Development of Health Impact Assessment in Thailand: Recent Experiences and Challenges. (Perspectives)
Phoolcharoen, Wiput, Sukkumnoed, Decharut, Kessomboon, Puttapong, Bulletin of the World Health Organization
The development of health impact assessment (HIA) in Thailand is taking place in difficult circumstances but with high hopes. For many years, the government has taken a clear direction to change Thai economy and society into a newly industrialized country. Many policies designed to fulfil this strategy, however--including investment in infrastructure and industrial development--have caused negative health effects on local people. Without a process for proper public participation, many conflicts have arisen around almost all large government projects throughout the country.
The constitution established in 1997 provided an enormous opportunity for further progress in restructuring the relationship between the state and civil society. It stimulates the process of decentralization of decision-making and resource allocation, and has created new institutions and mechanisms that allow greater accountability, transparency, representation, and participation at all levels of the development process. It calls for urgent empowerment of citizens, in order to facilitate their influence on the decision-making process in all aspects of implementation of the policy by both central and local government.
National health system reform, launched in 2000, has initiated the new concept of civil involvement in public policy processes. It advocates the development of healthy public policy (or putting health into non-health sectors) to pursue the principle of "all for health" in order to achieve the ultimate goal of health for all. The novel mechanism of HIA has to be created to mediate between all stakeholders of any public policy, so that they work together for a healthier society based on sound evidence.
National Health Act
Reform of the national health system was conducted alongside the drafting process of the National Health Act, which can be seen as an essential means to mobilize all stakeholders to collaborate with each other in redesigning a new mind set for their health system. Although the Act has not yet been finalized, the draft depicts vividly the core and essential structure of the desired health system. Health is stated as the ultimate goal of development and the dignity and basic human rights of all people, and has been redefined as "a state of well-being in four aspects: physical, mental, social, and spiritual". The rights and responsibilities of individuals, the community, local government, and central government in promoting and protecting health are well established. All determinants of health equality and security have been defined in categories such as food security, economic security, social security, political security, and health care security.
The new governance structure in the health sector has been introduced with two main new institutions: the National Health Assembly, as a forum for discussion where people may express their views and aspirations regarding health, and the National Health Committee, as the coordinating body to provide recommendations on national health policy and strategy. The concept of healthy public policy has been developed to ensure that any public policy will take health into account. At the same time, development of the HIA process is an important tool for participatory learning for healthy public policy-making.
The drafting of the National Health Act is planned to finish in 2003, after which it will be submitted to the parliamentary process. Presently, public awareness raising and political involvement schemes are progressing hand in hand with knowledge development in these essential elements of the National Health Act.
HIA development: platforms and pillars
One of the most important aspects to be developed in support of Thailand's health system reform is the knowledge base. The Health Systems Research Institute (HSRI) launched an HIA research and development programme to support the reform in 2001. Its first step was the review of HIA experiences in some selected countries, from which HSRI identified two basic platforms of HIA development that are very important for Thailand to consider. …