Preliminary figures between January to September 2024 indicated that ischaemic heart disease was the leading cause of death in the Philippines. The number of people who died from this illness was estimated at 75,500. Following this, cancer resulted in the deaths of about 43,000 people. Eating habits Heart diseases have been linked to high meat consumption, among others. In the Philippines, pork has been the most consumed meat type, followed closely by chicken. While pork meat is typically produced domestically, the country also imports pork to supplement its supply. However, plant-based food has started gaining popularity among Filipinos. In fact, a 2024 survey revealed that 69 percent of surveyed Filipinos consumed plant-based products, including meat alternatives. Common diseases in the Philippines Aside from heart and cerebrovascular diseases, the Filipino population is also exposed to infections, diabetes, skin diseases, and illnesses resulting from high meat consumption. In 2020, over 700,000 Filipinos contracted acute respiratory tract infections, followed by over 400,000 diagnosed with hypertension. In areas with high exposure to rain, dengue infections and leptospirosis have also become prevalent.

To estimate county of residence of Filipinx healthcare workers who died of COVID-19, we retrieved data from the Kanlungan website during the month of December 2020.22 In deciding who to include on the website, the AF3IRM team that established the Kanlungan website set two standards in data collection. First, the team found at least one source explicitly stating that the fallen healthcare worker was of Philippine ancestry; this was mostly media articles or obituaries sharing the life stories of the deceased. In a few cases, the confirmation came directly from the deceased healthcare worker's family member who submitted a tribute. Second, the team required a minimum of two sources to identify and announce fallen healthcare workers. We retrieved 86 US tributes from Kanlungan, but only 81 of them had information on county of residence. In total, 45 US counties with at least one reported tribute to a Filipinx healthcare worker who died of COVID-19 were identified for analysis and will hereafter be referred to as “Kanlungan counties.” Mortality data by county, race, and ethnicity came from the National Center for Health Statistics (NCHS).24 Updated weekly, this dataset is based on vital statistics data for use in conducting public health surveillance in near real time to provide provisional mortality estimates based on data received and processed by a specified cutoff date, before data are finalized and publicly released.25 We used the data released on December 30, 2020, which included provisional COVID-19 death counts from February 1, 2020 to December 26, 2020—during the height of the pandemic and prior to COVID-19 vaccines being available—for counties with at least 100 total COVID-19 deaths. During this time period, 501 counties (15.9% of the total 3,142 counties in all 50 states and Washington DC)26 met this criterion. Data on COVID-19 deaths were available for six major racial/ethnic groups: Non-Hispanic White, Non-Hispanic Black, Non-Hispanic Native Hawaiian or Other Pacific Islander, Non-Hispanic American Indian or Alaska Native, Non-Hispanic Asian (hereafter referred to as Asian American), and Hispanic. People with more than one race, and those with unknown race were included in the “Other” category. NCHS suppressed county-level data by race and ethnicity if death counts are less than 10. In total, 133 US counties reported COVID-19 mortality data for Asian Americans. These data were used to calculate the percentage of all COVID-19 decedents in the county who were Asian American. We used data from the 2018 American Community Survey (ACS) five-year estimates, downloaded from the Integrated Public Use Microdata Series (IPUMS) to create county-level population demographic variables.27 IPUMS is publicly available, and the database integrates samples using ACS data from 2000 to the present using a high degree of precision.27 We applied survey weights to calculate the following variables at the county-level: median age among Asian Americans, average income to poverty ratio among Asian Americans, the percentage of the county population that is Filipinx, and the percentage of healthcare workers in the county who are Filipinx. Healthcare workers encompassed all healthcare practitioners, technical occupations, and healthcare service occupations, including nurse practitioners, physicians, surgeons, dentists, physical therapists, home health aides, personal care aides, and other medical technicians and healthcare support workers. County-level data were available for 107 out of the 133 counties (80.5%) that had NCHS data on the distribution of COVID-19 deaths among Asian Americans, and 96 counties (72.2%) with Asian American healthcare workforce data. The ACS 2018 five-year estimates were also the source of county-level percentage of the Asian American population (alone or in combination) who are Filipinx.8 In addition, the ACS provided county-level population counts26 to calculate population density (people per 1,000 people per square mile), estimated by dividing the total population by the county area, then dividing by 1,000 people. The county area was calculated in ArcGIS 10.7.1 using the county boundary shapefile and projected to Albers equal area conic (for counties in the US contiguous states), Hawai’i Albers Equal Area Conic (for Hawai’i counties), and Alaska Albers Equal Area Conic (for Alaska counties).20

In 2024, there was one active barangay health worker (BHW) for about 95 people in the Philippines. The highest population-to-barangay health worker ratio was in the National Capital Region (NCR) with one active BHW for 763 residents. In contrast, Region 8 has one active BHW catering to 44 residents.

Abstract

Different countries have different health outcomes that are in part due to the way respective health systems perform. Regardless of the type of health system, individuals will have health and non-health expectations in terms of how the institution responds to their needs. In many countries, however, health systems do not perform effectively and this is in part due to lack of information on health system performance, and on the different service providers.

The aim of the WHO World Health Survey is to provide empirical data to the national health information systems so that there is a better monitoring of health of the people, responsiveness of health systems and measurement of health-related parameters.

The overall aims of the survey is to examine the way populations report their health, understand how people value health states, measure the performance of health systems in relation to responsiveness and gather information on modes and extents of payment for health encounters through a nationally representative population based community survey. In addition, it addresses various areas such as health care expenditures, adult mortality, birth history, various risk factors, assessment of main chronic health conditions and the coverage of health interventions, in specific additional modules.

The objectives of the survey programme are to: 1. develop a means of providing valid, reliable and comparable information, at low cost, to supplement the information provided by routine health information systems. 2. build the evidence base necessary for policy-makers to monitor if health systems are achieving the desired goals, and to assess if additional investment in health is achieving the desired outcomes. 3. provide policy-makers with the evidence they need to adjust their policies, strategies and programmes as necessary.

Geographic coverage

The survey sampling frame must cover 100% of the country's eligible population, meaning that the entire national territory must be included. This does not mean that every province or territory need be represented in the survey sample but, rather, that all must have a chance (known probability) of being included in the survey sample.

There may be exceptional circumstances that preclude 100% national coverage. Certain areas in certain countries may be impossible to include due to reasons such as accessibility or conflict. All such exceptions must be discussed with WHO sampling experts. If any region must be excluded, it must constitute a coherent area, such as a particular province or region. For example if ¾ of region D in country X is not accessible due to war, the entire region D will be excluded from analysis.

Analysis unit

Households and individuals

Universe

The WHS will include all male and female adults (18 years of age and older) who are not out of the country during the survey period. It should be noted that this includes the population who may be institutionalized for health reasons at the time of the survey: all persons who would have fit the definition of household member at the time of their institutionalisation are included in the eligible population.

If the randomly selected individual is institutionalized short-term (e.g. a 3-day stay at a hospital) the interviewer must return to the household when the individual will have come back to interview him/her. If the randomly selected individual is institutionalized long term (e.g. has been in a nursing home the last 8 years), the interviewer must travel to that institution to interview him/her.

The target population includes any adult, male or female age 18 or over living in private households. Populations in group quarters, on military reservations, or in other non-household living arrangements will not be eligible for the study. People who are in an institution due to a health condition (such as a hospital, hospice, nursing home, home for the aged, etc.) at the time of the visit to the household are interviewed either in the institution or upon their return to their household if this is within a period of two weeks from the first visit to the household.

Kind of data

Sample survey data [ssd]

Sampling procedure

SAMPLING GUIDELINES FOR WHS

Surveys in the WHS program must employ a probability sampling design. This means that every single individual in the sampling frame has a known and non-zero chance of being selected into the survey sample. While a Single Stage Random Sample is ideal if feasible, it is recognized that most sites will carry out Multi-stage Cluster Sampling.

The WHS sampling frame should cover 100% of the eligible population in the surveyed country. This means that every eligible person in the country has a chance of being included in the survey sample. It also means that particular ethnic groups or geographical areas may not be excluded from the sampling frame.

The sample size of the WHS in each country is 5000 persons (exceptions considered on a by-country basis). An adequate number of persons must be drawn from the sampling frame to account for an estimated amount of non-response (refusal to participate, empty houses etc.). The highest estimate of potential non-response and empty households should be used to ensure that the desired sample size is reached at the end of the survey period. This is very important because if, at the end of data collection, the required sample size of 5000 has not been reached additional persons must be selected randomly into the survey sample from the sampling frame. This is both costly and technically complicated (if this situation is to occur, consult WHO sampling experts for assistance), and best avoided by proper planning before data collection begins.

All steps of sampling, including justification for stratification, cluster sizes, probabilities of selection, weights at each stage of selection, and the computer program used for randomization must be communicated to WHO

STRATIFICATION

Stratification is the process by which the population is divided into subgroups. Sampling will then be conducted separately in each subgroup. Strata or subgroups are chosen because evidence is available that they are related to the outcome (e.g. health, responsiveness, mortality, coverage etc.). The strata chosen will vary by country and reflect local conditions. Some examples of factors that can be stratified on are geography (e.g. North, Central, South), level of urbanization (e.g. urban, rural), socio-economic zones, provinces (especially if health administration is primarily under the jurisdiction of provincial authorities), or presence of health facility in area. Strata to be used must be identified by each country and the reasons for selection explicitly justified.

Stratification is strongly recommended at the first stage of sampling. Once the strata have been chosen and justified, all stages of selection will be conducted separately in each stratum. We recommend stratifying on 3-5 factors. It is optimum to have half as many strata (note the difference between stratifying variables, which may be such variables as gender, socio-economic status, province/region etc. and strata, which are the combination of variable categories, for example Male, High socio-economic status, Xingtao Province would be a stratum).

Strata should be as homogenous as possible within and as heterogeneous as possible between. This means that strata should be formulated in such a way that individuals belonging to a stratum should be as similar to each other with respect to key variables as possible and as different as possible from individuals belonging to a different stratum. This maximises the efficiency of stratification in reducing sampling variance.

MULTI-STAGE CLUSTER SELECTION

A cluster is a naturally occurring unit or grouping within the population (e.g. enumeration areas, cities, universities, provinces, hospitals etc.); it is a unit for which the administrative level has clear, nonoverlapping boundaries. Cluster sampling is useful because it avoids having to compile exhaustive lists of every single person in the population. Clusters should be as heterogeneous as possible within and as homogenous as possible between (note that this is the opposite criterion as that for strata). Clusters should be as small as possible (i.e. large administrative units such as Provinces or States are not good clusters) but not so small as to be homogenous.

In cluster sampling, a number of clusters are randomly selected from a list of clusters. Then, either all members of the chosen cluster or a random selection from among them are included in the sample. Multistage sampling is an extension of cluster sampling where a hierarchy of clusters are chosen going from larger to smaller.

In order to carry out multi-stage sampling, one needs to know only the population sizes of the sampling units. For the smallest sampling unit above the elementary unit however, a complete list of all elementary units (households) is needed; in order to be able to randomly select among all households in the TSU, a list of all those households is required. This information may be available from the most recent population census. If the last census was >3 years ago or the information furnished by it was of poor quality or unreliable, the survey staff will have the task of enumerating all households in the smallest randomly selected sampling unit. It is very important to budget for this step if it is necessary and ensure that all households are properly enumerated in order that a representative sample is obtained.

It is always best to have as many clusters in the PSU as possible. The reason for this is that the fewer the number of respondents in each PSU, the lower will be the clustering effect which

In 2024, Myanmar had the highest crude death rate among the Southeast Asian countries, with *** deaths per thousand population. That year, Singapore had the lowest crude death rate, with *** deaths per thousand population.Factors that influence the death rateThe death rate, also called mortality rate, is generally influenced by various factors such as the social environment, diseases, health facilities and services as well as the food supply of the respective countries. Myanmar’s government spent five percent of its public budget on health in 2016. In 2020, health expenditure per capita in Myanmar amounted to around ** U.S. dollars. The Maldives had the lowest crude death rate in the Asia-Pacific region in 2024. There, health expenditure accounted for ***** percent of the country’s GDP. Furthermore, the share of undernourished people was at around ***** percent in Myanmar in 2020. Within Southeast Asia, Myanmar has also been one of the poorest countries. In 2020, the country’s GDP per capita was estimated at **** thousand U.S. dollars, the lowest across the Asia-Pacific region.

Different countries have different health outcomes that are in part due to the way respective health systems perform. Regardless of the type of health system, individuals will have health and non-health expectations in terms of how the institution responds to their needs. In many countries, however, health systems do not perform effectively and this is in part due to lack of information on health system performance, and on the different service providers. The aim of the WHO World Health Survey is to provide empirical data to the national health information systems so that there is a better monitoring of health of the people, responsiveness of health systems and measurement of health-related parameters. The overall aims of the survey is to examine the way populations report their health, understand how people value health states, measure the performance of health systems in relation to responsiveness and gather information on modes and extents of payment for health encounters through a nationally representative population based community survey. In addition, it addresses various areas such as health care expenditures, adult mortality, birth history, various risk factors, assessment of main chronic health conditions and the coverage of health interventions, in specific additional modules. The objectives of the survey programme are to: 1. develop a means of providing valid, reliable and comparable information, at low cost, to supplement the information provided by routine health information systems. 2. build the evidence base necessary for policy-makers to monitor if health systems are achieving the desired goals, and to assess if additional investment in health is achieving the desired outcomes. 3. provide policy-makers with the evidence they need to adjust their policies, strategies and programmes as necessary.

The healthcare ranking reflects the quality of health care and access to health services in different countries. The assessment includes various factors such as life expectancy, access to medical services, healthcare funding, and technologies.