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FIGURES could be scandalous, sometimes; especially when they reveal that some Filipinos die of starvation—yes, directly from starvation—in the new Millennium.
Based on data obtained by the BusinessMirror, starvation has killed 355 Filipinos between 2006 and 2020. At least 90.14 percent of these deaths, or a total of 320, happened just in a span of four years: between 2017 and 2020.
While there were years—2014 and 2016—when no deaths due to starvation were recorded, the years 2017 to 2019 saw exponential growth in starvation deaths. In 2017, there were 106 fatalities due to starvation; in 2018, 103; and, in 2019, 99 died of hunger.
However, Monetary Board Member Victor Bruce J. Tolentino told the BusinessMirror reporters that he was willing to bet that deaths caused by starvation still happen in advanced countries. This may be because starvation is not only a result of the inability to purchase food, but also access to social services.
“We don’t want to see it grow here and it is not then only a question of access to food, it might also be the appropriate social services. For those who are really in desperate straits. It may be that starvation is already the last step after you lose your job, after you don’t have relatives or friends who can help, after you cannot gain entry to a convent that’s a haven for the hungry, after you lose access to any facility, hospital or DSWD (Department of Social Welfare and Development)—you have been left entirely in the streets, or something like that,” he explained, partly in Filipino.
IRONICALLY, those who died of starvation could be envied by the living still struggling from hunger.
The number of Filipinos suffering from moderate or severe food insecurity (hunger) by the end 2021 was at 48.8 million. It’s a figure that Former Agriculture Undersecretary Fermin D. Adriano described as “scandalous.” Of the total figure, about 5.3 million Filipinos experienced severe food insecurity.
“The number of food insecure in the country is more than the population of Australia (26 million), Canada (35 million), Malaysia (30 million), and most of the countries in the world,” Adriano said.
“If this happened in developed countries, it will be enough to replace the sitting government. But we are not a developed country and, hence, our policymakers can get away with a crime,” he added.
Roehlano M. Briones, senior research fellow at Philippine Institute for Development Studies, agreed with Adriano’s observation. For him, the number of Filipinos experiencing hunger is already a “grave emergency.”
“This is a grave crisis. And the worst indicator—which is more worrisome—is suffered by the most vulnerable: stunting,” Briones told the BusinessMirror.
The State of Food Security and Nutrition in the World 2022 (SOFI) report explained that people who experienced severe food insecurity are those that have “likely run out of food, experienced hunger and, at the most extreme, gone for days without eating, putting their health and well-being at grave risk.”
Meanwhile, moderate food insecurity refers to “a lack of consistent access to food, which diminishes dietary quality, disrupts normal eating patterns, and can have negative consequences for nutrition, health and well-being” of the consumers, according to the report.
PHYSICIAN Oliver D. Lacambra told the BusinessMirror that the cases of people with starvation as the underlying cause of death are “very, very rare.”
“In my practice in the province, I have encountered just one case of death from starvation: an elderly living alone,” said Lacambra, who works at the Apayao Cagayan Medical Center in Abulog, Cagayan.
Lacambra, who has been practicing medicine and worked in various hospitals since 1999, said deaths from starvation could be due to multiple organ failures or severe infections “because the body’s immune system becomes low or weak.”
“The body will become thin, emaciated, wasted.”
Lacambra explained that death comes after “days or weeks.”
It all depends “on the remaining stores of energy in the body,” he said.
“Fats and proteins are converted to glucose. When starvation is prolonged and these (fats/proteins) are depleted, death is imminent.”
According to the physician, a hospital staff presented with a case of death with starvation as possible “underlying cause” usually gathers additional data.
“Additional and further information is elicited from relatives. The cause of starvation is determined whether the patient is intentionally deprived of food, etc.,” Lacambra told the BusinessMirror.
She added that if the cause of starvation is suspicious in nature, the hospital will report it to the Department of Social Welfare and Development and the police.
“The cause of death is categorized according to: first, immediate cause of death (usually sepsis, organ failures); second, underlying cause of death (starvation if proven); and, third, contributory,” Lacambra said adding that the latter are any illnesses that may have contributed to the death of the patient.
MEANWHILE, millions of Filipinos also suffer deaths caused by poor nutrition.
Malnutrition deaths, National Statistician Claire Dennis S. Mapa said, cover those caused by diseases such as kwashiorkor (edema); nutritional marasmus (thinness); marasmic kwashiorkor; and, unspecified severe protein-energy malnutrition.
Malnutrition deaths also cover deaths caused by protein-energy malnutrition of moderate and mild degree; retarded development following protein-energy malnutrition; and unspecified protein-energy malnutrition.
“Malnutrition is the condition that develops when the body is deprived of vitamins, minerals and other nutrients it needs to maintain healthy tissues and organ function. Malnutrition occurs in people who are either undernourished or overnourished,” a PSA official earlier told the BusinessMirror.
Based on PSA data, deaths caused by malnutrition surged 123 percent between 2015 when there were 2,803 Filipinos who died of malnutrition, and 2021 when the deaths reached 6,263.
The deaths caused by poor nutrition in 2021 were the highest on record in the six-year period. The data showed that since 2015, deaths caused by malnutrition have not exceeded 4,000 annually.
In the first three months of 2022, however, malnutrition deaths declined by 36.5 percent. PSA data showed that between January and March 2022, some 800 Filipinos died of malnutrition compared to 1,260 recorded in the same period last year.
However, despite the decline in the number of malnutrition deaths, data showed that it was the 20th top cause of death in the country in 2022 from 25th place in 2021.
GDP not felt
TOLENTINO said hunger and poor nutrition, as much as they are affected by access and availability to nutritious food, are also a symptom of a deeper problem in society, that of inequality.
He said that while it was true that the years 2017, 2018, and 2019 saw the economy growing above six percent annually, high growth in itself was not a guarantee that people will not grow hungry. GDP growth in 2017 averaged 6.9 percent and during the year, even posted a quarterly growth of 7.2 percent in the second quarter and 7.5 in the third quarter.
GDP growth in 2018 averaged 6.3 percent with the highest quarterly growth reaching 6.5 percent in the first quarter. The year before the pandemic, 2019, the economy grew 6.1 percent with the last quarter of the year posting a growth of 6.6 percent.
Given this high growth, to the layman it seemed impossible to think that there were over and nearly 100 people who died of starvation in these years. Tolentino said it is not impossible at all, given that growth may not have trickled down to the poorest Filipinos.
“(GDP) is a very broad number and a very broad experience but it does not really address income distribution concerns. We still have a lot of poor people and poor people who don’t have jobs and it is among the poor who are jobless that starvation would happen,” Tolentino said.
APART from the inequality, incomes in the Philippines have not really kept up with the rise in prices. Tolentino said any time incomes fall short of what is needed by families, there is a tendency for them to cut back on certain items.
Tolentino said these items include non-food needs that allow them to be productive and earn incomes as well as cheaper sources of nutrition. He said the recent spike in wheat prices could discourage Filipinos from consuming bread and similar items.
Many households, he said, could increase their intake of rice. While this allows them to prevent starvation, Tolentino said this does not bode well in terms of nutrition. This is a concern, especially at this time when the cheapest source of protein, eggs, have also seen an increase in prices.
“They will reduce their consumption of meat and fish and increase their consumption of rice and so the nutritional impact of that is bad. We (already have) too much carbohydrates (in our diets,” Tolentino said.
“(This is a) huge issue (since) very few of our children already get adequate levels of protein and dairy and that is a major cognitive development issue which is longstanding and which is now being seen in our educational performance metrics,” he added.
The number of undernourished Filipinos in the country has fallen to 5.7 million between 2019 and 2021 compared to 12.4 million Filipinos recorded in 2004 to 2006. Pundits attributed the decline to the growing economy and the effects of the 4Ps program.
THE primary concern involving children who lack nutrition is the prevalence of stunting among them. Philippine Institute for Development Studies (PIDS) Senior Research Fellow Valerie Gilbert T. Ulep found in his research that the common belief that Filipinos are “short” may not only be due to genetics, but due to malnutrition.
This, the short height of children, is one of the most common signs of stunting. But stunting is not just about height but also about cognitive development.
Former Socioeconomic Planning Secretary Cielito Habito earlier described stunting as one of the Philippines’s major development challenges. Habito said this may make these children “mediocre” when they grow up or be workers that have “low productivity.”
While the Philippine population remains young, reaping the full benefits of the demographic dividend from now until 2050 means having a strong and capable labor force. Habito said that if the working population are disadvantaged from a young age, the country’s demographic dividend could become a demographic time bomb instead.
The prevalence of wasting in Filipino children under 5 years old at the end of 2020 was at 600,000, while the number of stunted children was at 3 million.
Under-5 Filipino kids who were overweight remained at 400,000 in 2020 while obesity in the adult population rose to 4.1 million in 2016 from 3.2 million in 2012.
The number of infants aged 0 to 5 months who experienced exclusive breastfeeding rose to 1.1 million in 2020 from 800,000 in 2012. The prevalence of low birthweight in the Philippines remained at the 20-percent level in end 2015, translating to about 500,000 infants.
Getting more pricey
AND with inflation increasing to 6.1 percent, Tolentino worries that the rise in prices will just continue. Inflation in 2018, based on PSA data, averaged 5.2 percent. This is the same year when starvation caused the death of 103 Filipinos.
“It will become much more expensive,” Tolentino said. “This is the real issue, it is not about self-sufficiency; it is not about supporting farmers; it is not about the short-term changes in the price level. It is all about how you feed your people with the most competitive prices possible of all foods, so that they have access to it and that they have a choice of what these foods are and be able to meet their nutritional needs.”
According to the 2022 SOFI report, the number of Filipinos who cannot afford a healthy diet rose to 75.2 million in 2020 from 74.2 million in 2019.
The report was jointly prepared and published by the United Nations’ Food and Agriculture Organization, International Fund for Agricultural Development, Unicef, World Food Programme (WFP) and the World Health Organization.
The SOFI 2022 report revealed that the cost of a healthy diet in the Philippines in 2020 rose to a four-year high at $4.108 per person per day (about P230 at current exchange rate).
The cost of a healthy diet in the Philippines has been constantly increasing since 2017, when it was estimated at $3.843 per person per day. In 2018, it was $3.998 per person per day and reached $4.054 per person per day in 2019.
Based on the latest SOFI 2022 data, a Filipino should spend nearly $1,500 (about P84,000 at current exchange rate) annually to stay on a healthy diet.
ALBAY Rep. Joey Sarte Salceda, an economist, explained that the country’s food prices, measured by inflation, are strongly correlated to the number of hungry Filipinos.
Salceda projected that the country’s hunger increases by 0.29 percent for every one whole percentage (1 percent) of inflation rate.
If the country’s average inflation rate this year settles at 5.5 percent, it would translate to an additional 76,500 hungry Filipino families, Salceda explained.
“One thing that would limit our food security is high food prices. The poor Filipinos cannot buy properly because of expensive basic commodities,” Salceda said in an interview with CNN Philippines.
In Adriano’s view, the rising inflation and continuous peso depreciation would make it harder for Filipinos to purchase healthy food.
The country’s inflation accelerated to 6.1 percent in June while the peso has settled at the vicinity of P56 against the US dollar.
“They will make nutritious food more unaffordable to ordinary Filipino consumers,” Adriano, an agriculture economist for over 30 years, told the BusinessMirror.
“If food prices increase as a result of the depreciation of the peso (for those imported ones, like most canned goods – meat and fish) and supply shortages, these will mean that the greater income of the poor will go to purchasing food leaving little other needs (health, education, clothing, etc.),” Adriano added.
Citing a World Food Programme study, Adriano said Filipinos, particularly those earning a minimum wage, can “hardly” afford to buy nutritious food.
“It also noted that you almost have to double the take home pay of workers to afford decent nutritious food for the family,” he added.
The daily health diet cost estimated by the 2022 SOFI report for the Philippines of $4.108, or about P225 (at present exchange rate) is about 40 percent of the P570 minimum wage in the National Capital Region, based on BusinessMirror computations.
Make food cheaper
TOLENTINO said addressing hunger and malnutrition would involve bringing down the cost of food in the country and ensuring that all Filipinos, regardless of socioeconomic status, can purchase and have access to the same kind of items.
But bringing down the cost of food would not be simple. Tolentino said part of this solution is for the national government to bring down all tariffs imposed on various imported food items, including rice. It must be noted that the Philippines, to this day, is a net food importer.
Tolentino said rice imports, for one, are slapped with a 35-percent tariff if they are imported from ASEAN countries and where the bulk of our imports usually come from. A higher tariff is imposed when importing rice from countries outside Southeast Asia.
“So if you have a tariff, right now 35 percent on rice for example, you’re basically saying that people will need to shell out 35 percent more for the food that they’re eating compared to an ordinary consumer, say, in Thailand or Vietnam. The tariff is paid for by the people who consume the food,” Tolentino said.
In order to bring down the cost of food, Tolentino said the government should “drastically reduce” all tariff and non-tariff barriers that make food expensive in the Philippines. The recent reduction of the higher tariffs imposed on rice from outside ASEAN is a step in the right direction but more needs to be done in that regard.
He added that non-tariff barriers such as the need to issue certificates of necessity to import (CNI) in the case of fish should be removed in order to further bring down the cost for consumers.
At his age of 69, Tolentino said, he does not yet need glasses and jokingly attributed it to good nutrition, including condensed milk produced by the International Rice Research Institute (IRRI) when he was growing up.
“In our case, nasanay na tayo [we’ve gotten used to it], in a way. These policies have been around for so long that we have come to consider them as normal, which is so bad. We accept that NFA is a normal part of life, we accept that the idea of food security in terms of self-sufficiency is a normal fact of life, but it is not,” Tolentino said.
THE loss of one life due to malnutrition or hunger is one too many. But Tolentino said the data may not be that accurate. The number of starvation deaths in 2020 which reached 12, he said, may have been underreported. The lockdowns and other weaknesses in reporting deaths may be the culprit in this, if this number is indeed underreported.
In a report in 2021, the United Nations Economic and Social Commission for Asia and the Pacific (Unescap) said improving monitoring of the number of deaths and their causes will pave the way to achieve the universal civil registration and vital statistics (CRVS) systems by 2024. The Regional Action Framework contains 15 targets.
The Unescap said the timely mortality statistics disaggregated by causes of death are needed to develop and monitor public health policies and detect emerging health crises such as the Covid-19 pandemic. It stressed that there is a need to further train doctors and increase their awareness of the importance of accurate death certification.
Based on the report, some 22 countries did not have regular training provided on cause of death coding. The report added that nine of these countries did not have ad hoc training either. The Philippines, for its part, is stagnating in meeting the targets on reducing ill-defined cause of death code and in the use of verbal autopsy.
“I bet you actually, maybe there’s more. That 100, that is only what is officially reported,” Tolentino said. “(Starvation and malnutrition could be secondary causes), you are no longer eating well, and have choked from extreme hunger.”
Survey: Covid worsened hunger
COVID-19 could be lethal—in more ways than one.
A rapid assessment survey by the Department of Science and Technology – Food and Nutrition Research Institute (DOST-FNRI) showed that food insecurity experienced by Filipinos worsened in 2020 due to the pandemic.
The DOST-FNRI surveyed 5,717 households nationwide, with 56.3 percent of them reporting problems in accessing food in 2020 due to lack of money, limited public transportation, unemployment, limited food supply, and inability to buy food (elderly living alone).
To cope, the households resorted to buying food on credit (71.8 percent), borrowing food from family/neighbors/friends (66.3 percent), bartering food (30.2 percent) and reducing food intake of adults for children to have more (21.1 percent).
“Impact of food insecurity was higher in households with children (74.7 percent) and pregnant members (80.8 percent) than in households without such members,” the DOST-FNRI said.
The agency also reported that the surveyed households answered that their kids were stunted. The DOST-FNRI survey showed that 66.7 percent of the households were aware that stunting is caused by inadequate food intake and nutrition.
The survey showed that 1 out of 5 of the surveyed mothers perceived their children to be stunted.
TO note, the 2022 SOFI Report cited the local government of Quezon City for its remarkable “healthy food” procurement policy aimed at addressing nutrition-related problems in its locality.
“In one example of procurement policies with a wider scope, in the Philippines, in 2021, the Quezon City Healthy Public Food Procurement Policy introduced mandatory nutrition standards for all food supplies in city-run hospitals, offices, departments and institutions,” the 2022 SOFI read.
“A programme to source nutritious foods and healthy ingredients from micro-, small- and medium-sized enterprises (SMEs), supports the policy,” the 2022 SOFI added.
In July 2021, Quezon City Mayor Josefina Tanya “Joy” G. Belmonte issued Executive Order (EO) 16 series of 2021, titled, Quezon City Healthy Public Food Procurement Policy aimed at “positively” affecting the overall health and nutrition of her constituents.
Under the EO, all QC government units are required to source food products that comply with the city’s nutrition standards while encouraging procurement from micro, small and medium enterprises in the city.
“LGUs directly impact their constituents’ food choices and overall nutrition, through the food they procure and serve in city-administered institutions and during city-funded activities,” Belmonte said.
“Thus, the Quezon City Government is in a unique position to promote QCitizens’ health and nutrition through a healthy food procurement policy,” she added.
Quezon City became the first LGU in the country to establish such a type of food procurement policy.
PABLITO M. Villegas, vice president of Moringgaling Foundation Philippines Inc., said Filipinos’ pandemic-found love for urban gardening must continue in the new normal to supply household needs for healthy food.
“We need to go back to the basic Filipino diet, culinary and food menus. We must start buying and better still growing nutritious yet affordable foods like the malunggay, saluyot, mongo or mungbeans, squash, okra, camotes and green leafy vegetables, root crops and fruits in season,” Villegas told the BusinessMirror.
The agricultural economist also emphasized that feeding programs of local government units (LGUs) must be strengthened by incorporating Filipino-made nutritious food items.
One way to do this is by taking advantage of the “Sagip Saka” law (Republic Act 11321), which allows government agencies, including LGUs, to directly purchase food from local farmers, especially those from their concerned localities, he explained.
Villegas cited the plan of the Malvar Organic Farmers Agriculture Cooperative (Mofac) to soon supply bread with moringa (Moringa oleifera) to the feeding programs of their locality and eventually to the province of Batangas. Villegas is the general manager of Mofac.
The Mofac, according to the Department of Agriculture, is set to receive P4 million in government funding for its moringa project in Batangas that seeks to establish a nursery for malunggay seedlings, provision of organic fertilizers and inputs, as well as the processing for dry food-grade malunggay powder and dried malunggay leaves.
“We will coordinate with the DSWD and LGU to supply moringga buns for the benefit of lactating mothers and pregnant women,” he said, noting that malunggay or moringga is rich in Vitamins A, C, E and even in magnesium and calcium. Villegas added that the moringga buns would also utilize locally-produced flour like those made from coconut, banana, and cassava.
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