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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