International Trade and Health in Thailand: A Scoping Review.

International trade has become more complicated and is now related to more aspects of health and the health system. As Thailand is active in international trade and health, understanding what knowledge exists and determining the knowledge gap is essential for generating the necessary evidence in order to promote better understanding and allow evidence-based policy decisions to be made. This study reviewed the existence of knowledge on international trade and health issues in a scoping review, focusing on Thailand during the period 1991-2020. In total, 156 studies from seven databases and manual searching were included. Of these, 46% were related to trade in health services and 39% were linked to intellectual property, particularly access to medicines. This review found only a very small amount of research on other issues and did not identify any study on trade policies or products related to health and international trade and the environment. We therefore recommend that further studies should be carried out to provide more critical evidence-in particular, more research focusing on the impacts of trade on health-related goods and the analysis of the positive and negative impacts of international trade on industry is needed. Furthermore, better knowledge management through the publication of research findings and making them searchable on international databases will increase the visibility of international trade, increase our knowledge of health issues, and provide supporting evidence.

Nudge interventions to reduce fish sauce consumption in Thailand.

High sodium consumption is one of the four major risk factors contributing to non-communicable diseases around the world. Thailand has one of the highest rates of sodium consumption, with fish sauce being one of the main sources. The aim of this study was to examine whether changes in the micro-environment factors can affect fish sauce consumption behavior in a university setting in Thailand. We implemented four interventions (with one control) in five canteens across a Thai university. The study design was a Latin square, where the five canteens were randomized over five weeks to implement four interventions plus a control. Our interventions included behavior-oriented, cognitive-oriented, and affective-oriented nudges aimed to reduce the amount of fish sauce people add to their noodles during lunchtime at the university canteens. Results indicate that a simple change in how fish sauce was served can reduce fish sauce consumption. Serving fish sauce in a bowl with a spoon reduced the amount of fish sauce used per noodle bowl by 0.25 grams, compared to the normal condition where fish sauce is served in a bottle. Using a specially-designed spoon with a hole induced a larger reduction of 0.58 grams of fish sauce used per bowl. The other two interventions, cognitive- and affective- oriented nudges, also showed reductions of fish sauce usage, but the differences were not statistically significant. The findings can be used for policy implementation to advocate the use of a smaller sized spoon and a bowl to serve fish sauce instead of a bottle to reduce sodium consumption among Thai people.

Social violence among Thai gender role conforming and non-conforming secondary school students: Types, prevalence and correlates.

BACKGROUND: Gender role non-conforming behaviors are a significant risk factor for school-related violence. The objective of this study is to describe the types, prevalence and correlates of social violence among Thai secondary school students, with a focus on gender role non-conformity. METHODS: This article uses secondary data from a national study of 2070 secondary school students aged 13-20 years representing Bangkok and all four regions of Thailand. Students were asked about their gender/sexual identity, self-perception of their masculinity or femininity, and experiences of social violence. Correlates of social violence were examined using multivariable logistic regression models. RESULTS: Prevalence of social violence victimization was high (57%). Most students considered themselves to be as masculine or as feminine as other members of their sex (82.6%), while 9.1% thought that they were less masculine/less feminine, and 8.3% thought they were more masculine/more feminine. Students who considered themselves less masculine or less feminine than others of their sex (AOR = 1.59, 95% CI: 1.13, 2.25) were more likely to experience social violence, compared to students who considered themselves equally masculine/feminine. Students who self-identified as lesbian, gay, bisexual or transgender (LGBT) (AOR = 1.37, 95% CI: 1.01, 1.86) were also more likely to experience social violence, compared to students who did not identify as LGBT. However, students who considered themselves more masculine or feminine than other students of their sex (AOR = 0.62, 95% CI: 0.44, 0.88) were less likely to experience social violence. DISCUSSION: Students who identified as LGBT, or considered themselves to be less masculine or less feminine than other students of their sex, had higher odds of social violence victimization. Anti-bullying campaigns need to emphasize that perpetrating social violence is not tolerated, and gender-based violence needs to be included in comprehensive sexuality education curricula.

Legislating for public accountability in universal health coverage, Thailand.

Sustaining universal health coverage requires robust active public participation in policy formation and governance. Thailand's universal coverage scheme was implemented nationwide in 2002, allowing Thailand to achieve full population coverage through three public health insurance schemes and to demonstrate improved health outcomes. Although Thailand's position on the World Bank worldwide governance indicators has deteriorated since 1996, provisions for voice and accountability were embedded in the legislation and design of the universal coverage scheme. We discuss how legislation related to citizens' rights and government accountability has been implemented. Thailand's constitution allowed citizens to submit a draft bill in which provisions on voice and accountability were successfully embedded in the legislative texts and adopted into law. The legislation mandates registration of beneficiaries, a 24/7 helpline, annual public hearings and no-fault financial assistance for patients who have experienced adverse events. Ensuring the right to health services, and that citizens' voices are heard and action taken, requires the institutional capacity to implement legislation. For example, Thailand needed the capacity to register 47 million people and match them with the health-care provider network in the district where they live, and to re-register members who move out of their districts. Annual public hearings need to be inclusive of citizens, health-care providers, civil society organizations and stakeholders such as local governments and patient groups. Subsequent policy and management responses are important for building trust in the process and citizens' ownership of the scheme. Annual public reporting of outcomes and performance of the scheme fosters transparency and increases citizens' trust.

Maintenir la couverture sanitaire universelle exige une forte participation publique à l'élaboration des politiques et à la gouvernance. En Thaïlande, le régime de couverture universelle a été mis en œuvre dans tout le pays en 2002, permettant de couvrir l'ensemble de la population grâce à trois régimes publics d'assurance maladie et d'améliorer les résultats de santé. Bien que la position de la Thaïlande concernant les Indicateurs de gouvernance mondiaux de la Banque mondiale se soit détériorée depuis 1996, des dispositions en matière d'expression et de reddition de comptes ont été intégrées à la législation et à la structure du régime de couverture universelle. Nous discutons ici de la mise en œuvre de la législation relative aux droits des citoyens et à la reddition de comptes du gouvernement. En vertu de la constitution de la Thaïlande, les citoyens ont pu soumettre un projet de loi dont les dispositions en matière d'expression et de reddition de comptes ont été intégrées aux textes législatifs et transposées dans la loi. La législation rend obligatoire l'enregistrement des bénéficiaires, une assistance téléphonique 24h/24 et 7 j/7, des auditions publiques annuelles et une aide financière systématique pour les patients qui ont été victimes d'événements indésirables. Pour garantir le droit à des services de santé, permettre aux citoyens de faire entendre leur voix et s'assurer que des mesures soient prises, les institutions doivent être en mesure d'appliquer la législation. Par exemple, la Thaïlande devait pouvoir enregistrer 47 millions de personnes et les rattacher au réseau de prestataires de soins du district où elles vivaient, et réenregistrer les personnes qui changeaient de district. Les auditions publiques annuelles doivent faire participer les citoyens, les prestataires de soins, les organisations de la société civile et les parties prenantes telles que les collectivités locales et les groupes de patients. Les réponses qui en découlent au point de vue des politiques et de la gestion sont importantes pour instaurer la confiance dans le processus et permettre aux citoyens de se l'approprier. Les rapports annuels publics sur les résultats du régime de couverture permettent d'accroître la transparence et de renforcer la confiance des citoyens.

Para mantener la cobertura sanitaria universal se requiere una sólida participación activa del público en la formulación de políticas y la gobernanza. El plan de cobertura universal de Tailandia se implementó en todo el país en 2002, lo que permitió a Tailandia lograr una cobertura completa de la población a través de tres planes de seguro médico público y demostrar mejores resultados en materia de salud. Aunque la posición de Tailandia respecto de los Indicadores mundiales de gobernanza del Banco Mundial ha disminuido desde 1996, las disposiciones relativas a la voz y la rendición de cuentas estaban incorporadas en la legislación y en el diseño del plan de cobertura universal. Se discute cómo se ha implementado la legislación relacionada con los derechos de los ciudadanos y la rendición de cuentas del gobierno. La Constitución de Tailandia permitía a los ciudadanos presentar un proyecto de ley en el que las disposiciones sobre la voz y la rendición de cuentas se incorporaban con éxito en los textos legislativos y se aprobaban como ley. La legislación exige el registro de los beneficiarios, una línea telefónica de ayuda 24 horas al día los 7 días de la semana, audiencias públicas anuales y asistencia financiera gratuita para los pacientes que han sufrido eventos adversos. Para garantizar el derecho a los servicios de salud y que se escuche la voz de los ciudadanos y se adopten medidas, es necesario contar con la capacidad institucional para aplicar la legislación. Por ejemplo, Tailandia necesitaba la capacidad de inscribir a 47 millones de personas y ponerlas en contacto con la red de proveedores de servicios de salud del distrito en el que viven, y de volver a inscribir a los miembros que se trasladan fuera de sus distritos. Las audiencias públicas anuales deben incluir a los ciudadanos, los proveedores de servicios de salud, las organizaciones de la sociedad civil y las partes interesadas, como los gobiernos locales y los grupos de pacientes. Las respuestas políticas y de gestión subsiguientes son importantes para generar confianza en el proceso y en la apropiación del plan por parte de los ciudadanos. El informe público anual sobre los resultados y el rendimiento del plan fomenta la transparencia y aumenta la confianza de los ciudadanos.

Multisectoral governance for health: challenges in implementing a total ban on chrysotile asbestos in Thailand.

INTRODUCTION: Interest in multisectoral governance for health has grown in recent years in response to the limitations of government-centric policy formulation and implementation. This study describes multisectoral governance associated with policy formulation and implementation of a total ban on chrysotile asbestos in Thailand. METHODS: Qualitative methods were applied, including analysis of related literature and media, and in-depth interviews with key informants. Consent was obtained for interview and tape recording; protection of confidentiality was fully assured. RESULTS: An agenda on total ban of chrysotile asbestos was proposed to the National Health Assembly, where a resolution was adopted in 2010. The resolution was endorsed by the Cabinet in 2011, which mandated the Ministry of Industry to implement the ban immediately. There was uneven interest and ownership by stakeholders in the policy formulation process. Long delays in implementation have been observed. Furthermore, while the policy is likely to affect relatively few industries there has been misinformation on the safe use of chrysotile, and delaying tactics and pressure from major chrysotile-exporting countries. CONCLUSION: The National Health Assembly is a useful platform for policy formulation on complex policy issues requiring multisectoral action. However, policy implementation is challenging due to lack of clear policy across sectors. Success in protecting people's health requires participatory policy-making and effective governance of multisectoral action throughout implementation. The Assembly is not designed to enforce implementation, especially when power and authority lie with state actors, but monitoring and public reporting would be powerful tools to drive this agenda.

Governing multisectoral action for health in low- and middle-income countries.

Kumanan Rasanathan and colleagues argue that the potential of multisectoral collaboration for improving health remains untapped in many low- and middle-income countries.

Human resources for health in southeast Asia: shortages, distributional challenges, and international trade in health services.

In this paper, we address the issues of shortage and maldistribution of health personnel in southeast Asia in the context of the international trade in health services. Although there is no shortage of health workers in the region overall, when analysed separately, five low-income countries have some deficit. All countries in southeast Asia face problems of maldistribution of health workers, and rural areas are often understaffed. Despite a high capacity for medical and nursing training in both public and private facilities, there is weak coordination between production of health workers and capacity for employment. Regional experiences and policy responses to address these challenges can be used to inform future policy in the region and elsewhere. A distinctive feature of southeast Asia is its engagement in international trade in health services. Singapore and Malaysia import health workers to meet domestic demand and to provide services to international patients. Thailand attracts many foreign patients for health services. This situation has resulted in the so-called brain drain of highly specialised staff from public medical schools to the private hospitals. The Philippines and Indonesia are the main exporters of doctors and nurses in the region. Agreements about mutual recognition of professional qualifications for three groups of health workers under the Association of Southeast Asian Nations Framework Agreement on Services could result in increased movement within the region in the future. To ensure that vital human resources for health are available to meet the needs of the populations that they serve, migration management and retention strategies need to be integrated into ongoing efforts to strengthen health systems in southeast Asia. There is also a need for improved dialogue between the health and trade sectors on how to balance economic opportunities associated with trade in health services with domestic health needs and equity issues.

From data to policy: good practices and cautionary tales.

Sound statistics are a key component of evidence. However, many institutional, political, and practical barriers impede effective use of data to inform policy. In the fourth paper in this Series on health statistics, we look at the relation between health statistics and policymaking at country and global levels. We propose a fourfold framework to help the transition from data to policy. Good practices include: (1) reconciling statistics from different sources; (2) fostering communication and transparency, including reaching out to the media for dissemination; (3) promoting country ownership of data and statistical analyses; and (4) addressing conflicts of interest, including those arising when workers responsible for attainment of health goals are also charged with measurement and monitoring of progress. Further investments are needed not only in primary data collection across a full range of sources but also in building capacity in countries to analyse, interpret, and present statistics effectively in ways that are meaningful and useful for policymaking.

The way forward: experiences of health promotion development in Thailand.

A landmark in health promotion in Thailand came in 2001 with the launching of the Universal Health Coverage Scheme at the cost of approximately USD 2 billion a year. Another important event was the establishment of the Thai Health Promotion Foundation (ThaiHealth) as a health promotion funding mechanism that draws upon a 2 percent surcharge levied on alcohol and tobacco excise tax, approximately USD 50-60 million a year. The most significant institutional development is the promulgation of the National Health Act in 2007. The Act embraces the principle of human rights and key principles of the Ottawa Charter in 2005. It is a result of five years of extensive public dialogues on important health issues that enhanced public awareness and nation wide networking on health promotion. ThaiHealth regards itself as a catalyst for health promotion. The organisation collaborates with all sectors of the society, from the national to the grassroots level, and is the most notable organisation for health promotion in Thailand. ThaiHealth funds programs on health risks/issues such as alcohol, tobacco, accidents, exercise, as well as area or setting based programs, for example, school, work place, community, and programs that target specific population groups such as the youth, the elderly, Muslim community. The open grants program invites proposals from all kinds of organizations/groups interested in launching health promotion initiatives. The endeavour has started to bear fruit. Smoking and alcohol consumption rates have dropped and more people have become health conscious and do more exercise. However, much remains to be done as some population groups especially the youth have become susceptible to various kinds of health risks. This remarkable start must be sustained and reinforced by the continuation and expansion of knowledge generation and dissemination, relentless policy advocacy and creative public campaign, with a strong health promotion network as the most critical success factor.