Decolonizing Filipino Healthcare
Across the world, byproducts of structural oppression perpetuate inequity across political, social, and economic sectors. The effects of institutions from the past designed to marginalize and advantage different groups are cumulative and intergenerational. While powerful nations no longer implement forceful occupations on a large scale, they still exploit developing countries in hidden ways. The deep wounds left by colonial structures have only begun to heal; the inequalities that they produced remain and are continued by both implicit and explicit policies that work to maintain a status quo where ethnic, religious, and poor people groups are disadvantaged at the benefit of a privileged few. The prolonged effects of these colonial influences have enormous implications for health outcomes in developing countries.
Socioeconomic inequality directly correlates to healthcare access inequity, and the same institutions that reinforce the disenfranchisement and repression of minority groups also reinforce structural health disparities. These disparities can take the form of bias towards lower socioeconomic groups in healthcare, gender-based discrimination, and unequal access to medical care.
The Philippines is one of the most relevant examples of a country whose existing social inequalities are deeply driven by a long, bloody colonial history. Before independence in 1946, the Philippines' history was characterized by a never ending cycle of occupation by distant countries. The Spanish were the first to consolidate a singular rule over the country, which necessitated decades of disproportionately indigenous blood spilled to establish. Once colonial rule was ensured, a Western cultural hegemony was instilled that would be continued by US occupation following the Spanish-American war and the Philippine-American War.
Under the US occupation, systemic cultural domination spread like a destructive disease into all corners of Filipino life. In the mid-1900s, American urban planners, educators, and religious groups designed and implemented a society built on Western values that acted in the interest of those who would assimilate and obstructed those loyal to their native way of life. Filipinos who were lighter-skinned or could speak English were given the best jobs and education opportunities, while those who could not ended up working on plantations. The families that assimilated and collaborated with US rule were rewarded richly with political power and land, and this cumulative socioeconomic wealth continues to give those families oligarchic control over Filipino policies today.
Unlike nearby countries whose growing economies can be attributed to their transition towards manufacturing, the Philippines remains an agricultural-based country. One reason for this is the aftereffects of colonial engineering and the fact that the owners of the plantations are the same wealthy families with oligarchic control. Plus, after World War 2, the US brokered a treaty to reconstruct the Philippines under conditions that lowered the value of the Philippine peso, hindering the development of more advanced industry until today.
The implications of these colonial inequalities are dire for health outcomes in the Philippines, especially for ethnic minorities, farmworkers, and the LGBTQ community. Despite having some of the most fertile soil in the world, one-fifth of the population is impoverished, and malnutrition runs rampant. These trends can partly be attributed to wealthy families' totalitarian control over land distribution and resistance to manufacturing. Farmworkers are paid meagerly by the plantations and often lack enough income to feed their families adequately. Indigenous groups are also denied their land rights as plantations are built on top of them by wealthy colonial families. As a result, many ethnic minorities are displaced and live in unsanitary conditions that foster high rates of infectious disease and amoebic dysentery. High poverty rates also lead to higher teen pregnancy rates, infant and maternal mortality rates, and higher susceptibility to natural disasters due to lack of proper infrastructure. HIV, Tuberculosis, and dengue crises remain widespread, disproportionately affecting poorer communities as well.
An issue that often flies under the radar is mental health issues in the Philippines. Filipino youth face high rates of suicide attempts and mental health problems, and 40% of the Filipino population is under 18. In an evaluation of the Philippine mental health system, a prevalence of 16% of mental illnesses among children was found. Despite these alarming trends, there are only five government hospitals with psychiatric facilities for kids, 84 hospitals with psychiatric services, and only 60 child psychiatrists practicing in the country, mainly concentrated in wealthier regions. The United Nations criticized the Philippines for its aggressive approach to the pandemic, which potentially had an impact on children's mental health. However, more research needs to be carried out on this. Colonial mentalities also impact mental health in the Philippines, resulting in a loss of culture, language, and identity. Research shows that ethnic minorities with higher levels of colonial mentality exhibited lower confidence and self-esteem, which leads to a higher risk of substance abuse, another major issue in the Philippines.
LGBTQ communities and women are underserved in the Philippines, facing inequities in reproductive and mental healthcare. Colonialist structures built on heteronormative values stimulate biases and stigmas that impede the quality of health services. Conversion therapy is still used in the Philippines, a practice that violates human rights and contributes to poor mental health. Many issues affecting transgender Filipinos and LGBTQ take the form of inaccessibility to gender-affirming care and HIV/AIDS services.
While the Philippines has many enduring problems, its government is taking positive steps towards a more equitable healthcare system. The Universal Healthcare Act was passed in 2019, which enrolls all Filipino citizens in a National Health Insurance Program and suggests a pathway for future reforms in the health system. Also, The Philippine Psychological Association (PAP) recently committed to gender-affirming mental healthcare through a statement that called psychologists "to ensure the advancement of LGBTQ+ rights and welfare." NGOs, such as LoveYourself Inc., have implemented policies that improve access to free HIV testing and gender-affirming therapies. While the Philippines' healthcare system urgently needs reform, with the passing of the UHA, there have been some improvements in health financing and access.
A significant component of the path forward to improve health in the Philippines and other countries ravaged by oppressive occupations should be to focus on a restoration of the cultural identity that was lost to ethnic minorities and other marginalized groups. These restorative measures can include increased cultural history in schools and communities to raise a generation of students who recognize institutional bias and improve mental health services and access to food and medical care. A major problem with healthcare in the Philippines is how deeply Western values are integrated into its functioning. This results in communities not fitting into Western culture feeling out of place and uncomfortable.
Healthcare needs to take a more interpersonal approach. Much can be learned from NGOs that utilize community leaders with whom people can connect and relate for healthcare outreach. The health system needs to be a more welcoming, inclusive space instead of an environment dominated by the lingering shadow of colonialist structures. We can begin shifting to a more inclusive space by training community members to be healthcare workers and nurturing a space where diverse cultures are celebrated instead of shunned. To directly address health disparities, access to poor communities in plantations must also be increased, and the focus on wealthy plantation owners within health outreach needs to be decentralized as well.