Second National Communications outbreaks every three to five years remains a threat to public health. Efforts to eliminate Filariasis are hindered by the limited resources for the annual mass treatment in endemic areas.10 Malaria continues to be endemic in over 57 provinces in the country, affecting the poorer communities in far-flung barangays. Over 46 000 confirmed cases were recorded in 2005, with over 140 deaths. With significant improvements in diagnosis and treatment, and in personnel protection at the community level, the incidence of the disease is expected to be reduced in the coming years. It is an epidemic-prone disease in several provinces, especially in provincial border regions. Dengue continued to emerge as major outbreak in several cities of Luzon in 2006. Over 28, 000 cases were recorded in sentinel hospitals, but the real burden was estimated to be over 100 000 cases. Metro Manila and the Cordillera Autonomous Region recorded a 30% increase in cases, although mortality was reduced to 0.75%. Dengue is now spreading to semi-urban pockets of Mindanao. Over 23 million people in 39 provinces are living in filariasis-endemic areas and have been targeted for a five-year elimination campaign through annual mass drug administration (MDA). The Department of Health has increased its support to this initiative significantly and at present the MDA is being implemented in 34 provinces. Filariasis patients with permanent and long-term disabilities are also being targeted for community-based interventions. Cholera showed a marked increase in 2005 and was common in the two Regions of Mindanao and the Ilocos Region in Luzon where the cholera outbreak of 2004 occurred. Leptospirosis continues to be constantly reported, the highest incidence being in agricultural areas of the country and in Metro Manila, where flooding is frequent.11 We know that climate change is a public health problem and should be budgeted accordingly. Public health spending while it has been given priority still lacks the appropriations needed to fully respond to these diseases. While WHO recommends around 5% of GDP, we have spent around 1.49% of GDP for public health (private - 1.4% + public - 1.49% total =2.88%) in 1990, 12 and (Php 136 billion) 2.9% of GDP in 2003.13 As the NOH recognize these diseases, it treats them from the perspective of an infectious nature. Programs and budgets are designed to respond to them in this way. It has not yet considered in greater part the potential effects of climate change as a factor that will mediate the quality and quantity of the disease, its effect on the lifecycle of the carrying vectors as it interacts with the host population. Given this, climate change and health vulnerabilities will have to be adjusted as perspectives for the latter have to be considered. The readiness of the health personnel for service delivery will have a great difference. They as well as the affected population will have to understand that there are going to be added pathways which may alter how diseases will be expressed. 10 National Objectives for Health 2005-2010, Reducing Burden of Disease, Chapter 4, p.132. Available from http://www2.doh.gov.ph/noh2007/NOHWeb32/NOHperSubj/Chap4/PreventionCCD.pdf 11 http://www.wpro.who.int/countries/2007/phl/health_situation.htm 12 Atlas country page Philippines. Health. Available from http://ucatlas.ucsc.edu/country/165/health# 13 Philippine National health accounts 2003. 8