Context

Geography and population

The Philippines is an archipelago nation in Southeast Asia, consisting of over 7,000 islands and comprising a population of approximately 116 million, the 13th largest of any country on Earth.¹

A large majority of that population lives on the two largest islands, Luzon in the north (with 64 million residents) and Mindanao in the south (26 million). Another substantial share of the national population—about 21 million people—lives in a belt of islands between Luzon and Mindanao, known collectively as the Visayas.¹

Almost half of the country's population (48%) lives in urban areas, and each of the three predominant geographic island groups features a major metropolitan area. The largest of these is Manila, in southern Luzon. The core city is the national capital, and the metro area as a whole—which includes massive Quezon City, which is actually bigger than Manila proper—has a population of between 13 million and 15 million.¹

The considerably smaller but still sizable metro areas of Davao and Cebu, each with populations of over 3 million, are the major population centers of Mindanao and the Visayas, respectively.

During the 2008 to 2018 study period, the national population grew by 16 million. However, the rate of annual population growth cooled slightly, from 1.9% in 2008 to 1.7% in 2018.²

As might be expected from its large size and fragmented geography, the Philippines is home to a variety of ethnic groups. The largest of these is Tagalog, accounting for 24.4% of the national population. The official languages are Filipino (which is based on Tagalog) and English. The predominant religious identity is Roman Catholicism, professed by nearly 80% of Filipinos.¹

Economics

The national economy of the Philippines grew substantially over the study period. The country's gross domestic product (GDP) grew by about US$165 billion between 2008 and 2018, and its annual GDP growth rate increased during the same period, from 4.3% to 6.3%.³

The country's GDP per capita, measured in purchasing power parity terms using constant 2017 international dollars, increased from US$5,597 to in 2008 to US$8,366 in in 2018.⁴

Poverty at the national level also appears to have reduced considerably between 2008 and 2018. The proportion of Filipinos living at or below national poverty lines decreased by 37%, from 26.3% to 16.7% of the population. The proportion of Filipinos living in extreme poverty (less than US$2.15 a day) fell by approximately 75%,^5,6 from 11.3% to 3.0% of the population.

Agriculture yields only a small share of GDP (9.6%) but employs a quarter of working Filipinos.¹ The warm, humid archipelago supports a range of crops, including sugar cane, rice, coconuts, maize, bananas, vegetables, plantains, pineapples, and cassava.

Farms became more productive over the study period: the nation's food production index increased from 92.7 in 2008 to 101.7 in 2018. Over the same years, the crop production index rose from 95.4 to 102.8, and the livestock production index climbed from 85.7 to 98.1.^8,9

In addition to its agricultural goods, the Philippines is endowed with many valuable natural resources, including timber, petroleum, nickel, cobalt, silver, gold, salt, and copper.

Governance

The Philippines is a constitutional republic and has a presidential system of government, in which power is divided across the executive, legislative, and judicial branches. The president and vice president are elected by popular vote and serve six-year terms. The national legislature consists of a 24-member Senate and a House of Representatives, which has 250 members.¹⁰

Since the early 1970s, the provinces of the Philippines have been grouped into regions for more streamlined administration. Today there are 17 regions, each with a presidentially appointed regional development council (Figure 6).¹¹

The constitution specifically provides for the autonomy of local governments, and the role of localities was formalized and strengthened in the Local Government Code of 1991. Local government is divided into three levels, known collectively as local government units. These include, in descending physical size, provinces, cities, and barangays (wards), as shown in Figure 7.¹⁰

Health care sector

Among the major responsibilities assigned to the local government units in the 1991 legislation was the delivery of health services. Responsibility for care and treatment is therefore highly localized in the Philippines.

However, there remain some significant national-level health programs. One of these is the Philippine Health Insurance Corporation, popularly known as PhilHealth, which was created in 1995 as a universal health coverage program. In practice, though, the financing of care is a dual-track system, with both public and private insurance options.¹²

Health facilities fall into three broad categories: government hospitals, private hospitals, and primary health care facilities. About 60% of all hospitals are privately managed. Among public hospitals, localism prevails—only 10% are run by the Department of Health, and the other 90% are operated by local government units.¹²

Before 2012, hospitals in the Philippines were classified by four numerical levels, with higher numbers denoting greater size and more comprehensive offerings; however, that year, the number of levels was reduced to three. Basic general hospitals (Level 1 facilities) and somewhat larger regional hospitals (Level 2) are well distributed across the country. However, the facilities with the highest service capabilities and broadest specialty sets (Level 3) tend to be more concentrated in certain regions, particularly around Manila and central Luzon.¹²

The profile of health facilities—and patients—varies somewhat between the public and private sectors. There are almost four times as many tertiary (Level 3) private hospitals than public ones, and patients living in urban areas and the highest wealth quintile are most likely to visit private hospitals. The most commonly visited health facilities of all are the publicly managed rural health units and barangay health centers, accounting for about a third of all patient visits.¹²

Natural disasters and climate change

The Philippines is highly prone to natural disasters of various kinds, and these hazards could threaten the progress the nation has made in confronting anemia and other public health risks—through the overburdening of health systems; damage to health facilities, roads, and other infrastructure; proliferation of disease vectors such as floodwater, mosquitos, and pathogens; and an increase in economic distress as agricultural activity and other vital sources of income are interrupted.

The country is located along the Ring of Fire, the zone within which roughly 90% of the world's earthquakes and 75% of its volcanoes occur. The Philippines is also subject to severe rainstorms, flooding, and erosion-induced landslides. These derive from two distinct natural phenomena: the monsoon and the cyclone.¹

The Philippines has a monsoon climate, with a northeastern monsoon period running between November and April, and a southwestern monsoon season between May and October. While the resulting influxes of rain are historically crucial to agriculture, they can also result in severe flooding and landslides.

The archipelago is uniquely vulnerable to tropical cyclones (sometimes also referred to as typhoons or hurricanes). Approximately 20 of these storms enter the nation's territorial waters each year, with 7 to 9 typically reaching landfall. These can be devastating, as seen in 2013 when Typhoon Haiyan killed 8,000 people.¹³

It is estimated that since 1990, the country has faced 565 natural disasters, which have collectively resulted in 70,000 deaths and US$23 billion in economic damages.¹⁴ Figure 8 illustrates the profile of hazards that the nation has encountered over the past three decades.

The Philippines' latitude and oceanic setting make it vulnerable to several conditions related to climate change, including rising sea levels, extreme heat, intensified storm activity, and disrupted monsoon patterns. Flooding is a particularly significant risk, one that is exacerbated by widespread urbanization and logging.