HEALTH AND HEALTH CARE IN THAILAND

HEALTH AND HEALTH CARE IN THAILAND

Life expectancy at birth: total population: 73.83 years; country comparison to the world: 114; male: 71.45 years; female: 76.33 years. According to some reports, in the future the lifespan of Thais could be 15 year shorter than it otherwise might be because of lack of exercises, AIDS, drug addiction and pollution. "Life expectancy" is an abstract and complicated concept a complex formula that attempts to predict the lifespan of children born today by subjecting a hypothetical child born today to the current risk of dying in each bracket he or she mature through until, in effect, the accumulated risk of death is 100 percent. [Source: CIA World Factbook, Library of Congress]

Infant mortality rate: total: 15.9 deaths/1,000 live births; country comparison to the world: 107; male: 16.88 deaths/1,000 live births; female: 14.86 deaths/1,000 live births (2012 est.). The percent of birth attended by a trained health care professional: 85 (compared to 11 percent in Nepal and 97 percent in Sri Lanka). Children under the age of 5 years underweight: 7 percent (2006); country comparison to the world: 73.

Some 85 percent of the population had access to potable water in 2002, and 99 percent had access to sanitation. Despite progress in lengthening life expectancy, combating disease, and building public health facilities, Thailand in the late 1980s faced a bleak public health situation. One of the most critical national health problems was the water supply. In the mid-1970s, little more than 20 percent of the population, most of that portion being urban dwellers, was reported to have access to safe water. Even in Bangkok, where the proportion with such access was highest, only about 60 percent of the population had access to potable public water. In the countryside, inhabitants depended on shallow wells, roof drainage, rivers, and canals. [Source: Library of Congress]

According to the Thai government: It is important for a country to look after the health of its citizens. In Thailand, increased efforts have been made in order to ensure 1) a long life and low maternal mortality, 2) protection from HIV/AIDS, and 3) education about birth control.

History of Health Care in Thailand

The first hospitals in what is today Thailand date back to the Khmer Empire, which reigned over the northeastern region; in 1182-1186, King Jayavarman VII ordered the opening of 102 hospitals, or arokaya sala. The oldest pharmacological artifacts, a stone metate and roller for producing medicine from the Dvaravati period, have been uncovered in Sukhothai, the Thai capital before Ayutthaya. From the same kingdom comes the famous King Ramkham haeng Inscription, the first evidence of a Thai alphabet, upon which it is written how the king ordered the planting of a royal medicinal garden.

The capital of the Thai Kingdom, or Siam, later became Ayutthaya, which endured from the 14th to 18th centuries. Sometimes described as a Thai renaissance when King Narai the Great ruled, this enlightened monarch had a royal dispensary and drug stores opened. Royal Thai physicians also produced the first Thai pharmacopoeia, Tamra Phra Osot Phra Narai, with over 700 drug recipes. Meanwhile, Western, or international, medicine was being introduced, first by visiting Portuguese. Later, French missionaries established Ayutthaya Hospital. International medicine continued to have an influence, until King Phet Racha banned all Westerners from the Kingdom.

During the disastrous sacking of Ayutthaya by the Burmese in 1767, the royal library was destroyed, including all but two of its medical treatises, the Phramacopoeia of King Narai and Scriptures of Diseases. After King Rama I established a new Thai capital at Ratanakosin, or Bangkok, he ordered the renovation of Wat Phra Chetuphon, better known as Wat Pho, which is one of the oldest and largest Buddhist temples in Thailand, The walls were inscribed with royal drug remedies. He also established a royal dispensary, much like the one in Ayutthaya.

King Rama II continued this restoration and later issued a Royal decree for the establishment of drug dispensaries around the city and country. During the reign of Rama III, an American doctor, Dan Bradley, arrived in Thailand with smallpox vaccinations, and once more international medicine found favor in the Kingdom. King Mongkut, or Rama IV, continued to promote Western thinking, and his son, King Chulalongkorn the Great, or Rama V, established Siriraj Hospital, offering both Western and Thai treatments. Included in this facility was a school for surgeons and general practitioners, the latter studying in a three to four year course in traditional medicine. In 1895, the first medical textbook, Paetsat, which included both Western and Thai theories and practices, was published. All this led to the establishment of a Department of Health, which opened Thai and Western drugstores, Osot Sala. A government pharmaceutical factory, Osot Sala, was then started to supply these chains.

Health in Thailand in the 1980s

By Asian standards, the level of public health in Thailand was relatively good. In 1986 the life expectancy for men was 61 years; for women it was 65 years. In 1960 for both sexes life expectancy had been only 51 years. In 1984 deaths among children under age 4 averaged 4 per 1,000, while infant mortality for the same year was 47.7 per 1,000. The crude death rate for the population as a whole declined fairly consistently between 1920 and 1984, from 31.3 to 7.7 per 1,000. Much of the decline was a reflection of the successful struggle against malaria, which once had been the single greatest cause of illness and death. The expansion of the public health system in general, however, was also an undeniable factor in the improved health picture. [Source: Library of Congress]

The development of an international consumer economy brought new challenges and Western diseases, particularly for urban dwellers. Prostitution and narcotics use, which had been part of Thai culture for centuries, took on new dimensions as health hazards. With the worldwide spread of acquired immune deficiency syndrome (AIDS) and new strains of venereal diseases, Thailand became concerned about the welfare of its female citizens and the effects on tourism. By mid-1987 eleven people in Thailand were reported to have AIDS and about another eighty to be AIDS carriers. The government had begun to take such action as testing homosexuals and drug addicts for AIDS, testing donated blood supplies, sponsoring public information campaigns, and funding the development of an inexpensive AIDS testing kit by Mahidol University.

Men and Women’s Health in Thailand

A woman is 16 times more likely to die in childbirth in Thailand than in the United States. Maternal mortality rate: 48 deaths/100,000 live births (2010); country comparison to the world: 110. The lifetime risk of a mother’s death related to childbirth: 1 in 180 (compared to 1 in 10 in Nepal and 1 in 230 in Sri Lanka).

Liza Romanow wrote in the Global Majority E-Journal: “Consistent with global experiences, Thai women live on average longer than men. In 1980, Thai women lived about six years longer than Thai men. By 2009, the live expectancy for Thai women as well as men increased by about 3 years (from 69 years in 1980 to about 72 years in 2009 for Thai women; and from 63 years in 1980 to about 66 years in 2009 for Thai men). Hence, like in 1980, women lived about three years longer than men in 2009. However, the changes in life expectancy during the last 30 years have been different between Thai women and Thai men. Thai men experienced more volatility in changes of their life expectancy during the last 30 years than Thai women. [Source: Liza Romanow, Global Majority E-Journal, Vol. 3, No. 1 (June 2012), pp. 44-60. adb.org ]

Furthermore, the average changes in Thailand’s life expectancy over the last 30 years are very different to the average changes in life expectancy of other developing countries in East Asia and Pacific. Despite complex changes in Thailand’s life expectancy over time, with some variations across gender, the most important observation is that the life expectancy of other developing countries in East Asia and Pacific is now considerably higher than in Thailand. In 1980, Thai women lived about five years longer than women in other developing countries in East Asia and Pacific. In 2009, Thai women lived about two years less than women in other developing countries in East Asia and Pacific. In 1980, Thai men lived marginally longer (less than a year) than their counterparts in other developing countries in East Asia and Pacific. In 2009, Thai men lived about five years less than men in other developing countries in East Asia and Pacific. To summarize, while there do not seem to be significant gender discriminations in Thailand’s life expectancy, both Thai women and Thai men have (on average) been overtaken in terms of life expectancy by the other developing countries in East Asia and Pacific.

Even though women in other developing countries in East Asia and Pacific live now longer than Thai women, Thailand’s maternal mortality rate is still far lower than that of other developing countries in East Asia and Pacific. In 2000, Thailand’s maternal mortality rate was 63 deaths per 100,000 live births, while it was 130 deaths per 100,000 live births in other developing countries in East Asia and Pacific. Hence, in 2000, Thailand’s maternal mortality rate was less than half that of other developing countries in East Asia and Pacific. In 2008 (which is the latest available data), Thailand’s maternal mortality rate was 48 deaths per 100,000 live births, while it was 89 deaths per 100,000 live births in other developing countries in East Asia and Pacific. Hence, in 2008, Thailand’s maternal mortality rate was more than half that of other developing countries in East Asia and Pacific.

In other words, despite progress in reducing maternal mortality in both Thailand and other developing countries in East Asia and Pacific, the later have made more progress in absolute as well as in relative terms. In any case, one of the main reasons for why maternal mortality has been lowered and women’s life expectancy has gone up in Thailand is because of increased attention paid to women’s health. For example, Thailand’s National Health Development Plans have been paying particular attention ensuring good health care for women. “Maternal and child health has been important and has continually been declared as a top priority since the 3rd National Health Development Plan (NHDP 1972-1976) and continues to be so in the present plan (9th NHDP, 2002-2006), which has set ambitious targets for maternal, newborn and child health.”

In the early 1990s, the threat of HIV/AIDS grew rapidly in Thailand. Ever since, there has been increasing efforts to stabilize and reduce the epidemic. In order to do so, Thailand has increased access to protection from getting infected by HIV/AIDS, like the promotion of condoms. These efforts are beginning to work as is shown by the increased use of condoms in the sex industry. While Thai men are no longer visiting brothels in the numbers they once did, there has been an increase in extra-marital affairs and casual sex, and condom use has fallen dramatically. Meanwhile, HIV infection rates have spiked among young people, pregnant women and intravenous-drug users.

Health Customs in Thailand

Thailand as a history of being a drug and medicine consuming country. Illegal drugs are widely used and people medicate themselves with penicillin and steroids that they buy over the counter in drug stores.

Villagers often prefer locally prepared remedies, treatments by local healers and traditional massage therapy to hospitals and doctors. Massage is regarded by villagers as an important form therapy. Illness has traditionally been blamed on spiritual possession, fear, problems, and an imbalance of elements on the body. In the Northeast rituals such as bai sir sukwan (“tying” the soul back into a an ill or disturbed person) is an important form of healing.

A law was passed in the sixties to keep barbers from cleaning people's ears, an experience that apparently was like going to hell and back.

Low Iodine in the Thai Diet

According to statistics, over 20 percent of the Thai population do not consume enough iodine-added products, resulting in a high number of people with iodine deficiency. Iodine deficiency shows severe effects on pregnant mothers, sometimes leading to miscarriages. Iodine deficiency can also result in health problems in childeen, both before and after birth. It can cause low IQ, mental retardation and even brain damage in children. The World Health Organization has set to lower iodine deficiency by stating that purified salt consumed in communities must contain iodized salt at a minimum rate of 90 percent.

An article in the April 21 Global Post liberally quotes an International Council for the Control of Iodine Deficiency Disorders, or ICCIDD report on mental handicaps in certain villages in Thailand suffering iodine deficiency. The article notes a study by the Thai health ministry showing the IQ of Thai children at 91. Even this is better than the 2002 figure of 89. The UNICEF nutrition advisor quoted attributed the continuing challenges of providing iodized salt in the region (and iodized fish oil in Thailand) to "weak government regulation."

“'People used to make jokes, cruel jokes, about people from the hills,' said endocrinologist Cres Eastman, an Australian and vice-chairman of the International Council for the Control of Iodine Deficiency Disorders, or ICCIDD. “'But a lot of the so-called stupidity, which they thought was genetic, was clearly not so,' he said. 'It was environmental.' "A cretin, medically speaking, is a person born mentally handicapped and often physically deformed from an undernourished thyroid gland. "A cretin is born deprived of iodine, an element commonly absorbed through milk, seafood and crops grown in iodine-rich soil. By lacing table salt with small amounts of iodine, cretinism has been virtually eradicated in the industrialized world.

"In recent decades, a push by the United Nations and the World Health Organization has brought most of the developing world along too. Roughly 70 percent of the world now eats iodized salt, the biggest preventer of cretinism, compared to just 20 percent in 1990. "But while cretins have become rarer, too little iodine in a fetus or young child’s system still causes a more subtle problem: diminished IQs."

Health Care in Thailand

Health expenditures: 4.3 percent of GDP (2009); country comparison to the world: 153. In 2002 annual spending on health care amounted to US$321 per person in purchasing power parity (PPP). Total expenditures represented about 4.4 percent of the gross domestic product (GDP); of this amount, 57.1 percent came from public sources and 42.9 percent from private sources. [Source: CIA World Factbook, Library of Congress,*]

Physicians density: 0.298 physicians/1,000 population (2004); Hospital bed density: 2.2 beds/1,000 population (2002). In 1995 Thailand had 0.3 physicians and 1.9 hospital beds per 1,000 population. The Northeast has fewer doctors and hospitals per capita than other parts of the country. In 1981 there were 359 hospitals, with 1 bed per 734 people and 1 physician per 6,951 people. In the same year, the nation registered 1,142 dentists and more than 50,000 nurses and midwives. The percent of birth attended by a trained health care professional: 85 (compared to 11 percent in Nepal and 97 percent in Sri Lanka). *

In the early 2000s, Thaksin government passed a health initiative that allows any Thai citizen to see a doctor for 30 baht (75 cents), including services, tests and medications. The 30-baht initiative was one of populist policies instituted by Thaksin after he first took office bn 2001. Critics claim the policy has undermined the Thai health care system because local hospitals are not properly reimbursed. Many hospitals and clinics lowered their service in accordance with the fees. Many praise the program. For example, poor people who couldn’t get top quality health care before can now no ocul could cancer chemotherapy for under $1.

The Thai government has ignored international patents and approved generic version of profitable drugs such as Plvix made by Bristol-Myers Squibb and Kaletra, an AIDS treatment made by Abbot Laboratories.

Hospitals in Thailand

There are over a hundred private hospitals in Bangkok. Many are outfit with up-to-date medical technology. Many were built in the boom years preceding the Asian economic crisis in 1997. These hospitals suffered after the crisis when Thais no longer could afford their services, many tried to fill their bed by attracting foreign patients with—for them—cheap medical services.

Although a disproportionate number of health care facilities are concentrated in the Bangkok area, Western-style medical treatment was provided throughout the country by a network of hospitals, regional health centers, and other clinics. In some of the larger hospitals staffers glide through the halls on roller blades with files in their hands.

According to the Thai government: Hospitals and other medical facilities in Thailand pride themselves on their high standards, and many have subjected their premises and systems to the most rigorous inspections by applying for accreditation and certification, whereby a qualified standards organization - distinct from the healthcare organization under review - assesses the hospital or facility to determine if it meets a set of standards and requirements designed to improve the quality of patient care. Thailand was the first country in Asia to achieve JCI accreditation in 2002, and 15 hospitals are now accredited.

Doctors in Thailand

Many Thai doctors have been trained in the United States or Australia. They earn only a fraction of what their counterparts in the West earn. Highly trained nurses are paid only $500 a month.

A Thai woman complaining of chest pain was x-rayed and founded to have a surgical clamp left in her body during an operation 18 years earlier.

According to the Thai government: The physicians, surgeons and nurses have been trained to the highest levels, while many specialists have been conducting research and gaining experience at the world’s best medical institutes with some even leading the field in which they specialise. Many Thai doctors and surgeons practicing today have won awards for their work, and more than 500 doctors practicing in Thai hospitals are American Board Certified. These medical professionals are skilled at providing the highest quality medical treatment.

Stem Cell Research in Thailand

Chularat Saengpassa and Pongphon Sarnsamak wrote in The Nation: “Thai successes in stem-cell research have come despite a lack of funding or a national plan. Local development of the technique has been direction-less and under-funded. At least three universities have reported success in stem-cell research. [Source: Chularat Saengpassa and Pongphon Sarnsamak, The Nation, October 22, 2012~~]

“Chulalongkorn University proclaimed that it was the first in Thailand to produce human embryonic stem cells and established the country's first embryonic stem-cell bank. Police General Hospital has developed adult stem cells to treat arthritis sufferers. The hospital is now conducting a clinical trial on 60 arthritis patients aged 45-60. The human trial is expected to be completed ub late 2012. In October 2012, a team of researchers at Mahidol University's Siriraj Hospital said they had discovered a method to extract pure stem cells from human amniotic fluid, which they say could be potentially used to treat several severe conditions such as arthritis. ~~

“But looking behind their success stories, we can see that most of them had to rely on their own funds to establish their laboratories and conduct studies. Only a portion of the money came from the government. "The government has never paid attention to supporting scientific research. We had to use our own funds collected from donations to do stem-cell research and conduct studies," Lt-General Jongjet Aojanepong, director of Police General Hospital, said recently. The hospital has spent about Bt3 million-Bt4 million to conduct stem-cell research on arthritis patients. The hospital also wants to conduct another study on how stem cells can restore severely damaged neurons next year, but still lacks a budget to carry on. ~~

“Stem-cell research is booming in Thailand, but there is no central organisation to systematically manage the research budget and chart the direction of stem cell research. Even though the government has set up the National Research Council of Thailand (NRCT) to oversee all research in the country, most of the budget was allocated to support research on agriculture, which is a priority need for the country. ~~

“The council gets about Bt10 billion from the government to support all research in the country, but only Bt60 million-Bt100 million per year goes to stem-cell research, said Dr Soottiporn Chittrmittrapap, secretary-general of the NRCT. In Thailand, there are at least four main agencies supporting stem-cell research - the NRCT; the Thailand Research Fund; the National Science and Technology Development Agency; and the Public Health Ministry. But these agencies work separately on stem-cell research. ~~

“Bangkok Hospital, run by BGH, has conducted stem-cell research in the treatment of heart disease, but had to stop after the Medical Council issued a regulation forbidding private hospitals from conducting such research. The hospital has been limited to joining with foreign medical institutions, such as the University of Texas MD Anderson Centre, by supporting financial sources in the study of bone-marrow transplants. ~~

Image Sources:

Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, Lonely Planet Guides, Library of Congress, Tourist Authority of Thailand, Thailand Foreign Office, The Government Public Relations Department, CIA World Factbook, Compton’s Encyclopedia, The Guardian, National Geographic, Smithsonian magazine, The New Yorker, Time, Newsweek, Reuters, AP, AFP, Wall Street Journal, The Atlantic Monthly, The Economist, Global Viewpoint (Christian Science Monitor), Foreign Policy, Wikipedia, BBC, CNN, NBC News, Fox News and various books and other publications.

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© 2008 Jeffrey Hays

Last updated May 2014

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