Geography and Demographics
The present report discusses health determinants and healthcare policy in Thailand, a country located in Southeast Asia. Myanmar and Laos border Thailand from the North, and Laos and Cambodia – from the east. Thailand is bordered to the South by Malaysia and to the West by the southern extremity of Myanmar. The Gulf of Thailand is located to the south and the Andaman Sea to the west. The Board of Investment of Thailand (2020) estimates the current population of the country at 66.56 million. The total population of females outpasses that of males: 35,282,367 (50.9%) vs. 34,081,357 (49.1%) respectively. The most populous age group is individuals aged 25-54 (31 million, or 45.56%). The second most populous are children under 14 years old (11.3 million, or 16.45%), followed by adolescents (ages 15-24, 13.02%), mature (ages 55-64, 13.01%), and senior citizens (65+, 11.82%).
Ethnically, Thailand is a homogenous country with 97.5% of the population being Thai, 3.7% – Burmese, and 1.1% – other. The overwhelming majority (94.6%) of Thai residents practice Buddhism, while Islam (4.3%) and Christianity (1%) are minor religions. In less than a generation, Thailand has made a transition from a lower-income to an upper-middle-income country with the current GDP per capita at $19,476 (The Board of Investment of Thailand, 2020). The average monthly salary is 20,854 baht ($688) (The Board of Investment of Thailand, 2020). However, Thailand is still struggling with making education accessible to wider populations. As of 2016, the cumulative educational attainment of completing at least primary school was 65.74% (Index Mundi, 2016). Around 31.9% of the population completed upper-secondary education, and 14% obtained a Bachelor’s degree.
Vulnerable Populations
Thai Health Promotion Foundation (ThaiHealth) (n.d.), an autonomous government agency, singles out several groups of people who are vulnerable in terms of their access to medical care. Disabled people, who make up around 3% of Thailand’s population, or two million. 65% of people with disabilities are unemployed, and the majority of them live in rural areas where they cannot easily access healthcare services (ThaiHealth, n.d.). Women of Thailand still suffer from gender gaps in many aspects of their lives, and healthcare is not an exception. Thummapol et al. (2018) find that the provision of medical services is not equally distributed, and structural and socioeconomic barriers are often listed as reasons for delayed care or complete avoidance. According to Thummapol et al. (2018), the indigenous populations of rural Thailand are especially vulnerable in this regard. Not only do these demographics experience difficulties finding a healthcare practice in their region, but they also suffer from discrimination and negative attitudes of healthcare providers. Conversely, able-bodied, ethnic-majority people living in urban areas enjoy better healthcare indicators.
Health Goals and Healthcare Priorities
The Health Information System Development Office (HISO) (2017) states that Thailand’s health goals are largely shaped by the United Nations’ sustainable development goals (SDG). The interpretation of SDG 3, “Ensure healthy lives and promote well-being for all at all ages,” is tailored to meet Thailand’s unique needs. For example, in line with this SDG, the country seeks to put an end to the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases by 2030 (HISO, 2017). Prevention and treatment of alcohol and drug abuse are also important points in developing the long-term healthcare strategy of Thailand.
The workforce and infrastructure are also some of the highlights of the plan. The country experiences not only workforce shortages but also an unequal distribution of cadres with rural areas being practically deprived of any quality medical help. It is the spread of non-communicable diseases that the new infrastructure, and especially, vaccine dissipation will address in the next ten years (HISO, 2017). Thailand’s health goals and priorities are in line with the World Health Organization’s (WHO) (2019) recommendations and progress indicators for the South-East Asia Region, in which Thailand has the top-ranking healthcare system. The WHO (2019) lists reproductive health, non-communicable disease prevention, and universal coverage as the primary goals of healthcare policies for Thailand, Myanmar, Laos, Vietnam, and other countries in the region.
The plan stresses women’s health, maternal health, and the well-being of newborns. As of now, women and children still remain a vulnerable health demographic with some of their issues overlapping and requiring complex solutions. The Nation Thailand (2020) reports although almost all secondary schools have adopted the Comprehensive Sexuality Education (CSE) program, its contents do not serve students’ needs in an adequate manner. In particular, topics such as sexual rights, gender equality, and diversity are poorly covered and do not provide students with critical skills for navigating sexual and romantic relationships. For instance, 41% of male vocational school students think that it is acceptable to beat their wives if they are unfaithful. The adolescent pregnancy rate also reflects the faults of the current sexual education program. Accompanied by widespread unsafe domestic abortion practices, it puts women in a disadvantaged position. When it comes to maternity, Thailand’s government is dissatisfied with the maternal mortality rate (37 per 100,000) and neonatal deaths (5.3 per 1,000) (The Nation Thailand, 2020). The measures that are supposed to help the situation are extending universal healthcare coverage and making education and family planning resources more acceptable.
Healthcare Organization and Human Rights
As of 2019, Thailand’s healthcare system ranked sixth globally and first in Southeast Asia. The 2007 and subsequent versions of the Constitutions of Thailand guarantee citizens’ rights to: (1) receive public healthcare services; (2) survival and physical, mental and intellectual development (especially, in relation to children and youth); (3) public welfare and public utilities use; (4) impact the government’s decisions’ regarding health-related policies; and (5) impact and participate in the activities that preserve the environment and, hence, improve public health (The World Health Organization, 2015). The healthcare system is primarily overseen by the Ministry of Public Health (MOPH), the national health authority responsible for developing and introducing health policies. However, MOPH does not have a monopoly on public health legislation as today, it is integrated into an interdependent network of state agencies such as the Health Systems Research Institute (1992), the Thai Health Promotion Foundation (2001), the National Health Security Office (NHSO) (2002), and the National Health Commission Office (NHCO) (2007) (The World Health Organization, 2015). Non-state actors and civil society groups also play a role in shaping the public health strategy and extending and ensuring Thai residents’ human rights.
The country’s health care is an entrepreneurial market-driven system and a mix of public and private providers. However, the majority of hospitals remain publicly funded: according to the World Health Organization (2015a), 927 hospitals are public and 363 are private. When it comes to clinics and health centers, the situation is reversed. The government runs only 9,768 facilities while the remaining 25,615 are privately owned (The World Health Organization, 2015a). Back in the early 2000s, Thailand was one of very few lower-middle-income countries that could offer their citizens universal healthcare coverage. Today, universal health care comprises three key programs: the civil service welfare system, Social Security (private employees), and the universal coverage scheme for all Thai nationals. As a result of comprehensive healthcare reforms, 99% of the population are insured in one way or another.
Health Indicators, Causes of Death, and Burden of Disease
Table 1. Comparison of Thailand’s key health indicators and other Southeast Asian countries.
As seen in Table 1, Thailand has the best life expectancy out of the three neighboring Southeast Asian countries. Its neonatal mortality rate is almost four times lower than in Laos and Myanmar. In addition, Thailand spends the biggest share of its GDP on health when compared to its neighbors. However, the physician density is almost the same across the board, exposing the overall shortages. The leading causes for males in Thailand are stroke (9.4%), road accidents(8.1%), HIV/AIDS (7.9%), ischemic heart diseases (6.4%), and chronic obstructive lung diseases (5.7%). The leading causes for females are somewhat different: this demographic is more likely to die from stroke (11.3%); diabetes (8%), ischemic heart disease (7.5%), and renal diseases (5.4%) (Rao et al., 2010). As for the prevalence of infectious and non-infectious diseases, the figures are as follows:
- Cancer (125 per 100,000 people);
- Diabetes (9.6%);
- HIV/ AIDS (1.1%);
- Hepatitis (6.4%) (The Institute for Health Metrics and Evaluation, 2020).
Environmental Factors
The climate of Thailand is tropical with three distinct seasons: the hot season (March to mid-May), the rainy season (mid-May to October), and the dry and cool season (November to February). The biggest threat to public health stems not from the climate itself but from climate change. The World Health Organization (2015b) predicts that if left uncontrolled, global heating will exacerbate some of the existing weather extremities. In the high-emission scenario in which the world does not address the greenhouse effect, Thailand is likely to experience weather events, such as heatwaves, droughts, and heavy rainfall.
The WHO (2015b) estimates that as many as 2.5 million can be directly at risk of floods. However, the impact is more profound than deaths, physical injuries, and property drowning. Extreme weather events impact food production and access to drinking water. They have the potential of disrupting entire ecosystems and facilitating the spread of infectious diseases. From July 2011 to January 2012, Thailand had seen the worst flooding in the past five decades. The natural disaster affected the lives of 13.6 million Thai nationals in 65 provinces, but especially in the northern and central parts of Thailand (Promchote et al., 2016). The death toll of the 2011-2012 floods was 815, and the economic damages were estimated at US$45.7 billion.
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