Department of Health - Philippines

Health Promotion Bureau

Healthy Pilipinas
The Philippines’
Health Promotion Framework Strategy 2030
Healthy Pilipinas
The Philippines’ Health Promotion Framework Strategy 2030

Department of Health - Philippines

Department of Health Compound, San Lazaro St.,
Santa Cruz, Metro Manila, Philippines

Editorial Board Beverly Lorraine Ho

Rodley Desmond Daniel Carza

Associate Editors Andrea Margreth Ora-Corachea

Jose Lorenzo Lim

HPFS Task Force Aurora Banda Alfonso

Margarita Alexandra Antonio
Joerem Ceria
Janus Ted Maclang
Dasha Marice Sy Uy

Technical Writers Margarita Alexandra Antonio

Carissa Inez Delos Santos
Janus Ted Maclang
Dasha Marice Sy Uy
Anne Marie Rey
Sarah Guinto

Erika Modina, EpiMetrics

Abigail Lim Tan, EpiMetrics

Cover & Layout Artist Pauline Kae Indita

Administrative Support Joerem Ceria

Acknowledgements

The Philippine’s Health Promotion Framework Strategy 2030 is a product of months of

multisectoral consultation and coordination with national government agencies (NGAs),
local government units (LGUs), developmental partners, the private sector, civil society
organizations (CSOs), and medical societies. The Department of Health-Health Promotion
Bureau (DOH-HPB) are grateful for the invaluable contributions of the following:

National Government Agencies and Government Offices

● Bureau of International Narcotics and ● Department of Social Welfare and
Law Enforcement Affairs Development
● Commission on Human Rights ● Department of Transportation
● Council for the Welfare of Children ● East Avenue Medical Center
● Dangerous Drugs Board ● National Center for Mental Health
● Department of Education ● National Council on Disability Affairs
● Department of Finance ● National Disaster Risk Reduction and
● Department of Interior and Local Management Council
Government ● National Economic and Development
● Department of Labor and Employment Authority
● Department of Science and ● National Nutrition Council
Technology - Food and Nutrition ● Philippine Drug Enforcement Agency
Research Institute

Academic Institutions
● Ateneo Center for Research and ● Don Mariano Marcos Memorial State
Innovation University
● Ateneo School of Government ● Mariano Marcos State University
● Ateneo School of Medicine and Public ● UP College of Public Health
Health ● UP Diliman Department of Psychology
● UP Diliman PsycServ

Development Partners
● UN AIDS Philippines ● USAID RenewHealth
● UNICEF - Philippines ● World Food Programme
● USAID - Philippines ● World Health Organization -
● USAID ReachHealth Philippines
Private Sector Entities
● A Single Drop for Safe Water, Inc. ● National League of Philippine
● Action for Economic Reforms Government Nurses
● Action on Smoking and Health ● New Vois Association of the
Philippines Philippines
● Agap Banta ● Nutrition Center of the Philippines
● AltMobility Philippines ● Nutritionists and Dieticians
● Alyansa ng May Kapansanang Pinoy, Association of the Philippines
Inc. ● Oceana
● ANG NARS Partylist ● Pambansang Koalisyon ng
● ASEAN Training Center for Preventive Kababaihan sa Kanayunan
Drug Education ● Pediatric Infectious Diseases Society
● Asian Medical Students Association - of the Philippines
Philippines ● Philippine Academy of Family
● Autism Society of the Philippines Physicians
● Ayos na Gamot sa Abot-Kayang ● Philippine Anti-Discrimination Alliance
Presyo Coalition of Youth Leaders (PANTAY)
● Babaylanes, Inc. ● Philippine Association for the Study of
● Cancer Warrior Foundation Overweight and Obesity
● CARE Philippines ● Philippine Association of Nutrition
● Center for Policy Studies and ● Philippine Cancer Society
Advocacy on Sustainable Development ● Philippine College of Chest Physicians
● Diabetes Philippines ● Philippine College of Emergency
● Empower Medicine
● EpiMetrics, Inc. ● Philippine College of Lifestyle
● Foundation for the Philippine Medicine
Environment ● Philippine College of Physicians
● Happy Hour Philippines for Mental ● Philippine College of Surgeons
Health ● Philippine Foundation for Vaccination
● Healthcare Without Harm ● Philippine Guidance Counsellors
● HealthJustice Philippines Association
● ImagineLaw ● Philippine Heart Association
● Integrated Midwives Association of ● Philippine League of Government and
the Philippines Private Midwives
● Integrated Risk Management ● Philippine Medical Association
Association of the Philippines ● Philippine Mental Health Association
● International Union Against ● Philippine Nurses Association
Tuberculosis and Lung Disease ● Philippine Obstetrical and
● Life Cycles Philippines Gynecological Society
● Likhaan Center for Women’s Health ● Philippine Pediatric Society
● Lupus-Inspired Advocacy ● Philippine Pharmacists Association
● Makati Medical Center ● Philippine Physical Therapy
● Medical Action Group Association
● Mental Health Philippines ● Philippine Red Cross
● Move As One Coalition
● Philippine Society for Microbiology ● Southeast Asia Tobacco Control
and Infectious Diseases Alliance
● Philippine Society of Endocrinology ● The Framework Convention Alliance
Diabetes and Metabolism for Tobacco
● Philippine Society of Public Health ● The Library Foundation - Sexuality
Physicians Health and Rights Educators (TLF
● Physicians for Peace SHARE)
● Provincial Federation of Persons with ● ThinkWell
Disability Workers Association of ● Vital Strategies
Eastern Samar ● Women’s Health Philippines
● Psoriasis Philippines ● Women’s Global Network for
● PWD Philippines Reproductive Rights
● Resilient Philippines ● World Association for Psychological
● Safe Kids Worldwide - Philippines Rehabilitation - Philippines
● Save the Children - Philippines ● Youth for Mental Health
● Social Watch Philippines ● Zuellig Family Foundation
● 2030 Youth Force in the Philippines

Private Sector Individuals

● Ms. Sara Alvarez ● Dr. Paul Gideon Lasco
● Dr. Geminn Louis C. Apostol ● Ms. Amor Maclang
● Dr. Vicente Belizario, Jr. ● Mr. Jun Ryan Orbina
● Dr. Philippe Borremans ● Ms. Elizabeth Puyat-Murga
● Ms.Nina Castillo-Carandang ● Ms. Kathleen Solis
● Ms. Cathy Church-Balin ● Community Physiotherapy and
● Ms. Jenny Florendo Rehabilitation Facilitators
● Dr. Luis Gatmaitan ● Representatives from UHC
● Mr. David Dereck Golla Implementing Sites and Centers for
Health Development nationwide

The HPB sincerely hopes that this initial effort will flourish into deeper, stronger, and more
vigorous intersectoral cooperation. We look forward to working with all sectors towards a
Healthy Pilipinas.
Table of Contents

PAGE

Vision for a Healthy Pilipinas ……………………………………………………………………………………... 1

An Introduction to the Health Promotion Framework Strategy .…………...…………….. 5

Settings Prioritized for Health Promotion ……..…………………………………………………………. 8

Strategies for Implementing Health Promotion .……………………………………………………... 9

Health Literacy and Health Promotion ……………………………………………………………………… 11

Priority Areas for Action …...………………………………………………………………………………………... 13

Priority Area 1: Diet and Physical Activity ……………………...……………………………………. 14

Priority Area 2: Environmental Health ………………………………………..………………………... 19

Priority Area 3: Immunization ……………………..………………………………………………………... 24

Priority Area 4: Substance Use ……………………………………………………………………………... 27

Priority Area 5: Mental Health ……………………………………………………………………………….. 32

Priority Area 6: Sexual and Reproductive Health ………………………………………………... 35

Priority Area 7: Violence and Injury Prevention ..………………………………………………... 38

Investments in Health Promotion ……………………………………………………………………………… 41

Monitoring the Health Promotion Framework Strategy …..…………………………………….. 43

References …………………………………………………………………………..……………………………………….. 46
LIST OF FIGURES PAGE

Figure 1. Health Promotion Framework Strategy 2030 ……………..………………..………… 6

Figure 2. Milestones of the Health Promotion Framework Strategy ……………………. 7

Figure 3. Health Promotion Framework Strategy Monitoring and Evaluation

Framework …………………………………………………………………………………………………………………….. 43

LIST OF TABLES PAGE

Table 1. Diet and Physical Activity Behavioral and Health Outcome Targets ……… 15

Table 2. Environmental Health Behavioral and Health Outcome Targets ……………. 20

Table 3. Immunization Behavioral and Health Outcome Targets ………………………….. 24

Table 4. Substance Abuse of Tobacco Behavioral and Health Outcome Targets . 28

Table 5. Substance Abuse of Alcohol Behavioral and Health Outcome Targets … 29

Table 6. Substance Abuse of Drugs and Other Illicit Substances Behavioral and
Health Outcome Targets ……………………………………………………………………………………………… 30

Table 7. Mental Health Behavioral and Health Outcome Targets …………………………. 32

Table 8. Sexual and Reproductive Health Behavioral and Health Outcome 35

Targets ……………………………………………………………………………………………………………………………

Table 9. Violence and Injury Prevention Behavioral and Health Outcome Targets 38

Table 10. Return of Investment and Public Health Impact by Priority Area in 10
years ………………………………………………………………………………………………………………………………. 41

Table 11. Behavioral Outcome Indicators …………………………………………………………………. 44

 Health Promotion Framework Strategy 2030 | 1

Vision for a Healthy Pilipinas

By 2030, the DOH envisions a Healthy Pilipinas wherein healthy governance, healthy settings,
and health-literate individuals are present, and achieving optimum health for every Filipino is
possible.

The DOH together with its partners shall make healthy behaviors the easier choice for
everyone, every time, everywhere. In achieving a Healthy Pilipinas, health is a shared
responsibility of all Filipinos and all sectors of society. Thus, everyone has a role in making
an impact in promoting health.

Policies should be in place to address the various social determinants of health and ensure
that services are equitably provided especially to Geographically Isolated and Disadvantaged
Areas (GIDAs) and Socio-Economically Disadvantaged Areas (SoEDA).

The vision also includes that every aspect of a Filipino’s life is healthy and health-promoting.
This includes their physical, social, political, and economic environment; as well as the
healthcare services they are able to access. Environments where Filipinos live, study, or work
must make the healthy choice not only possible but the easy and obvious choice.

All these make it possible for Filipinos, most especially the youth, to be literate on health
issues, to understand and act on their right to health, and to navigate the health system. In a
Healthy Pilipinas, Filipinos practice healthy habits and behaviors from a young age, with the
understanding that their fellow Filipinos, their communities, and their country stand behind
them in ensuring their right to health.

Principles of a Healthy Pilipinas

Equity

Health is socially determined. This means that some population groups may face more
barriers to engaging in healthy behaviors as compared to others. The following are only a
few examples of how certain groups are predisposed to poor health due to their
circumstances:

1. Socioeconomic Status
About one-fifth of Filipinos still live below the poverty line1. For many low-income
individuals and families, making ends meet is much more important than making
healthy choices. These poor health habits which many had no choice but to pick up
can increase the risk of various health conditions, which, in turn, are expensive to
treat, reinforcing a cycle of poverty and ill health.

1
Philippine Statistics Authority (August 2022) Proportion of Poor Filipinos was Recorded at 18.1
Percent in 2021 https://psa.gov.ph/poverty-press-releases/nid/167972
 Health Promotion Framework Strategy 2030 | 2

2. Disabilities
At least 81% of Filipinos live with some form of disability2. Not only can disability take
many different forms, but it can also severely limit Filipinos’ ability to participate fully
in everyday life. While people with disabilities have specific health needs, their health
is also negatively affected by discrimination and lack of inclusion3.

3. Gender
LGBT+ people of any age, ethnicity, religion, or socio-economic group are more likely
to fall behind in terms of health. They are at higher risk of substance abuse and
mental health concerns; STIs; cancer and cardiovascular disease; and gender-based
violence, among others. Stigma and discrimination from peers, the community as a
whole, and even healthcare providers also exacerbate risks for LGBT+ people4.

4. Sex
Women are still marginalized and discriminated against in ways that do not allow
them full control of their own bodies and health. Aside from being more vulnerable to
various health concerns, gender-based violence, and the ill effects of poverty,
women’s health concerns are often downplayed and not taken seriously. Thus, many
suffer from damaging or debilitating conditions, without access to the treatment they
need.

5. Indigenous People
The Philippines has about 12 to 15 million indigenous people. Around the world, they
make up one-third of the poorest and suffer disproportionately in terms of health.
Issues such as systemic discrimination, loss of ancestral lands and displacement,
destruction of traditional ways of life, and loss of identity and culture can magnify ill
health effects for indigenous people5.

6. Education
Education is a catalyst for development and a health intervention in its own right.
Education matters so much to health as these two are closely tied together by three
main connections: education creating opportunities for better health, poor health
putting educational attainment at risk, and existing conditions in people’s lives.

2
Philippine Statistics Authority. (03 May 2019). Disability spares no one: a new perspective. (PSA
Reference No. 2019-062). Retrieved from:
https://psa.gov.ph/ndps/disability-survey-id/138567#:~:text=Results%20of%20the%20National%20Di
sability,23%20percent%20with%20mild%20disability.
3
CDC - National Center on Birth Defects and Developmental Disabilities. (15 September 2020).
Disability and health inclusion strategies. Retrieved from:
https://www.cdc.gov/ncbddd/disabilityandhealth/disability-strategies.html
4
Human Rights Watch. (June 2017). Just Let Us Be: Discrimination against LGBT students in the
Philippines. Retrieved from:
https://www.aidsdatahub.org/sites/default/files/resource/human-rights-watch-just-let-us-be-lgbt-phili
ppines-2017.pdf
5
United Nations Department of Economic and Social Affairs. (2016). State of the World’s Indigenous
Peoples: Indigenous Peoples’ Access to Health. Retrieved from:
https://www.un.org/esa/socdev/unpfii/documents/2016/Docs-updates/SOWIP_Health.pdf
 Health Promotion Framework Strategy 2030 | 3

7. Geographic Location
Different settings and environments play a vital role in shaping risks that may affect
the health and well-being of people; this can include an individual’s community,
housing, and access to transportation and open spaces. By being informed of the
risk factors of individuals and their environment, policy interventions can be
formulated to help improve their health and quality of life.

For health equity to be achieved, it must be acknowledged that some groups will require
more support than others. Efforts not only to acknowledge specific health concerns, but also
to ensure access, affordability, and acceptability of the resources and environments that can
help minimize disadvantages and ensure that every person is competent, motivated, and
supported to live healthy lives.

Health promotion activities must be cognizant of the barriers that various sectors may
experience as they develop and maintain their health. Health promotion is thus most
effective when it works not only for the majority, but also for those who may be
economically, politically, or socially disadvantaged.

Participation

Health is a fundamental human right for everyone. Each individual must be allowed to shape
their own health and well-being. Thus, participation in governance processes of the health
sector must be placed as an integral component of all health promotion activities. This
ensures that the interventions are applicable and relevant to those that will be most affected
by the policies and programs.

Participation must also be cognizant of the different sectors and groups that co-exist within
communities, and ensure that their diverse experiences are accounted for in the crafting of
plans and implementation of programs. Likewise, ensuring representation of vulnerable
groups is a key component of achieving health equity and securing everyone’s right to good
health.

Partnerships

Championing health promotion cannot be done by the Department of Health alone. Partners
shall be engaged to ensure the promotion of policies, programs, and plans will be
comprehensive and well-rounded. Likewise, all policy-determining units or committees in the
public health sector shall ensure professional and ethical practice in championing and
prioritizing the promotion and protection of public health.

Partnerships for health promotion shall be conducted in a way that builds public trust and
confidence.
 Health Promotion Framework Strategy 2030 | 4

Responsiveness

All health promotion policies, programs, and plans shall be responsive to the needs and
emerging social determinants of health. These shall also be formulated based on
cost-effective strategies for these to be maximized to ensure that it shall be beneficial for
Filipinos.

Likewise, policies, programs, and plans shall also be implemented in a timely manner for
them to be responsive to the health needs of Filipinos.
 Health Promotion Framework Strategy 2030 | 5

An Introduction to the Health Promotion

Framework Strategy

Health promotion is enshrined in the 1986 Ottawa Charter for Health Promotion, the 1998
Rio Declaration of the Social Determinants of Health, the 2005 Bangkok Charter for Health
Promotion in a Globalized World, and the more recent 2021 Geneva Charter for Well-Being.
By addressing the root causes, or the determinants of poor health, health promotion
empowers individuals and communities to take charge of and improve their health and
well-being.

These important considerations have been recognized by the Philippine government as well.
The UHC law mainstreams health promotion as part of its efforts to provide affordable and
quality healthcare services and produce better health outcomes while providing financial
protection for all Filipinos. As mandated by the Universal Health Care Act, the Health
Promotion Framework Strategy (HPFS) of the Department of Health (DOH) will serve as the
basis for all programs of the Department in relation to increasing health literacy and
addressing the social determinants of health (Figure 1).
 Health Promotion Framework Strategy 2030 | 6

Figure 1. Health Promotion Framework Strategy 2030

The HPFS focuses on promoting health and well-being and reducing inequity by improving
individual habits through its identified key priority areas: diet and physical activity,
environmental health, immunization, substance abuse, mental health, sexual and
reproductive health, and violence and injury prevention; and fostering environments
conducive to health by using a settings-based approach to the implementation of its
programs and activities. The settings-based approach shall cultivate healthy communities,
schools, and workplaces to address the socioeconomic factors and the physical
environment which affect one’s health. Overall, the HPFS provides the foundation for
preventing deaths, diseases, disability, and health inequities at a population level, rather than
improving individual treatment or disease management.

The HPFS aims to usher a new generation of healthy Filipinos, and ultimately make Healthy
Pilipinas and Ambisyon 2040 a reality sooner rather than later.

To lay down the foundations for a Healthy Pilipinas, the focus of the HPFS during the early
years of its implementation would be to establish structures and processes. This work will
serve as the basis to deliver necessary outputs and outcomes on the implementation of
healthy settings (communities, schools, and workplaces) and priority areas for action. The
structures include the establishment of the Health Promotion Bureau pursuant to Section 30
 Health Promotion Framework Strategy 2030 | 7

of the Universal Health Care Law, including the creation of Health Promotion Units in the
Centers of Health Development for each region and in Province-wide and City-wide Health
Systems. Whereas, the processes include the creation of policies that would provide the
basis to implement the programs, research, campaigns, and other activities for health
promotion.

Figure 2. Milestones of the Health Promotion Framework Strategy

Once these structures and processes are built and established, one of the primary focus of
the HPFS is in improving health literacy including the knowledge, attitude, and practices
(KAP) of the Filipino people on health-promoting behaviors through collaborative work with
different sectors of the society, implementation of effective interventions, and social and
behavioral change communication campaigns. It is relevant to implement routine
measurements of health literacy and KAP so that these changes can be detected. In addition
to this, health disparities and inequalities shall also be measured to get a glimpse of the
status of health equity in health promotion. These shall inform subsequent programs and
plans to promote health equity from 2025 onwards.

Life-Stage Approach

The life-stage approach refers to an approach that recognizes that all stages of a person’s
life are interlinked. It also recognizes the importance of health interventions at every stage of
a person’s life from conception to old age. The lifestage of a person are identified as the
following:

1. Pregnancy, childbirth, and neonatal - covers all aspects of childbearing, from

conception to early infancy.
2. Childhood - refers to a person from newborn to below 10 years of age
3. Adolescence - refers to a person between the ages of 10 to 19 years of age who is in
transition from childhood to adulthood.
4. Adulthood - refers to an individual aged 20 years to 59 years and 11 months.
5. Older adult - refers to a person at least 60 years old.

Through a focus on youth, the advantages to health and well-being can be maximized by
helping Filipinos maintain both from a young age. In addition, transition points, such as the
transition from birth to adolescence, from school to work, or from good health to sickness,
 Health Promotion Framework Strategy 2030 | 8

leave individuals vulnerable to changes which can affect their health and well-being, so extra
attention and support must be provided during these times.

A focus on the youth, and on transition points are key to effective interventions using the life
course approach. During these times, managing risk factors such as adverse childhood
experiences, crime and violence, substance misuse, and poor educational attainment, will
lead to resilience against health challenges in the later stages in life.

Settings Prioritized for Health Promotion

Settings are integral for health promotion — wherever Filipinos live, study, or work,
environmental, organizational, and personal factors interact to affect health and well-being.
This is why multisectoral action and a settings-based approach to address risk factors,
promote health, and prevent disease are necessary. The Philippines recognizes this in the
UHC Republic Act No. 11223, or the Universal Health Care Law. The law enshrines
partnerships between various sectors and the national and local government in ensuring the
creation of enabling settings to improve health and quality of life and to promote health
literacy and healthy behaviors among all Filipinos.

The following are key settings for health promotion:

1. Healthy Communities - Local governments and other organized communities are

instrumental in creating and enabling health-supportive environments and human
settlements, providing basic sanitation, and supplying access to health care, among
others. Thus, healthy communities must commit to improving political, economic,
and social conditions; foster holistic approaches to health management; and
encourage communication among leaders and members.

2. Healthy Schools - Health promotion in schools can maximize the impact of health
education and interventions among school-aged Filipinos, and in addition, has the
potential to impact the home environments and communities of Filipino students and
school personnel. Healthy schools foster health by creating healthy school policies,
improving the physical school environment, teaching health skills and providing
health education, linking with parents and communities, and providing access to
health services.

3. Healthy Workplaces - With more people spending more time at work, healthy
workplaces are necessary to ensure the continued health of Filipino workers.
Workers must be enabled and directly involved in ensuring that the workplace
promotes health and well-being, prioritizing the prevention of health hazards and
concerns, and creating an integrated response to the specific health needs of all
workers.
 Health Promotion Framework Strategy 2030 | 9

Strategies for Implementing Health Promotion

The HPFS will work towards its goals through the implementation of strategies based on the
Ottawa Charter. The Ottawa Charter proposes advocating for favorable health conditions;
enabling people to reach their full health potential; and mediating between different interests
in society in the pursuit of health through the following implementation strategies:

● Reorienting the health sector

Health services must shift focus from curative treatment to prevention of disease
and promotion and attainment of the total needs of the whole person or community.
The development of a strengthened primary care system integrating school,
workplace, and community services can prevent health issues from worsening. In
addition, by fostering ownership of health and health promotion by all, and opening
channels between the health and other sectors, the integration of processes and
services that promote health can be more easily achieved.

● Creating supportive environments

This strategy focuses on enhancing social, community living and working, and natural
and built environments to prioritize health and build individual, setting, and
institutional capacity to support health. By encouraging and embodying care for
others and the natural or built environment, all people are able to ensure that
environments are safe, stimulating, satisfying, and enjoyable.

Thus, health promotion initiatives, such as the more traditional capacity-building and
development, as well as health impact assessments, and encouragement of
community-based services and support groups, among others, can be harnessed to
reduce stigma, increase supportive behavior among peers, and foster healthy
cultures and physical environments that support healthy behaviors.

● Strengthening community action

Health promotion works through inclusive development, community ownership,

public participation, and social support. Communities must work together to address
the gaps on health system strengthening — this includes setting priorities, planning
strategies, and implementing these strategies. As such, communities must be
supported.

Interdisciplinary partnerships across national government, civil society, the private

sector, and local communities to connect needs with resources; involving the
community in end-to-end health intervention development, creating shared value;
creating spaces for marginalized groups to participate in decision-making; and
harnessing the political will of local leaders in prioritizing health are all ways to
strengthen community action.
 Health Promotion Framework Strategy 2030 | 10

● Building healthy policy

Healthy policy includes the development of legislation, fiscal measures, taxation, and
organizational and process changes that promote health. Joint, coordinated action to
identify health issues, obstacles, and solutions is important — thus, all policymakers
in all sectors must be aware of their potential effect on health, and communities
must be involved in policy making on health. In addition, research, data management,
and monitoring and evaluation should be used effectively to ensure that policies
address the relevant issues and that these policies are implemented correctly.

● Developing personal skills

Health promotion supports personal and social development through the provision of
information and education to enhance health and life skills. Freer accessibility of
information will be fostered by increasing and maximizing platforms and channels
for health skills onboarding; while improved health education, including education on
health rights, will foster the development of functional health literacy. Through these,
individuals and communities will be equipped with the skills and information they
need to maximize opportunities to improve and maintain health and well-being
gained through the previous four strategic actions.

In addition, key messages must be unified, as well as accessible and understandable

to all. These messages must not just increase knowledge on improving health and
maintaining well-being; they must also lead to behavior change toward the adoption
of healthy habits and behaviors and positive health-seeking behavior. Health
promotion must maximize available communication channels and integrate and
harness the perspectives of various stakeholders toward health.
 Health Promotion Framework Strategy 2030 | 11

Health Literacy and Health Promotion

The HPFS revolves around the key themes of having health promoting places or
environments through healthy governance and healthy settings, as well as health promoting
people to develop positive health behaviors. The concept of health literacy is central to these
themes as it empowers the people to support and make healthy lifestyle choices. Given the
modern day complexities with a surge of unvalidated health information leading to a global
infodemic and misinformation, products and environments that foster unhealthy lifestyles,
and complex health systems, people find it increasingly difficult to make healthy lifestyle
choices. Even the most educated person will find it hard to navigate through these
complexities, more so an ordinary individual. Throughout the years, programs and plans have
been set to strengthen and promote the health of the people overlooking the crucial role of
health literacy in generating behavioral change.

The statement from the Ottawa Charter for Health Promotion where "people cannot achieve
their fullest health potential unless they are able to take control of those things which
determine their health" stresses the links of health literacy to gain autonomy and make
informed decisions on their health. Studies have shown that health literacy is a stronger
predictor of one's health status over income, education levels, and even race. Thus,
improving health literacy is expected to generate positive behavioral change, improve health
outcomes, and reduce associated costs in health spending. The challenge, however, is that
gaining competencies in health literacy is a lifelong process and that a whole-of-government
and whole-of-society approach should be taken to improve these competencies over time.

Health literacy, recognized as one of the key pillars to promote health, is an integrative and
intersectoral tool for the implementation of the WHO's Thirteenth General Programme of
Work 2019-2023, the Shanghai Declaration on promoting health in the 2030 Agenda for
Sustainable Development, and the Health 2020 European policy framework and strategy for
the 21st century. It also serves as an essential component of the HPFS from which the seven
key priority areas for action were built upon.

Factors affecting health literacy are not limited by individual factors but also system and
professional factors. Individual factors such as literacy skills, general knowledge on health,
demographic characteristics, culture, and experiences cannot be identified independently
from health literacy. Likewise, the infrastructure of a health system which dictates availability
and access to health services and resources, the competencies of the workforce, and the
public health practice affect the overall public health context in which individuals operate.
Health literacy as a dynamic and multidimensional concept has then been defined on the
basis of conceptual models which integrate both medical and public health perspectives.

Health literacy, defined as "the degree to which individuals have the capacity to obtain,
process, and understand basic health information and services needed to make appropriate
health decisions," is classified into two types: comprehensive and functional health literacy.
Comprehensive Health Literacy (CHL) refers to the perceived ability of an individual to
 Health Promotion Framework Strategy 2030 | 12

perform tasks related to his or her ability to access, understand, appraise, and apply health
information. Functional Health Literacy (FHL), on the other hand, is the ability of a person to
understand and perform basic numerical calculations based on the responses to a set of
questions after an exposure to educational health material.

In 2018, the DOH in collaboration with the University of the Philippines - College of Public
Health, conducted a survey to assess the CHL and FHL of Filipinos. Results show that less
than half (40.21%) of the respondents had sufficient CHL with only 8 out 100 Filipinos
(8.25%) recorded an excellent CHL. The variations across the dimensions show there were
limitations in accessing (45.94%), appraising (43.81%), understanding (35.78%) and applying
(35.69%) health information respectively. In terms of FHL, at least 6 out of 10 Filipinos
(63.70%) had adequate FHL. However, given that the health material used in the survey was
a carefully designed vaccination flyer by the DOH, it was considered that this may be an
overestimate if another material was used where health information given were not designed
as well as the vaccination flyer.

Investments in measuring health literacy will ensure that long term improvements are made
which translates to effective implementation of policies, programs, and health services. In
order to support the implementation of the HPFS, The DOH Health Promotion Bureau (HPB),
in collaboration with the Centers for Health Development (CHD), will implement a nationwide
assessment on the comprehensive and functional health literacy levels of Filipinos, as well
as their their knowledge, attitude, and practices relative to the seven key priority areas. In line
with the Local Health Systems (LHS) Maturity Level, an annual surveillance was also set to
have the respective localities ensure that any improvements made in health literacy will be
sustained as we work through a vision of a Healthy Pilipinas.

Findings in health literacy shall guide practice on how to effectively communicate existing
programs and strategies not only across the health promotion priority areas but on overall
health. It provides clinicians, public health professionals, and workers alike a critical
evaluation of how we should do our work and to create standards for practice to
fundamentally address issues in health literacy and close the gap on what we communicate
versus what the general public understands.
 Health Promotion Framework Strategy 2030 | 13

Priority Areas for Action

The HPFS has seven priority areas in which efforts to improve health outcomes, through
health promotion, will be focused. These priority areas were chosen through a
comprehensive process involving consultations with various stakeholders, including local
governments and other NGAs, medical societies, developmental partners, CSOs, and more,
both within and beyond the health sector; review of data on the leading causes of health
loss; alignment with the Philippines’ local and international commitments with regard to
health and well-being; and review of data on the modifiability of behavior.

The seven priority areas are as follows:

1. Diet and Physical Activity: Enabling improved nutrition and increased physical
activity
2. Environmental Health: Tackling environmental and climate impacts on health
3. Immunization: Promoting vaccine use
4. Substance Use: Preventing tobacco use, illicit drug use, and harmful alcohol use
5. Mental Health: Increasing psychosocial and mental well-being
6. Sexual and Reproductive Health: Promoting positive sexual and reproductive
behavior
7. Violence and Injury Prevention: Protecting communities from violence and injury

These seven priority areas articulate the seven behaviors that help make Filipinos espouse a
healthy lifestyle. The sections according to each specific key priority area depict the current
situation faced by the Filipino people and how each of these health-promoting behaviors
contributes to the attainment of the desired health outcomes. Furthermore, the results of the
2021 collaborative study of the DOH and the Philippine Institute for Development Studies
(PIDS) entitled “The Economic Case for Disease Prevention and Health Promotion” as well as
relevant documents shall guide the formation of the recommended or best buy interventions
in health promotion for the achievement of the targets identified.
 Health Promotion Framework Strategy 2030 | 14

Priority Area 1: Diet and Physical Activity

Enabling improved nutrition and increased physical activity

Good nutrition and physical activity are the foundation of good health, and work hand in
hand to enable a healthy lifestyle. These fundamental components of population health
encompass a vast array of social and economic concepts from food security to city
planning, and culturally accepted norms and eating practices. Aside from barriers in relation
to the aforementioned, commercial determinants, such as excessive marketing of unhealthy
establishments, foods, and drinks, have also begun to deter healthy eating.

Practices that lead to unhealthy diets aggravate health conditions and progress to various
diseases, specifically non-communicable diseases. Unhealthy diets contribute to a
significant amount of the total burden of disease in the country with 1.5% attributed to high
consumption of salt and 0.5% to high consumption of trans fatty acids (TFA). Consumption
of sugar-sweetened beverages (SSB) also contributes to about 0.5% of the burden of disease
from diabetes and ischemic heart disease.6 In addition, insufficient fruit and vegetable
consumption of less than the recommended intake of 400 grams per day contributes to an
estimated 19% of the total burden of disease specifically from esophageal cancer, ischemic
heart disease, and stroke.7 For Filipino children, non-exclusive breastfeeding contributes to
an estimated 25% to 60% of the total burden of disease of children specifically from diarrhea
and lower respiratory tract infections.8

In 2019, two in 10 Filipino children under five years old are underweight, while three in 10 are
stunted. In addition, 56% of Filipino households remain food insecure while the COVID-19
pandemic and the resulting community quarantine have further increased undernourishment
and involuntary hunger locally.

Obesity is also a growing problem with the majority of Filipinos insufficiently physically
active. Rapid urbanization, poor urban planning movements, and even the COVID-19
pandemic have contributed for a more sedentary lifestyles.Insufficient physical activity was
estimated to contribute to around 12% of the total burden of disease from diabetes,
ischemic heart disease, and stroke. This translates to around 800,000 life-years lost and
long-run economic productivity losses in US dollars purchasing power parity (PPP) of 6

6
World Health Organization. (2019). Prevention and control of noncommunicable diseases in the
Philippines: The case for investment. (WHO/UHC/CD-NCD/19.90). Retrieved from:
https://www.who.int/docs/default-source/wpro---documents/countries/philippines/reports/preventio
n-and-control-of-noncommunicable-diseases-in-the-philippines---the-case-for-investment.pdf?sfvrsn=6
005b6d1_2#:~:text=In%202015%2C%20noncommunicable%20diseases%20(NCDs,)%20(WHO%2C%2
02017a).
7
Uy, A. B., & Jimeno, C. (2021). Cardiometabolic Risk Factors leading to Diabetes Mellitus among the
Young (YOD) from the 8th Philippine National Nutrition Survey. Journal of the ASEAN Federation of
Endocrine Societies, 36(1), 12-24. https://doi.org/10.15605/jafes.036.01.02
8
Department of Science and Technology - Food and Nutrition Research Institute (DOST-FNRI). (n.d.).
Expanded National Nutrition Survey: 2019 Results, Nutritional Status of Filipino Preschool Children
(Presentation). Retrieved from: http://enutrition.fnri.dost.gov.ph/site/presentation.php?year=2019
 Health Promotion Framework Strategy 2030 | 15

billion.

Evidence supports that diet and physical activity are amongst the most impactful behaviors
a person can modify to further improve their health. It is imperative that Filipinos eat
healthier diets and exercise enough to ensure that whether they are young or old, they are fit,
active, and protected from diet-related diseases. The health-promoting behavior of
consuming healthy diets and engaging in physical activity are expected to reduce mortality
attributed to non-communicable diseases and reduce all forms of malnutrition with the
targets specified above. Whereas, Filipinos engaging in physical activity are also expected to
have a reduced burden of mental health disorders due to its positive effects on mental
health. Needless to say, multi-sectoral action and collaboration are critical to address
unhealthy diets and sedentary lifestyles due to rapid urbanization and globalization.

Table 1. Diet and Physical Activity Behavioral and Health Outcome Targets
BEHAVIORAL HEALTH TARGET
BASELINE TARGET BASELINE
OBJECTIVE OUTCOME BY 2030

Filipinos 86.2% 50% relative Reduce 4.7% 3.1%

consume increase from mortality
healthy diets Health Literacy baseline attributed to (PSA Vital Statistics SDG target of
Assessment - Report, 2019)
Knowledge, Attitude, non-communi reduction by
Health Literacy one-thirds
and Practices (2021) cable
Assessment -
Knowledge, Attitude, diseases
and Practices (2021)

Reduce all Underweight SDG target to end

forms of and CED all forms of
malnutrition <5yrs: 19.1% malnutrition and
5-10yrs: 25.5% Global Nutrition
≥20 yrs: 8.4% Targets

Stunting Underweight
<5yrs: 29.6% and CED - 0.0%
5-10yrs: 24.9%
10-19yrs: 26.6% Stunting
40% reduction
Wasting <5yrs: 17.8%
<5yrs: 5.7% 5-10yrs: 14.9%
5-10yrs: 7.8% 10-19yrs: 16.0%
10-19yrs: 11.5%
Wasting
Overweight and Reduce to <5%
Obesity (60% reduction
0-59 mos: 3.5% across all age)
5-10yrs: 10.4% <5yrs: 2.3%
10-19yrs: 10.7% 5-10yrs: 3.1%
≥20 yrs: 36.6% 10-19yrs: 4.6%

(Expanded National Overweight and

Nutrition Survey,
Obesity
2019)
0% increase
0-59 mos: 3.5%
5-10yrs: 10.4%
10-19yrs: 10.7%
≥20 yrs: 36.6%
 Health Promotion Framework Strategy 2030 | 16

Filipinos 15.3% 15% relative Reduce 10% Reduced

increase from developed a mental
engage in burden of health problem in the
prevalence of
physical Health Literacy baseline mental health past 12 months baseline
Assessment -
activity Knowledge, Attitude, disorders
Health Literacy National Survey on
and Practices (2021)
Assessment - Mental Health and
Knowledge, Attitude, Well-being (NSMHW)
and Practices (2021)

Best Buy Interventions

Diet and nutrition

The World Health Organization (WHO) recommends best buy interventions to address the
burden of unhealthy diets including reduction of salt intake through the reformulation of food
products, the establishment of supportive environments such as hospitals, schools, and
workplaces, implementation of front-of-pack labeling for food items, and setting targets for
the amount of salt in foods and meals. Among the critical components in implementing
these interventions is mass media campaigns to foster behavioral change in the population.
The reduction of the current sodium consumption in the Filipino diet of 4.1 grams per day to
at least 2.0 grams per day can avert 365,214 life-years lost and productivity losses of $ 3.3
billion (PPP). Reduction of the prevalence of insufficient fruits and vegetable consumption
from 92% in 2015 to 62%, a relative reduction of 30 percentage points, will avert 190,123
life-years lost and productivity losses of $ 16.7 million (PPP). Likewise, through a
settings-based approach with the promotion of healthy schools that offer healthy foods and
provide nutrition education and skills, the consumption of fruits and vegetables was shown
to potentially increase by 8.4%.

The institutionalization of public policies to improve the diets of Filipinos such as the
“National Policy on the Elimination of Industrially-Produced Trans-Fatty Acids for the
Prevention and Control of Non-Communicable Diseases” under DOH Administrative Order
2021-0039 aims to support the reformulation of food products to decrease the current 0.2%
consumption to 0% and subsequently avert 122,949 life-years lost and productivity losses of
$ 1.1 billion (PPP). The taxation of SSBs under the Tax Reform for Acceleration and Inclusion
(TRAIN) Act including other reforms to decrease harmful levels (>120 grams per day) of SSB
consumption is expected avert 2,799 life-years lost and productivity losses of $ 0.2 million
(PPP) by decreasing the current 2.1% harmful SSB consumption to 0%.

Improving the availability of healthier beverages in the home environment is among the
high-impact interventions shown to have the largest potential of reducing SSB intake by at
least 72%. Other interventions include the promotion of drinking water at schools as an
alternative to SSBs, menu board calorie labeling in restaurant chains and cafes, in-store
traffic light labeling of healthy (green), less healthy (yellow), and unhealthy (red) beverages,
 Health Promotion Framework Strategy 2030 | 17

and multi-component community campaigns that focus on lowering consumption of SSBs

that may potentially reduce intake from around 14% to 38%.

Increasing the proportion of mothers who exclusively breastfeed their children from 49% to
70% will avert at least 154,433 life-years lost and productivity losses of$ 1.4 billion (PPP).
Among the specific interventions to improve breastfeeding, breastfeeding education for
mothers and the promotion of baby-friendly hospitals may potentially increase the
proportion of mothers who exclusively breastfeed their children by 20% to 24% while
personalized breastfeeding support through home visits or appointments with health
workers can potentially increase exclusive breastfeeding by 10%.

Box 1. Best Buy Interventions for Diet and Nutrition

Developing Healthy Public Policies

● Public policy on elimination of Trans-Fatty Acids (TFA) for the reformulation of
food products
● Reduce salt intake through reformulation of food products to contain less salt and
the setting of target levels for the amount of salt in foods and meals
● Reduce salt intake through the implementation of front-of-pack labeling
● Taxation of sugar sweetened beverages (SSB)

Creating Supportive Environments

● Promotion and improving the availability of healthier beverages in the environment
(home, school, work, etc.) such as safe drinking water instead of SSB
● Promotion of in-store traffic light labeling of healthy (green), less healthy (yellow),
and unhealthy (red) beverages
● Reduce salt intake by enabling provision of lower sodium options and the
establishment of these supportive environment in public institutions such as
hospitals, schools, workplaces, and nursing homes, and others
● Promotion of menu board calorie labeling in restaurant chains and cafes

Developing Personal Skills

● Reduce salt intake through behavior change communication and mass media
campaign
● Promotion of the baby-friendly hospitals initiative (BFHI) for successful
breastfeeding
● Promotion of personalized breastfeeding support through home visits or
appointments with health workers
 Health Promotion Framework Strategy 2030 | 18

Physical Activity

Community-wide public education and awareness campaigns for physical activity combined
with community-based education, motivation, and other environmental programs were
among the WHO best buy interventions for physical activity. Reduction in the prevalence of
physical inactivity from 43% to 38%, a 5 percentage points relative reduction (as
recommended) will avert 40,819 life-years lost and productivity losses of $ 379 million
(PPP).

For specific interventions, an increase in the awareness or knowledge of the health benefits
of physical activity by at least 2-4 times through community-wide campaigns is estimated to
reduce the prevalence of physical inactivity by 2.5% to 5.10%. Meanwhile, an increase in
eHealth interventions for children and adolescents 5 to 19 years old may reduce the
prevalence of physical inactivity by 2% to 8%. Depending on the age of the target population,
family-based social support reduces the prevalence of physical inactivity by about 20%
community social support on physical activity by about 13% to 15%. Among adolescents,
school-based physical education has the largest potential to reduce the prevalence of
physical inactivity to as high as 158%. Across all ages, the creation or improvement of places
for physical activity has the potential to reduce prevalence by 23% while point-of-decision
prompts like signages placed along elevators and escalators to motivate people to be more
active have the potential to reduce prevalence by 35% to 40%.

Box 2. Best Buy Interventions for Physical Activity

Creating Supportive Environments

● Creation or improvement of places for physical activity
● Promotion of the use of point-of-decision prompts like signages among elevators
and escalators

Strengthening Community Action

● Community-wide public education and awareness campaign for physical activity
which includes mass media campaign combined with other community-based
education, motivational and environmental programs aimed at supporting
behavioral change of physical activity levels
● Community- and family-based social support programs for physical activity

Reorienting Health Services

● Improvement of school-based physical education
● Increase e-Health interventions for children and adolescents

The settings-based implementation approach for the HPFS can be leveraged based on the
identified best buy interventions in Box 1 and 2 through modifications in the environment.
Most of these interventions can be championed with partnerships and stakeholder
engagement.
 Health Promotion Framework Strategy 2030 | 19

Priority Area 2: Environmental Health

Tackling environmental and climate change impacts on health

We cannot separate our health from the well-being of our environment and planet.
Throughout the years, the continuous use and abuse of our natural resources have led to
short- and long-term negative impacts on our health and well-being. We constantly face
dangers with our environmental exposure to pollution either by land, water, or air. Extreme
weather events and disasters also impact not only our health, but our overall lifestyle, and
livelihood. Likewise, structural inequalities brought about by poverty and lack of
development continue to predispose people to unsanitary environments which can largely be
prevented.

Environmental exposures continue to affect health in the Philippines and the world. In 2017,
Filipinos were shown to have a mean annual exposure of 18.07 µg/m3 to air pollutants like
methane, nitrous oxide, carbon dioxide emissions, and many others. Exposure to air pollution
was estimated to contribute to about 10% to 22% of the total burden of disease from lower
respiratory tract infections, lung cancer, ischemic heart disease, and stroke; which translates
to about 1.07 million life-years lost.9

In terms of sanitation facilities, in 2020 although the majority of Filipino families (97.5%)
were reported to have improved sources of drinking water, around 80.2% do not practice any
method or treatment to ensure that their drinking water is safe. Only eight out of 10 (80.4%)
of Filipino families have basic level sanitation facilities or those which are considered as
improved facilities which are not shared with other households. Around 2.6% of Filipino
families still have unimproved sanitation facilities while 3.5% have none and are still
practicing open defecation. When it comes to handwashing facilities, nine out of 10 (90.6%)
Filipino families have handwashing facilities but 12.6% of these families still rely on mobile
objects such as buckets, jugs, or kettles and 6.7% have no soap available.10 Overall,
unimproved water sources and sanitation facilities contribute to an estimated 35% and 25%
of the total burden of disease from diarrhea which translates to 188,000 life-years lost and
135,000 life-years lost respectively. In particular, lack of handwashing facilities was
estimated to contribute at least 5% to 8% of the total burden of disease from diarrhea which
translates to 143,000 life-years lost.

Environmental risks account for much of the disease burden in the country which includes
air pollution (both outdoors and inside the household) and access to clean water and
sanitation. The Philippines is also among the most vulnerable countries in terms of

9
Global Burden of Disease Collaborative Network (2020). Global Burden of Disease Study
2019 (GBD 2019) Results. Seattle, United States: Institute for Health Metrics and Evaluation
(IHME). Available from http://ghdx.healthdata.org/gbd-results-tool
10
Philippine Statistics Authority. (October 2018). Philippines National Demographic and Health Survey
2017. Retrieved from:
https://psa.gov.ph/sites/default/files/PHILIPPINE%20NATIONAL%20DEMOGRAPHIC%20AND%20HE
ALTH%20SURVEY%202017_new.pdf
 Health Promotion Framework Strategy 2030 | 20

experiencing disasters exacerbated by the climate crisis. Natural disasters lead to numerous
chronic diseases, infections, and even needless deaths that can be mitigated through
improved natural and built environments through safe and sustainable urban development,
as well as increased preparedness and resilience.

Tackling these negative environmental and climate impacts on health requires conscious
attention to how we treat the environment and the built infrastructures in which we live.
Health promotion’s role in this regard is to educate, mobilize, and empower local government
units (LGUs) and their respective communities to take action in improving their living
environment. Table 2 summarizes the behavioral and health outcome targets for
environmental health.

Table 2. Environmental Health Behavioral and Health Outcome Targets

BEHAVIORAL HEALTH TARGET
BASELINE TARGET BASELINE
OBJECTIVE OUTCOME BY 2030

Filipinos 31.2% 50% relative Reduce 12.75% DALYs 6.38% DALYs

practice increase from exposure to 16.15% Deaths 8.08% Deaths
sustainable Health Literacy baseline environmental/
Assessment - occupational (IHME Global Burden
lifestyles Knowledge, Attitude, (50% reduction)
and Practices (2021)
Health Literacy risk of Disease, 2019)
Assessment -
Knowledge, Attitude,
and Practices (2021) Reduce the 5,218 2,609
number of
persons directly (National Disaster
Risk Reduction (50% reduction)
affected by Management
climate-related Council, 2018)
disasters per
100,000 of the
population

Filipinos 76.8% 50% relative Reduce 12.75% DALYs 6.38% DALYs

practice increase from exposure to 16.15% Deaths 8.08% Deaths
improved Health Literacy baseline environmental/
Assessment - occupational (IHME Global Burden
sanitation Knowledge, Attitude, (50% reduction)
and Practices (2021)
Health Literacy risk of Disease, 2019)
Assessment -
Knowledge, Attitude,
and Practices (2021)

Filipinos 73.2% 50% relative Reduce the 5,218 2,609

practice increase from number of
persons directly (National Disaster
disaster Health Literacy baseline Risk Reduction (50% reduction)
Assessment - affected by
preparedness Knowledge, Attitude, Management
and Practices (2021) Health Literacy climate-related Council, 2018)
Assessment - disasters per
Knowledge, Attitude,
and Practices (2021)
100,000 of the
population

Reduce burden 10% Reduced

of mental health developed a mental prevalence of
health problem in the
disorders past 12 months
baseline

National Survey on
Mental Health and
Well-being (NSMHW)
 Health Promotion Framework Strategy 2030 | 21

Best buy Interventions

For environmental health, although cost-effective or “best buy” interventions haven’t been
evaluated, there was a multitude of inter-sectoral and collaborative strategies and priority
actions that have been highlighted in WHO guidance documents. This includes, but not
limited to, improving air quality, water, and sanitation safety planning, operationalization of
policies and programs for environmental and occupational health services in health care
facilities including refugee camps or other areas that host internally displaced persons,
development or updating of environmental health emergency profiles and plans including
capacities to respond to chemical, radiological, or even nuclear events.

Based on the estimates of the collaborative study with PIDS, improving air quality from the
current 96% exposure of the population to particulate matter (PM 2.5) to 71% would avert an
estimated 280,759 life-years lost and productivity losses of $2.6 billion (PPP). Improving
water sources of the Filipino population from 95% to 100% would avert 188,074 life-years
lost and productivity losses of $1.7 billion (PPP). Decreasing the proportion of Filipinos with
unimproved sanitation facilities from 23% to 5% would avert 105,267 life-years lost and
productivity losses of$ 978 million (PPP). Finally, increasing handwashing facilities from 82%
to 95% would avert 103,643 life-years lost and productivity losses of $962 million (PPP).

In terms of specific cost-effective interventions, conducting latrine promotion programs to

motivate communities and provision of health information campaigns alone may only
increase the proportion of improved sanitation facilities by at least 8%. On the other hand,
community-level interventions have been shown to improve the number of functioning
sanitation facilities to at least 21% to 24%. Likewise, current evidence also shows that
school programs promoting handwashing, mass media campaigns, and even training of
community-based agents of change are expected to yield around 0.5% to 3.3% increase in
handwashing practices.

Aside from these interventions, numerous guidance documents from the WHO such as
climate resilience and environmentally sustainable healthcare facilities, urban health
initiative11, and frameworks for emergency preparedness were adapted in the context of
health promotion to highlight interventions that would contribute to the achievement of the
HPFS. For example, to achieve sustainable lifestyles there are various factors that should be
considered such as water itself, its supply, and its treatment, and not just sanitation and
wastewater. There are also healthcare wastes, chemicals, air quality, and even food
production and management of food waste which should be considered. In terms of
emergency preparedness, the programs, plans, and activities of the health sector should
cover information tools and support services on environmental health (including water,
sanitation, and hygiene), management of chronic diseases and communicable diseases

11
World Health Organization. (26 May 2021). Urban Health Initiative a model process for catalysing
change, Making health a priority in the design of air pollution free cities. Retrieved from:
https://www.who.int/publications/i/item/WHO-HEP-ECH-AQH-2021-1
 Health Promotion Framework Strategy 2030 | 22

control shall be ensured, and health care delivery services (including infrastructure) must be
integrated into the national emergency preparedness plan.

Box 3. Interventions for sustainable lifestyles

Developing Healthy Public Policies

● Adoption of the WHO Chemical roadmap which provides a framework for
addressing chemical safety by the health sector and healthcare facilities
● Implementation of radiation safety policies that recognize multiple benefits which
can be obtained while addressing and minimizing health risks

Creating Supportive Environments

● Ensuring adequate water supply and wastewater treatment facilities
● Affordable waste-water treatment technologies available and functional in small-
to medium-scale healthcare facilities
● Transportation planning and use of cleaner fuels and cooking technologies to
reduce indoor air pollution
● Limiting amount of meat intake, cutting on fast-food or junk food, composting food
waste, supporting local produce and own food production

Developing Personal Skills

● Increasing awareness of health hazards related to health care waste, provision of
training in proper waste management, improve infrastructures such as appropriate
incineration technology, and enforcement of appropriate regulations

Box 4. Best buy Interventions for improved sanitation

Developing Personal Skills

● Health information campaigns and community motivation to promote awareness
of sanitation practices and WASH including Latrine Promotion Programs

Strengthening Community Action

● Community-level interventions to improve functioning sanitation facilities by having
trained or hired individuals as latrine supply agents who carry out free delivery and
installation of sanitation facilities in households
● Promotion of handwashing in school programs that encourage habit formation and
public commitment
● Mass media campaigns to promote handwashing combined with training of
community-based agents of change such as health workers, teachers, or
community leaders

Box 5. Interventions for disaster and emergencies

Developing Healthy Public Policies

● Ensure that interventions address community needs and not what service agencies
perceive as their needs
● Ensuring that the rebuilding process is “health focused” or health driven and rather
than only health system driven
 Health Promotion Framework Strategy 2030 | 23

Developing Personal Skills

● Promoting awareness on “go bags” for preparedness during disasters
● Experiential learning on emergency management
● Provide training and guidance in performing actions needed during a disaster
● Engaging survivors in decision-making

Strengthening Community Action

● Organizing communities to make them health and safety conscious
○ Promoting health of the community and families as part of emergency
preparedness plans
○ Community involvement and participation in assessing risks and
vulnerability
○ Availability of tailored risk information based on an individual characteristic
● Support reconnecting scattered members of the community to rebuild
● Building networks with the government, NGOs, CSOs, and services agencies

The interventions in Box 4 were proven to be cost-effective based on the PIDS study.
Nonetheless, although the other interventions were not evaluated based on their
cost-effectiveness, these were interventions recommended in the global community and
more comprehensive in their approach for addressing health promotion in environmental
health. Due to the wide scope of environmental health and its constantly evolving concept
which may take form through different terminologies such as Ecohealth, One Health, and the
now Planetary Health; the DOH recognizes that these interventions may not be exhaustive
and shall continuously adapt as new evidence arises.
 Health Promotion Framework Strategy 2030 | 24

Priority Area 3: Immunization

Promoting vaccine use

Every year, vaccines save millions of lives from vaccine-preventable diseases (VPDs). In the
Philippines there are 13 recommended vaccines from birth to age 18. However, the recent
shift in perception of vaccine effectiveness, importance, and safety has influenced the
decline in vaccine confidence and uptake in the country12.

The Philippines has been experiencing sub-optimal vaccine uptake. Consequently, there have
been more reports of refusals and these ultimately led to the measles and polio outbreaks in
2019. It was estimated that in the Philippines, sub-optimal vaccination coverage leads to a
significant burden of disease with around 1.1 million life-years lost and lifetime productivity
losses of$ 10.8 billion (PPP).

We must not forget that there are a number of VPDs that still require increased coverage.
During the pandemic, vaccines provided people with security in preventing severe cases of
COVID-19 and limiting transmission. Despite the continuous emergence of variants, vaccine
equity remains to be one of the key measures stated by the WHO to curb the pandemic.
Vaccinations are not only our right to a healthy life but also our shared responsibility to
ensure a healthy future for the Filipino community.

Table 3. Immunization Behavioral and Health Outcome Targets

BEHAVIORAL HEALTH TARGET
BASELINE TARGET BASELINE
OBJECTIVE OUTCOME BY 2030

Filipinos are 14.3% 50% relative Reduce the 59.98 SDG: Eliminate
fully increase from prevalence measles incidence measles and
immunized Health Literacy baseline of (per 1M population)
Assessment - rubella (0.0)
(FIP) Knowledge, Attitude, vaccine-prev
Health Literacy
and Practices (2021)
Assessment - entable 434.0
Knowledge, Attitude, diseases tuberculosis incidence SDG: End the
and Practices (2021) (per 100k population) epidemics of
tuberculosis
reported cases of
(0.0)
vaccine-preventable
diseases from VPD
surveillance Other VPD
(see Monitoring and (see Monitoring
Evaluation) and Evaluation)

12
Figueiredo, A. D., Simas, C., Karafillakis, E., Paterson, P., & Larson, H. J. (2020). Mapping global
trends in vaccine confidence and investigating barriers to vaccine uptake: A large-scale retrospective
temporal modelling study. The Lancet, 396(10255), 898-908. doi:10.1016/s0140-6736(20)31558-0
 Health Promotion Framework Strategy 2030 | 25

Best buy Interventions

WHO recommends complete vaccine coverage or a full immunization status to prevent the
incidence of vaccine-preventable diseases not only among children but also among adults.
Likewise, vaccination against human papillomavirus (HPV) among 9 to 14-year-old girls was
also recommended for the prevention of cervical cancer. Increasing alone the proportion of
fully immunized children from 70% to 95% would avert at least 595,077 life years lost and
productivity losses of$ 5.5 billion (PPP) and this does not even include other routine
vaccinations administered until adulthood.

Among the interventions employed to improve vaccination, it was shown in the collaborative
study with PIDS that making full use of the health information system by requiring schools
and colleges to get students immunized or having them provide their documentation of
immunity may increase full immunization status to almost 100%. However, these are among
the compelling types of interventions which may not look amenable across all learning
institutions for various reasons. Instead, students may be encouraged to provide their
documentation of vaccinations to open the path towards other effective interventions such
as sending reminders or notices to get vaccinated or even getting health education
messages to improve vaccination uptake and coverage across population groups. It was
shown that setting reminders and provision recall notices from healthcare providers may
potentially increase vaccination coverage by at least 10.7%. These reminders or notices may
also include health education messages on the importance of vaccination and may be
delivered through various methods tailored to the preference of an individual e.g. by phone
call, text or instant messages, e-mail, and others. A combination of such measures, including
other recommended interventions in the Immunization Agenda 203013 and other available
evidence were considered for health promotion.

Box 6. Interventions for Immunization

Developing Personal Skills

● Provide educational opportunities and information resources for immunization
● Promotion of communication tool-based training for healthcare workers to address
vaccine hesitancy
● Use of mass media as an approach to promote vaccine uptake

Strengthening Community Action

● Encourage students to provide documentation of vaccination in attending child
care, schools, or colleges.
● Use of feasible and acceptable digital interventions to promote vaccine uptake14

13
World Health Organization. (April 2020). Immunization Agenda 2030: A Global Strategy To Leave No
One Behind. Retrieved from:
https://www.who.int/publications/m/item/immunization-agenda-2030-a-global-strategy-to-leave-no-o
ne-behind
14
COVID-19 Global Evaluation Coalition (2020). Effects of digital interventions for promoting
vaccination uptake. Retrieved from:
https://www.covid19-evaluation-coalition.org/documents/VACCINES-Brief-2.pdf
 Health Promotion Framework Strategy 2030 | 26

○ Client reminder and recall notices by various methods (i.e. telephone or

mobile phone call, SMS or text messages, instant messages, e-mail, etc.)
● Use of client or family incentive rewards to motivate people to get vaccinated

Reorienting Health Services

● Strengthen immunization information and promote the use of high-quality
"fit-for-purpose" data for action
● Evaluate and scale up promising innovations as appropriate, based on best
available evidence
 Health Promotion Framework Strategy 2030 | 27

Priority Area 4: Substance Use

Preventing tobacco use, illicit drug use, and harmful alcohol use

The prevalence of substance abuse is a complex public health issue. Its health impacts on
those who engage in it are proven to be fatal. In the Philippines, it was estimated that direct
smoking results in 2.7 million life-years lost, while second-hand smoking results in an
additional 592,000 life-years lost. Moreover, direct smoking was noted to be a significant
contributor on the burden of disease in asthma, diabetes, stroke, ischemic heart disease, and
lung or tracheal cancer while second-hand smoking was noted to be a significant contributor
on the burden of disease in asthma, diabetes, stroke, ischemic heart disease, lung or
tracheal cancer, and even breast cancer. When it comes to alcohol consumption, binge
drinking defined as 5 or more standard drinks in a row for men or 4 or more standard drinks
in a row for women, contributes to around 1% to 3% of the total burden of disease from liver
cancer and liver diseases, stroke, and intracerebral hemorrhage which translates to 900,000
life-years lost.

Substance abuse also harms those who do not engage in it — some examples of secondary
harm due to substance abuse include the inhalation of secondhand smoke, road traffic
incidents related to persons driving under the influence of alcohol, dangerous drugs, and
similar substances, and cases of domestic violence. With the emergence of novel and highly
addictive tobacco and nicotine products, the elimination of substance abuse is all the more
urgent and relevant today.

An individual’s use of tobacco or nicotine products, excessive drinking, or use of drugs has
underlying social determinants, and understanding these factors can help us support users
in quitting, and prevent non-users from using them in the first place. For instance, people
with lower income and whose jobs are insecure are prone to engage in substance abuse
because of this stress15. The social marginalization of gender and sexual minorities is
another example. Hence, preventing substance abuse begins with securing every Filipino’s
psychosocial wellbeing.

To eliminate the public health concern that is substance abuse, a conducive environment for
cessation must be encouraged16. Substance use that may lead to substance abuse must be
curbed. Empowering families and peers to support people who engage in substance abuse
can be effective. The culture of fear and stigma surrounding drug use must also be
addressed to encourage persons who use drugs to seek help from health professionals.
Finally, policies that reduce the accessibility and availability of tobacco products and the
advertisement of alcohol can help reduce substance abuse.

15
Garrett, B.E., Dube, S.R., Babb, S., McAfee, T. (2014). Addressing the Social Determinants of Health
to Reduce Tobacco-Related Disparities. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5104348/
16
Galea, S., Vlahov, D. (2002). Social determinants and the health of drug users: socioeconomic
status, homelessness, and incarceration. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1913691/
 Health Promotion Framework Strategy 2030 | 28

Table 4. Substance Abuse of Tobacco Behavioral and Health Outcome Targets

BEHAVIORAL HEALTH TARGET
BASELINE TARGET BASELINE
OBJECTIVE OUTCOME BY 2030

Filipinos avoid 93.9% 50% relative Reduce the 23.8% adults 16.7% adults
smoking increase from number of
Health Literacy baseline current tobacco Global Adult Global Adult
Assessment - users, both for Tobacco Survey Tobacco Survey
Knowledge, Attitude, 2015 2015
and Practices (2021)
Health Literacy adults and the
Assessment - youth
Knowledge, Attitude, 12.5% youth 8.8% youth
and Practices (2021)

Global Youth Global Youth

Tobacco Survey, Tobacco Survey,
2019 2019

Reduce 4.7% 3.1%

mortality
attributed to PSA Vital Statistics SDG target of
non-communica Report, 2019x reduction by
one-thirds
ble diseases

Reduce burden 10% Reduced

of mental health developed a mental prevalence of
health problem in the
disorders past 12 months
baseline

National Survey on
Mental Health and
Well-being (NSMHW)

Best buy Interventions on Tobacco Use

WHO best buy interventions on tobacco control include increase in excise taxes and price of
tobacco products, plain or standardized packaging or large graphic health warnings,
comprehensive bans on tobacco advertisement, promotion, and sponsorship, mass media
campaigns informing people about the harms of smoking as well as second-hand smoke,
and elimination of second-hand smoke exposure in all indoor workplaces, public places, and
public transport.

A 30% reduction in the current prevalence of direct smoking from 24% to 17% and the current
prevalence of second-hand smoking from 22% to 15% would avert a total of 994,198
life-years lost and productivity losses of $ 1.6 billion (PPP). For tobacco control
interventions, tobacco taxation estimates have shown that at least a 75% price increase is
needed to expect a 30% reduction in the prevalence of smoking. Graphic health warnings has
the potential to reduce prevalence by 52%, bans on tobacco advertising, promotion, and
sponsorship by 22.7%, bans on point-of-sale displays for tobacco products by 17.9%,
whereas aggressive media campaigns and regulations for workplace and school exposure
by 9.3%, 9.4%, and 4.6% respectively.

Box 7. Best buy Interventions for tobacco use

Developing Healthy Public Policies

 Health Promotion Framework Strategy 2030 | 29

● Increase excise taxes and prices on tobacco products

● Implement plain / standardized packaging or large graphic health warnings on all
tobacco packages
● Enact and enforce comprehensive bans on tobacco advertising, promotion, and
sponsorship
● Eliminate exposure to second-hand tobacco smoke in all indoor workplaces, public
places, public transport
● Implement effective mass media campaigns that educate the public about the
harms of smoking / tobacco use and secondhand smoke

Table 5. Substance Abuse of Alcohol Behavioral and Health Outcome Targets

BEHAVIORAL HEALTH TARGET
BASELINE TARGET BASELINE
OBJECTIVE OUTCOME BY 2030

Filipinos avoid 96.3% 50% relative Reduce binge 55.6% adults 44.5% adults
harmful increase from drinking among
alcohol use Health Literacy baseline currently 45.9% 36.7%
Assessment -
Knowledge, Attitude, drinking adults adolescents adolescents
Health Literacy
and Practices (2021)
Assessment - and (Expanded National
Nutrition Survey,
Knowledge, Attitude, adolescents
2019)
and Practices (2021)

Reduce 4.7% 3.1%

mortality
attributed to (PSA Vital Statistics SDG target of
non-communica Report, 2019) reduction by
one-thirds
ble diseases

Reduce burden 10% Reduced

of mental health developed a mental prevalence of
health problem in the
disorders past 12 months
baseline

National Survey on
Mental Health and
Well-being (NSMHW)

6.2 3.1
Reduce Monthly average Monthly average
index crime rate index crime rate
incidence of
interpersonal
(Administrative data
violence - Philippine National
Police, 2018)

11.9 5.95
Reduce deaths per 100,000 per 100,000
population population
due to road
traffic injuries
Vital Statistics
Report, 2019

3.8 fatalities 1.9 fatalities

426 non-fatalities 213 non-fatalities
Reduce
incidence of per 100,000 per 100,000
employed persons employed persons
occupational-
related injuries (BLES Integrated
Survey/
Occupational Injuries
Survey/ Integrated
 Health Promotion Framework Strategy 2030 | 30

Survey on Labor and

Employment, 2015)

Best buy Interventions for Alcohol use

For the prevention of the harmful use of alcohol similar to the term “binge drinking”,
WHO best buy interventions include an increase in excise taxes of alcoholic beverages,
comprehensive bans on advertising and promotion, as well as restrictions on the physical
availability of retailed alcohol by reducing hours of sale. A 10% reduction on the prevalence
of binge drinking from the current 24% to 22% (based from the WHO recommendations) will
avert at least 68,552 life-years lost and productivity losses of $ 630 million (PPP). For
strategies, alcohol taxation has the potential to reduce the prevalence of binge drinking by
increments from a 3.4% reduction provided a 25% price increase, a 6.7% reduction provided a
50% price increase, and a 10.1% reduction provided a 75% price increase. Restricting access
of alcohol to adolescents and imposition of dram shop liability laws such as holding
restaurants, bars, or shop owners or servers responsible for harms inflicted on others by
patrons under the influence of alcohol may also potentially reduce the prevalence of binge
drinking by 4.0%.

Box 8. Best buy Interventions for alcohol use

Developing Healthy Public Policies

● Increase excise taxes on alcoholic beverages
● Enact and enforce bans or comprehensive restrictions on exposure to alcohol
advertising (across multiple types of media)
● Enact and enforce restrictions on the physical availability of retailed alcohol (via
reduced hours of sale)
● Promote dram liability laws that would hold shop owners responsible for harms
inflicted on other persons by patrons under the influence of alcohol

Table 6. Substance Abuse of Drugs and Other Illicit Substances Behavioral and Health
Outcome Targets
BEHAVIORAL HEALTH TARGET
BASELINE TARGET BASELINE
OBJECTIVE OUTCOME BY 2030

Filipinos avoid No data No data Reduce the 2.05% 0.0%

drug use available available number of
current drug (National Household
Survey on the
users aged 10 Patterns and Trends
to 69 years old of Drug Abuse,
2019)17

Reduce 4.7% 3.1%

mortality
attributed to PSA Vital Statistics SDG target of

17
Dangerous Drugs Board. (2019). 2019 National Household Survey on the Patterns and Trends of
Drug Abuse. Retrieved from:
https://www.ddb.gov.ph/images/downloads/2019_Drug_Survey_Report.pdf
 Health Promotion Framework Strategy 2030 | 31

non-communica Report, 2019 reduction by

one-thirds
ble diseases

Reduce burden 10% Reduced

of mental health developed a mental prevalence of
health problem in the
disorders past 12 months
baseline

National Survey on
Mental Health and
Well-being (NSMHW)

Interventions for Drug Use

Prevention of drug use and abuse entail a three-pronged approach which include provision of
information within the community, as well as the involvement of schools and families. The
impact of drug prevention was shown to be related with age wherein family-based programs
would heavily impact young children while conditions with peers heavily impact older
children or adolescents. Both approaches highlight the importance of early intervention to
transform a child’s trajectory from a risky path to a protective one through social and
emotional support from parents and the family.

Box 9. Interventions for Drug Use

Strengthening Community Action

● Community-wide mass media campaigns on awareness about the harms of drug
abuse combined with family- or school-based programs
● Family-based prevention programs which enhance family bonding and improve
parenting skills, as well as provide and reinforce drug education and information
for prevention
○ Encourage parents to use positive parenting methods, educate that
parental stress, depression, or anger affect behavior and psychosocial skills
of children
○ Encourage improving protective factors such as parental support
○ Encourage early intervention of risk factors such as aggressive behavior
and poor self-control during childhood toward positive behaviors
● Promote school programs which improve both academic and social-emotional
learning for early intervention of risk factors and reinforcement of drug-resistance
skills and anti-drug attitudes especially among adolescents

Overall, interventions in Boxes 7-9 shall contribute to addressing issues in substance use for
tobacco, alcohol and drug use in order to achieve the behavioral and health outcome targets
for the HPFS.
 Health Promotion Framework Strategy 2030 | 32

Priority Area 5: Mental Health

Increasing psychosocial and mental well-being

Psychosocial resilience is the ability to cope both mentally and emotionally to challenges
and adversity. The Philippines has the most number of depressed people in South-East Asia
with one in five Filipinos suffering from mental or psychiatric disorders.18 In fact, mental
health is ranked as the third most common disability in the country, especially among the
youth. One perfect example of an issue affecting mental health are cases of bullying.
Bullying is estimated to contribute to about 34% of the total burden of disease in anxiety and
mental disorders. Moreover, cases of bullying do not scar a child only at one point in time;
rather, most would have long-term effects on their mental health.

Proactive behavior and treatment are essential for mental hygiene and well-being. If
neglected, mental health can become a serious barrier to a satisfying and fulfilling life and
may lead to the development of risky behaviors.Thus, equipping people with the skills to
understand and regulate their emotions, teaching sensitivity and empathy, as well as
promoting balanced and non-toxic culture is more crucial than ever.

In a country that is constantly facing the repercussions of natural disasters and various
forms of interpersonal and systemic violence and conflict, greater attention is needed to
build psychosocial resilience and well-being. Much has yet to be done in mainstreaming
what mental well-being means, and its relevance to all.

Table 7. Mental Health Behavioral and Health Outcome Targets

BEHAVIORAL HEALTH TARGET
BASELINE TARGET BASELINE
OBJECTIVE OUTCOME BY 2030

Filipinos 94.7% 50% relative Reduce 4.7% 3.1%

practice increase from mortality
self-care Health Literacy baseline attributed to PSA Vital Statistics SDG target of
Assessment - non-communic Report, 2019 reduction by
Knowledge, Attitude, one-thirds
and Practices (2021)
Health Literacy able diseases
Assessment -
Knowledge, Attitude,
and Practices (2021) Reduce burden 10% Reduced
of mental developed a mental prevalence of
health problem in the
health past 12 months
baseline
disorders
National Survey on
Mental Health and
Well-being (NSMHW)

Reduce the 4,418 2,945

incidence of
suicide (Intentional
Self-Harm as cause

18
Ayalin, A. (2016, October 6). 1 in 5 Filipinos suffer from mental health disorder, says Solon. ABS.
https://news.abs-cbn.com/news/10/06/16/1-in-5-filipinos-suffer-from-mental-health-disorder-says-sol
on#:~:text=Hontiveros%2C%20chair%20of%20the%20Senate,illness%20for%20every%20100%2C000
%20Filipinos.
 Health Promotion Framework Strategy 2030 | 33

of death, 2020)

Reduce the 12,778 0

number of new
HIV infections (HIV/AIDS & ART
Registry of the
Philippines, 2019)

Reduce the 16% mistimed 8.0% mistimed

number of 11% unwanted 5.5% unwanted
unwanted or
mistimed (National
pregnancies Demographic and
Health Survey, 2017)

Best buy Interventions

In 2019, the WHO identified cost-effective interventions to improve mental health and
prevent suicide19, population-based interventions among adolescents include the conduct of
a universal and an indicated (i.e., identification of adolescents where intervention is
indicated) school-based socio-emotional learning program and regulatory bans of highly
hazardous pesticides in collaboration with the agricultural sector. Individual interventions
were also needed in terms of basic psychosocial support, psychological treatment, and
provision of medicine depending on a person’s mental health condition.

In the Philippines, part of the general approach in promoting school-based programs include
addressing school-age bullying. Bullying may not only inflict physical harm but also mental
and emotional harm. Consequently, the advent of new technology also resulted in new forms
of bullying such as cyber bullying that was shown to grow at an alarming rate among ASEAN
countries. Iit was estimated that in the Philippines, bullying contributes to 34% of the total
burden of disease in anxiety and mental disorders which translates to 51,105 life-years
lost.20 In 2007, the Philippines was also identified by the WHO to rank third among countries
with high rates of mental health problems in the Western Pacific Region.

Improving mental health was estimated to avert 500,000 life-years lost and productivity
losses of $ 81 billion (PPP). Likewise, reduction of the current prevalence of child bullying
from 40% to 20% would avert 25,553 life-years lost and productivity losses of $ 235 million
(PPP). Similarly, an investment case report on mental health in the Philippines developed by
the WHO in 2021 has also shown that modeled intervention packages for mental health
would save more than 5,000 lives and return 700,000 healthy life years over the course of 10
years.

19
World Health Organization. (July 2021). WHO menu of cost-effective interventions for mental
health. Retrieved from https://www.who.int/publications/i/item/9789240031081
20
World Health Organization. (2021). Prevention and management of mental health conditions in the
Philippines. The case for investment. Manila: World Health Organization Regional Office for the
Western Pacific.
 Health Promotion Framework Strategy 2030 | 34

On the aspect of health promotion, universal school-based socio-emotional learning

interventions were also amongst the interventions with the high returns on investment based
on the 2021 WHO report. Universal school-based interventions estimated to cost roughly
Php 7.5 billion were shown to yield a gain of about Php 22 billion in total productivity and
110,154 healthy life years over 10 years. Consequently, in the PIDS collaborative study,
universal school-based programs such as teaching students on the problems of violence, its
prevention, or tackling topics or skills in emotional self-awareness, emotional control,
self-esteem, positive social skills, social problem solving, conflict resolution, or team work
were shown to have the potential to reduce the prevalence of bullying in children by 24%.
Regulatory bans of highly hazardous pesticides were shown to prevent suicide , translated
to about 8,181 life years gained. In facilitating service provision, collaborative care
management with health care system level integration among primary care providers,
patients, and mental health specialists for depressive disorders can potentially decrease the
proportion of people with mental health problems in the population by at least 80% while
universal school-based cognitive behavioral therapy programs to reduce depression and
anxiety symptoms can also decrease this by around 27%.

Box 10. Best Buy Interventions for Mental Health

Developing Healthy Public Policies

● Regulatory bans of highly hazardous pesticides to prevent suicide

Creating Supportive Environments

● Implement universal and indicated school-based programs
○ Improve mental health and prevent suicide in adolescents
○ Tackle emotional self-awareness, control, and other measures to prevent
violence or bullying

Reorienting Health Services

● Promotion of a collaborative care management with health care system level
integration among primary care providers and mental health specialists

The aspect of health promotion in terms of mental health is very important but not often
explored. Most of the time, programs in mental health are focused on service provision or
delivery of care. Thus, the interventions provided in Box 10 were limited based on available
evidence of interventions evaluated in terms of its cost-effectiveness. Nevertheless,
promotion of health literacy on mental health and self-care shall contribute not only on the
prevention of mental health conditions but on the improvement of the detection of this
otherwise hidden epidemic on mental health.
 Health Promotion Framework Strategy 2030 | 35

Priority Area 6: Sexual and Reproductive Health

Promoting positive sexual and reproductive behavior

Sexual and reproductive health (SRH) is more than just the absence of sexually-transmitted
or reproductive diseases and illnesses. To attain and maintain full SRH, people’s sexual and
reproductive rights must be respected, protected, and fulfilled. This includes fostering
positive and respectful approaches to sexuality and sexual relationships; ensuring sexual
experiences are pleasurable, safe, and free from violence; and enabling people to decide if,
when, and how often to reproduce.

Legal, economic, and socio-cultural barriers still prevent women, the LGBT+ community, and
the youth from attaining full sexual and reproductive health. The Philippines thus records
high rates of unplanned and teenage pregnancy; increased maternal risk and mortality
associated with unsafe abortion and other complications; increased spread of sexually
transmitted infections (STIs), including human immunodeficiency virus (HIV); and poor
uptake of modern contraceptive use21. These, in turn, have effects on long-term maternal and
child nutrition and health, education, employment, social standing, and more. In fact, it was
estimated that unsafe sex practices account for 32% of the total burden of disease from HIV
or STIs translating to about 120,210 life-years lost. Furthermore, with the health system
disruptions brought about by the COVID-19 pandemic, it was noted that there has been a
61% drop in HIV testing services in 2020 which emphasizes the need for better ways to
address sexual and reproductive health of the people.

Sexual and reproductive health inequity is exacerbated by gender, sexuality, socio-economic

class, religion, disability, as well as other determinants of health. To increase uptake of
healthy sexual and reproductive behavior, supportive environments must be created through
reducing cultural and social stigma and discrimination and increasing accessibility of sexual
and reproductive health services, especially for vulnerable groups.

Table 8. Sexual and Reproductive Health Behavioral and Health Outcome Targets
BEHAVIORAL HEALTH TARGET
BASELINE TARGET BASELINE
OBJECTIVE OUTCOME BY 2030

Filipinos do 81.4% 50% relative Reduce the 8.6% 4.3%

not engage in increase from number of girls
risky sexual Health Literacy baseline aged 15-19 who (National
Assessment - have begun Demographic and
behavior Knowledge, Attitude, Health Survey, 2017)
and Practices (2021)
Health Literacy childbearing
Assessment -
Knowledge, Attitude,
and Practices (2021) Reduce the 12,778 0
number of new
HIV infections (HIV/AIDS & ART
Registry of the

21
Melgar, J.L.D., Melgar, A.R., Salgado, J. (April 2015). Country profile on universal access to sexual
and reproductive health: Philippines. Retrieved from:
https://library.pcw.gov.ph/sites/default/files/Country-Profile-SRH-Philippines.pdf
 Health Promotion Framework Strategy 2030 | 36

Philippines, 2019)

Reduce the 16% mistimed 8.0% mistimed

number of 11% unwanted 5.5%
unwanted or unwanted
mistimed (National
pregnancies Demographic and
Health Survey, 2017)

Reduce burden 10% Reduced

of mental health developed a mental prevalence of
health problem in the
disorders past 12 months
baseline

National Survey on
Mental Health and
Well-being (NSMHW)

Best Buy Interventions

WHO recommendations to promote sexual and reproductive health and rights include
comprehensive sexuality education and provision, contraception counseling and provision,
care during antenatal, intrapartum and postnatal periods, as well as care for safe abortion,
prevention of STIs and HIV22.

Halving the proportion of the Filipinos who practice unsafe sex from 97% to 49% would avert
60,399 life-years lost and productivity losses of$ 555 million (PPP). Community or
group-level interventions to increase protective behaviors among men who have sex with
men (MSM) was noted to be a high impact activity which may reduce the prevalence of
unsafe sex practices by 40.1%. Other strategies such as group-based comprehensive risk
reduction interventions and parenting interventions to reduce risky sexual behaviors of
adolescents also have the potential to reduce the prevalence of unsafe sex practices by at
least 14.5% and 7.3% ,respectively.

Box 11. Best Buy Interventions for Sexual and Reproductive Health

Creating Supportive Environments

● Strengthen formal and informal evidence-based comprehensive sexuality
education and provision incorporated with concepts of human rights and gender
equality

Developing Personal Skills

● Provision of information to enable people make informed choices on their sexual
and reproductive health
● Awareness raising and reinforcing the role of the society as a whole for a
rights-based prevention and response to sexual violence
● Educate and increase uptake for contraception counseling and provision, care for

22
World Health Organization. (2011). WHO Guidelines on Preventing Early Pregnancy and Poor
Reproductive Health Outcomes Among Adolescents in Developing Countries. Geneva, CH: WHO
Press. Retrieved from:
https://www.who.int/immunization/hpv/target/preventing_early_pregnancy_and_poor_reproductive_o
utcomes_who_2006.pdf?ua=1
 Health Promotion Framework Strategy 2030 | 37

safe abortion, and prevention of STI/HIV

● Improvement of caregiver or parenting skills to modify adolescent’s risk or
protective behaviors on sexual and reproductive health

Strengthening community Action

● Community or group-level HIV behavioral interventions that influence knowledge
and beliefs to increase protective behaviors among men who have sex with men
● Group-based comprehensive risk reduction interventions for adolescents by
promotion of abstinence and sexual risk reduction to reduce risk of pregnancy, HIV,
and other STI
 Health Promotion Framework Strategy 2030 | 38

Priority Area 7: Violence and Injury Prevention

Protecting communities from violence and injury

Violence and injury, whether intentional or unintentional, causes harm to millions of people
around the world every day. In the Philippines, around 17% of women in 2017 had suffered
from physical violence or abuse in their lifetime while about 5% of women had suffered from
sexual violence or abuse.23 Overall, the WHO estimates that around 3% to 6% of the total
burden of disease from alcohol and major depressive disorders were attributable to sexual
violence in women which translates to 11,352 life-years lost. These figures represent only
acts of violence of women but it cannot be ignored that this may also occur for men,
children, the elderly, and people from all walks of life.

The impacts of violence and injury are both deep and far reaching: they include poorer
physical and mental health and disability; maldevelopment or deprivation; poorer access to
housing, employment, financial security, and social support; or even death. In addition, there
are often significant economic and social effects, which are felt by the entire community,
most especially the youth that may span across generations.

Though formerly regarded as accidental and random, injuries are now understood to be
largely preventable. Understanding and taking action on the causes of violence and injury
can mitigate their effects and reduce their incidence. Addressing individual factors that
heighten the risk of violence by building healthier life and relational skills, building an
environment that prevents violence and injury, promoting the development of systems of
support, and encouraging social structures, norms, and practices to prevent violence and
injury, as well as their effects.

Table 9. Violence and Injury Prevention Behavioral and Health Outcome Targets
BEHAVIORAL HEALTH TARGET
BASELINE TARGET BASELINE
OBJECTIVE OUTCOME BY 2030

Filipinos do 79.7% 50% relative Reduce the 6.2 3.1

not engage in increase from incidence of Monthly average Monthly average
Health Literacy baseline interpersonal index crime rate index crime rate
violent and Assessment - violence
dangerous Knowledge, Attitude, (Administrative data
Health Literacy
behavior and Practices (2021) - Philippine National
Assessment -
Knowledge, Attitude, Police, 2018)
and Practices (2021)
Reduce the 11.9 5.95
death rate due per 100,000 per 100,000
to road traffic population population
injuries
Vital Statistics

23
Philippine Statistics Authority. (October 2018). Philippines National Demographic and Health Survey
2017. Retrieved from:
https://psa.gov.ph/sites/default/files/PHILIPPINE%20NATIONAL%20DEMOGRAPHIC%20AND%20HE
ALTH%20SURVEY%202017_new.pdf
 Health Promotion Framework Strategy 2030 | 39

Report, 2019

Reduce the 3.8 fatalities 1.9 fatalities

number of
426 non-fatalities 213 non-fatalities
occupational
injuries and per 100,000 per 100,000
diseases employed persons employed persons
acquired
(BLES Integrated
Survey/
Occupational Injuries
Survey/ Integrated
Survey on Labor and
Employment, 2015)

Reduce burden 10% Reduced

of mental health developed a mental prevalence of
health problem in the
disorders past 12 months
baseline

National Survey on
Mental Health and
Well-being (NSMHW)

Reduce the 4,418 2,945

incidence of
suicide (Intentional
Self-Harm as cause
of death, 2020)

Best buy interventions

The WHO identified interventions with compelling evidence on its effectiveness in

addressing injuries and violence. Thepackage of interventions focuses on theprevention,
provision of support, and ensuring availability of high quality trauma-informed care for
violence of all forms including gender-based violence, violence against women, intimate
partner violence, and sexual violence. Health promotion interventions may be centered on
campaigns to improve health literacy as well as prevent and avoid violent and dangerous
behaviors.

Based on the collaborative study with PIDS, the reduction of sexual violence from 5% to 3% is
estimated to avert 5,676 life-years lost and productivity losses of$ 52 million (PPP).
Whereas, prevention of road and traffic injuries were estimated to avert 742,301 life-years
lost and productivity losses of$ 6.8 billion (PPP). Health promotion programs such as school
based programs which promote personal safety and injury prevention, healthy growth and
sexuality, prevention of substance use or abuse, and promotion of student-led "safe school
committees" have the potential to reduce sexual violence and injury by 22%. These
measures are also expected to address other types of violence and injuries among women,
men, children, and the LGBT+24 community.

24
Human Rights Watch. (June 2017). Just Let Us Be: Discrimination against LGBT students in the
Philippines. Retrieved from:
https://www.aidsdatahub.org/sites/default/files/resource/human-rights-watch-just-let-us-be-lgbt-phili
ppines-2017.pdf
 Health Promotion Framework Strategy 2030 | 40

Box 12. Interventions for Violence and Injury Prevention

Developing Healthy Public Policies

● Implement an integrated Safe System Approach that is anchored in the following
components: speed management, leadership on road safety, infrastructure design
and improvement, vehicle safety standards, enforcement of traffic laws, and
survival after a crash
● Set and enforce safe boating, shipping and ferry regulations
● Reduce the availability and harmful use of alcohol
● Reduce access to guns, knives, and pesticides

Creating Supportive Environments

● School-based program promoting personal safety and injury prevention, healthy
growth and sexuality, and prevention of risky behaviors
○ Prevention programs to reduce dating violence and improve conflict
resolution of interpersonal relationships
○ Promotion of student-led “safe school committees”
● Provide safe places away from water for preschool children
● Install barriers controlling access to water
● Build resilience and manage flood risks and hazards

Developing Personal Skills

● Teach school-age children swimming and water safety skills
● Train individuals in safe rescue and resuscitation

Strengthening Community Action

● Implement community and school-based strategies (parent training, parent-child
programmes, social development, etc),
● Promote settings-based programs to address gender norms and attitudes, and
implement victim identification and care and support programs

Measures on preventing injuries and violence are not limited to avoiding physical injuries but
are linked to interventions that tackle mental health, substance abuse, and socio-economic
problems. Although there exist limited evaluation studies on the cost-effectiveness of
interventions for violence and injury prevention, it shall not become a limiting factor to
promote a whole-of-system, whole-of-government, and whole-of-society approach for a
unified action.
 Health Promotion Framework Strategy 2030 | 41

Investments in Health Promotion

Financial investments on health promotion is essential for an efficient and effective

operationalization of the HPFS to achieve a Healthy Pilipinas. The in-depth discussions on
the seven priority areas build the case on the association between interventions that address
behavioral outcomes and its impact in terms of the burden of associated diseases,
life-years lost and productivity losses.

Return of Investment and Public Health Impact

The estimated costs of identified best buy interventions from the 2021 collaborative study
with PIDS and the WHO recommended interventions per priority area were used as reference
in assessing the return on investments for addressing each of the priority areas. Table 10
provides the 10-year cost and productivity gains estimates and the benefit-cost ratio per
priority area accounting for a 4% annual inflation rate and using the conversion factor of 1
USD = 51.25 Php.

Investments in health promotion have positive economic returns. Interventions that address
low immunization coverage are the most cost beneficial with about PhP127.33 returns for
every PhP1 spent. This is followed by interventions which address substance abuse (Php
114 for every Php 1 spent), environmental health (Php 48 for every Php 1 spent), and diet and
physical activity (Php 35 for every Php 1 spent). The calculation only accounted for
outcomes in terms of productivity gains and may be interpreted as an underestimation as it
did not consider the gains in terms of healthy life-years gained.

To better inform policies and efficient resource allocation, an investment plan for the
implementation of the HPFS will be developed to also look at both the direct and indirect
cost of the interventions both in economic and health terms.
 Health Promotion Framework Strategy 2030 | 42

Table 10. Return of Investment and Public Health Impact by Priority Area in 10 years
Priority Area 10-yr cost of 10-yr productivity Benefit-cost ratio
interventions gains
(in billions, Php) (in billions, Php)

Diet and Physical 9.09 325.52 35.83

Activity

Environmental 6.57 321.76 48.99

Health

Immunization 2.23 283.36 127.33

Substance Use 1.03 117.91 114.54

Mental Health 4.24 12.04 2.84

Sexual and 16.11 28.45 1.77

Reproductive
Health

Violence and 2.76 2.67 0.97

Injury

Average 6.00 155.96 47.47

 Health Promotion Framework Strategy 2030 | 43

Monitoring the Health Promotion Framework

Strategy

A strong monitoring system is necessary to objectively assess the progress and impact of
health promotion interventions at the national, regional, and local levels. Guided by the UHC
Act Monitoring and Evaluation Framework in the DOH Administrative Order 2021-0026
“Monitoring and Evaluation Framework for Republic Act 11223, otherwise known as the
Universal Health Care Act,” the HPFS M&E Framework was formulated to reflect the target
behavioral and health outcomes per priority area as well as other strategic goals and targets
set by the department’s national objectives for health, relevant mandates as per the
Universal Health Care act, and guidelines from the WHO.

Figure 3. Health Promotion Framework Strategy Monitoring and Evaluation Framework

To track the progress on the country-wide implementation of health promotion interventions,

regular monitoring of relevant health and health-related indicators from national surveys or
surveillance systems will be done. A baseline study on relevant health promotion indicators
will also be initiated to guide the identification of targets in terms of healthy behaviors, and
healthy and health-promoting settings for the next 10 years. Furthermore, the monitoring and
evaluation framework of the HPFS shall be reviewed every medium-term to reflect new
strategies and data sources to utilize the latest available data or information.
 Health Promotion Framework Strategy 2030 | 44

Impact Evaluation on Improved Behavioral Outcomes

The evaluation of the behavioral outcomes of the HPFS shall be guided by the list of
behavioral outcome indicators (Table 11) annual health literacy assessments and
knowledge, attitude, and practice studies shall be conducted to track the progress and
inform expansion and/or re-calibration of strategies and targets.

Table 11. Behavioral Outcome Indicators

HPFS TARGETS
DATA
INDICATOR BASELINE
SOURCE
2025 2030

Proportion of Filipinos consuming 86.2% HLA-KAP 30% relative 50% relative

healthy diet increase from increase from
eNNS for baseline baseline
supplementary
information on
dietary pattern
and practices

Proportion of Filipinos engaging 15.3 HLA-KAP 30% relative 50% relative

in the recommended levels of increase from increase from
physical activity baseline baseline
10-17 yrs: 82.7%
eNNS 10-17 yrs: 10-17 yrs:
20-59 yrs: 38.8%
Proportion of insufficiently 70.7% 66.8%
physically active adolescents and
20-59 yrs: 20-59 yrs:
adults
34.9% 33.0%

10% reduction 15% reduction

(Global NCD (Global Action
Targets) Plan on
Physical
Activity)

Proportion of Filipinos practicing 31. 2% HLA-KAP 30% relative 50% relative

sustainable lifestyles increase from increase from
baseline baseline
Proportion of Filipinos with
improved sanitation 76.8%

Proportion of Filipinos practicing 73.2%

disaster preparedness

Proportion of Filipinos getting 14.3 HLA-KAP

fully immunized
12-23 mos: 70%
Percentage of children who 24-35 mos: 66% 95% vaccine 95% vaccine
(2017) National
received all basic vaccinations Demographic coverage coverage
and Health
12-23 mos: 61% (Immunization
Survey (NDHS) (Immunization
Percentage of children who 24-35 mos: 33% Agenda 2030 and Agenda 2030 and
received all age-appropriate (2017) local targets) local targets)
vaccinations
 Health Promotion Framework Strategy 2030 | 45

Proportion of Filipinos avoiding: HLA-KAP 30% relative 50% relative

● smoking 93.9 increase from increase from
baseline baseline
● harmful alcohol use 96.3

Proportion of Filipinos practicing 94.7 HLA-KAP 30% relative 50% relative

self-care increase from increase from
baseline baseline

Proportion of Filipinos avoiding 81.4 HLA-KAP 30% relative 50% relative

risky sexual behavior increase from increase from
baseline baseline
 Health Promotion Framework Strategy 2030 | 46

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