Abstract
Background: The Philippines is facing a dual burden of managing both infectious and non-communicable diseases (NCDs). The Universal Health Care (UHC) Act mandates a transformative shift from curative focus to health promotion and disease prevention, where lifestyle medicine plays a crucial role. Objectivess: This paper outlines the initiatives taken by the Philippines to address the exponential burden of NCDs by integrating lifestyle medicine into the healthcare system. Specifically, we focus on: 1. Discussing the history and current state of evidence-based lifestyle interventions within the UHC framework. 2. How we have developed interprofessional competency-based lifestyle medicine education (CBME) programs for healthcare providers. 3. Our experience in establishing cross-sectoral collaboration and policy support for sustainable implementation of lifestyle interventions. Methods: The Philippine College of Lifestyle Medicine initiated the CBME framework integrated into hospitals, medical schools, and universities with pilot programs. Culturally relevant, community-engaged lifestyle medicine programs were initiated, resulting in the declaration of local ordinances. Conclusion: The realization of UHC priority goals can be enhanced by embedding lifestyle interventions within the healthcare system. Pilot programs demonstrate the scalability of lifestyle medicine interventions that require policy support, extensive cross-sectoral collaboration, community engagement, and recognition of lifestyle medicine as a reimbursable healthcare service.
Keywords: Universal Health Care, lifestyle medicine education, lifestyle intervention, health promotion framework
“Establishing a strong evidence base for lifestyle interventions will ensure its efficacy and relevance, presenting strategies tailored to the unique needs of Filipinos.”
Introduction
In the Philippines, non-communicable diseases (NCDs) are on the rise. Cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases are the leading causes of mortality and morbidity in the country. These account for 68% of annual deaths. 1 Lifestyle factors—unhealthy diets, insufficient physical activity, inadequate sleep, harmful alcohol consumption and tobacco use—are linked to these non-communicable diseases. Limited access to preventive healthcare services and socioeconomic inequalities are also exacerbating factors. 2
Furthermore, the limited infrastructure for early detection and accurate diagnosis, high cost of treatment, and the fragmented healthcare service delivery pose barriers to the locale, especially those in rural and underserved areas. Infectious diseases draw medical attention, however, addressing NCDs, the top causes of morbidity and mortality are deprived of due diligence. Coordinated approaches to chronic care management is lacking and results in medical care continuity gaps. 3
Public awareness regarding healthy lifestyle and NCD prevention is minimal despite the efforts of both the government and non-government organizations due to factors such as cultural norms, misinformation and low community involvement. What is more, the speedy urbanization and economic growth in some areas, increased sedentary behavior and consumption of processed, unhealthy foods, further compound the problem.2,3 Moreover, the uneven and inconsistent implementation of existing policies, laws and measures remains a challenge, despite the adoption of such progressive policies as Sin Tax Reform Law, an act increasing the excise tax rates imposed on alcohol and tobacco products. 4 This reflects limited capacity for effective enforcement and monitoring.
The Philippine Healthcare System is traditionally skewed towards curative, rather than preventive and health promoting interventions. This has drained the effort and allocation of resources from preventive and community-based health promotion measures. 4 However, the recent legislative initiatives through the Universal Health Care Act reflects a shift in policy priorities, aligning with the global trends that emphasize prevention and health promotion. Lifestyle intervention is mandated as the cornerstone of primary health care, thus addressing the exponential NCD crisis.2,5
As the implementation of preventive and lifestyle intervention in healthcare facilities is gaining momentum, the Philippine College of Lifestyle Medicine (PCLM) initiatives are buoyed, propelled and supported by local ordinances and enacted national policies. The PCLM plays a pivotal role in the significant paradigm shift by leading education and advocacy in collaboration with private and government institutions. These initiatives have led to the integration of Lifestyle Medicine in the curricula of schools, universities, and training hospitals, with the aim of ensuring that physicians, allied health professionals and health coaches are equipped with the knowledge and skills needed to provide evidence-based lifestyle interventions.
Historical Beginnings
Globally, Lifestyle Medicine (LM) concepts gained prominence decades back. In the Philippines in approximately 1987, LM intervention was introduced in the community and churches, spearheaded by grassroots efforts. This was nationally known as NEWSTART which stands for Nutrition, Exercise, Water, Sunshine, Temperance, Air, Rest and Trust in Divine power. 6 This approach resonated among the Filipino’s cultural values of promoting holistic health and well-being. It emphasized the significance of preventive and behavioral changes to combat chronic diseases, long before LM became a recognized discipline.
In 2009, structured lifestyle medicine practice in the Philippines was introduced through the evidence-based Complete Health Improvement Program (CHIP) initiative. Scientifically validated methods of reducing risk factors associated with NCDs slowly aligned with the evolving attention to incorporate into the mainstream, interventions that are lifestyle-based. Following this early initiative is the institutionalization of CHIP at the Adventist Medical Center Manila representing a valuable milestone in lifestyle medicine. 7
Moreover, a government-funded program related to lifestyle modification was launched by the Remnant Institute Inc. in 2010, in collaboration with the Philippine Agricultural Training Institute and some local government units. The program was implemented on a nationwide scale, promoting preventive health care, targeting a diverse range of beneficiaries. The program underscored the integration of evidence-based lifestyle practices and nutrition education, providing the tools to effectively prevent and manage chronic diseases at the community level. 8
With increasing momentum, the Philippine Organization of Lifestyle Medicine was established and led by visionary faculty members of the Adventist University of the Philippines in 2015 and was reinforced by the inaugural Lifestyle Medicine Conference in 2016. 9 Sharing of knowledge and professional development was enhanced, leading physicians, allied professionals, educators and researchers to share the impact of healthcare transformation through lifestyle medicine. But even with such promising potential, the progress in introducing lifestyle medicine in the medical community has faced challenges. Lifestyle medicine was confused with alternative and complementary medicine, which triggered skepticism among medical societies and hindered the acceptance and integration of lifestyle medicine into mainstream discipline.
Progress Highlights
In 2019, however, the Philippine College of Lifestyle Medicine (PCLM) was established and legalized. It became an institution dedicated to foster lifestyle medicine professional competency development, and it established the structured pathway for training and certification. The PCLM professionalized lifestyle medicine as a medical specialty and subspecialty integrated into the Philippine healthcare system. Moreover, the PCLM, through it’s incumbent president represented Asia as member of the Lifestyle Medicine Core Competency Review Team spearheaded by the American College of Lifestyle Medicine. 10 In the same year, the Adventist University of the Philippines (AUP) College of Health introduced the Master of Public Health program majoring in lifestyle medicine. This was duly approved by the Commission on Higher Education (CHED), a marked advancement in lifestyle medicine integration into public health education. The AUP College of Medicine also incorporated the updated competencies in its undergraduate curriculum, advancing LM competencies to all year levels. This dual academic approach has an aim to produce new generation of holistic and LM-focused healthcare providers.
A landmark milestone was obtained by the PCLM in 2022, when it was officially accredited as an Affiliate Specialty Society of the Philippine Medical Association (PMA) under the division of the Philippine Academy of Family Physicians (PAFP). It concretized PCLM’s role as a credentialing body for Lifestyle Medicine Specialists in the country and placed PCLM at the helm of lifestyle medicine integration into the nation’s health care system. The PCLM has laid a groundwork in elevating lifestyle medicine service delivery through training, certification and practice standards, providing evidence-based approach within the broader medical community. This recognition advanced the alignment of lifestyle medicine with national health priorities and supported the paradigm shift to sustainable healthcare solutions.
Furthermore, the rising worldwide demand for interprofessional training in lifestyle medicine was met with the establishment of the International Federation of Lifestyle Medicine Professionals (IFLMP) in 2024. This innovative organization caters to a wide spectrum of professionals, including but not limited to allied health providers, health coaches, and educators.
Concurrently, the Philippine Lifestyle Medicine Council (PLMC) is founded as the accrediting body for all lifestyle medicine training institutions, organizations and lifestyle medicine centers in the country. This will ensure that highest lifestyle medicine standards are practiced—a safeguard to credibility and effectiveness. This will further impose standard framework for the training program development, evaluation and accreditation of lifestyle medicine centers, and regulation of lifestyle medicine practitioners in the Philippines.
These advancements highlights the Philippines as an emerging leader in lifestyle medicine movement. Its experience shows how multidisciplinary collaboration and institutional support can metamorphose health care delivery. This reflects progressive integration of lifestyle medicine into the national healthcare system—propelled by the emergent need to mitigate the NCD insurgence. It further emphasized the significance of innovation, standardization, and public health goal alignment to harness a resilient, sustainable and proactive healthcare system.
Policies and Government Suppport
The Philippine healthcare system through the Universal Health Care Act (Republic Act No 11223) is moving towards a transformative shift from a disease and curative focus to a more proactive and preventive strategies, a shift that addresses the country’s increasing NCD burden. The integration of Lifestyle intervention into the healthcare system is in consonance with the UHC priorities, key administrative policies, and frameworks. Included are the Department of Health (DOH) Administrative Order 2021-0063, Joint Administrative Order 2022-0001, and Joint Administrative Order 2023-0001. Lifestyle modification as health promotion strategy was emphasized not only in primary healthcare but also 5 in educational institutions, community, and workplaces.
Administrative Order 2021-0063
The Health Promotion Framework Strategy outlined by the Department of Health’s Administrative Order 2021-0063 is the crucial policy that established the roadmap for health prevention policies and interventions. The Administrative Order directs the integration of lifestyle intervention into national health initiatives, orienting clinical management and public health strategies to holistic disease prevention and health promotion. It promotes multidisciplinary collaboration focusing on behavioral risk factors such as poor nutrition, physical inactivity and use of harmful substances. 11
Joint Administrative Order 2022-0001
The crucial role of educational institutions in shaping health behaviors and outcomes is the emphasis of Joint Administrative Order 2022-0001. Learning institutions are encouraged to serve as important environments where lifelong habits and values can be cultivated. The policy promulgates that students should be provided with the knowledge, skills, attitudes and behaviors needed for informed health decisions. These transcend classroom boundaries and involve the community, stakeholders and health advocates. The Joint Administrative Order 2022-0001 transformed the role of educational institutions as agents of health promotion along with their academic operations. 12
Joint Administrative Order 2023-0001
The workplace as an environment for health promotion is the essence of Joint Administrative Order 2023-0001. It extends a public health initiative platform into professional settings. The Department of Health, the Department of Labor and Employment (DOLE), and the Civil Service Commission (CSC) issued this policy, exhibiting a unified governmental effort to foster healthier work environments. This creates an environment conducive to physical, mental, and social well-being, resonating with international health standards, and positions the Philippines as a leader in workplace health initiatives. 13
Competency-Based Lifestyle Medicine Education Framework
Competency-Based Lifestyle Medicine Education (CBLME) is central to ensuring the quality of training in lifestyle medicine for healthcare professionals in the Philippines. This framework emphasizes specific, observable outcomes that ensure medical professionals develop the competencies necessary for delivering evidence-based lifestyle interventions. By focusing on measurable skills and knowledge, this training framework aligns with the practical demands of lifestyle medicine practice, fostering a high standard of healthcare delivery.
Additionally, the framework of Entrustable Professional Activities (EPAs) is used and includes patient encounters with the use of validated lifestyle medicine assessment tools, performing lifestyle medicine shared medical appointments, and disease management using targeted lifestyle interventions. These activities bridge the gap between theoretical knowledge and real-world application. 14
CBLME is structured across multiple stages to provide both flexibility and depth (Table 1). The foundational stage includes self-paced modules that introduce the theoretical concepts of lifestyle medicine followed by synchronous preceptorship wherein trainees engage in interactive learning with experienced mentors. Immersion and mentorship programs further enhance this experience by placing trainees in real-world clinical settings. During these sessions they gain hands-on experience and develop practical skills, under expert supervision. Additionally, Community-Engaged Lifestyle Medicine (CELM) program is embedded in the framework which enables trainees to apply their skills in diverse environments, emphasizing the importance of public health outreach and community engagement. Finally, trainees are expected to conduct lifestyle medicine research and quality assurance assessment that foster a deeper understanding of the field and contribute to the evidence base in the country. 15
Table 1.
Competency-Based Lifestyle Medicine Education Framework.
| Category | Description |
|---|---|
| Outcomes-based training | Identifies knowledge, skills, attitudes, and behaviors necessary for effective lifestyle medicine practice |
| Delineation of competencies | Identifies core competencies in lifestyle medicine, such as patient assessment, behavioral change counseling, nutrition, physical activity, stress management, sleep, and substance use cessation |
| Stages of training | • Foundational: Basic knowledge acquisition and understanding |
| • Intermediate: Skills development and supervised practice | |
| • Advanced: Independent practice with refinement of clinical decision-making | |
| Entrustable Professional Activities (EPAs) | Includes observable tasks that trainees perform independently, such as |
| • Conducting a comprehensive lifestyle assessment | |
| • Developing and implementing an individualized lifestyle intervention plan | |
| • Conducting shared medical appointments | |
| • Leading group coaching sessions or community-based programs | |
| • Conducting digital lifestyle medicine programs and remote patient monitoring | |
| • Educating patients on evidence-based lifestyle modifications | |
| Indirect observation | Involves reviewing trainee performance through |
| • Case presentations | |
| • Reflective journaling and portfolios | |
| • Feedback from patients and peers | |
| Direct observation | Requires real-time assessment of clinical skills, such as |
| • Structured observation during patient interactions | |
| • Use of checklists during supervised practice | |
| • Objective Structured Clinical Examinations (OSCEs) |
The evaluation in this lifestyle medicine training framework is multifaceted, ensuring that trainees not only acquire theoretical knowledge but also demonstrate practical competence (Figure 1). Theoretical assessments evaluate foundational knowledge, while direct observation and feedback provide real-time insights into clinical performance. Upon completing the lifestyle medicine training and successfully passing the national specialty board examination, one can earn the Diplomate Certification that signifies proficiency as a Lifestyle Medicine Specialist.
Figure 1.
Competency-based lifestyle medicine assessment.
For those seeking further training, the 2-year Clinical Fellowship in Preventive and Lifestyle Medicine offers an opportunity to develop expertise in managing complex cases. The pilot program is implemented through a consortium of the University of the Philippines - Philippine General Hospital (UP-PGH), the largest public healthcare system in the country, and the Antique Medical Center, a private healthcare system. The fellowship training emphasizes the integration of primary, secondary, and tertiary preventive strategies using lifestyle interventions, preparing physicians to address a wide spectrum of health challenges among admitted patients referred for lifestyle medicine care with a special focus on patient-centered, family-focused, 16 community-oriented approaches. 16
Lifestyle Medicine Best Practices
While lifestyle medicine has been slowly incorporated into both the private and public healthcare systems, there is a paradigm shift in the country’s approach to disease prevention and management. It is deliberately implemented in the outpatient, inpatient care, and community settings reflecting a growing recognition of lifestyle-related disease as an important public health issue that needs innovative, evidence-based strategies to address.
Healthcare institutions nationwide have been sending their medical staff for lifestyle medicine training and certification to equip them with the knowledge and skills to deliver high-quality lifestyle medicine interventions. This can result in the establishment of lifestyle medicine departments within hospital systems. Specialists from endocrinology, oncology, cardiology, rehabilitation medicine, pediatrics, obstetrics and gynecology, psychiatry and even surgery to name a few have been referring their patients in the lifestyle medicine department for a more collaborative, comprehensive and patient-centered care that addresses the root causes of conditions rather than merely managing symptoms.
Local Ordinance Supporting Lifestyle Medicine Programs
Local ordinances provide a scalable direction in intensifying lifestyle medicine-based public health programs. This initiative presents a legal institutional framework for the sustained implementation of lifestyle interventions at the grassroots level. The PCLM members leading different local healthcare systems have played a crucial role in the advancement of these local legislative measures. This resulted in the formulation and implementation of several municipal and city ordinances, ensuring the continuous inclusion of lifestyle medicine interventions into community health governance with sustainable allocation of resources, regardless of the future changes in the local political leadership. This best practice provides a template for other local government units to adopt in support of the UHC mandates, including the Department of Interior Local Government (DILG) in the implementation of the UHC priority areas. 17
Department of Health (DOH) Lifestyle Medicine Training
The lifestyle medicine training initiative of the Department of Health (DOH) physicians in Calabarzon, the largest region in the Philippines in terms of population, is one of the significant pilot programs conducted in collaboration with the PCLM. Its aim is to equip healthcare providers with lifestyle medicine competencies, enabling effective provision of lifestyle interventions within primary care settings.
Following the successful first phase of the Calabarzon training, a similar program was simultaneously implemented in the Mimaropa, an archipelagic region with significant geographical challenges in terms of healthcare access. This further extends the delivery of lifestyle medicine services to more remote and underserved communities in the country. There are over one hundred thirty healthcare providers who completed the basic training program and about half of them are currently under advanced training to qualify for the national board examination in lifestyle medicine under the subsidy of the DOH and the scholarship grant from the PCLM. These initiatives highlight the collaborative framework between the DOH and PCLM, serving as a potential scalable model for integrating lifestyle medicine programs across various regions in the Philippines, emphasizing its crucial role in primary healthcare transformation aligned with the proactive realization of UHC objectives. 18
Armed Forces of the Philippines (AFP) and the Philippine National Police (PNP) Lifestyle Medicine Programs
A recent groundbreaking transformation was mandated by the Surgeon General, converting the Armed Forces of the Philippines Camp General Emilio Aguinaldo Station Hospital (AFP-CGEASH) into a dedicated lifestyle medicine and wellness center. This strategic paradigm shift in the AFP’s approach to healthcare delivery aims to alleviate the burden on its tertiary healthcare facilities, currently overwhelmed with NCD cases, imposing significant financial and operational challenges within the military health service. The AFP-CGEASH aims to function as a step-down care facility, providing the needed continuum of care for patients transitioning from acute medical services to lifestyle and wellness programs for the recovery phase. Part of the realization of this program is the ongoing support of the PCLM in the conduct of Community-Engaged Lifestyle Medicine (CELM) program for AFP personnel and beneficiaries. Selected medical staffs of AFP-CGEASH were also ordered to undergo lifestyle medicine training to strengthen efficient implementation of the AFP’s lifestyle program. 19
Moreover, the Philippine National Police (PNP) General Hospital has also been integrating lifestyle medicine interventions into its healthcare framework. The initiative was spearheaded by lifestyle medicine physicians within the PNP General Hospital. The PNP has implemented a regular quarterly lifestyle assessment and counseling programs tailored to the specific needs of its beneficiaries. The same initiative is proposed to be adopted at the regional level to increase lifestyle medicine service delivery amongst PNP personnel. 20
Both initiatives highlight the crucial role of lifestyle medicine in the transformative advancement of healthcare delivery in their respective communities. They also serve as pioneering proof-of-concept models for integrating lifestyle medicine interventions within institutional healthcare systems. 9
Agricultural Training Institute (ATI) Nutrition-Sensitive Agriculture Program
The development and implementation of innovative community-based lifestyle medicine training programs was established through the collaboration of the PCLM with the Remnant Institute and Agricultural Training Institute (ATI). This includes diversified farming and culinary medicine; lifestyle and wellness programs; and nutrition-sensitive agriculture (NSA), representing a forward-thinking strategy that integrates the culture of healthy eating behaviors in agriculture. This program is a food-based approach to agriculture with the aim to improve nutrition outcomes specifically among vulnerable populations by reducing the gap between the commercially available food and the food needed to maintain health. This approach emphasizes the practical training on nutrient-rich food production, advocating for the use of locally sourced ingredients for consumption. This fully subsidized program was implemented across all regions in the country, featuring best practices among different ATI centers adopting healthy practices. The targeted beneficiaries of these programs include farmers, rural improvement clubs, learning sites, extension service providers, and senior citizens reflecting the inclusive and transformative objectives that addresses the unique health needs by combining lifestyle medicine with sustainable agriculture practices. 8
Culinary Medicine Training Programs
The Asian Institute of Culinary Medicine (AICM) positioned the PCLM as the leading provider of culinary medicine programs across Asia where healthcare providers, nutritionists, food technologists, chefs, and food enthusiasts are trained to combine medical science and culinary skills to adopt and sustain healthy eating behaviors. This program focuses on practical application of nutrition science in clinical settings with the aim to bridge the knowledge-gap in understanding socio-cultural aspects of food preparation and preference, often underemphasized in dietary counseling. Culinary medicine fosters sustainable translation of nutrition prescriptions into the patient’s daily plate. The primary goal is for patients to develop a positive relationship with healthy food and create new neurological pathways to overcome unhealthy eating behaviors. This program emphasizes the importance of a positive approach to nutrition counseling, rather than the traditional restrictive advice that more often results in poor initiation and adherence to dietary lifestyle change. 21
Digital Lifestyle Medicine
Lifestyle Medicine Solutions (LMS), a provider of digital lifestyle medicine interface in Asia, has positioned PCLM as a pioneer in promoting digital and remote lifestyle medicine services. Lifestyle medicine trainees and practitioners are provided with validated lifestyle medicine assessment tools and structured program ensuring delivery of quality care. The integration of technology into lifestyle medicine practice enhances the capacity of healthcare providers to deliver patient-centered care in diverse settings, filling in the logistic gaps in lifestyle medicine service delivery. 22
The digital platform has transformed how lifestyle medicine is practiced and taught, as telemedicine and digital health tools has enabled practitioners to monitor their patients progress “real-time,” while facilitating interactive education sessions and providing personalized interventions. With the hands-on training experience in delivering lifestyle interventions in the digital platform, the next generation of lifestyle medicine providers will be fully equipped with the skills to address challenges of modern healthcare delivery. 23
Emerging Priorities
The integration of lifestyle medicine into the Philippine healthcare system represents a transformative opportunity to address the gap in the provision of lifestyle medicine as the initial and maintenance intervention for non-communicable diseases in the country. To achieve this, there are three critical areas of future focus: expansion of training collaboration initiatives, establishment of reimbursement mechanisms, and advancement of research and innovation.
Expansion of Training Initiatives
As the significance of lifestyle medicine is gaining its momentum, it is imperative to reinforce the integration of lifestyle medicine pillars in the medical education and allied health curricula. These will equip future health care professionals with the knowledge and skills necessary to incorporate lifestyle medicine as part of the standard practice of care in their respective professions and health care delivery system, offering a scalable solution for the country’s grappling challenges of chronic disease burden.
The expansion of training initiatives amongst physicians, allied health professionals, and health coaches in the Philippines will create a more robust generation of providers equipped to realize the UHC priority areas through enhanced preventive health care services. Such initiative is critical in filling the gap of healthcare service delivery between the rural and the urban setting, thus promoting health equity.
Reimbursement
For lifestyle medicine intervention to be sustainable, a reimbursement system should be in place. This system will encourage healthcare professionals to incorporate them into patient care. Reimbursement systems will improve service delivery in primary health care systems that provide lifestyle-focused interventions, such as shared medical appointments, nutrition counseling, enhanced physical activity programs, stress management techniques, and smoking cessation. This will enhance preventive services accessibility to every Filipino regardless of socioeconomic status, promoting equitable health care resources to everyone. 24
Lifestyle Medicine Research
Locally conducted research is crucial in advancing lifestyle medicine practice in the Philippines. Establishing a strong evidence base for lifestyle interventions will ensure its efficacy and relevance, presenting strategies tailored to the unique needs of Filipinos. This will provide culturally appropriate interventions that will support lifestyle medicine healthcare practices, education, policymaking, and reimbursement mechanisms.
Recommendations
The success of lifestyle medicine in the Philippines hinges on strengthened collaborations across all health sectors, continuous lifestyle medicine training innovation, effective policy development, and robust local research initiatives. National integration of lifestyle medicine principles in medical and allied health curricula has proven vital in equipping healthcare providers with knowledge and skills necessary in maintaining preventive care and lifestyle interventions as the backbone of primary healthcare system. To further escalate and sustain lifestyle medicine initiatives, it is imperative to establish policy frameworks that will support lifestyle intervention as a reimbursable healthcare service that will incentivize healthcare providers and ensure accessibility of lifestyle medicine services for Filipinos.
Conclusion
The Philippine College of Lifestyle Medicine’s multidimensional initiative of embedding lifestyle medicine in health promotion and educational framework strategies showed a scalable model in realizing the Universal Health Care goals. By prioritizing resources targeting health promotion and lifestyle medicine intervention reimbursement, Philippines will be well-equipped to address the exponential burden of chronic diseases, improve health outcomes, and reduce healthcare costs.
Footnotes
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
ORCID iDs
Mechelle Acero Palma https://orcid.org/0000-0002-0447-2692
Bysshe Fernan https://orcid.org/0009-0006-9953-6738
Vigilanda Solijon https://orcid.org/0009-0000-0167-6385
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