Analysis of Primary Healthcare Issues in Thailand: A Report

This report examines the primary healthcare issues in Thailand, highlighting the impact of social determinants on health outcomes. It focuses on prevalent issues such as obesity and malnutrition, exploring their epidemiological trends and underlying causes, including poor diet and physical inactivity. The report discusses the role of nurses in addressing these health challenges within the primary healthcare system, emphasizing their involvement in implementing health policies, providing counseling, and promoting health awareness. It also addresses the importance of cultural competence in healthcare delivery, particularly in a diverse population, and the need for nurses to adapt their communication and care to meet the needs of different ethnic groups. Furthermore, the report analyzes the universal health coverage initiatives in Thailand and discusses challenges related to health equity, healthcare financing, and the need for social justice in healthcare provision, emphasizing the government's efforts to reduce health disparities and improve access to healthcare services.

Running Head: HEALTH ISSUES IN THAILAND
PRIMARY HEALTHCARE ISSUE IN THAILAND
Name of the Student
Name of the University
Author’s Note

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Introduction
The issue of social determinants is prevalent in every country, be it a developed or a
developing country. The health status of a country can be determined by its population,
economy, literacy, its distribution in the social level, and its health policies. These factors play a
major role in a country’s progress and its position in a global context. The effects of the social
determinants on the health are complex because it is interconnected to several areas such as
governance, socioeconomic factor, public and social policies (Johnson & Svara, 2015). Thailand
has several prevailing health issues that are affecting their public health all over the world, such
as the issue of poor diet and physical inactivity. This is the cause of a chronic lifestyle disorder
known as obesity in which a person has excess fat in their body that causes several health
conditions. A person with a higher BMI over 30 has obesity. The epidemiology suggests that
Thailand has been a target of such diet-related diseases due to several factors, which will be
explained in detail. WHO’s 5 principles of health is found in the primary health care of every
country, in Thailand as well. It includes equity, access, empowerment, self-determination and
inter-sectoral collaboration. In primary health care, a nurse works on such issues as it is their
responsibility to make people aware and serve them when the public is going through a health-
related dilemma. Cultural competence is another factor that affects the role of a nurse in a
primary healthcare. The issue of social justice and health inequity contributes to the prevalence
of disease as well as the control of the epidemic, which makes it an important issue (Thippayana,
2014).

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Discussion
The social determinants of health are the conditions in which a person lives that include
their birthplace, financial conditions, and lifestyle, and in Thailand, it is the socio-political
inequalities, economic, literacy, equity and social justice. Certain determinants of demand were
seen during the implementation of health card in Thailand. New legislation and policies were
designed to reduce the ill effects of the determinants and the health inequity is managed by
taking action according to the disease control plans and treating the existing health issues. Health
equity is achieved in recent years in Thailand, as seen in the empirical evidence (Supakankunti,
2001). The health systems have four dimensions that include health status, health care utilization,
health financing, and health risk behaviour. The population health indicated that the prevalent
issues were under-five mortality rate, the prevalence of child (pneumonia and diarrhoea) and
malnutrition, which is divided into 3 parameters known as wasting, stunting and underweight.
The health risks indicate that smoking and consuming alcohol is prevalent in the country, the
healthcare utilizations look after the hospital admissions and ambulatory visits that are specific to
healthcare privileges. Health financing means that it is monitored by the direct payment for the
health of households when compared to the government who should be paying (Teerawattananon
& Luz, 2017). The equity stratifiers such as demographic, geographical, economic and social
characteristics of the population are used as a criteria for the concentration of health dimension.
Thailand has a universal health coverage that covers 90% of the population with the help of 3
public health schemes, disparity in certain health dimensions that means health resource
utilization is demonstrated in every chronic disease found in Thailand. The social determinants
of health known as equity and social justice is an important factor for the prevalence of the major
health issue seen in Thailand. Poor diet and physical inactivity could have been decreased with

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the help of equity and social justice and that is the essential step taken by the government of
Thailand (Jitnarin et al., 2011). Health insurance of Thailand including voluntary insurance is
under development that has questioned the idea of equity. In the last 5 years, the health care
expenditure has elevated to a high level but there is no evidence of patient quality and safety.
The increase in the healthcare expenses and the provision of healthcare services has raised
question amongst the public regarding health equity because only the financially privileged can
access these services, which widens the gap of inequality. The government needs to intervene in
such matters and provide healthcare subsidies, public health policies for the underprivileged and
giving finance-related health services to the vulnerable populations including the delivery of
such services with the help of government facilities and staff. Social justice is the act of
maintaining a social balance in the society in which people of every class achieves the
government facilities, health services and distribution of opportunities. Obesity and other diet-
related disorders are a cause of equity and social justice in Thailand (Phanphairoj & Loa, 2017).
Thailand has an increasing rate of obesity and overweight, as seen in the epidemiological
studies. Overweight in children under the age of 5 has been increasing every year because it was
1% in 1987, 8% in 2006, and 11% in 2012, but there was a decline of 8% from 2015-2016.
Overweight and obesity in adult is always on a rise especially in women than men because it is
found in 17% of women and 12% of men. In recent years, the prevalence is 26% in men and
33% in women in the year 2014. In 1990, 1% of men and 3% of women were found to be obese
and now in the present time, 6% of men and 11% of women were known to be obese in 2014.
Another aspect of poor diet is the issue of malnutrition in children but from 1993 to 2012,
stunting declined to 23%, 44% decline was seen in the underweight, wasting was 7% in 2012 and
overweight increased to 132% in 18 years. Thailand has tried several approaches to reduce

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hunger and malnutrition including some more challenges that come out as a health issue for the
government (Elulu et al., 2014). The interpretation of these epidemiology studies shows that
Thailand is the target of chronic lifestyle disorder of obesity, which is caused due to social
determinants and the lack of awareness in the country due to several reasons such as poverty,
illiteracy, and social backwardness in some population. According to the epidemiological data,
women are at a higher risk of obesity because they are less outgoing than men, and that is the
reason for physical inactivity and eventually poor diet. This affects the maternal health as well,
which affects child health in the demographic. Micronutrient deficiency is also seen in the
population of Thailand, which gives more evidence about the issue of poor dietary intake. The
disease in focus due to micronutrient deficiency is iron deficiency anaemia because the
prevalence in children under the age of 5 is on a 30% rise since 2011. Women of the
reproductive age suffering from anaemia is at a prevalence of 24% according to the Food and
Agriculture Organization (2017) (Kanyamee et al., 2013).
The primary health care of Thailand plays a major role in the area of public health just
like other countries. It focuses on lowering the health deterioration and improving the health care
quality and accessibility with the help of policies and facilities. It works for decreasing the gap of
health inequity in the population of Thailand by reducing the healthcare costs, increasing
accessibilities to the vulnerable groups and partnering with organizations for the welfare of
families and communities. It provides scope for early detection of illness, disease prevention,
management of acute and chronic health problems, health promotion and rehabilitation. The
Universal health coverage has been a prominent initiative by the government in Thailand as it
ensures equity through equal access to healthcare services and providing quality and safety
standards for the patients that helps in increasing efficiency (Kooienga & Carryer, 2015). The

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health care system in Thailand has 3 levels that includes primary, secondary and tertiary care and
primary healthcare consists of community health centres/health posts and drugstores, it aims for
a comprehensive and holistic care. Thailand has a Nursing and Midwifery Council (TNMC),
which indicates that nurses are the foundation of primary health care. Various studies have
shown that nurses are the health care personnel that provides health related services to the remote
areas of Thailand (Wongkit & McKercher, 2016). Several leaders in Thailand express that nurses
should be the care givers in the primary health sectors because the educational cost of nurses is
not as high as the physicians, nurses are experienced in holistic care more than any other medical
professional and providing them with primary health education can improve the services, nurses
might have a better communication skill because they are more trained in interacting with
patients that enhances their interpersonal relationships, the number of nurses are higher than any
health professional in Thailand, and when nurses are given the required training about the
primary healthcare sector there is no need for hiring physicians to increase the workforce
(Halcomb et al., 2016). The nurses are involved in eradicating the issue of poor dietary intake
and physical inactivity in Thailand because they are active in the primary health care department.
The epidemic of obesity in Thailand needs to be intervened by nurses in the primary health care
and it is being done by them through the help of various implementations and facilities. The
government provides funds to these sectors, which helps the nurses in taking their action to a
higher level. Children and adults are at a risk of obesity, which shows that there is some
complication in their diet and lifestyle that needs to be changed. Nurses look after the people
who come for medical consultations and requires serious medical intervention regarding their
health and BMI. According to Winichagoon (2013), the nurses are a part of several food and
nutrition related policies such as the National Food and Nutrition Plan and Improving

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Nutritional Care: A Joint Action Plan from the Department of Health and Nutrition Summit
stakeholders. These policies addresses the issue of maternal and child under nutrition, child and
adult obesity that is the related to the mentioned health issue in Thailand. Other than that they
personally conduct counselling and demonstration workshops for people at risk to obesity and
other chronic lifestyle disorders (Hanucharurnkul, 2007).
Cultural competence is evident in Thailand because people from several ethnicities are
found in the country. The southernmost provinces of Thailand has the maximum number of
variety in the cultural context. This makes it important for the nurses to have a cultural
competence in managing the health care needs of different people. The nurse’s cultural
competency is at a moderate level but it needs to be elevated so that they can deliver to the
multicultural needs. A diverse population has migrated to the country of Thailand as seen in the
21st century and this is a challenge to the nursing care department (Songwathana & Siriphan,
2015). Several ethnicities and regions such as Malay Muslims, Thai Buddhists and the Thai
natives of China have migrated from different regions of the country and half of them are not
even registered. To support the health issue of obesity, cultural competence should be utilized
because this health complication is prevalent in people irrespective of the ethnicity. Nurses need
to be prepared and trained in the aspect of increasing their interpersonal communication skills
that will help them in interacting with people of various ethnicity. The shift in demography of the
country indicates globalization, increasing immigration and rise in the population of minorities
that demands an efficient team of nurse that can respond to the diverse cultural health needs.
Public awareness is improving in regards to the diversion of population and expanding the
workforce of health experts. As a reflection, it can be said that cultural competence plays a huge

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factor in the delivery of medical facilities because it affects the approach as well as the outcome
in few cases (Kim & Kim, 2013).
Conclusion
To conclude this essay, it can be said that Thailand is affected by the epidemic of obesity
according to the epidemiological data and it is severe due to several social determinants of health
such as poverty, illiteracy, equity and social justice. A number of risk factors increases the health
issues of the country such as obesity, malnutrition, deficiency and chronic lifestyle diseases.
Nurses in the primary health care sectors are actively involved to eradicate the issue of obesity in
the population of Thailand because they are the health related personnel as appointed by the
government of the country. The cultural competence is a concept in Thailand due to the vast
diverse population that has migrated from the other parts of the region and it affects the nurse’s
role as well as the delivery of healthcare facilities.

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