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Racism, xenophobia, and discrimination are key determinants of health and equity and must be addressed for improved health outcomes. We conclude that far broader, deeper, transformative action is needed compared with current measures to tackle adverse effects of racism on health. To challenge the structural drivers of racism and xenophobia, anti-racist action and other wider measures that target determinants should implement an intersectional approach to effectively address the causes and consequences of racism within a population. Structurally, legal instruments and human rights law provide a robust framework to challenge the pervasive drivers of disadvantage linked to caste, ethnicity, Indigeneity, migratory status, race, religion, and skin colour. Actions need to consider the historical, economic, and political contexts in which the effects of racism, xenophobia, and discrimination affect health. We propose several specific actions: a commission that explores how we action the approaches laid out in this paper; building a conversation and a series of events with international multilateral agency stakeholders to raise the issue and profile of racism, xenophobia, and discrimination within health; and using our multiple platforms to build coalitions, expand knowledge, highlight inequities, and advocate for change across the world.

This article reflects on the roles anthropologists have played in responding to the COVID-19 pandemic in the Philippines, and identifies the challenges – from the methodological to the political – they faced in fulfilling these roles. Drawing on the author’s personal and professional experiences in the country, as well as on interviews with other anthropologists, this article identifies three major roles for anthropologists: conducting ethnographic research; bearing witness to the pandemic through first-person accounts; and engaging various publics. All these activities have contributed to a greater recognition of the role of the social sciences in health crises, even as anthropologists struggle to gain the same legitimacy as their clinical and public health counterparts. The article concludes by making recommendations that can better prepare local anthropologists in responding to future health crises.

With millions of cases and thousands of deaths every year in Asia and Latin America, dengue fever continues to be of global public health significance. This article uses the concept of 'medical populism' to analyse the political construction of the 2019 dengue epidemics in Bangladesh, the Philippines, and Honduras. Through this framework, we examine the narratives of these outbreaks by reconstructing how political actors simplified the discourse, spectacularised the crises, offered multiple knowledge claims, and forged divisions between the people and 'dangerous others'. Taken together, our case studies, obtained through government, journalistic, and scholarly sources, illuminate the role of medical populists (who are almost always politicians) in defining and responding to public health emergencies, underscoring the performative dimension of disease outbreaks. By detracting attention from less spectacular but more substantive policies and programs, these 'performances' of health crises perpetuate health inequities, especially in fragile democracies like the aforementioned Global South countries. We conclude by reflecting on the implications of medical populism to public health, health communications, and the inevitable recurrence of epidemics.

Understanding people's concepts of illness and health is key to crafting policies and communications campaigns to address a particular medical concern. This paper gathers cultural knowledge on infectious disease causation, prevention, and treatment the Philippines that are particularly relevant for the COVID-19 pandemic, and analyzes their implications for public health. This paper draws from ethnographic work (e.g. participant observation, interviews, conversations, virtual ethnography) carried out individually by each of the two authors from February to September 2020. The data was analyzed in relation to the anthropological literature on local health knowledge in the Philippines. We find that notions of hawa (contagion) and resistensiya (immunity) inform people's views of illness causation as well as their preventive practices - including the use of face masks and 'vitamins' and other pharmaceuticals, as well as the ways in which they negotiate prescriptions of face mask use and physical distancing. These perceptions and practices go beyond biomedical knowledge and are continuously being shaped by people's everyday experiences and circulations of knowledge in traditional and social media. Our study reveals that people's novel practices reflect recurrent, familiar, and long-held concepts - such as the moral undertones of hawa and experimentation inherent in resistensiya. Policies and communications efforts should acknowledge and anticipate how these notions may serve as either barriers or facilitators to participatory care and improved health outcomes.

Background The last few decades have seen the rising global acknowledgment of the importance of ethics in the conduct of health research. But research ethics committees or institutional review boards (IRBs) have also been criticized for being barriers to research. This article examines the case of the Philippines, where little has been done to interrogate the health research and IRB culture, and whose circumstances can serve as reflection points for other low- and middle-income countries. Methods Semi-structured interviews were conducted from July to October 2020 to elicit health researchers’ perspectives and experiences regarding IRBs and the ethics approval process in the country, as well as counterpoint narratives from researchers who have also worked for IRBs. Results Across the fields of clinical, public health, and social science research, the issue of ethics review revealed itself to be foremost an issue of inequity. IRB processes serve as a barrier for those outside the academe; those belonging to institutions, cities, or entire regions without their own accredited IRBs; and researchers working independently, without ample budget, or on highly specialized topics—more so for non-clinical researchers who must grapple with the primarily biomedical framework of most IRBs. Consequently, the research landscape invariably favors those with the resources to do research, and researches that tend to attract funding. Conclusion The broader challenge of equity in health research will entail more fundamental reforms, but proximal interventions can be done to make the ethics approval process more equitable, such as enhancing institutional oversight, regulating IRB fees, and enabling a more supportive and welcoming environment for early-career, student, independent, and non-clinical health researchers. This article ends by reflecting on the implications of our findings toward the larger research culture.

Patients' embodied experiences do not always correspond to the biomedical concepts of particular diseases. Drawing from year-long fieldwork in the Philippines that involved semi-structured interviews, focus group discussions and digital diaries, we examine how individuals 'do' hypertension through their embodied experiences and the knowledge and practice that emerge from them. Drawing inspiration from Annemarie Mol's work on the notion of 'multiplicity' of disease, our analysis was informed by a commitment to privileging patients' embodied experiences and the multiple ontologies of hypertension. We find that for patients diagnosed with hypertension in the Philippines, symptoms enact illness; patients rely on their own embodied knowledge to define their illness' nature (e.g., diagnosis), experience (e.g., frequency of symptoms and non-chronicity) and praxis (e.g., self-care practices). We show how this knowledge gained from having embodied experiences of living with the disease interacts in various ways with biomedical knowledge, other diagnostic labels and clinical practices, to shape how hypertension manifests and is managed by patients. Beyond interrogating the relationship between what counts as a 'disease' and what is considered a 'symptom', our findings underscore the need to pay attention instead to the mutually co-constitutive processes of embodied experiences and disease categories in co-producing patient knowledge.

Drawing on face-to-face and virtual fieldwork in the Philippines, I document the emergence of antibody testing as a popular practice among Filipinos during the COVID-19 pandemic, helping them make decisions about vaccines and other life choices. Antibodies gave people a sense of agency and control amid a health crisis for which political and medical authorities failed to offer certainty and hope, particularly at a time of vaccine scarcity and viral surges. However, by diverting attention from the health care system to individual immune systems, antibodies also reinforced the individual "responsibilization" that has characterized the Philippine government's pandemic response.

This paper uses the lens of medical populism to analyze the impact of biocommunicability on COVID-19 testing through a case study approach. The political efficacy of testing is traced through two mini-case studies: the Philippines and the United States. The case studies follow the approach of populism scholars in drawing from various sources that ‘render the populist style visible’ from the tweets and press releases of government officials to media reportage. Using the framework of medical populism, the case studies pay attention to the ways in which coronavirus testing figured in (1) simplification of the pandemic; (2) spectacularization of the crisis; (3) forging of divisions; and (4) invocation of knowledge claims. Identifying and critically analyzing how knowledge is generated is an essential step to recognizing the impact that political styles have on the COVID pandemic. The political actors in each case study have shaped knowledge of the epidemic, in the way they construct the idea of ‘testing’, and in how they mobilize testing as an ‘evidence-making practice’. Their actions shaped how the pandemic—as well as their responses—is measured. This framework contributes to public policy debates by providing evidence of the impact of medical populism on pandemic response efforts.

This article traces the trajectory of the Catholic Church’s discourses on drug use in the Philippines since the first time a statement was made in the 1970s. By drawing on official statements by the Catholic Bishops Conference of the Philippines (CBCP), it argues that shifts in emphasis have taken place through the years: the destruction of the youth, attack on human dignity, and then social moral decay. Collectively, they emanate from an institutional concern for peace and order. But they also reflect the moral panic around drug use that has been around for decades, which, on several occasions, Filipino politicians, including President Duterte, have mobilized as a populist trope. In this way, the article historicizes the Catholic Church’s official statements and frames them in terms of morality politics through which values and corresponding behavior are defined by an influential institution on behalf of society whose morality it deems is in decline. The article ends by reflecting on the recent statements by the CBCP that invoke compassion and redemption.

This article seeks to contribute to the “history of height” in the Philippines by looking at Filipino bodily representations and height differences during the Spanish colonial period. From Pigafetta’s account onward, European chroniclers typically described Indios (natives) as having average, varied, or unremarkable height. However, during the nineteenth century a new discourse emerged: that of a short-statured Filipino. Likely the consequence of actual physical changes and nascent racial ideologies on the part of Spaniards, this view would set the stage for Filipinos to be typologizedas “short”—and for shortness to be problematized as a sign of racial and social inferiority. KEYWORDS: HEIGHT • COLONIALISM • RACIAL SCIENCE • HISTORICAL ANTHROPOLOGY • MEDICAL HISTORY

This article argues that local constructions of risky and safe spaces, as articulated by the notions 'loob' (inside) and 'labas' (outside), informed popular and political responses to the COVID-19 pandemic in the Philippines, leading to an overemphasis on staying at home and, conversely, a general avoidance or fear of outdoor spaces that was at times reinforced by public health authorities. Practices and policies related to the pandemic response rendered this binary opposition between 'loob' and 'labas' visible, from regulations concerning the use of personal protective equipment to restrictions of access to outdoor spaces. While this emergent form of bodily proxemics was contested and negotiated over time, its tenacity throughout the pandemic underscores the importance of understanding how people spatialize risk in times of health crises.

Adequate child nutrition is critical to child development, yet child malnutrition is prevalent in crisis settings. However, the intersection of malnutrition and disasters is sparse. This study reviews existing evidence on nutrition responses and outcomes for infants and young children during times of crisis. The scoping review was conducted via two approaches: a systematic search and a purposive search. For the systematic search, two key online databases, PubMed and Science Direct, were utilized. In total, data from 32 studies were extracted and included in the data extraction form. Additionally, seven guidelines and policy documents were included, based on relevance to this study. Overall, the existing evidence demonstrates the negative impacts of crises on nutritional status, diet intake, anthropometric failure, and long-term child development. On the other hand, crisis-related interventions positively affected nutrition-related knowledge and practices. Further studies should be carried out to explore the sustainability of the interventions and the success of existing guidelines. Since this study focuses only on nutrition among children under three, further studies should likewise consider an extended age range from three to five years.

The rise of digital mobile communications has made possible novel research methods that can provide a better understanding of patients’ experience of non-communicable diseases. This study explores the opportunities and challenges in employing “digital diaries” via mobile phones to track the lived experiences of people with hypertension in the Philippines. Following in-depth interviews, 40 hypertensive adults were invited to submit digital diaries over 12 months. Mobile phones were found to be an efficient way of reaching participants, although it was difficult to collect in-depth narratives about their experiences using the medium beyond nominal responses about symptoms and treatment. Possible explanations include the asymptomatic nature of hypertension, which limited the participants’ experiences of the illness, as well as the platform itself, which our mostly-elderly, low-income participants may not be comfortable with. Despite these challenges, “digital diaries” hold potential for the study of other chronic conditions, provided that researchers engage in extensive co-production with participants to understand their preferences. Researchers also need more training in the use of these methods appropriately as part of a suite of methods for capturing the experience of people living with chronic illness.

Community health workers in low- and middle-income country primary health care systems are well suited to perform essential functions on the frontlines of Covid-19 pandemic responses. However, clear and coordinated guidance, updated infection control training, and reliable access to personal protective equipment must be ensured in order to deploy them safely and effectively. With these additional responsibilities, community health workers must also be supported to ensure that hard-fought gains in population health, including progress on non-communicable diseases, are sustained throughout the pandemic.

The desire for light(er) skin is widespread around the world and has been the subject of extensive critical scholarship. But far less attention has focused on skin-lightening practices among boys and men, even as historical and contemporary data show that it is both a long-standing and growing trend in many Asian countries. This study builds on a focused ethnography of young men’s skin-lightening practices in two Philippine cities. Using Norbert Elias’ notion of ‘figurations’, we look at how shifts in gender ideologies, socio-economic changes, processes of urbanisation and popular culture trends are reflected in these practices. We find that the pursuit of a whiter skin is not an individual project, but a mode of body modification which is enacted in figurations among male peers, between men and women, and between men and their employers and customers in a globalising economy. Overall, skin practices and preferences among young men in the Philippines are best understood in terms of changing notions of masculinity, the unchanging quest to look compatible (bagay) with one’s peers, and the desire to keep up ever-changing trends.

Various factors have been implicated in vaccine hesitancy and loss of vaccine confidence, but the specific ways and particular moments in which immunisation programmes and vaccine scares are politi...

If we are to look for signs of the times and hints of the future, we need not look further than our own bodies. The average human today is both taller and heavier than at any other time of history ...

Summary box In 2016, the Philippines embarked on an unprecedented mass immunisation campaign against dengue fever, becoming the first Asian nation to authorise the commercial use of Dengvaxia, the dengue vaccine manufactured by the French pharmaceutical Sanofi Pasteur.1 In December 2017, nearly 2 years since the campaign started, Sanofi announced that Dengvaxia may actually cause ‘more severe disease’ in those who have not had previous dengue infection.2 By then, over 800,000 Filipino schoolchildren had been inoculated.1 Criminal investigations against involved government figures ensued, with one critic likening the mass vaccination programme to a ‘genocide against Filipino children’.3 The deaths of several children who had received the vaccine became a focal point of the scandal, as the Public Attorney’s Office ran a highly publicised and dramatised investigation, from televised autopsies to the chief lawyer appearing alongside the grieving mothers in media interviews.3–5 The resulting ‘crisis of confidence’ against the public health sector sent immunisation rates plummeting to an all-time low, precipitating a measles outbreak across the country, exacerbating already-low immunisation rates.5 What went wrong, and how could a different—or more deliberate—communications strategy have contributed to averting those mistakes? In this article, we identify several lessons on health communication from the dengue vaccine controversy that may prove beneficial …

Background. Children comprise a significant proportion of persons with disabilities (PWDs) in the Philippines, and represent a major public health challenge. One under-explored topic is the “lived experiences” of their parents and guardians as well as the roles they play in caring for their children. This qualitative study responds to this research gap by eliciting and foregrounding their experiences and narratives. Methods. Six focus group discussions (FGDs) were conducted among parents of children with disabilities (CWDs) in Davao City and Tagum City. These were complemented by 12 key informant interviews among healthcare providers in both cities. Results. For many parents, coming to terms with a disability is a difficult and lengthy process, but one that ends with a measure of relief and eventual adaptation. Living with disability, meanwhile, is fraught with medical, financial, educational, and social challenges. A positive religious outlook allows them to make sense of disability, helping them to overcome these challenges. Support groups and the health care system are likewise crucial factors towards family resilience. Conclusion. Our findings show that the experience of disability is shared among family members, particularly, the parents of CWDs; thus, underscoring the need for a family-centered approach in policies, clinical care, and communications efforts involving children with disability in the Philippines.

Objectives. Within the last two decades, studies worldwide have documented catastrophic health spending and out-of-pocket expenditure in low- and middle-income countries like the Philippines. This study sought to unpack patients and their families' lived experiences in dealing with such financial challenges. Methods. This paper stems from a multi-sited qualitative project in the Philippines involving FGDs that sought to elicit people’s long-term health goals and the barriers they encounter in attaining good health. Focusing on the domain of health financing, we used principles of grounded theory to analyze how low and middle-income Filipinos pay for their health needs. Results. For many Filipinos, health financing often necessitates various actors' participation and entails predictable and unforeseen complications throughout the illness trajectory. We describe the lived realities of health financing through four domains: ‘pagtitiis’ (enduring the illness), ‘pangungutang’ (borrowing the money), ‘pagmamakaawa’ (soliciting help from the government and non-government channels), and PhilHealth—the State-owned national insurance agency—whose (non-)role figures prominently in catastrophic expenditure. Conclusion. Our paper illustrates how illness not only leads to catastrophic expenditure; expenditure-related challenges conversely account for poorer health outcomes. By exploring the health system through qualitative means, we identify specific points of intervention that resonate across LMICs (low and middle-income countries) worldwide, such as addressing predatory loan practices and ‘hidden’ costs; improving public health communications; expanding government insurance benefits; and bolstering health literacy to include health financial literacy in the school and community settings.

Summary box The disproportionate mortality of COVID-19 and brutality of protective institutions has shifted anti-racism discourses into the mainstream.1 Increased reckoning over categorisations of people demonstrate that racial categories, while imprecise, fluid, time and context-specific, embody hierarchical power. We interrogate categorisations used in the UK, South Africa and the USA; their origins and impact. We emphasise needing to recognise commonality of power structures globally, while acknowledging specificity in local contexts. In identifying such commonality, we encourage use of the term ‘minoritised’ as a universal alternative. Various historical and geographical contexts give rise to categorisations, consistently exposing the use of power in creating separation. The UK term BAME (Black, Asian and minority ethnic) reflects decades of categorising groups of people referred to in the 1940s and 1950s as ‘coloured immigrants’; ‘New Commonwealth immigrants’ or ‘African, Caribbean and Asian’ immigrants. This terminology, highlighted their perceived differences and non-White identity. From the 1960s to the early 1990s, ‘Black’ was used by some, as a political term to highlight the shared history of colonialism and political and cultural entanglement that brought African peoples, people from the Indian subcontinent and Caribbean people of all heritages to Britain. BME (Black and minority ethnic), a governmental …

Hypertension, a major risk factor for non-communicable diseases, remains poorly controlled in many countries. In the Philippines, it is still one of the leading causes of preventable deaths despite the accessibility and availability of essential technologies and medicine to detect and treat hypertension. This paper characterizes the 'therapeutic itineraries' of people with hypertension from poor communities in rural and urban settings in the Philippines. We employ longitudinal qualitative methodology comprised of repeat interviews and digital diaries using mobile phones from 40 recruited participants in 12 months. Our findings demonstrate that therapeutic itineraries, rather than being organized according to categories that stem from the structure of the health system (i.e., diagnosis, treatment, follow-up, adherence), diverge from clinical pathways. Therapeutic itineraries begin at a stage we label as 'pre-diagnosis' (PD). Following this, itineraries diverge according to two possible entry points into the healthcare system: via incidental diagnosis (ID) whereby participants were diagnosed with hypertension without deliberately seeking care for hypertension-related symptoms and symptom-driven diagnosis (SD) whereby their diagnosis was obtained during a clinical encounter specifically prompted by hypertension-related symptoms. Participants whose itineraries follow the SD route typically oscillated between periods of regular and intermittent medical treatment, while participants who were diagnosed incidentally (ID) typically opted for self-care As we follow our participants' therapeutic itineraries, we explore the confluence of factors informing their care journey, namely, their conceptions of hypertension, their social relationships, as well the choices and trade-offs they make. We conclude with policy implications from our findings, chief of which is our proposition that models of care based on mere access and availability of clinical interventions fail to reflect the complexity of people's lay understanding and their lived experiences of hypertension and are thus ultimately unhelpful in improving its control.

Background Community health workers (CHWs) are an important cadre of the primary health care (PHC) workforce in many low- and middle-income countries (LMICs). The Philippines was an early adopter of the CHW model for the delivery of PHC, launching the Barangay (village) Health Worker (BHW) programme in the early 1980s, yet little is known about the factors that motivate and sustain BHWs’ largely voluntary involvement. This study aims to address this gap by examining the lived experiences and roles of BHWs in urban and rural sites in the Philippines. Methods This cross-sectional qualitative study draws on 23 semi-structured interviews held with BHWs from barangays in Valenzuela City (urban) and Quezon province (rural). A mixed inductive/ deductive approach was taken to generate themes, which were interpreted according to a theoretical framework of community mobilisation to understand how characteristics of the social context in which the BHW programme operates act as facilitators or barriers for community members to volunteer as BHWs. Results Interviewees identified a range of motivating factors to seek and sustain their BHW roles, including a variety of financial and non-financial incentives, gaining technical knowledge and skill, improving the health and wellbeing of community members, and increasing one’s social position. Furthermore, ensuring BHWs have adequate support and resources (e.g. allowances, medicine stocks) to execute their duties, and can contribute to decisions on their role in delivering community health services could increase both community participation and the overall impact of the BHW programme. Conclusions These findings underscore the importance of the symbolic, material and relational factors that influence community members to participate in CHW programmes. The lessons drawn could help to improve the impact and sustainability of similar programmes in other parts of the Philippines and that are currently being developed or strengthened in other LMICs.

Young people in Puerto Princesa, the Philippines, are drawn to working as salespeople for AIM Global, a purveyor of the nutritional supplement C24/7. The company relies on multilevel marketing, in which sellers recruit other sellers, offering youth not only the chance to earn money but also educational discounts, access to bank cards, and an opportunity to develop do‐it‐yourself entrepreneurial skills. Trainers encourage sellers to capitalize on their intimate relations, to tailor the supplements to assuage aging clients’ metabolic‐health anxieties, and to use C24/7 themselves so that they can testify to its benefits. Such “sociometabolic” work is omnipresent in urban settings, where workers in beauty salons and gyms likewise promise to mitigate the material, bodily disturbances caused by toxic environments and precarious living conditions. [multilevel marketing, youth, sociometabolic labor, relational work, aspirations, nutritional supplements, metabolic health, ecology, Philippines], Capsules of the supplement C24/7 (bottom left) and a promotional leaflet for C24/7, noting its contents, benefits, and metabolic action.