Health Inequity Reduction in ThailandOn the Way Toward Healthy Public Policy

Cholnapa ANUKULSocial Inequity Reduction Network (SIRNet), Thailand

274 Collaborative Governance for Health Equity and Healthy Public PoliciesSaturday, July 19, 2014: 8:30 AM-10:20 AM

Room: F206RC15 Sociology of Health

OutlineBackground

Health & Health Equity Situation in Thailand

SIRNet: integrated intersectoral actionObjectivesMethodsFindingsConclusion

Country Background

Total population (2012) 66,785,000Gross national income per capita (PPP international $, 2012) 9,280

Life expectancy at birth m/f (years, 2012) 71/79Probability of dying under five (per 1 000 live births, 2012) 13

Probability of dying between 15 and 60 years m/f (per 1 000 population, 2012) 182/90

Total expenditure on health per capita (Intl $, 2012) 386

Total expenditure on health as % of GDP (2012) 3.9

Latest data available from the Global Health Observatory

0.6%Unemployment rate

16%Percentage of women in Thai

Parliament

3.4%Inflation rate

4Million households affected by

drought per year

55Average age of rice farmer

Social Determinants of Health Inequities A Conceptual Framework for Action on the Social Determinants of Health, World Health Organization, 2010

Governance

MacroeconomicPolicies

Labor market structure

Social PoliciesLabor, Housing, Land

Cultural & Societal Values

Socioeconomic &

Polictical Context

Socioeconomicposition

IMPACT on equity in health

and well-being

STRUCTURAL DETERMINANTS

Differential social, economic and

health Consequences

Differences inExposure

Differences inVulnerability

Health System

INTERMEDIARY DETERMINANTS

Public PoliciesHealth, EducationSocial Protection

Social ClassGender

Ethnicity (Racism)

Education

Occupation

Income

National Health Commission  Office (NHCO)

Social Research Institute, Chula 

University

International Health Policy 

Program (IHPP)

Health System Research 

Institute (HSRI)

Thai Health Promotion Foundation

Social Inequity Reduction Network

Policy Mobilization

Researches

Core Team & Steering 

Committee

Social Awareness

Working Model: Integration

4 Thematic Reports

Monitoring System

Conceptual Framework

8 projects

51 areas

Conceptual FrameworkQualitative Research

Quantitative Research

Policy recommendations

Research process

Public Policy Process

Agenda Proposal

Agenda Selection

Conceptual Framework

Evidences

Social Workers

Conceptual Framework

Draft Resolution

Agenda Circulation

among constituencies

National Health

Assembly

2000 members from 182 constituencies, experts, int’l representatives, interested persons and observers 

Mechanism • Various kind of Working Groups (young researchers, youth facilitators, ngos)

Knowledge

• Theories: health equity, SDH and social justice in Thai context• 4 health thematic reports (gender equality, reproduction health, informal labor)• 16 social research reports and 3 social inequity situation review reports• Various policy recommendations

Policies• Participatory Occupational Health Policy in Nation Level

Social Awarenes

s • Health Equity & Social Justice Agenda Setting• 2 Health & Social Equity Annual Reports

3 Years - Collaborative Results

Objectives

AchievementLeverage Need

Better Intersectoral Collaboration Working Model

MethodologiesObservations and Lesson Learned Interviews

Thirapandhu’s 3 levels of IntegrationsBasics: philosophy, value, meaningProcess: working process, structureOutput: output, outcome, impact

CSDH’s 5 level of participationInformation, consultation, engagement, co-ordination, empowerment

Longwe’s 5 levels of empowermentSocial welfare, equality of access, problem awareness, participatory

policy mobilization in all levels, power control

Findings: Collectiveness

Community of commitment of interdisciplinary researchers

Consensus strategy for social health equityEquity lens: monitoring of public policies

Fair equality of opportunityThe greatest benefit to the least-advantaged members of society

Well-being of marginalized population groups complete social health equity

Equity policy always includes the least-advantaged members of society

Findings: Integration GapsKnowledge and Action

Burawoy’s 4 types of knowledge: theory, critics, policy, communicationParticipatory action researches without health and equity lensThematic reports without participation processConceptual framework and Strategy based on action researches results

Research linkage: health and social science researchersDifferent views of evidence-based research

Need of health status database / health inequity monitoring indicators

Professional practices: academics, social workers and policy makers

Dialogues and Actions

Inter-organizational Collaboration:Skills and project works integration

Findings: Empowerment Needs

Dialogues in all levelsAcademics, social workers, communities, networks,

organizational leaders, society

Healthy public policy processLeverage of participatory action researches to public policy

process

Leadership skillsCollective and transformative Leadership

Conclusion

ChallengesStrengthening collective resourcesClosing the gapsSupply the needs

New collaborative working modelsAdvanced integration levelMore participation

• Propose health policies and strategies

Network of members and communities

• Management of the Health Promotion Fund

• Management of the NationalHealth Security Fund

• Health related operation

Local Administrative Organizations

• National HealthStatute

Other Networks

• Creationof knowledge

สช. ปรบัปรุง พ.ย.

50

• Health Assembly

Parliament

CabinetNESAC NESDB

HSRI

Ministry of Public Health and other

ministries relevant to health

THF

NHSO

อปท.Regional Agencies

NHC/NHCO

Web of the National Health System Mechanism 

Professionaland AcademicNetwork

Press and medianetworks

HA