Some Health Implications of Globalization in Thailand
Sitthi-amorn, Chitr, Somrongthong, Ratana, Janjaroen, Watana S., Bulletin of the World Health Organization
In recent years Thailand's economy has become increasingly dependent on international forces (1). With this exposure have come advances in health care technology and improvements in living standards, as well as increasing disparities between social groups (2) and exposure to health risks from other parts of the world (3, 4).
Prior to 1997, when the economy was strong, there was intense competition for a share of the health market. Resources were invested in speculative markets with potential for large expansion. Private hospital beds increased from 8066 in 1982 to 21 297 in 1992 and 34 973 in 1996. The number of specialized doctors in private hospitals increased, leading to shortages in the public sector (5). The culture of free enterprise brought with it an enlarged middle class, insurance coverage for hospitalization, tax incentives for private health care, heavy investment in advanced health technology for private sector use, and an internal "brain drain", at the expense of public health (5, 6). Aggressive promotion increased the demand for expensive imported medicines and procedures (7, 8). The cost of medical care for civil servants and state employees has quadrupled in the last seven years, reflecting the lack of adequate governance in the health care business sector (5, 9). Meanwhile the share of the underprivileged in the country's overall wealth was decreasing (4). The slump of 1997, followed by devaluation of the baht, and recession with its concomitant negative health impact, reflects the country's overdependence on cheap labour and foreign investment, and consequent inability to control and protect its own economy.
Direct health effects
Perhaps the most important direct effect of globalization on health in Thailand is unequal access to medical care by different social groups. The rise in imported sophisticated technologies has increased costs and necessitated new training. An analysis made in 1996 found that the average cost of medical care per admission was 1558 bahts for health cardholders (rural) and 9981 bahts for civil servants (privileged), a sixfold difference (10). If these Facilities were treating similar diseases, explanations are needed for the huge variation. The economic gap might create demand unrelated to need and distort market competition. The organization of health service delivery was obscure, and there were no rules governing the payment of providers. Unequal access to care was reflected by unequal health status (2). Infant mortality in the poorest regions was twice as high as in the richest ones.
Second, there are increasing problems of environmental pollution. These include inadequate treatment of raw sewage (for instance, in tourist areas), and the notorious air pollution in Bangkok and other big cities (11). Environmental degradation and disruption of the ecosystem have led to frequent floods and changes in disease vector behaviour. The construction of a dam in the North-eastern region, financed by a loan from a development bank, has caused natural disasters affecting food production (12).
Third, concerns about new infections and the resurgence of old ones have been on the rise. International trade and travel are shaping the patterns of epidemics. The plague scare in India had worldwide reverberations. The nipah virus outbreak in Malaysia caused concerns in Thailand (13). Cholera epidemics can inflict enormous costs on a country, and this results in attempts to hide them by calling the disease "severe diarrhoea". The costs associated with controlling HIV infection continue to rise. Fears of foot and mouth disease have affected meat consumption. The control of new dangers of this kind will require global cooperation but many aspects of control have to be country-specific.
Fourth, globalization has brought with it unhealthy lifestyles. Health has been damaged by the promotion of fashionable drugs, foods and other consumer products such as tobacco, alcohol, melatonin and Viagra. …