occupational health and safety regarding occupational diseases, injuries, accidents, and existing occupational health and safety policies. Data were also extracted from reviews of literature and other related research studies. Data analysis was done through a critical appraisal of the Philippines' current occupational health and safety in terms of occupational diseases, injuries, accidents, and existing occupational health and safety policies. Results: Most of those working in the informal sectors do not have enough social protection in the Philippine context. Others in the same situation involve construction workers, farmers, miners, and waste or garbage pickers. Child labor was also seen to be prevalent, risking these children's health and safety. Another issue is on gender, and wherein women were found to have lesser protection than their counterparts. Among the industries present in the country, administrative and support service activities, manufacturing, wholesale and retail trade, financial and insurance activities, education except for public education, and agriculture, forestry, and fishing were seen to have a high prevalence of occupational diseases. The study has shown occupational safety and health among various occupational groups and categories, the profile of occupational diseases in Philippine industries, and the OSH programs implemented in industries. Conclusion Analysis of available data confirmed the presence of threats of unsafe and unhealthy conditions in various jobs and workplaces. To keep up with other nations, the country should strive more with its local developments.
Occupational Diseases ; Occupational Injuries

Introduction: Small-scale mining (SSM) is mining by individuals, groups, families, or cooperatives with minimal or no mechanization, often in the market's informal (illegal) sector. According to the Mines and Geosciences Bureau (MGB) in the Philippines, the gross production value of small-scale mining as of the 1st to 3rd quarter of 2020 was 0.5 billion pesos (1.05 billion USD). Objectives: This study investigated the work process in small-scale mining in the northern part of the Philippines. It documented the occupational hazards that small-scale gold miners are exposed to in each of the work processes. Methods: The target population is a community in the northern Philippines where the majority of the males are engaged in small-scale gold mining. This qualitative study used work observation and hazards analysis tools to investigate small-scale miners' work processes and hazard exposures. Results: The most widely employed mining technique in the target community is dog-hole mining consisting of several sub-processes: tunneling, ball milling, and gravity concentration, cyanide leaching, and smelting. The occupational hazards identified were noise exposure from the dynamite blast, temperature extremes, and exposure to dust from dynamite blasting. The small-scale miners were subjected to prolonged crouching and bending, handling tools, and carrying heavy sacks filled with mineral ores. The miners resorted to improvised protective equipment such as wearing sleeveless shirts and drinking water for temperature extremes, distancing themselves from the mining blasts during dynamite blasting, and intermittently used carts with manual handling to transport ores packed in sacks. In the ball milling and gravity concentration process, machine-related accidents such as cuts from the crusher were observed. In cyanide leaching, which uses massive amounts of cyanide, the most prevalent hazards were heat, dust, and chemicals such as cyanide fumes. The risks included smoke from burning ore and coal and exposure to borax and nitric acid fumes in the smelting process. Conclusion This study documented the work process in small-scale gold mining and the hazard exposures in this type of informal industry. It is suggested that the local and national governments implement intervention programs for occupational health and safety measures, and social security nets are provided for the small-scale miners in Itogon, Benguet.
Cyanides ; Occupational Health

Introduction: The Lancet Countdown used Global Burden of Disease (GBD) data to track mortality from diseases influenced by climate change. The Philippines is one of the most vulnerable nations to climate change. Objective: This study aimed to provide summative data on climate change and health-environmental factors based on several large databases. It looked into the correlation of climate change to selected health variables and correlated environmental factors to health chosen variables in the Philippines. Methods: The database was assembled through a compilation of different secondary data. Climate change variables were acquired from the Global Burden of Disease (GBD 2017) Study on Health-related Sustainable Development Goals Indicators from 1990 to 2030. The data for the Philippines were obtained. These indicators include air pollution mortality, disaster mortality, household air pollution, malaria incidence, mean PM2.5, non-communicable disease mortality, neglected tropical diseases mortality, unimproved sanitation, and unsafe water. The resulting database was analyzed using exploratory data analysis techniques with descriptive statistics and line graphs to analyze trends over the years. Then Pearson correlation analysis was done to explore the linear relationship between health indicators, climate indicators, and environmental indicators. Results: The study results showed that the trend in the Philippines for air pollution mortality, household air pollution, malaria incidence, and neglected tropical diseases mortality is in a downward direction. However, non-communicable disease mortality was constantly increasing from 41.99 in 1990 to 55.00 in 2016. Meanwhile, the mean temperature is significantly negatively correlated to household air pollution, malaria incidence, and neglected tropical diseases and significantly correlated with non-communicable diseases. Also, NOAA adjusted sea level is significantly positively correlated with air pollution mortality, malaria incidence, disaster mortality, and non-communicable diseases. It is negatively correlated with malaria incidence and neglected tropical diseases prevalence. Global mean CO2 is significantly negatively correlated with household air pollution, malaria incidence, and neglected tropical diseases prevalence. On the other hand, it was significantly and positively correlated with air pollution mortality and non-communicable diseases mortality. Household air pollution health risk was significantly positively correlated to mean PM2.5 levels in the Philippines. Unimproved sanitation was positively correlated with household air pollution, malaria incidence, and neglected tropical disease prevalence. Conclusion As recordings of heat index increased, there was a correlation with NCD, Malaria, Disaster, and NTD infection mortality. With the evidence of the correlation of increasing temperature and pollution to health, the urgency to focus on addressing these problems was present in this study. Further research may help in policymaking to target drivers of pollution which affect extreme climate changes.
Climate Change ; Air Pollution

Introduction: Trauma scoring standardizes the severity of injuries of patients brought to trauma centers and is predictive of the outcome or prognosis among trauma victims. Hence, creating a trauma score allows for proper prioritization as well as proper management of patients in the emergency departments. Objectives: The objective of the study is to come up with a trauma scoring system that correlates to the probability of survival of a patient using the patient databases in major hospitals in the Philippines representing the three major island groups, Luzon, Visayas, and Mindanao. The study will also compare this proposed trauma scoring system with the gold standard (Revised Trauma Score) developed by Champion in 1989. Methods: The proposed Philippine Trauma Scoring System (PTSS) was based on data from the eight largest tertiary hospitals catering to trauma patients. A total of 40,286 patient charts were reviewed. The proposed trauma scoring system integrates concepts used in the Revised Trauma Score (RTS), with addition of age (from Kampala Trauma Scoring), as well as the Injury Score (based on the number of body parts injured). This proposed scoring system was weighted, using logistic regression to come up with coefficients for the components of the PTSS for a more accurate prediction of patient survival. The Receiver Operating Characteristic (ROC) was used to plot Sensitivity vs. 1-Specificity. In this analysis, ROC was used to evaluate and compare how good the models are in predicting patient recovery. Results: The components of GCS, RR, SBP, age, and body parts injured were significant predictors of patient outcomes for patients with trauma, specifically the road crash patients in this Philippine study. This study showed that both the PTSS and RTS have a significantly greater area under the curve than the diagonal reference line, which means that both the scoring system have a significant predictive value. The best predictive value, however, comes from the proposed scoring system that is developed from this study in the Philippines. Compared to the gold standard, PTSS Model 1 is a better predictor of outcomes than the gold standard RTS (ROC-AUC = 0.659 vs. 0.633) using only 22,214 valid subject population that contained all the variables needed for the PTSS analysis. Conclusion In a developing country like the Philippines, there are limited resources especially in the healthcare setting. Therefore, it is important to lessen errors in triaging which may result in resource waste and a higher risk of adverse outcomes for the patients. Thus, the PTSS developed in this study can be used by Philippine hospitals as it is uniquely based on Filipino patients using a large database representative of the eight largest tertiary hospitals in the Philippines. The proposed PTSS is shown in this study as the best classifier for patient outcome compared to the gold standard – RTS of Champion.
Triage

Background: eHealth is the use of information and communication technologies (ICT) for health. It helps in improving the flow of information, through electronic means, in support of the delivery of health services, and the management of health systems. eHealth is used as the strategic context and tool in achieving population health, improved health system status, and socio-economic development goals. Objectives: This study is aimed at looking at the Philippine National eHealth Strategy, particularly the components of Terminology Standards and Interoperability concerning the eHealth strategy in the Philippines, and to assess the barriers and gaps in the integration of these two components. Methods: This study used secondary literature, internet search, Philippine laws, administrative orders, memorandum circulars, and grey literature to discourse terminology standards and interoperability in the Philippine eHealth system, and issues and gaps related to these components that may impede the delivery of Universal Health Coverage in the country. Results: The current Philippine National eHealth strategy includes the following sector governance, legislation, policy and compliance, eHealth solution (i.e., services and applications), strategy and investment, infrastructure (government), human resources, and standards and interoperability. Philippine Health Information Exchange (PHIE) is a software platform in the country that aims to connect many isolated electronic health systems. The proposed interoperability layer across health systems and services in the Philippines includes Patient’s Primary Healthcare Consultation at the Rural Health Unit, health research, legal information, patient healthcare at tertiary hospital, and health insurance claims. The study results showed that issues and gaps related to the interoperability of eHealth in the Philippines include technical issues such as lack of common semantics, lack of an institutional mechanism to regulate EMR, lack of incentives among eHealth providers and stakeholders to adopt standards for interoperability. Conclusion The effort of the Philippines to achieve interoperability and standards in eHealth goals can be characterized as a work in progress. The government, private sector, physician, patient, and other stakeholders are deemed to continuously develop a shared vision and interoperate under a standardized guide as eHealth is a complex endeavor that covers many aspects.
Telemedicine

Introduction: Around 1.35 million people die due to road traffic accidents yearly. In the Philippines, there is an increasing trend of mortality and morbidity caused by road crashes. Objective: The objective of the study is to show the epidemiology of transport and vehicular crash (TVC) cases in the Philippines using the Department of Health (DOH) Online National Electronic Injury Surveillance System (ONEISS) from 2010 to 2019. Methods: We used data from ONEISS, a web-based system to electronically capture injury-related data from health facilities, store data in a centralized and secure location, process and consolidate data, and transform this data into meaningful information. For Transport and Vehicular Crash cases, risk factors such as drug use, alcohol use, mobile phone use, seatbelt, and helmet use are included. There are also data on vehicle type, place of crash, and activity. Descriptive and inferential statistics were computed to explore and analyze the ONEISS dataset, particularly the epidemiology of transport and vehicular crashes (TVC). Results: There were a total of 296,760/894,989 (31%) patients admitted due to transport and vehicular crash (TVC) based on the 10-year data from ONEISS (2010–2019). There was an increasing trend in the number of transport/ vehicular crashes (TVC) during this period, with an average increase of 25.58% cases per year. Most victims were drivers (45.6%), males (72.5%), and from the younger age group (0-30 years old). Fatal crashes were observed to occur from 6:00 pm to 5:00 am while most accidents occurred during leisure activities (32.5%). The highest reported contributing factor was drunk driving (n = 25,537). There was observed low compliance on the use of vehicular safety equipment. The most common types of injuries for the TVC victims were abrasions, contusions, burns, and concussions while the vehicle most involved in TVC was the motorcycle. Motorcycle use was found to be associated with worse emergency room (ER) outcomes (p <.0001) and the highest injury types such as multiple injuries, abrasion, avulsion and burn. Alcohol use was also significantly associated with multiple injuries, abrasion, avulsion, burn, open fracture, open wound, and amputation (p < 0.05). Conclusion The trend of road traffic vehicular crashes affecting mainly the younger population has economic repercussions. Motorcycles are also most involved in crashes, hence, the need for motorcycle safety laws in the country. There is also a need to strengthen current laws and legislation governing road safety and to focus on structuring a systematic post-crash response for both the local government and hospitals throughout the Philippines.
Accidents, Traffic ; Alcoholic Intoxication