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Health Inequity Reduction in Thailand: On the Way Toward Healthy Public Policy


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Presentation at 18th ISA World Congress of Sociology,
Facing an Unequal World: Challenges for Global Sociology,
13-19 July 2014, Yokohama, Japan.

274 Collaborative Governance for Health Equity and Healthy Public Policies
Saturday, July 19, 2014: 8:30 AM-10:20 AM
Room: F206
RC15 Sociology of Health

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Health Inequity Reduction in Thailand: On the Way Toward Healthy Public Policy

  1. 1. Health Inequity Reduction in Thailand On the Way Toward Healthy Public Policy Cholnapa ANUKUL Social Inequity Reduction Network (SIRNet), Thailand 274 Collaborative Governance for Health Equity and Healthy Public Policies Saturday, July 19, 2014: 8:30 AM-10:20 AM Room: F206 RC15 Sociology of Health
  2. 2. Outline Background Health & Health Equity Situation in Thailand SIRNet: integrated intersectoral action Objectives Methods Findings Conclusion
  3. 3. Country Background Total population (2012) 66,785,000 Gross national income per capita (PPP international $, 2012) 9,280 Life expectancy at birth m/f (years, 2012) 71/79 Probability 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
  4. 4. Social Determinants of Health Inequities A Conceptual Framework for Action on the Social Determinants of Health, World Health Organization, 2010 Governance Macroeconomic Policies Labor market structure Social Policies Labor, Housing, Land Cultural & Societal Values Socioeconomic & Polictical Context Socioeconomic position IMPACT on equity in health and well-being STRUCTURAL DETERMINANTS Differential social, economic and health Consequences Differences in Exposure Differences in Vulnerability Health System INTERMEDIARY DETERMINANTS Public Policies Health, Education Social Protection Social Class Gender Ethnicity (Racism) Education Occupation Income
  5. 5. 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
  6. 6. Policy Mobilization Researches Core Team & Steering Committee Social Awareness Working Model: Integration
  7. 7. Research process
  8. 8. Public Policy Process Agenda Proposal Agenda Selection Conceptual Framework Evide nces 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
  9. 9. 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 Awareness • Health Equity & Social Justice Agenda Setting • 2 Health & Social Equity Annual Reports 3 Years - Collaborative Results
  10. 10. Objectives Achievement Leverage Need Better Intersectoral Collaboration Working Model
  11. 11. Methodologies Observations and Lesson Learned Interviews Thirapandhu’s 3 levels of Integrations Basics: philosophy, value, meaning Process: working process, structure Output: output, outcome, impact CSDH’s 5 level of participation Information, consultation, engagement, co-ordination, empowerment Longwe’s 5 levels of empowerment Social welfare, equality of access, problem awareness, participatory policy mobilization in all levels, power control
  12. 12. Findings: Collectiveness Community of commitment of interdisciplinary researchers Consensus strategy for social health equity Equity lens: monitoring of public policies Fair equality of opportunity The 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
  13. 13. Findings: Integration Gaps Knowledge and Action Burawoy’s 4 types of knowledge: theory, critics, policy, communication Participatory action researches without health and equity lens Thematic reports without participation process Conceptual framework and Strategy based on action researches results Research linkage: health and social science researchers Different 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
  14. 14. Findings: Empowerment Needs Dialogues in all levels Academics, social workers, communities, networks, organizational leaders, society Healthy public policy process Leverage of participatory action researches to public policy process Leadership skills Collective and transformative Leadership
  15. 15. Conclusion Challenges Strengthening collective resources Closing the gaps Supply the needs New collaborative working models Advanced integration level More participation
  16. 16. •Propose health policies and strategies Network of members and communities •Management of the Health Promotion Fund •Management of the National Health Security Fund • Health related operation Local Administrative Organizations • National Health Statute Other Networks •Creation of knowledge สช. ปรับปรุง 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 Professional and Academic Network Press and media networks HA