using innovation in tobacco taxation in promoting health - prakit vathesatogkit
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using innovation in tobacco taxation in promoting healthTRANSCRIPT
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- Why Setting up ThaiHealth?
- The process of setting up
ThaiHealth
- How ThaiHealth operate?
- Some of Thai Health’s first
decade achievement
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Thailand :1990-1995: low budget interventions on tobacco control
Enacting two comprehensive Tobacco
Control Law in 1992 (Product control &
smoke free areas).
Regular tobacco tax increases policy in
1993.
Problem faced
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1. Government provide very little
budget for tobacco control.
2. Request for more budget through
conventional method were
unsuccessful.
The idea of setting up “health
promotion fund” originally arise from
we want to secure funding to support tobacco control
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There are other emerging non
communicable diseases
Alcohol related problem
Road traffic accident
Cardiovascular diseases
facing the same problem as with
tobacco control: no funding
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Thailand in 1995 - 96
Per capita alcohol consumption rank no. 7th of
the world and increasing
13,000 traffic accident death per year, Half of
which age 15-35 year
26% related to drunk driving
Traffic accident cost 1,707 million US$
= 2.25-3.48% of GDP
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If health promotion efforts succeed
in reducing health care expenditure
in tobacco, alcohol, traffic accident
by 10 percent,
Thailand would save 488
million US$ per year.
Research Estimate
Ministry of Finance : Health financing reform policy (1996)
Appoint working group to study;
1. Universal Health Insurance,
- to provide health security.
2. Setting up Health Promotion Institute
/ Foundation,
- to decrease health care cost.
The 2nd policy was intended to compliment
the 1st policy.
Challenges faced when Establishing Thai Health
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Winning support from cabinet member;
Overcoming MOH’s query
- We already are conducting HP, why
set up a new agency?
- If set up a new agency, why not set it
up in MOH?
Overcoming MOF’s reluctance.
- Why a dedicated funding?
- Why not from the regular budget?
WHAT IS
“HEALTH PROMOTION ?”
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Need to clearly explain
Population Groups Classify
According to Health Status
Healthy
Having Risk behavior
Diseases but not seeking
care
Sick and seek care
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Group 1
Group 2
Group 3
Group 4
Population Groups Classify
According to Health Status
Healthy
Having Risk behavior
Diseases but not seeking
care
Sick and seek care
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Health Promotion
Conventional
Health Care system
Population Group 1
prevent them to progress to Group 2
Educate about how to improve their
health/avoid unhealthy lifestyles
Control of unhealthy environment
- physical environment eg.
Road/air quality
- marketing of unhealthy
products/food
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“Health Promotion”
Population Group 2/3/4
Help them to;
- stop smoking/drinking
- abandon risk behavior
a) not exercise/unhealthy food
b) unsafe driving
Promote healthy behavior exercise/health food.
Regulate marketing of unhealthy products.
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“Health Promotion”
Measures (Action) to promote health
- Build healthy public policy
- in all ministries;
- Create health supportive
environment.
- Get community involve.
- Reorient – adjust health services.
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“Make healthy choice easy choice”
New approach 17
- Lifestyle
- Environment
Preventive &
Promotive care
services
Activator for
change; :
Mainly within MOH Out side MOH
Involve the whole of the
government and society
Involve MOH and those
who are sick & family
Existing approach
Targeting different groups of population
Healthy
Having Risk behavior
Diseases but not seeking
care
Sick and seek care
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Health
Promotion (ThaiHealth)
Conventional
Health
Care system (MOH)
Ministry of Finance : Health financing reform policy (1996)
MOF was the sponsor of the
Thailand Health Promotion
Foundation Bill, steering the
bill through the cabinet and
the parliament.
establishing Thai Health
Promotion Fund under an
autonomous state agency,
requiring 2% of alcohol and
tobacco surcharged (levy) to this
fund
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1. Health promotion needs regular and sustainable
budget.
2. Because health promotion concentrate on
software rather than hardware, existing funding
agencies do not understand process-based
funding priorities.
3. A dedicated/specific source of funding provide a
predictable, more stable amount of budget.
4. Less susceptible to diversion of funding for
other purposes.
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Critical proposal/Politically acceptable source of budget
- The fund to come from tobacco and
alcohol importer/producer to pay an
additional 2% of excise levy
(whenever they pay for the excise
tax)
- Key word:Government does not
have to pay
- : The polluter pay
1. The nature of the work (Health Promotion)
Development VS. Established services
Project based not Service based
2. Success is based on innovation
3. Not achievable through bureaucratic system
4. Needs flexible management
5. An autonomous agency is less susceptible to administrative interference (of programs and projects)
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Under the bureaucracy system
Difficulty (if not impossible) in working
with agencies out side MOH eg : NGOs
Tendency to subject to bureaucratic/political interferences
Instability of the budget
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2010 Budget = 100 million USD.
Thai Health Promotion Foundation Act 2001
• Promotion of good health of Thais according to National Public Health Policy
• Encouraging healthy lifestyles through social and physical
environments
• Supporting community initiatives to promote better
health conditions
• Campaign and sponsorship of sports, the arts and
popular cultures
• Development and research (D&R)
Health promotion is NOT only health education.
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The Executive Board
Prime Minister as Chairman
Health Minister as First Vice Chairman
An Expert as Second Vice Chairman
Member: Representative from 9 ministries
Health / Education / Transportation / Sport /
Interior / labor /University / Prime minister’ s office /
Socio cultural economic board
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• Eight Independent Experts in
fields of health promotion,
community development, mass
communication, education, sports,
arts and culture, law, as we all as
administration
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1. Tobacco Control
2. Alcohol Control
3. Traffic Injuries and Disasters Prevention
4. Health Risk Factors Control Nutrition
5. Health of Specific Group of Population
6. Health Promotion in Community
7. Children Youth and Family Health
8. Health Promotion in Organizations
9. Physical Activities and Sports for Health
10. Social Marketing and Communication
11. Open Grants and Innovative Projects
12. Health Promotion through Health Service Systems
13. Supportive Systems for Health Promotion
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Knowledge Social movement
Policy advocacy
ThaiHealth Funding Strategy
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Open grant = 10% of budget
Proactive program = 90% of budget
Priority health issue (By Board)
- Situation analysis
- Program development
- Strategic partners
- Program review process
- Contracting
- Implementation
Key players in tobacco control
Ministry of Health - policy development
Tobacco control Research center. Mahidol U.
NGO - ASH , THPI - advocacy ,lobbying
- public awareness campaign
Health Professional Network
- smoke free health facility
- smoking cessation
- Quitline 1600 Teacher network - smoke free school
- smoking ed program
Thai Health Promotion Foundation - funding
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Achievements on tobacco
control (2001-2010) 33
National surveillance system
Ban on banning cigarette display
Pictorial warnings
Smoke Free environment Regulation
Regular increase of tobacco tax
National quitline
Health professional/Teacher network against
tobacco
Mass media campaign
Community based programs
Key players in alcohol control
1. Alcohol Control Office : MOH
2. Center for Alcohol Study : IHPP
3. Stop-Drink Network : Community/NGOs
4. Drink Don’t Drive Foundation
5. Integrated Management for Alcohol
Problem : cessation
6. ThaiHealth : funding
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Alcohol policy outcomes
Before the establishment of ThaiHealth and triangle network
There were 6 national alcohol control policies in 50 years
national alcohol policies (1950- 2002) 1. Alcohol act 1950
2. Limited sale time (1961)
3. Prohibit sale to intoxicated person (1966)
4. Drunk driving (1979)
5. Warning message(19p97)
6. Free trade (1999)
After the establishment of ThaiHealth and triangle
network
There are 9 national alcohol control
policies in 4 years
national alcohol policies (2003- 2007)
1. Prohibit sale for under 18 (2003)
2. Partial ad ban (2003)
3. Establishing the national alcohol control
committee (2003)
4. Prohibit sale in school (2004)
5. Warning message in outdoor billboard and
movies (2004)
6. Prohibit sale in fuel station (2005)
7. Increase warning messages (2005)
8. Increase excise tax (2005)
9. Alcohol control act (2006 – 2007)
8 yrs per 1 policy 2 policies per 1 year 44
Children, Dental health and Obesity
Before 2002, no national policies or networks to reduce sugar consumption among children
2002, NSN (govt, professional orgs, academic institutes)
2004, the Sugar Consumption Reduction Plan
2007 FDA regulation: 5 highest consumed snacks must have nutritional labeling & warning slogan “eat less & exercise regularly”
2008, Regulations on sugar in infant formulae milk powder
2009, 3,250 schools free of soda soft drinks
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To have waist circumference of
male<36 inch, female<32 inch
• Media strategies.
• Health care provider’s roles.
• Community base program.
• Policy advocacy and lobbying by the
Royal College of Physician of
Thailand.
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2010( Million USD)
- Tobacco = 5.3
- Alcohol = 9.3
- Traffic accident = 6.6
- Physical activity = 6.5
- Nutrition = 4.7
- Social marketing = 6.6
- Total = 39.0
Total ThaiHealth revenue (2010) = 100.0
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1. Targeting different groups of population.
2. Work horizontally rather than vertically.
3. Multispectral collaboration across ministries
/ NGO / public / private.
4. Pilot / innovative projects.
5. Fund social marketing / mass media
campaign .
6. Flexible financing mechanism.
What has ThaiHealth done that the
government could not or did not do? 49
1. Support health promotion in accordance
with national health policy.
2. Prime Minister as chairman of the board
Work hand in hand with MOH.
Minister of Health as deputy chair of the board.
Do things that MOH can not or difficult to do.
Funding for MOH projects that can not secure
support from regular budget. ( not service base)
The relation between ThaiHealth
and government 50
Over all Health Promotion
and Prevention Budget (Million USD) 51
Source 2009
MOH 400
NHSO 309
Civil Service insurance 45
Local gov 198
Other gov agencies 7.6
International aid 13
Total 972
ThaiHealth 114
=% of total 11.7%
Preventive
Promotive
services
Health promotion
ThaiHealth Budget as % of
total health
(million USD)
2006 2007 2008
Total Gov.
Health Budget 6,365 7,421 8,780
Thai Health 74 74 94
= 1.16% 0.99% 1.07%
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Population Groups Classify
According to Health Status
Healthy
Having Risk behavior
Diseases but not seeking
care
Sick and seek care
53
Health Promotion
(1 % of health budget)
Conventional
Health
Care system(99
% of health
budget)
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Obstacles:
Securing continuity of political support
Threats from the health opposition industries
and commercial companies
Challenges:
Convincing all stakeholders of the proven
benefit of the Health Promotion Foundation
Capacity building of health promotion
manager, advocators and experts need
continuous improvement
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Health
Promotion
Foundations in:
Legislation
Year
set up
Yearly funds
2006-7
in USD
(per person)
1. Austria Health Promotion
Act
1998 9,700,000 (1.18)
2. Switzerland Health Insurance
Act
1994 14,000,000 (1.90)
3. Thailand Health Promotion
Act
2001 63,000,000 (0.96)
4. Victoria
(Australia)
Tobacco Act 1987 26,000,000 (5.10)
5. Western
Australia
Tobacco Control
Act
1990 14,400,000 (7.00)
6. Malaysia Malaysian Health
Promotion Board
Act
2006 10,000,000 (0.45)
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Associate members
1. Mongolian Health Promotion Foundation
2. Health 21 Foundation Hungarian
3. Management Centre for Health Promotion, Korea
4. Oman Health Promotion Initiative
5. Polish Health Promotion Foundation
6. Tonga Health Promotion Foundation (TongaHealth)
7. BC Coalition for Health Promotion,
8. British Columbia, Canada
9. Ministry of Health & Family Welfare, India
10. Health Promotion Initiative, Iran
THANK YOU
www.thaihealth.or.th
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