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Phusit Prakongsai, MD. Ph.D.Walaiporn Patcharanarumol, MSc. Ph.D.
Viroj Tangcharoensathien, MD. Ph.D.International Health Policy Program (IHPP) - Thailand
Presentation to the World Bank workshop on ‘Managing Vulnerability in East Asia and the Pacific’
-2426 June 2008The Siam City Hotel
How to design and implement effective public health to prevent and mitigate
the impact of disease: experiences from Thailand and beyond
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Outline of presentation
• Burden of disease in Thailand in 2004• Two examples of public policies and disease
prevention in Thailand:– Control of tobacco consumption in Thailand– HIV/AIDS
• Health expenditure in Thailand in 2001 and 2005
• Innovative financing on health promotion• Conclusions and policy recommendations
Disability adjusted life years (DALY) loss in Thailand
by three major categories in 2004
Total = 9.9 Million DALYs (Males: 5.7 , Female: 4.2)Group I Infections, maternal, perinatal and nutritional conditions = 2.1 Million DALYsGroup II Non-communicable diseases = 6.5 Million DALYsGroup III Injuries = 1.3 Million DALYs
Male Female
Group III, 1.0
Group II, 3.4
Group I, 1.2
Group III, 0.3
Group II, 3.1
Group I, 0.9
Source: Thai Burden of Disease (BOD) Study
Top ten: DALY loss in Thailand in 2004
Top ten: DALY loss in Thailand in 2004
% of Total 52.6 42.8
Rank DiseaseDALY('000)
% %DALY('000)
Disease
1 HIV/AIDS 645 11.3 7.4 313 Stroke2 Traffic accidents 584 10.2 6.9 291 HIV/AIDS3 Stroke 332 5.8 6.4 271 Diabetes4 Alcohol dependence/harmful use 332 5.8 4.6 191 Depression5 Liver and bile duct cancer 280 4.9 3.4 142 Ischaemic heart disease6 COPD 187 3.3 3.0 125 Traffic accidents7 Ischaemic heart disease 184 3.2 3.0 124 Liver and bile duct cancer8 Diabetes 175 3.1 2.8 118 Osteoarthritis9 Cirrhosis 144 2.5 2.7 115 COPD
10 Depression 137 2.4 2.6 111 Cataracts
Male Female
DALY
Source: Thai Burden of Disease (BOD) Study
Prevalence of regular smoking in Thailand from 1991 to 2006
30.46
25.3622.47
19.47 18.94
0
5
10
15
20
25
30
35P
reva
len
ce o
f re
gu
lar
smo
kin
g (
pe
r 1
00
p
op
ula
tion
)
1991 1996 2001 2004 2006
2
2.11
2.42
2.97
4.6
36.91
37.16
42.93
49.21
55.63
0 10 20 30 40 50 60
2006
2004
2001
1996
1991
Prevalence in male (per 100 population)Prevalence in female (per 100 population)
Source: Tobacco Control Research and Knowledge Management Centre (TRC)
• Currently, Thailand has a strong comprehensive tobacco control policy
• It took almost four decades of effective tobacco control efforts• Effective interventions through the Framework Convention on
Tobacco Control (FCTC):– The regular tax increase policy is on course,– Total bans on smoking in public places with strong enforcement,– Total bans on advertising and cigarette displays and strong enforcement,– Pictorial health warnings on cigarette packages.
Public policies in reducing regular smoking and morbidity in Thailand
30.525.4
22.5 19.5 18.9
55
79
0
10
20
30
40
50
60
70
80
90
year
pe
rce
nt
0
500
1,000
1,500
2,000
2,500
3,000N
um
be
r o
f c
iga
rre
tte
c
on
su
me
d (
mill
ion
p
ac
ks
)
prevalence of cigarette smoking
percent of excised tax on tobacco
Number of cigarette consumption in million packs
Smoker Die From Emphysema
Cigarette Smoke Kill
Cigarette SmokeCause
Lung Cancer
Examples of health warning on cigarette
packages in 2005
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Key successes of tobacco control in Thailand
• There is a need to have a champion (either GO or NGOs) who work patiently and continuously with legislators and regulators as well as policy makers,
• Being direct, clear, and ready with realistic proposals to offer politicians,
• Policy-relevant research is very important in mobilizing public opinion and lobbying for government actions, especially for Minister of Finance and Minister of Health,
• Nationalism and cultural values can be successfully used to encounter tobacco promotion from international tobacco companies.
Enormous current benefits of prior Enormous current benefits of prior prevention efforts towards HIV/AIDS prevention efforts towards HIV/AIDS
control in Thailandcontrol in Thailand
0.7
7.1
0
2
4
6
8
10
1985 1990 1995 2000 2005 2010
Cu
rren
t HIV
Infe
ctio
ns
in m
illio
ns
Baseline No Intervention
Red line represents what might have been if behaviors had not changed
Infectionsprevented
907
680
277
292174
136
461
803915
1208
10611145
1250
0
200
400
600
800
1000
1200
1400
1984-1990
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Outcome of introducing prevention oOutcome of introducing prevention off mother-to- mother-to-child transmission of HIV (PMTCT) in 2000child transmission of HIV (PMTCT) in 2000
Pediatric AIDS cases in Thailand 1984 – 2003Pediatric AIDS cases in Thailand 1984 – 2003
MOPH Thailand, Epidemiology Division
Inadequate health expenditure for health promotion and disease prevention in Thailand
Health administration and health insurance
8.5%
Medical goods4.3%
Ancillary services 0.4%
Prevention and public health services
4.8%
Services of curative & rehabilitative care
78.1%
Gross capital formation
3.9%
• From 2001 to 2005, health expenditure for health promotion and disease prevention in Thailand decreased from 8% to 4.8%.
• The majority of health expenditure was for curative services and rehabilitation, 79% in 2001 and 78% in 2004.
Innovative financing for health promotion: Thai Health Promotion Foundation (THPF)
• THPF is a statutory public organization established by the Health Promotion Foundation Act in 2001
• The Fund is an innovative financing mechanism generating revenue from 2% surcharge of alcohol and cigarette sales
• Its mission is to empower civic society and promotes
well-being of the citizens by acting as a catalyst and provide financial support for health promotion projects,
• Three main factors for early achievements of THPF– Financial sustainability,– Accountable agency with efficient management structure,– Effective strategies in promoting public health and
policies
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Conclusions and policy recommendations
• Sustaining positive public policies in controlling tobacco consumption and reducing other major disease burden e.g. alcohol consumption, road traffic accident, diabetes, and hypertension, hyper-lipidemia, etc.
• Increasing level of financing health promotion and disease prevention (primary, secondary, and tertiary prevention),
• Increasing value of money through applying cost-effective clinical prevention and health promotion suggested by the Disease Control Priority for Developing Countries (2nd edition),
• Improving program effectiveness (technical efficiency) in health promotion and disease prevention,
• Sustain and accelerate the work of Thai Health Promotion Foundation through:– Increase the level of sin tax from 2% to 5%,– Diversify the portfolio of the THPF to cover more cost-
effective interventions, esp. effective coverage of interventions focusing on chronic NCD.