Today’s ‘New Ilustrados’ and the resurrection of the Filipino intelligentsia

 (Published in ENRICH magazine, 2022)

EDUCATION IS NOT MERELY the acquisition of rote knowledge. Neither is it a tool for ruthless political or material gain. At its loftiest, education is an arsenal of ideas -- and ideals -- wielded by informed citizens that must advance freedom, democracy and the liberal values girding them.

It presupposes critical thinking, moral values and a capacity for action. An educated person realizes his hard-won knowledge must ultimately be used for the good of society. He knows he must do something that keeps his country a haven for freedom and democracy.

All these words are majestic concepts. They have to be. Patriotic Filipinos have died for these ideals throughout our tumultuous history.

“Ignorance is servitude, because as a man thinks, so he is; a man who does not think for himself and allowed himself to be guided by the thought of another is like the beast led by a halter," admonished our National Hero, Dr. Jose Rizal.

He believed freedom from ignorance can be had through education. His dream was to see a class of educated Filipinos lead his country in its fight for political reforms and equal human rights.

"Without education and liberty, which are the soil and the sun of man, no reform is possible, no measure can give the result desired," declared Rizal.

Filipino ilustrados in Madrid, Spain, 1890

Rise of the Ilustrado

In Rizal's time, the class of intellectual Filipinos were the "Ilustrados". "The enlightened ones" or "the erudite" launched the Propaganda Movement in 1872. Written words, both scathing and uplifting such as those published in “La Solidaridad”, were the Ilustrados’ chosen weapon in their fight against Spanish tyranny.

The Ilustrados of the 19th century consisted of well-educated young men from the elite or landholding class of native Filipinos ("Indios") and "mestizos" such as Rizal, and were roused to action by the liberal ideals of the Age of Enlightenment during their studies in Europe.

Among the demands made by the Ilustrados was for Spain to establish an educational system in Las Islas Filipinas independent of the rapacious Spanish friars or “frailes”. The Ilustrados demanded Spain grant Indios basic human rights, which would accrue once their Motherland was a Spanish province with representation in the Spanish Cortes.

"There can be no tyrants where there are no slaves," asserted Rizal.

While ultimately futile, the Propaganda Movement inspired the founding of the Kataastaasan, Kagalanggalangang Katipunan ng mga Anak ng Bayan in 1892 by warrior-patriots under Andres Bonifacio, an ardent devotee of Rizal. Revolution followed in 1896 and independence from Spain in 1898.

“A nation need not be the colony of a foreign power; it can be the colony of its own leaders.”

Salvador de Madariaga, Spanish writer and historian

The New Ilustrados

The Ilustrados were an intelligentsia. They were an educated class of intellectuals and university-educated men regarded as the country's vanguard in political, artistic and social thought.

Like Rizal, a number of Ilustrados were scholars, academics, journalists, literary writers, scientists, artists and teachers. More broadly, an intelligentsia consists of the educated and intellectual people in a society or country. Our intelligentsia today also comprises young adults whose intellect is being honed by their exposure to the immense amounts of truths on the internet.

The fight against Spanish tyranny in the late 19th century was ignited by the first Filipino intelligentsia. Today’s young Filipino intelligentsia -- which I call the “New Ilustrados” -- also has to confront grave social challenges but a revolution against imperialism is not one of them.  They face a new antagonist.

“A nation need not be the colony of a foreign power; it can be the colony of its own leaders”, noted the late Spanish writer and historian, Salvador de Madariaga, at his Jose Rizal Lecture in Manila in the 1960s. De Madariaga was one of the principal authors of the Oxford Manifesto on liberalism that details the basic political principles of the international Liberal movement.

The imminent danger facing this country stems from leaders wedded to ambitions at odds with the noble aim of seeking always the common good. In Roman Catholic social teaching, acting in the common good means respecting the rights and responsibilities of all and sundry.

This is not the case among segments of this country’s political elite that covet absolute power and brook no dissent in their quest for personal empire.

Endemic poverty, stubborn income inequality, the devastation wrought by climate change and social upheavals in Philippine society are some of the more intractable challenge the New Ilustrados must confront.

But where is this young Filipino intelligentsia?  

Does this collection of gifted intellectuals and knowledge workers exist as a distinct level of Filipino society? Is it at the forefront of intellectual thought in science, the arts, culture, technology, the academe and politics?

Or must we hunt for these beings with the intense zeal of astronomers searching for extraterrestrial intelligence? Do they gather in secret online chat rooms for fear of persecution by the jaded masses, there to revel in their shared knowledge among others of their kind?

Are the New Ilustrados the richly educated? The religious orders steeped in arcane learning? Are they civil society? Or, were I a game show contestant, is the answer letter D, or “All of the above”?

Are they the faceless intellectuals venting their anger at the rigmarole called Philippine politics and its endemic corruption while beseeching God to “deliver us from evil”? Is the Filipino intelligentsia the imperceptible academia engrossed in scholarly pursuits while banishing all else?

Do they write for the respected daily newspapers and media that fiercely uphold the holy tenets of responsible journalism against unhinged online bloggers and vloggers?

And who are the leading lights of this invisible stratum of society? The Ilustrados had Rizal, Marcelo del Pilar and Graciano Lopez Jaena. Who speaks for the Young Ilustrados of today?

Who are the Young Ilustrados thinkers? And where can one read about their multitude of opinions, and of the invigorating clash of ideas that mark an intelligentsia? Who are these people?

Without an intelligentsia, who is there to speak out with authority on the complex issues that bedevil the Filipino? Who will wield the intelligentsia’s power of using knowledge to goad governments and corporations into positive action for the common good?

In this Information Age, why are Filipinos who know more afraid to show society they know more? Is knowledge still a Scarlet Letter?

Yes, a Filipino intelligentsia does exist, but nothing much has been heard of or from it. Perhaps it’s because intellectuals prefer to work muted in the background, as if they were merely the neurons giving life to that most vital of organs we call the human brain.

Silence, however, is not always golden. There is a ringing truth to this centuries-old comment by the English philosopher Herbert Spencer: “The great aim of education is not knowledge but action”.

The Filipino intelligentsia must take action to change this country for the better by using its vast knowledge to make sense of the world around us. It must proudly announce its existence as a force-in-being.

It must assert itself as the intellect of this nation against the strident voices of sock puppet internet trolls, bombastic amateurs, rabble-rousers and those bent on kleptocracy. Where is the Filipino intelligentsia?

Dr. Jose Rizal, Marcelo H. del Pilar and Mariano Ponce

Resetting Democracy

National Artist of the Philippines for Literature, the late Francisco Sionil Jose, essayed an answer to this question in 1988. In his diatribe, “The Filipino Intelligentsia”, he argued that our young and culturally weak country is “bereft of a system that assures civic continuity and that we are not heirs to an ancient intellectual tradition”. The outcome: a maimed intelligentsia.

He noted the brevity of our country’s history compared with those of our Asian neighbors such as Japan and China has helped stifle the full flowering of the Filipino intelligentsia.

“Without an anchor to such a past, we cannot really blame anyone and the building of a society in which the intellectuals have failed is still the Filipinos' sole responsibility”, said Sionil Jose, who was one of our foremost writers in English.

To our New Ilustrados will fall the enormous task of building a society where the contribution of our intellectuals cannot be denied and overlooked. Like their forebears, words and courage will be their weapons.

The question now is will our New Ilustrados take action. Over time, they will, and their actions might lead to consequential outcomes.

The main challenge facing the New Ilustrados will be to forge a true Filipino identity. This identity must be anchored on our cultural values and founded on the ideals underlying a strong liberal democracy such as freedom, equality before the law, constitutional government and opposition to tyranny. Call it “Resetting Democracy” for the better.

The core values Filipinos hold dear include a strong bias towards social harmony or togetherness as embodied in the “pakikisama” syndrome; a strong love of family; a yearning for education; promoting the common good; an expansive tolerance, friendliness and hospitality, and religiosity.

Pervasive materialism, however, is corrupting many of these values. The challenge facing the New Ilustrados as leaders will be to liberate our core values from the destructive influence of money, greed, politics and patronage. No easy task given our country’s everlasting poverty. Resetting Democracy must be a key goal for the New Ilustrados.

Sionil Jose came to the stunning conclusion that the “values which we have regarded as the foundations of our culture … must now be re-examined and discarded if the country is to change”. He also challenged the intelligentsia of his time to do more to advance social reform while upbraiding them for being “more concerned with the form than the substance of democracy”.

“I measure the stature of our leaders, and the members of our intelligentsia, by how much genuine commitment they give to this basic Filipino problem”, he pointed out. Sionil-Jose died in January 2022.

Where is the Filipino intelligentsia?

F. Sionil Jose

 

 

‘Like puberty and pimples’, or a closer look at Rich Asia’s ‘unseen epidemic’

 (Published in ENRICH magazine, 2022)

POPULAR CULTURE (including our own) tends to portray nerds as young people wearing oversized eyeglasses. Same goes for older nerds, or the guys we like to call scientists. Nerds and glasses go together like puberty and pimples, right?

We see this well-worn trope on our big and little screens. Think bespectacled super wizard Harry Potter whose eyesight “really was awful”, said Hermione Granger. There’s also shy Daily Planet reporter Clark Kent ditching his nerd glasses as he transforms from Supernerd into Superman. But what kind of vision disorder afflicts nerds in real life, and these two superheroes?

A decades-old epidemic raging among children and young adults in East and Southeast Asia's richer countries gives us a clear answer. Kids with glasses have to contend with the curse of myopia and the many health maladies it brings in its train. Blindness is the most serious.

Also called nearsightedness and short-sightedness, myopia exacts a painful personal toll among some in the "glass-class". There's social ostracism (hot girls hate nerdy guys), and the risk a nerdy guy or girl will wind-up an "incel" (involuntarily celibate). Not a suitable state of affairs if your life-goal is to have kids and raise a happy family.

Levity aside, myopia is a huge and serious health problem in the Asian countries I mentioned. Happily, Filipino kids have evaded this worst of this plague for now -- but for reasons that aren't all that flattering.

Rich Asia's curse

There were some 2.6 billion nearsighted people worldwide in 2020, or 33% of the total world population of 7.8 billion, according to the German statistics portal, Statista. Myopia, however, runs rampant in the region I call "Rich Asia". The prevalence of myopia has been reported as ranging from highs of 70% to 90% in the Asian countries comprising Rich Asia: mainland China, Hong Kong, Japan, the Republic of China (Taiwan), Singapore and South Korea.

This means myopia isn't only a nerd problem but one afflicting a lot of kids and young adults in Rich Asia. The rest-of-the world is also becoming more nearsighted. The World Health Organization (WHO) forecasts that 50% of the world’s population will have myopia by 2050. That’s close to five billion persons.

These stats reveal why myopia is the most common eye problem in the world today. Myopia’s wide prevalence in East Asia, which includes Rich Asia, is high enough to warrant the use of the term epidemic to describe its scope.

This “unseen epidemic” is at its worse in Singapore with a population of only 5.7 million persons. Myopia's pervasiveness is so bad some Singaporean pundits have taken to calling their own country the "Myopia Capital of the World" and "the epicenter of the East Asian myopia epidemic".

"The prevalence of myopia in Singapore is among the highest in the world, with 65% of our children being myopic by Primary 6, and 83% of young adults being myopic," revealed Prof. Wong Tien Yin, former Medical Director of the Singapore National Eye Center, in a speech delivered in 2019.

"As such, Singapore is often labeled as the 'Myopia Capital of the World'. By 2050, it is projected that 80 to 90% of all Singaporean adults above 18 years old will be myopic and 15 to 25% of these individuals may have high myopia".

In sheer numbers, however, it's China that has the most number of myopes. China's myopia rate of 31% means more than 400 million of today's 1.4 billion Chinese are nearsighted.

Myopia's prevalence in China's high schools stands at 77%. This figure jumps to a stunning 80% among college students.

In South Korea, the myopia rate comes to 50% in kids aged 5 to 11 years-old and 78.8% in those 12 to 18 years of age. A decade ago, 96% of 19 year-old males in Seoul had myopia, according to one study. Of this total, 22% had what can be called high myopia, which is a rare inherited type of high-degree nearsightedness.

Taiwan back in 2014 reported that 18% of first graders, 52% of sixth graders and 80% of university students were myopic. A study by Taiwanese doctors found the prevalence of myopia among schoolchildren increased rapidly from 1983 to 2017.

A study in 1983 confirmed some 70% of Taiwanese high school graduates needed glasses or contact lenses to see properly. This percentage has ballooned to 80% today.

Japan still struggles with short-sightedness. A study by Japanese researchers revealed the prevalence of myopia in Japan rose rapidly from only 11.6% in 1949 to 62.3% in 2017 among high school students in all of the country's 47 prefectures. It also said "the prevalence of myopia among adults will increase" as these teenagers grow older.

Bespectacled Chinese boys

Reasons why

Knowing all of this leads to the obvious question: "Why do many children and young adults in Rich Asia suffer disproportionately from myopia in the first place"?

There are a number of credible answers including heredity, but the three most prominent are deformed eyeballs, far too much "near work" and not spending enough time outdoors in the healthy sunshine.

Eye doctors agree most myopia is caused by misshapen eyeballs. This consensus can be appreciated when we consider an accepted clinical definition of the disease.

"Nearsightedness, or myopia, as it is medically termed, is a vision condition in which people can see close objects clearly, but objects farther away appear blurred", according to the American Optometric Association.

"Myopia occurs if the eyeball is too long or the cornea (the clear front cover of the eye) is too curved. As a result, the light entering the eye isn't focused correctly, and distant objects look blurred. Myopia affects nearly 30% of the U.S. population".

A refractive error in the eye, myopia also tends to be progressive i.e. it worsens over time. A myope's vision will deteriorate throughout childhood and adolescence before becoming more stable in adulthood. Myopia tends to run in families.

Without treatment, high myopia complications can lead to blindness. This makes it a must for myopes to have regular eye examinations and to wear corrective eyeglasses or contact lenses.

Myopia is also defined as blurred vision beyond two meters or 6.6 feet. It worsens when the eye grows longer, a deformity that causes the retina to stretch. Over time, a misshaped retina makes the eye vulnerable to serious diseases like macular degeneration, retinal detachment, glaucoma and diabetic retinopathy, according to ophthalmologists..

Too much near work is a no-no

Excessive near work, a major cause of myopia, was defined as " . . . the sum of activities with short working distance such as reading, studying, writing, doing homework, watching TV, or playing video games, etc", by  a scientific paper published 2015 in the  peer-reviewed open access journal, PLOS One.

The PLOS One study found "that more time spent on near work activities was associated with higher odds of myopia,” but added a caveat the associations between time spent reading and myopia have not been consistently observed. Singapore’s experience confirms the link between near work and higher odds of myopia.

"In fact, a higher exposure to near work is the main contributing factor -- besides heredity and genetic factors -- to increased risks of myopia . . . among children in Singapore," said Clinical Associate Professor Dr. Lee Shu Yen, Head of the Surgical Retina Department at the Singapore National Eye Center (SNEC), in 2019.

These findings lead to the hard-to-accept conclusion a child seems more likely to become nearsighted the more years he spends in school. It also suggests nearsightedness is basically universal by the time children reach college.

“The more educated you are, and the higher your grades, and the more you participate in after-school classes and tutorials -- the more likely you are (to be myopic)”, said Dr. Ian Morgan, a retired biologist who studies myopia at Australian National University, in Canberra, Australia.

It seems myopia, for the most part, is an affliction of the bookish and is correlated with academic performance. A number of studies confirm a strong link between myopia and education, especially the excessive near work demanded by too much reading and writing. 

"The prevalence of myopia has increased dramatically in recent years around the world and, in some highly educated groups such as law and medical students, it now exceeds 80%," said the PLOS One study.

Youngsters excessively eyeballing small smartphone screens as they play video games for hours on end also worsen the myopia epidemic. A Filipino doctor believes 90% of frequent mobile or online gamers have myopia.

Barbaric stress

A crucial reason why many students in Rich Asia study so inhumanly hard is the inordinate pressure placed on them to do well in school. This pressure reaches a peak in high school when they face the daunting task of passing their country's punishing college admission examinations. Acing these exams is seen as the guarantor of future success in countries such as China and South Korea.

Failing has been known to destroy lives. Student suicides due to intense academic pressure are a horrific fact of life in Rich Asia.

Depression and suicides are unfortunate by-products of educational systems such as those in China and South Korea that place barbaric stress on hapless high school students to pass a single, all-consuming exam.

South Korean parents believe a good university is a passport to professional and financial success for their children. They’d rather their children take college at one of the prestigious "SKY" universities: Seoul National University, Korea University and Yonsei University.

Chinese parents share a similar outlook. Their dream is to see their children matriculate at top tier universities such as the big three (Tsinghua University, Peking University and Shanghai Jiao Tong University) for the same reasons as Korean parents. And, like Korean parents, many Chinese parents apparently push their children to the limit of their endurance to pass these exams.

In China, kids have to hurdle the dreaded "Gaokao", or the National College Entrance Examination, considered by some as the world's toughest college admissions test.  Gaokao was identified as a contributing factor in 93% of student suicides in China in 2014.

It's just as bad in South Korea. Since 2007, suicide has been the leading cause of death among young Koreans, according to data from Statistics Korea. Having to pass the country's dreaded "Suneung" (the Korean College Scholastic Ability Test) is one of the reasons why close to one in three students see suicide as a means of escape from the almost unbearable academic pressures they must endure to attain this aim.

Myopia

Let there be light

Excessive time studying and cramming, and spending long hours playing games on smartphones means young people in Rich Asia and elsewhere are spending more time indoors. The still raging COVID-19 pandemic that began spreading in 2020 has added immensely to time young people spend bereft of healthy sunlight.

A number of studies have found that time spent outdoors is strongly associated with a lower risk of myopia. The corollary is that kids who spend less time outside are more likely to become nearsighted.

One of these studies involving children in California published in 2007 found time spent outdoors is strongly associated with a lower risk of myopia. Simply being outdoors is the key factor so it doesn't matter if kids play sports or just stroll around.

Another study, this one in 2008, involving Singaporean children of Chinese ethnicity studying in Australia and Singapore came to the same conclusion. It found that 29% of Singaporean students in Singapore had myopia compared with just 3% of those studying in Sydney.

The main difference was time spent outdoors by the Sydney Singaporeans. The kids in Sydney spent 13.75 hours a week outdoors compared to a scant three hours for those in Singapore.

“The big difference was the Chinese children in Australia were outdoors a lot more than their matched peers in Singapore,” said Dr. Morgan.

He estimates children need to spend around three hours per day outdoors to lower their myopia risk. A WHO report on myopia released in 2015 found that children should spend more than two hours a day outdoors.

The protective effect from being outdoors might be due to the intensity of sunlight releasing more retinal dopamine, which is a neurotransmitter. Dopamine appears to help regulate the rate at which our eyes grow. Too little dopamine causes our eyes to grow too long to focus properly.

Also called the "feel-good hormone", dopamine is associated with learning, memory, pleasurable sensations and other bodily functions.

This exposure to sunlight reduces a child's risk of myopia even if the child has two myopic parents and does near work. This theory explaining the positive effect of the outdoors, called the "daylight exposure theory", has gained wide acceptance.

Taiwan has taken this theory seriously. In 2010, the government began a nationwide program called “Tian-Tian Outdoor 120” that goaded schools to take pupils outside for two hours daily. The results of the program reversed a decades-long trend of rising myopia rates. Myopia rates fell from 49.4% in 2012 to 46.1% in 2015 among the millions of Taiwanese primary-school pupils involved in the program.

Myopia isn’t the Philippines’ biggest problem

Studies reveal that up to 29% of Filipino children suffer from myopia, said ophthalmologist Dr. Alexander Gonzales II of the Ospital ng Makati at a conference in 2018. He noted that 90% of frequent mobile or online gamers are nearsighted.

The prevalence of myopia in the general population is even higher. It's been estimated at 40% by Dr. John Ang, vice president for Education and Professional Services of Essilor Asia Pacific, Middle East, Russia and Africa. He also said school kids must spend more time outdoors.

"Changing lifestyles is very important like in Sydney where students have two hours outside play per day, they are three percent myopic," he said.  "I'm not sure, but maybe we Asians push our children more to be indoors and study, unlike the Australians, they are more the sporty type".

It's long been proven that myopia can be corrected and managed. Early detection of the disease is vital to curbing its potential to inflict more damage to one's vision.

"Eyeglasses are the simplest and safest way to correct and manage myopia", said Dr. Ang.

Among his suggestions for eye health is for children to spend at least two and a half hours outdoors daily. Kids should also have an eye exam every six months and take a break when using computers or using smartphones and other digital devices.

The low myopia rate among Filipino schoolchildren compared to their peers in Rich Asia is something to cheer about but it’s not the worst problem our youngsters face.

In late 2019, the Philippines was assailed by the humiliating news Filipino students ranked the lowest among 79 countries in mathematics, science, and reading. The report that disclosed this shameful news came from the Program for International Student Assessment (PISA) of the Organization for Economic Cooperation and Development (OECD).

It revealed that in mathematics and science, Filipino 15 year-olds rated 353 points and 357 points, respectively, compared to the OECD average of 489 for both categories. The Philippines ranked second to the last in math and science, and last in reading.

The report based on the 2018 survey said more than 80% of students in the Philippines did not reach a minimum level of proficiency in reading. It called this failure “one of the largest shares of low performers amongst all PISA-participating countries and economies”.

 “Fifteen-year-old students in the Philippines scored lower in reading, mathematics, and science than those in most of the countries and economies that participated in PISA 2018”, said the OECD report. “No country scored lower than the Philippines and the Dominican Republic”.

The poor results categorized four in five Filipino students as Level 2, or “low performers,” in the subject. OECD said Level 2 students have a proficiency “too low to enable them to participate effectively and productively in everyday life”.

The Philippines’ score in PISA has been on a steady decline for the past two decades. It dropped by 61 points (from 358 in 2003 to 297) and by 83 points (from 332 in 2003 to 249) in math and science. The PISA survey is held every three years with the last one taking place in 2021.

Another international test rubbed more salt into this wound. Our Grade 4 pupils posted the lowest scores in mathematics and science among the 58 countries involved in a 2019 study by the Trends in International Mathematics and Science Study.

Clearly, myopia is not the major problem besetting Philippine education. Ignorance is.

Philippine education is failing our youth

 

The Good, the Bad, and the Ugly ... about Black

 (Published in ENRICH magazine, 2022)

IS IT TOTALLY in black-and-white if I say black is still the coolest color out there? Or is it simply an excuse used by slightly neurotic young adults to mask their low self-esteem?

Truth is, black is a color you love or hate. Or is it, love to hate? Wearing black either makes you feel a whole lot sexier or marks you as a person less than generous.

The ambivalence about the color black isn't new. Even the previous statement about black being a color is a misnomer. Technically, black isn't a color at all. It's a hue, or the pure form of any color.

Black is black because it absorbs all the wavelengths of light and converts these wavelengths into heat. So, don’t go out wearing black on a hot day, which seems like most days in the Philippines. White is also a hue and also isn't a color (for the opposite reason compared to black).

Black, however, commands an almost slavish loyalty as a wardrobe color among a segment of young Pinoy adults. Call them Goths, hip-hoppers, Millennials or something else. Black is a bewildering choice given how hot and humid this country gets during the hottest dry season months from March to May. Now why is that?

Hollywood goddess Audrey Hepburn in the classic Little Black Dress from Givenchy.

The good about black

Black is a prominent color among a goodly number of young Filipinos as you can see on our streets. It also retains its cachet as a color of sophistication. Black is an attractive color after all, especially if worn with panache.

In color psychology, black is the color chosen by persons that want to impress others while steeling their self-confidence at the same time.

If a man wants to dress to impress, he confidently dons the classic Black Suit with tie (which Filipinos still refer to as the "Americana"). Or, he sports a head-turning, all-black rig to astonish all and sundry. “He’s so hot!” has both a figurative and literal meaning in this case.

Women with verve slip on the elegant little black dress (LBD) made immortal by Hollywood goddess, Audrey Hepburn, and flaunt their sexy allure with extravagant bling. The few Goth girls among us will naturally choose black for their predictably monochromatic and boring wardrobe.

About half of the women and 64% of men in a study agreed that black exudes confidence. This study on the psychology of black published in the United States also saw respondents rank black either first or second in having the most "good" attributes among colors.

Black was perceived as a "serious" and "reliable" color that boosts one's self-esteem. It was rarely seen or rated as a "bad" color.

A survey on how people perceived others based on the color of clothes they wore was taken in 2021 and involved 1,000 people. It found six in 10 respondents favored black as a color of confidence (or 48% of women and 64% of men).

It concluded that people in black were regarded by others as serious and reliable. Black dressers were also perceived as solid team players ideal for job interviews -- and also for first dates.

Among many Millennials (those born from 1981 to 1996) and some Zoomers aka Generation Z (1997 to 2012), dressing in black appears to be a symbol of confidence, credibility and self-expression. Black reveals their drive for recognition and power.

Goth girls in their favorite color -- black, of course.

People that prefer wearing black take themselves very seriously and expect others to treat them accordingly. Millennials and Zoomers are quite alike in a lot of ways, and seem to share a preference for black as a fashion and emotional statement.

It seems black also reflects the drive of these people to persevere in the struggle for a better future. And who can blame them given the series of economic and emotional disasters inflicted on them by the Great Recession of 2008, COVID-19 in 2020 and Putin's War of 2022?

This trio of tragedies has stunted their education; left them with low paying jobs and denied many of them a shot at a more prosperous future. Black seems to have become the symbol of the youth's war against despair and failure.

On the other hand, the realization they might not be as prosperous as their parents has led to a jump in depression and other mental health concerns among Millennials and Zoomers.

Some of the young, especially those in the West, see black as the color of an activist liberalism that literally fights for justice, social equality and climate protection. Black is the uniform color of this global army of left-wing liberal activists -- even in the Philippines.

It is the de rigueur hue for the anti-fascist and anti-racist political movement in the United States called "Antifa" (a portmanteau of the German “antifaschistisch” or anti-fascist). Antifa men and women clad head-to-foot in black like Japanese "ninja" have gained fame (or notoriety) because of their violent street battles against neo-Nazis, white supremacists and alt-right racists in many American cities since 2017.

Antifa fighters choose to don black to create a bond of equality and camaraderie. This color choice has led to their other nickname: the "Black Bloc".

Black's association with heroism goes back to Medieval Europe, an era that lasted from about 500 to 1500 CE, when bards wrote of "Black Knights" and their exploits. The most famous Black Knight was King Richard the Lionheart of England who assayed the role in the immortal historical novel, Ivanhoe, by Sir Walter Scott published in 1819.

Hollywood is one huge reason why a ton of Millennials and Zoomers still see black as the color of cool. And who doesn’t want to be a cool superhero in a stunning black costume? But today’s onscreen superheroes such as Batman and the X-Men began their crime-fighting careers as comic-book characters sporting bright and colorful livery. This riot of colors changed on the big screen to plain and boring black.

Batman, as played by Adam West in the hit 1966 TV series, “BAMed!”,  “BIFFed!” and “SOCKed!” his way to fame dressed in a gray body suit and a dark blue mask, cape, gloves and boots. Not a tinge of black on him. When the first issue of The X-Men hit the stands in 1963, all five teen heroes (Cyclops, Marvel Girl, Beast, Iceman and Angel) went into action in blue and yellow uniforms.

Today, actors in the movie versions of Batman (like Robert Pattinson) and The X-Men preen onscreen in total badass black, as do other superheroes and super villains in the Marvel Comic Universe and the DC Universe. There is no sign Hollywood’s enduring infatuation with superhero black is waning. And fan kids will keep on strutting in badass black.

The Antifa Black Army

The "bad"

The current dalliance with fashionable black, however, flies in the face of the Filipino historical narrative. Black is the traditional color of death and villainy in our culture, shaped as it is by folk Catholicism and centuries-old indigenous paganistic folklore at odds with Christianity.

Associating black with death goes back to before Spain embarked on its enslavement of the Philippines in the 16th century. It began with Islam, which was introduced to Philippine tribes in the late 13th century by Arab and Muslim Gujarati (people from the Indian state of Gujarat) missionaries and merchants.

Islamic belief holds that black is the color of "Jahannam", Islam's version of the Christian Hell. Jahannam, also called "the abyss" or "the fire", is an enormous land with seven levels located below heaven or "Jannah" ("paradise").

In the Islamic tradition, widows must wear black during the 40-day period of mourning for their husbands. They must also remain in their late husband’s home and are forbidden from entertaining suitors during this sad time.

On the other hand, Muslims regard white, the color of the flag of the Prophet Muḥammad, as the purest and cleanest color in Islam. It is for this same reason white is the color of Muslim burial shrouds.

Under the influence of Roman Catholicism, Catholic Filipinos during the 377 years of Spanish tyranny were taught black was the color of Satan, evil, Hell and death.

Then and now, most Christian Filipino funerals prefer black as the color of mourning. In an old but dying Filipino tradition, grieving family members will wear black in some way or the other to manifest their sorrow.

Men used to wear a black ribbon around their arms; women dressed completely in black while children pinned black ribbons on their clothing. This tradition is dying.

The embodiment of Death in Western culture is usually portrayed as a ghastly living skeleton garbed in a long and hooded black robe. The “Grim Reaper” wields a long and crooked scythe to reap the souls of sinners by the thousands and consign them to Hell. Filipinos have imbibed this concept, as well.

Clearly, black was never a favorite color of Filipino Muslims and Filipino Christians.

One might expect black to be associated with Filipino wars and warriors. Not so. Red (and not black) was the dominant color of the Philippine Revolution against Spain ignited on August 19, 1896 by the Katipunan (Kataastaasang Kagalanggalang Katipunan ng mga Anak ng Bayan).

Most of the Katipunan war flags -- which were the first war flags of the Filipino nation -- had red as their dominant color. Red symbolized the blood of the Katipuneros who swore to fight to the death for Philippine independence in what the Spaniards called the "Guerra Tagala" or the Tagalog War.

One notable exception to red's dominance was the black flag of Gen. Mariano Llanera of Nueva Ecija. His flag consisted of a black field emblazoned with a white letter "K", beneath which lay a skull and crossbones device, both in white.

The ugly

Starting next summer and all the summers thereafter, Filipinos should consider the Sun their Eternal Enemy -- a clear and ever-present threat to their health -- and banish heat absorbing black clothes as a favorite summer wear for the same reason. Think heat stroke and sunburn among the ugly health problems associated with overheated human bodies.

Black is not the healthy color to constantly wear in a warm tropical country like the Philippine. Most of us have known this since we were kids, which is why many school uniforms are in white. Science also proves black absorbs more heat than any other color.

Black clothes and other black materials efficiently absorb most of the sun's light and infrared radiation, causing the material to get hotter as it absorbs radiant energy. It isn’t a color because it doesn’t have a specific wavelength. Black is, therefore, the absence of visible light, which is a type of radiation that travels in electromagnetic waves.

On the other hand, white clothes are very poor absorbers of incident visible sunlight and infrared light. Most of these wavelengths are reflected away and don't increase the heat content of white clothes. White clothes are the better choice in hot climes.

Black roses

 

"Malas" causes cancer -- or does it?

 (Published in ENRICH magazine, 2022)

THE CONTENTIOUS CLAIM most adult cancers are due to "bad luck" or "malas" shouldn't be seen as a death sentence. Neither should it be regarded as a Gospel truth that deters us from doing all the good stuff proven to prevent cancer and extending our healthspans.

This unending hue and cry over the allegedly huge role chance (or is it Fate) plays in the development of cancer was triggered by a research paper published January 2015 in the peer-reviewed journal, Science. The paper suggested that cancer as a whole occurs by chance and can't be attributed mostly to heredity or lifestyle risk factors such as smoking and alcohol use.

The study asserts that two-thirds of adult cancers across different tissues are simply the result of sheer “bad luck”. Bad luck in this case refers to random DNA mutations occurring in genes that later progress into cancer.  You're lucky if these mutations don't trigger cancer. If not, it's your bad luck.

These random and potentially harmful DNA mutations accumulate in our bodies when stem cells (cells that generate all other cells with specialized functions) divide into various tissues, explained Dr. Cristian Tomasetti, an eminent cancer biologist and an associate professor of oncology and biostatistics at Johns Hopkins University who is one of the study's two authors.

Dr. Bert Vogelstein, a professor of oncology and Howard Hughes Medical Institute investigator at The Johns Hopkins Medical School, is co-author of the paper, "Variation in cancer risk among tissues can be explained by the number of stem cell divisions".

The study is a technical description of how cancer rates vary in different tissues and is based on data from the United States. It did not focus on cancer prevention or on lifestyle changes that deter cancer.

The study suggests our inherited genes, environmental factors and risky lifestyle choices such as smoking, alcoholism or eating too much red meat play a small role in cancer development.

"Here, we show that the lifetime risk of cancers of many different types is strongly correlated (0.81) with the total number of divisions of the normal self-renewing cells maintaining that tissue's homeostasis," wrote Tomasetti and Vogelstein.

"These results suggest that only a third of the variation in cancer risk among tissues is attributable to environmental factors or inherited predispositions.

"The majority is due to 'bad luck,' that is, random mutations arising during DNA replication in normal, noncancerous stem cells. This is important not only for understanding the disease but also for designing strategies to limit the mortality it causes".

Tomasetti and Vogelstein found a strong relationship between how often certain cells divide in different kinds of human tissue and the lifetime chance cancer will develop in those tissues. They confirmed the more often cells divide, the more likely this tissue will develop cancer since duplicating DNA can lead to mistakes, and DNA mistakes can cause cancer.

Tissues with stem cells that divide a lot tend to develop higher rates of cancer. That's why colon cancer is more common than brain cancer. On the other hand, stem cells that rarely divide are likely to have lower cancer rates.

Vogelstein explained that cancer occurs when tissue-specific stem cells mutate or make random mistakes. These mistakes occur when one chemical letter (Adenine, Thymine, Guanine or Cytosine) in our DNA is incorrectly exchanged for another during the replication process in cell division. The massive accumulation of these mistakes over time increases the risk cells will grow unchecked into cancer.

"All cancers are caused by a combination of bad luck, the environment and heredity, and we've created a model that may help quantify how much of these three factors contribute to cancer development," said Vogelstein.

Bad luck causes cancer

Unlucky 22

A layman’s knee-jerk reaction to the “bad luck” conclusion is to ask "What's the use of a healthy lifestyle if there's practically nothing you can do to prevent cancer"?

Does this mean we should abide by the Epicurean blandishment to "Eat, live and be merry for tomorrow we die"? It's a tempting course of action given the study, but one that's wrong on all counts.

"If two-thirds of cancer incidence across tissues is explained by random DNA mutations that occur when stem cells divide, then changing our lifestyle and habits will be a huge help in preventing certain cancers, but this may not be as effective for a variety of others," said Tomasetti.

Tomasetti and Vogelstein found that 22 of the 31 cancer types they studied could largely be explained by the "bad luck" of random DNA mutations during cell division. There are more than 100 types of cancer, of which carcinoma is the most common.

The 22 "bad luck" cancers identified by Tomasetti and Vogelstein are those in which “primary prevention measures are not likely to be as effective”. Primary prevention measures, which involve screening, seek limiting our exposure to carcinogens to prevent the start and spread of cancer.

They include lifestyle interventions (such as regular physical activity and not smoking) and medical interventions (vaccinations). Tomasetti and Vogelstein also said the early detection of cancer is a viable secondary prevention measure for some cancers that can't be overcome by prevention.

 he 22 "bad luck" cancers consist of head osteosarcoma, glioblastoma, medulloblastoma, head and neck, thyroid medullary, lung (for non-smokers), esophageal, osteosarcoma of the arms, hepatocellular carcinoma, pancreatic ductal adenocarcinoma, pancreatic islet tumors, gall bladder, duodenum, small intestine, pelvis osteosarcoma, ovarian germ cell, testicular germ cell, melanoma, osteosarcoma, leg osteosarcoma, chronic lymphocytic leukemia and acute myeloid leukemia.

The other nine cancer types are due to bad luck plus environmental or inherited factors. These include basal cell carcinoma, HPV-16 (human papillomavirus-16) head and neck, thyroid follicular, lung (smokers), HCV (hepatitis C virus) hepatocellular, colorectal adenocarcinoma, Lynch colorectal and familial adenomatous polyposis or FAP colorectal.

Extrinsic factors

The conclusions of the paper by Tomasetti and Vogelstein are still hotly debated. The study continues to draw withering criticism and outrage from its foes, especially cancer prevention doctors who see it as negating the message that most cancers can be prevented. The furor has escalated with the publication of new studies seeking to counteract the "bad luck" hypothesis.

Eleven months after Tomasetti and Vogelstein's study, a team of cancer biologists and statisticians published a study in Nature, the British weekly scientific journal, detailing the contrary opinion using mathematical, epidemiological and molecular evidence.

“A majority of cancers are due to extrinsic factors,” declared Dr. Yusuf Hannun, director of the cancer center at Stony Brook University in New York State and senior author of the paper in response to the contention most cancers are the result of random biological mistakes.

“External factors can influence the rate of stem-cell division and the number of mutations", Hannun added.

The rebuttal explained that cancers are more prevalent than can be explained by cell division alone. This can be seen by the huge geographical variation in rates of different cancers, which suggest cancers are triggered by much more than intrinsic factors like cell division.

For example, prostate cancer is 25 times more common in Australia than south-central Asia (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka) while breast cancer is five times more common in Western Europe compared to East Asia (China, Japan, Mongolia, North Korea, South Korea, and Taiwan).

The Stony Brook study also said the non-inclusion of common cancers such as prostate and stomach cancer might have skewed the conclusion about the importance of cell division in explaining which tissues likely develop cancers. It pointed out cancers due to cell-division errors form the base to which cancers due to other causes are added.

The paper concluded that “unavoidable intrinsic risk factors (such as cell division) contribute only modestly, less than 10-30 percent, to the development of many common cancers”.

Doubling down

Partly in response to the Stony Brook study, Tomasetti and Vogelstein in 2017 released another paper (also published in Science) that defended their original findings and also sought to correct what they saw were widespread misinterpretations about it.

Based on health records from 69 countries, the new study argues that 66% of cancer-causing genetic mutations arise from the “bad luck” of healthy, dividing cells making random mistakes when copying their own DNA. This time, the new study admitted the cause of many cancers might be environmental factors.

It analyzed cancer genomes in a United Kingdom database to classify if cancer-causing mutations are hereditary, if they originate from the environment or are random DNA-copying mistakes.

Tomasetti and Vogelstein now pointed out their new conclusion does not mean that two-thirds of cancers can't be prevented. Vogelstein said understanding the role of unforced errors “could provide comfort to the millions of patients who developed cancer but led near-perfect (healthy) lifestyles”.

“This is particularly true for parents of children who have cancer” and who might blame the tragedy on the genes they passed on to their child or the environment they provided.

Hannun, however, was skeptical of the new study and remarked he wasn’t “very impressed with the overall conclusion”.

Cancer can be prevented

Prevention still matters since some 42% of cancers are preventable. Tomasetti and Vogelstein admitted as much in their original study when they said "One of the most promising avenues for reducing cancer deaths is through prevention". They also said the early detection of cancer is a viable secondary prevention measure for cancers that can't be controlled by prevention.

We must take heart from the knowledge our chances of not developing cancer are affected by the lifestyle choices we make. We have to do the right thing. The Mayo Clinic, which has been consistently ranked among the best hospitals in the United States, offers these cancer-prevention tips.

* Don’t use any type of tobacco to avoid lung, throat, mouth, larynx, pancreas, bladder, cervix and kidney cancer.

* Maintaining a healthy weight and being physically active helps fight cancer. A healthy weight might lower the risk of breast, prostate, lung, colon and kidney cancer, among others. Physical activity might lower the risk of breast cancer and colon cancer.

* You've also got to go on a healthy diet by eating lots of fruits and vegetables. Also limit your intake of processed meats such as ham, bacon and frankfurters since eating lots of this stuff can slightly increase the risk of colorectal cancers and other chronic diseases.

* Regular medical examinations boost the chances of discovering skin, colon, cervix and breast cancer early on. Early discovery increases the likelihood of successful treatment of early stage cancer.

* Vaccinate yourself against Hepatitis B, which can increase the risk of developing liver cancer. Also vaccinate against the Human papillomavirus (HPV) that can lead to cervical cancer, squamous cell cancers of the head and neck and other genital cancers.

* Avoid risky behaviors such as unsafe sex with multiple partners to preclude acquiring sexually transmitted infections like HIV or HPV. People with HIV or AIDS are at a higher risk of cancer of the anus, liver and lungs. HPV increases the risk of cervical cancer, cancer of the anus, penis, throat, vulva and vagina.

* Protect yourself from skin cancer, one of the most common types, by avoiding the midday sun, staying in the shade and using sunscreen when needed.

Cancerous cells

About cancer

Cancer, which can begin in almost any of the more than 37 trillion cells in the human body, is basically uncontrolled cell growth. A growing mass of cancerous cells can later develop into a tumor.

In the Philippines, 189 of every 100,000 Filipinos were afflicted with cancer in 2012. Four Filipinos died of cancer every hour or 96 cancer patients per day, according to a study conducted by the University of the Philippines’ Institute of Human Genetics, National Institutes of Health.

Cancer is one of the five leading causes of death in the Philippines with lung cancer due to smoking causing the most cancer deaths. Lung cancer caused by tobacco remains the biggest single cause of cancer deaths worldwide (six million deaths annually).  There were an estimated 1.1 billion smokers on our planet in 2019.

The five most common cancers globally are carcinomas that attack organs and glands such as the lungs, breasts and skin. There's leukemia, which affects the body’s blood forming tissues. Sarcoma affects soft or connective tissues such as muscle, fat, bone and blood vessels.

Melanoma occurs in cells that pigment the skin. Lymphoma attacks the lymphatic system, which is part of the body's germ-fighting network.

Advancing age is the top risk factor for developing cancer with people over 65 running the greatest risk of acquiring the disease. The median age of a cancer diagnosis in the U.S. is 66 years-old.

For many of us, cancer will be in our future. One in two women and one in three men in the U.S. will develop cancer in their lifetime based on 2015 data. It’s equally grim in the United Kingdom where one in two men and women will be diagnosed with cancer. Cancer prevention starts now.

Height does matter, and in more ways than one

 (Published in ENRICH magazine, 2022)

IN THE PHILIPPINES, the phrase "stand tall" should be taken with a figurative, and not literal, meaning.

That's because Filipinos still retain the dubious honor of being one of the world's shortest people in average population height, average female height and average male height. On average, Filipino men and women are a mere 156.41 cm (5 feet 1.57 inches) tall, according to data released in 2019 by NCD Risk Factor Collaboration (NCD-RisC), a project linked to Imperial College London. This made Filipinos the fifth shortest people in the world based on NCD-RisC reckoning.

The same data also showed the average Filipino man with a height of 163.22 cm (5 feet 4.25 inches). That's as tall as Hollywood stars Michael J. Fox and Kevin Hart. The average Filipina is 149.60 cm (4 feet 10.89 inches) tall. Heightwise, that’s similar to former President Gloria Macapagal-Arroyo, superstar Nora Aunor and the late Hollywood legend Judy Garland.

Filipinos are only marginally taller than citizens of Timor-Leste, which topped the shortest stature list of NCD-RisC. The average height of both males and females from Timor-Leste was 155.47 cm (5 feet 1.28 inches). The average Timorese man stands 159.79 cm (5 feet 2.90 inches) tall while the average woman gets to 151.15 cm (4 feet 11.50 inches).

On the other hand, the average Timorese woman (151.15 cm) is taller than the average Filipina (149.60 cm). This makes Filipinas the second shortest in the world behind the women of Guatemala, who have an average height of 149.38 cm (4 feet 10.81 inches).

NCD-RisC is a global network of health scientists that provides timely data on major risk factors for non-communicable diseases for all countries.

The question now is why are we still of such short stature when this problem has been with us for generations? There are short and easy answers to this question.

Basically, it boils down mostly to genetics (or biological factors) coupled with the right food and adequate nutrition (or socioeconomic factors), especially in childhood.

Some scientists estimate that genetics accounts for more than 60% of a person's height. This being the case, a relatively well-to-do Filipino couple whose height is above average will likely sire taller than average children.  The reverse is also true.

The hereditary advantage conferred by tall parents who have enough money to regularly feed their children more protein (generally meat) than carbohydrates (rice) in their kids' growing years should see much taller children. Most Filipinos, however, are neither tall nor rich. The consequences of these realities are what we see daily on our streets: a sea of short and poor Filipinos.

Stunted, poor and malnourished

Height matters, and not only because of bragging rights. It turns out "height is a proxy indicator of how well the Philippines is doing as a society to reduce childhood poverty and improve access to nutrition," according to a report released in 2015 by Save the Children Philippines. It appears the Philippines is failing in this task.

"If the Philippines is to progress economically, we must not leave the poorest children behind," said the report with the title, "Sizing Up the Stunting and Malnutrition Problem in the Philippines".

World Atlas, an educational geography website online since 1996, publishes its own set of global stature statistics. In 2017, it estimated the average height of Filipinos at only 154.9 cm (5 feet 1.5 inches), a full 8.3 cm (3.3 inches) shorter than the estimate from NCD-RisC.

This made the Philippines the country with the third shortest population in the world. Instead of Timor-Leste, World Atlas said Bolivia had the world's shortest population. It placed the height of the average Bolivian at 151.1 cm (4 feet 11.5 inches).

What makes the estimate by World Atlas remarkable is that it attributed the short stature of Filipinos to "severe malnutrition problems ... especially prevalent in the event early age pregnancies, where the mother is not fully physically equipped for childbirth and childcare".

It noted the Department of Education (DepEd) admitting 1.8 million malnourished Filipino children are in danger from abnormalities such as stunting.

"The result is that the likelihood of this situation being repeated in the next generation is high. Although feeding programs have been launched, funds are not adequate enough," it reported.

It appears the DepEd estimate is off the mark. A report published by the Philippine Daily Inquirer in 2015 claimed 30% of all Filipino children under the age of five were stunted or short for their age. In numbers, this is an astonishing 3.6 million children, the ninth largest number of any country at the time.

"This is not a theoretical problem; this is a nutritional emergency," said the story.

At 63%, the Autonomous Region in Muslim Mindanao (ARMM) had the highest level of stunting among children in the entire country. Childhood stunting in Mindanao comes to 40%. This figure is equivalent to the average for all of sub-Saharan Africa consisting mostly of black African countries.

The report defined "stunted" as a child chronically malnourished during the first 1,000 days of its life, or from conception until the second birthday. This is the critical growth period for any child.

The World Health Organization (WHO) asserts stunting is the irreversible outcome of inadequate nutrition and repeated infections during the first 1,000 days of a child’s life.

The latest data about stunted Filipino children remains troubling and points to a neglect of the problem by both the national and local governments. The World Bank estimated 29% of Filipino children in 2019 age five and below were stunted.

It said the Philippines is still plagued by childhood stunting because of undernutrition, which it labeled "the silent pandemic". Stunting keeps most children in poverty for their entire lives while poverty creates the conditions leading to stunting.

In 2015, poverty meant 1.5 million Filipino children went through a day without a full meal. Some 2.7 million Filipino children missed a meal because their families don't have enough money for three meals a day. This situation has remained rampant.

In 2018, the Department of Health (DOH) estimated there were 4.2 million stunted Filipino children and more than 300,000 children under five years that are severely wasted, or thin for their height. Severely wasted children have at least nine to 12 times an increased risk of death.

The toll taken by malnutrition on Filipino children is gruesome and heartbreaking. UNICEF Philippines estimates 95 Filipino children die every day from malnutrition.

Another indignity: 27 out of 1,000 Filipino children do not live past their fifth birthday. And still another:  a third of Filipino children are stunted, and stunting after two years of age can be permanent, irreversible -- and even fatal. We must put a stop to this!

Bad for the brain

Malnutrition and poverty are also bad for the brain. A poor and stunted Filipino child will unlikely achieve his full cognitive and intellectual potential.

WHO and the United Nations Children's Fund (UNICEF) both agree stunting affects the cognitive development of children, which can be seen in their paltry academic results at school.

Nine out of 10 Filipino children at age 10 cannot read or understand a simple story by the age of 10. This translates into a record high "learning poverty" of 90.5%. The inability of Filipino children to read by 10 years-old will also mean they face huge obstacles to learning math, science and a host of other more difficult subjects.

 Learning poverty is defined by the World Bank as a child being unable to read and understand simple text by age 10. Also called "galloping illiteracy", learning poverty will later translate into economic poverty.

 It has gotten far worst over the past two years due to the cancellation of face-to-face classes in the aftermath of COVID-19. Before COVID-19 struck in early 2020, learning poverty in the Philippines was lower at 69.5%.

Malnourished Filipino children

First 1,000 days

During the presidential campaign 2016, candidates were asked to support the “First 1,000 Days Act,” a piece of legislation pending in Congress whose goal was to make reducing stunting and improving nutrition nationwide a presidential priority.

The man that won the presidential race, Rodrigo Duterte, did do something: he signed laws aiming to address the malnutrition problem. In the middle of his six-year long administration that bowed out on June 30, 2022, he signed Republic Act 11148 into law on November 29, 2018.

RA 11148, or the “Kalusugan at Nutrisyon ng Mag-Nanay Act," is more popularly known as the First 1,000 Days Law.  It seeks to boost national and local health and nutrition programs through an integrated strategy for maternal, neonatal, child health and nutrition in the first 1,000 days of a child's life.

"This law will complement the much-awaited Universal Health Care Law to further boost the country’s health status on our way to make Filipinos the healthiest in Southeast Asia by 2022 and in Asia in 2040,” boasted DOH Secretary Francisco Duque III.

Over three years later or in June 2022, the national government announced its intent to borrow $178.1 million from the World Bank to further support RA 11148.

It said the loan will “increase the utilization of a package of nutrition-specific and nutrition-sensitive interventions and improve key behaviors and practices known to reduce stunting in targeted local governments”. The project will be jointly implemented by the DOH and the Department of Social Welfare and Development (DSWD).

“It’s important that we focus on the health and nutrition of children starting in their mother's womb, especially because it has a big effect on their capacity to learn,” said Sen. Sherwin Gatchalian, who co-authored RA 11148.

“We should make sure that our communities have enough participation and capability, together with the local government, in order to ensure the good health of Filipino children”.

RA 11148 complements Republic Act No. 11037 (or the Masustansyang Pagkain Para sa Batang Pilipino Act) signed into law on June 2018. This is a law "Institutionalizing a National Feeding Program for Undernourished Children in Public Day Care, Kindergarten and Elementary Schools to Combat Hunger and Undernutrition among Filipino Children and Appropriating Funds Therefor".

Both laws are part of the national government's bid to eliminate hunger and reduce all forms of malnutrition. They also intend to secure healthy lives, promote the well-being of Filipinos, and end hunger and food insecurity.

Up and down

Up until his death in 2020, Junrey Balawing from Sindangan, Zamboanga del Norte was the shortest living man in the Philippines and the world. He stood tall at 56.0 cm (22.0 inches), as verified by Guinness World Records in 2012.

He became the world's shortest non-mobile person after the death of Chandra Bahadur Dangi from Nepal in September 2015. Chandra measured 54.6 cm (21.5 inches). Balawing was only 27 at the time of his death in the City of Dapitan.

On the opposite end of the scale, the tallest indigenous Pinoy on record is Raul Dillo standing at an eye-popping 221 cm (7 feet 3 inches), a height he hit when he was only 17 years-old. Now 30 years-old, this giant used to play basketball in college and in the defunct Metropolitan Basketball Association but never shone despite his height advantage.

Dillo later played bit roles in a number of Filipino movies where he was predictably typecast as a giant. Asked about the downside to being gigantic in 2012, he replied: “Sa transportation ang hirap. Kung bus, okay pa. Pero tulad ng tricycle, mahirap.”

The tallest home-grown Philippine Basketball Association (PBA) player is center Edward Joseph "E. J." Feihl, whose ceiling was 215.9 cm (7 feet 1 inch).  The second overall pick in the 1995 PBA draft, Feihl played for Ginebra San Miguel and six other teams until his retirement in 2007.

Feihl was born in Santa Barbara, Pangasinan to a Filipino mother and a German father. He’s 52 years-old.

The dearth of six-foot tall home-grown Filipino giants is a reason why the PBA is riddled with towering imports. In 2021, the PBA implemented a height limit of 198 cm (6 feet 6 inches) on imports to prevent the favorite Pinoy sport from being completely dominated by foreign skyscrapers.

 

Raul Dillo

Have you heard of this new disease called ageing?

 

(Published in ENRICH magazine, 2022)

A MOMENTOUS DEBATE raging in the global medical community will profoundly alter the way we perceive and treat the many diseases and infirmities that inevitably come with growing old.

At issue is the vexed question: "Is ageing a disease"?

It is a conundrum the informed Filipino layman will likely answer with, "Of course, not". In his world view, ageing is not a disease because he knows of no disease or medical condition called ageing. But he does realize chronic diseases like cancer, diabetes, stroke, arthritis, heart disease and Alzheimer's are prevalent among his old parents and even older grandparents.

The World Health Organization (WHO), however, no longer holds with certainty the view that ageing is not a disease. In January 2022, WHO effectively paved the way for defining ageing, specifically biological ageing or senescence, as a disease in the 11th revision of the International Classification of Diseases (ICD-11).

Its reasoning: old age gives rise to biological changes that make people more vulnerable to diseases that worsen with age like cancer and arthritis. Some experts contend ageing is the biggest risk factor for heart disease, cancer and dementia.

WHO, therefore, has apparently redefined ageing as a treatable condition that can be delayed and cured like a disease. It likely sees "ageing itself" as the principal cause of the myriad of illnesses linked to old age.

This redefinition of ageing as a disease should also lead doctors and scientists to address not only the effects of ageing but the underlying causes of the symptoms linked to ageing.

It's known that the processes underlying age-related diseases probably overlap. Therefore, if scientists can determine what biological processes make people more susceptible to age-related diseases such as heart disease and Alzheimer’s, a treatment might be found that can potentially treat multiple diseases at once instead of one at a time.

Age-related diseases are deadly. Of the 150,000 people that die every day across our planet, about two-thirds (close to 100,000) die from age-related causes. Even wars can't kill as many people. Some 27,000 people died daily in World War 2, the deadliest war in human history.

What exactly is ageing?

This festering dispute among the learned leads us to the question as to what ageing -- or the process of becoming older -- really is.

A medical definition describes chronological ageing as a time-dependent functional decline marked by a progressive loss of physiological integrity. This attenuation leads to the impairment of bodily functions and increases one's vulnerability to death. In other words, the older you get, the weaker and sicker you become. But is this due to the cumulative effects of individual age-related diseases, or to ageing as a disease? That is the question.

At the biological level, ageing is caused by the gradual accumulation of molecular and cellular damage over a person’s lifetime. These molecular level changes trigger a decline in mental and physical function and increase the risk of disease and death.

Then, there's the role cellular senescence plays in ageing. Ageing is also defined as the accumulation of senescent cells. Senescent cells cause many of the degenerative changes we perceive as ageing, as well as age-related diseases.

Cellular senescence is the process in which cells age and stop dividing permanently -- but don't die. Over time, massive numbers of old, or senescent, cells accumulate in our body tissues.

These "living-dead" cells or zombies release a range of inflammatory factors and enzymes that destroy the tissues in which they reside. As a result, our immune cells attack and kill senescent cells, thereby changing our tissues for better or worse.

In one fell swoop

ICD, the tool that ignited the ageing firestorm, is a globally used diagnostic tool published by WHO to help doctors and healthcare professionals identify diseases. It is a healthcare classification system providing diagnostic codes for classifying diseases.

The specific changes to ICD-11 about ageing involve general symptoms (code “MG2A”) and in the causality section of “XT9T”.  ICD-11 classifies "old age" as a specific disease in contrast to ICD-10 where old age is classified as a “general symptom”. Another contentious change was replacing the code for “senile debility” with the code MG2A, which originally stood for “old age”.

WHO also implemented an extension code (or a new category of codes) for "ageing related", or XT9T diseases. These are diseases “caused by pathological processes which persistently lead to the loss of organism’s adaptation and progress in older ages”. Extension codes provide additional information on a disease, injury or disorder.

The new code XT9T can be immediately applied to relevant conditions listed in ICD-11, as well as to future relevant medical conditions.

On the other hand, the implementation of the extension code XT9T in ICD-11 "is not tantamount to formal recognition of ageing as a disease," asserts an editorial in the peer-reviewed scientific journal, The Lancet. The advent of XT9T does, however, "signal acknowledgment by WHO of ageing as a major disease risk factor and of the considerable public health problem posed by ageing-related diseases".

The new proposals in ICD-11 intend to ensure ICD has a complete list of pathologies and disorders related to ageing. It also seeks to guarantee and account for the full spectrum of degenerative changes.

Accomplishing this means all ageing-related pathologies will have to be included in disease or disorder classifications, which wasn't the case previously. This omission meant an ageing diseases classified and assessed for the level of severity in one organ can be unclassified in another. It is a confusing situation at best.

More seriously, the absence of classifications and staging can result in less than ideal treatments since pathological ageing changes are not included in ICD.

The ageing-related changes to ICD-11 came from a joint proposal submitted to WHO’s ICD-11 Task Force by the Biogerontology Research Foundation, the International Longevity Alliance, and the Council for Public Health and the Problems of Demography.

Cellular senescence

Raging storm

The release of ICD-11 quickly ignited a storm of controversy, splitting medical professionals involved in gerontology, longevity science and other disciplines having to do with ageing into pro-disease and anti-disease factions.

Advocates for classifying ageing as a disease have long argued ageing is the biggest risk factor for chronic diseases, which are today treated individually as a matter of course. They contend ageing is not a deviation from the normal state as can be expected from a disease.

Treatments that focus on the underlying ageing process will “in one fell swoop, intervene in several or many chronic diseases of ageing,” claims Dr. Alexander Fleming, the founder of Kinexum (a company that develops drugs and biotech products).

Dr. David Sinclair, professor of genetics at Harvard Medical School and one of the better known longevity scientists, agrees that ageing is the main cause of all major diseases in society today.

"I'd argue that just because ageing happens to more than half of us, is no reason to not include it as a disease," he noted. "In fact, I would say it's even more important that we work on trying to combat it, because ageing is the main cause of all major diseases in society now.”

This line of thinking mirrors that made by Dr. Leonard Hayflick, professor of anatomy at the University of California San Francisco School of Medicine, back in 1962.

At the time, Dr. Hayflick argued that if old age is a risk factor for nearly all of the diseases likely to kill us, "why then are we not devoting significantly greater resources to understanding what … increase(s) vulnerability to all age-associated pathology?"

He said the lack of distinction between ageing and age-related diseases “is the most serious impediment to our understanding of the ageing process.”

Dr. Hayflick gained fame by discovering a limit to how many times human cells divide before they become senescent. His name is inextricably linked to the discovery of the key role telomeres play in the ageing process.

The declaration by WHO seems a belated acknowledgement of a landmark study about ageing published in February 1954 by Dr. Robert Perlman in which he described ageing as a “disease complex" while emphasizing the etiologic significance of both internal and external environmental stress.

Perlman's study, “The Ageing Syndrome”, published in the Journal of American Geriatrics Society has slowly gained adherents over the past half century.

In 2015, a team of international researchers published a study in the online biomedical and life sciences journal PubMed Central with the provocative title, “It is time to classify biological ageing as a disease.” It sees "the ageing process as the underlying cause for the chronic diseases affecting the elderly".

Alarm bells

The ageing-related revisions in ICD-11 were met with alarm by medical professionals holding the contrary but majority view. Current thinking contends ageing is a natural process and not a disease, and "should not be considered a disease in and of itself."

A paper published in The Lancet in October 2021 took WHO to task for supporting moves to classify ageing as a disease.

"We argue that simply equating old age as a disease in the ICD-11 is potentially detrimental and deleterious from clinical, research, and humanitarian points of view, and propose alternate productive solutions," wrote the study authors.

They argue chronological age has limited use in diagnosis, prognostication, and treatment guidance. In addition, “age by itself is of limited use for the assessment of population health, for the evaluation of initiatives designed to promote healthy ageing, and for health or social care planning. “

Instead on harping on ageing, the authors "propose that frailty should be included as a clinical disorder instead of old age." They ask WHO "develop the reporting of frailty in the ICD classification system" and argue that frailty "is a much more homogeneous and better-defined clinical entity" compared to old age.

They claim ICD-11 branding ageing as a disease will potentially magnify the socioenvironmental disadvantages in terms of equality in healthcare provision endured by the elderly.  Ageing as a disease will also reinforce commonly held ageistic beliefs in society and the medical community.  Validation of ageistic beliefs will also stand to worsen the societal marginalization and discrimination against the elderly.

The International Association of Gerontology and Geriatrics based in Belgium and comprising 84 national societies from 72 countries has also assailed the inclusion of old age as a pathological criterion in ICD-11. Others are urging WHO to revise the ICD-11 classification of old age.

What's at stake

Behind the fire and fury engulfing those for and against the proposition is a deep concern for the plight of the elderly. The implications of the WHO declaration that ageing is a disease -- which many medical professionals dispute or dismiss -- will massively affect the healthcare provided the elderly and the development of drugs needed to combat diseases of ageing.

The protagonists don't dispute ageing is a one-way street culminating in six feet of subterranean real estate. What they can't agree on is how to make this final journey more tolerable, which means an emphasis on healthy ageing or our healthspan.

Those that contend ageing should be classified as a disease want to goad governments and pharmaceutical firms into emphasizing the development of therapeutic interventions targeting ageing and ageing-related diseases.

They argue that new therapeutic interventions for ageing will lead to the acceptance of ageing as a disease. This acknowledgement will help ensure treatments are covered by health insurance providers, especially those in the West. It is also critical to boost funding from grant-awarding organizations for ageing research.

The poorest of Filipinos

The implications of this debate on ageing in the Philippines will be huge.

The country has an elderly population age 60 up of more than 12 million persons. This total comprises 11% of the total population of 110.8 million persons, estimated the Commission on Population and Development (PopCom).

In 2015, PopCom said the country’s population will begin to age by 2025 to 2030. It was because of this former PopCom executive director Juan Antonio Perez III said he was gravely concerned that “social protection systems have yet to catch up with social conditions”.

“People are living longer but in poorer health and socio-economic conditions," said Perez.  "They are only partially reaping the benefits of better health and social conditions."

He warned the government has only 10 years to craft programs for the elderly that address healthcare, rehabilitation, depression and daily activities, among others.

He emphasized senior citizens will need the government’s help as they will be “the poorest members of the population because usually their pensions are not enough for them”. Not much has occurred since 2015 to negate this warning.

In 2017, the Philippines was ranked 60th out of 191 countries in WHO’s Ranking of the World's Health System. The country with the world’s best healthcare was France; Singapore had Asia’s best healthcare system.