Diarrhea, mainly caused by unsafe water, is still among the top causes of illness.

SUCH DISPARITY is also evident among central cities and peripheral provinces, or first-class and lower-class municipalities. To make matters worse for the poor, more government services and accredited health-care facilities are in the affluent areas. These disparities are unlikely to even out in the coming years Among members of the Philippine Health Insurance Corporation (PhilHealth), for example, the wealthy and healthy are currently more likely to avail themselves of the insurance benefits than the ill but impoverished, who cannot afford to lose a day's pay or the bus fare to consult a doctor. This trend will likely continue in the next decade.

When family planning and health-care providers do not reach out to the poor and those living in more peripheral areas, it is unlikely that the underserved would spare the extra cost of transportation and access to information and services. Not surprisingly, the number of infant deaths and maternal mortality in our country continues to be high. Apart from a disturbing picture of dying babies and dying mothers, the University of the Philippines Population Institute estimates abortion rates as ranging between 320,400 to 480,600 annually. These figures translate to one abortion for every five to six pregnancies.

The number of women hospitalized for high-risk deliveries and some even dying because of abortion and complications in our country is huge. Based on reimbursements records, these account for over 30 percent of PhilHealth's spending and amounts to around P1.15 billion each year.

Women from households with higher income have greater use of, and possibly better access to, family planning services. Several studies already show that the number of children that each woman has is related to household-income levels. Richer couples have on average two children, which is the number that most women want. But while married women in poor households say they had wanted around three children at most, majority of them end up with at least one or two more, with many even having more than five children. These figures may or may not include the young children who have died. The rate of deaths of infants and under-five-years-old among the poor in the Philippines is double those among affluent Filipino households.

It has been suggested that it is not only the absolute amount of income that is important for health but also the relative disparity with which the income is distributed. One possible explanation for this is that the social stress associated with such inequity can lead to more smoking, alcohol abuse, and other unhealthy behaviors. It is also conceivable that when too much of the total income is in the hands of the rich who can afford private education and medical care, there is less money for the poor. There is simply less interest among those with money to contribute to funding for public education, public health, and social services. (Blame that partly on growing cynicism, which can kill philanthropic instincts. But plain greed and selfishness play a part, too.)

The correlation between the distribution of disease and the disproportionate allocation of resources is supported by another observation: there are fewer deaths when there was less inequity. This reflection is based on what has taken place in countries with increasing incomes but constant class differentials, and compared with poorer but more egalitarian societies. Hidden behind the health situation reported by our statistics, for example, is the marked inequity and the wide disparity in the health status among Filipinos. According to the Department of Health and our health administrators, there are persistent, large variations in health status across population groups and geographic areas. Again, while there are pockets of excellent health among the rich, the burden of disease is heaviest on the majority who are poor.

	Patients in a government hospital get meager care, and the migration of health workers will make it much more difficult to meet the burgeoining health care needs of the future.

THE IRONY is that as the health and health care divide widens between the haves and the have-nots, we are seeing an exodus of health professionals headed for work overseas. This trend is likely to continue in the coming decade. Would that we could count on steady support from the countries that benefit from our countrymen's labors and who have drawn our resources. Yet it is difficult to beg for aid and assistance from foreign donors and multinational corporations. It is more difficult to find solace in the infusion of dollar remittances from overseas workers, including those who should be looking after our own people's health, when these come at the expense of families separated by seas and continents and of health institutions in dire need of trained and skilled personnel.

Still, for every 3,000 physicians who yearn for the chance to work abroad, many do choose to stay. For every 300 medical graduates pining for positions in expensive medical centers there are those who would work among the poor. For every 30 successful health professionals who have left our country there is someone who will come back home.

It is, however, distressing to realize that choosing to stay means a harder life for a physician's family. It is depressing to witness a young nurse or midwife walking in mud as the latest car models roar by. It is disheartening to have barangay doctors reading torn medical books under the flickering light of a kerosene lamp while many other people enjoy a sparkling nightlife. It is demoralizing to be in a country that chooses to break up families and offer our health workers to the uncertainties of foreign employment rather than spending for the means to maintain the human resources that are vital to the health of our people.

Fifteen years ago, I worked as a rural health physician in Kabugao, in Apayao province. My wife was the chief of the district hospital. We lived there for two years with our daughter, who was just 11-months old when we first arrived. Our next child, my son was conceived in that part of the Cordillera mountains. The number of doctors in Kabugao has barely increased since we left, and it may stay that way (or even see a decline) in 2015. With the continuing lure of better pay and better opportunities in the city hospitals of our country and the health centers in other countries, how can there be more health workers in places like Kabugao? Can I myself even care enough to go back to work in the municipal health office I left so many years ago?

I may hesitate, but fortunately there are hardier souls out there. Even now thousands of rural health workers continue to labor in the most difficult and trying circumstances, while there are still doctors who can barely make both ends meet but are sticking it out in the hinterlands. Thousands more nurses have surrendered to a lonely life away from home-not in some foreign land, but in areas in the Philippines they know need them most. These are the heroes who may yet bridge the health gap between the rich and the poor and help heal the wounds of our society.