-Thailand International Health Policy Program -Thailand International Health Policy Program How to design and implement effective public health to prevent and mitigate the impact of disease: experiences from Thailand and beyond Phusit Prakongsai, MD. Ph.D. Walaiporn Patcharanarumol, MSc. Ph.D. Viroj Tangcharoensathien, MD. Ph.D. International Health Policy Program (IHPP) - Thailand Presentation to the World Bank workshop on ‘Managing Vulnerability in East Asia and the Pacific’ 26 June 2008 The Siam City Hotel International Health Policy Program -Thailand International Health Policy Program -Thailand Outline of presentation • Burden of disease in Thailand in 2004 • Two examples of public policies and disease prevention in Thailand: – Control of tobacco consumption in Thailand – HIV/AIDS • Health expenditure in Thailand in 2001 and 2005 • Innovative financing on health promotion • Conclusions and policy recommendations 2 Disability adjusted life years (DALY) loss in Thailand by three major categories in 2004 Group III, 0.3 Group I, 1.2 Group III, 1.0 Group I, 0.9 Group II, 3.4 Group II, 3.1 Male Female Total = 9.9 Million DALYs (Males: 5.7 , Female: 4.2) Group I Infections, maternal, perinatal and nutritional conditions = 2.1 Million DALYs Group II Non-communicable diseases = 6.5 Million DALYs Group III Injuries = 1.3 Million DALYs Source: Thai Burden of Disease (BOD) Study Top ten: DALY loss in Thailand in 2004 DALY Male Rank Disease 1 HIV/AIDS 2 Traffic accidents 3 Stroke 4 Alcohol dependence/harmful use 5 Liver and bile duct cancer 6 COPD 7 Ischaemic heart disease 8 Diabetes 9 Cirrhosis 10 Depression % of Total Female DALY % ('000) 645 11.3 584 10.2 332 5.8 332 5.8 280 4.9 187 3.3 184 3.2 175 3.1 144 2.5 137 2.4 52.6 % 7.4 6.9 6.4 4.6 3.4 3.0 3.0 2.8 2.7 2.6 42.8 Source: Thai Burden of Disease (BOD) Study DALY Disease ('000) 313 Stroke 291 HIV/AIDS 271 Diabetes 191 Depression 142 Ischaemic heart disease 125 Traffic accidents 124 Liver and bile duct cancer 118 Osteoarthritis 115 COPD 111 Cataracts Prevalence of regular smoking in Thailand from 1991 to 2006 Prevalence of regular smoking (per 100 population) 35 30.46 30 25.36 25 22.47 20 19.47 18.94 15 10 5 0 1991 1991 4.6 1996 2.97 2001 2.42 2004 2.11 2006 2 0 1996 2001 2004 2006 55.63 49.21 42.93 37.16 36.91 10 20 30 40 50 60 Prevalence in male (per 100 population) Prevalence in female (per 100 population) Source: Tobacco Control Research and Knowledge Management Centre (TRC) Public policies in reducing regular smoking and morbidity in Thailand • Currently, Thailand has a strong comprehensive tobacco control policy • It took almost four decades of effective tobacco control efforts • Effective interventions through the Framework Convention on Tobacco Control (FCTC): The regular tax increase policy is on course, Total bans on smoking in public places with strong enforcement, Total bans on advertising and cigarette displays and strong enforcement, Pictorial health warnings on cigarette packages. – – – – 3,000 90 79 80 55 2,000 50 40 1,500 30.5 25.4 30 22.5 19.5 20 18.9 49 48 25 25 46 47 25 45 25 44 25 43 25 25 41 42 25 40 25 39 25 38 25 25 36 37 25 25 35 0 34 0 25 1,000 500 10 25 percent 60 prevalence of year cigarette smoking percent of excised tax on tobacco Number of cigarette consumption in million packs Number of cigarrette consumed (million packs) 2,500 70 Smoker Die From Emphysema Cigarette Smoke Kill Cigarette Smoke Cause Lung Cancer Examples of health warning on cigarette packages in 2005 International Health Policy Program -Thailand International Health Policy Program -Thailand Key successes of tobacco control in Thailand • There is a need to have a champion (either GO or NGOs) who work patiently and continuously with legislators and regulators as well as policy makers, • Being direct, clear, and ready with realistic proposals to offer politicians, • Policy-relevant research is very important in mobilizing public opinion and lobbying for government actions, especially for Minister of Finance and Minister of Health, • Nationalism and cultural values can be successfully used to encounter tobacco promotion from international tobacco companies. 8 Enormous current benefits of prior prevention efforts towards HIV/AIDS control in Thailand Baseline Current HIV Infections in millions 10 8 Red line represents what might have been if behaviors had not changed No Intervention 7.1 Infections prevented 6 4 2 0 1985 0.7 1990 1995 2000 2005 2010 Outcome of introducing prevention of motherto-child transmission of HIV (PMTCT) in 2000 Pediatric AIDS cases in Thailand 1984 – 2003 1400 1208 1250 1200 1000 1145 1061 915 907 803 800 680 600 461 400 277 200 21 74 136 29 0 19841990 1991 1992 1993 1994 1995 1996 MOPH Thailand, Epidemiology Division 1997 1998 1999 2000 2001 2002 2003 Inadequate health expenditure for health promotion and disease prevention in Thailand • From 2001 to 2005, health expenditure for health promotion and disease prevention in Thailand decreased from 8% to 4.8%. Health administration and health insurance 8.5% Gross capital formation 3.9% • The majority of health expenditure was for curative services and rehabilitation, 79% in 2001 and 78% in 2004. Prevention and public health services 4.8% Medical goods 4.3% Ancillary services 0.4% Services of curative & rehabilitative care 78.1% Innovative financing for health promotion: Thai Health Promotion Foundation (THPF) • THPF is a statutory public organization established by the Health Promotion Foundation Act in 2001 • The Fund is an innovative financing mechanism generating revenue from 2% surcharge of alcohol and cigarette sales • Its mission is to empower civic society and promotes well-being of the citizens by acting as a catalyst and provide financial support for health promotion projects, • Three main factors for early achievements of THPF – Financial sustainability, – Accountable agency with efficient management structure, – Effective strategies in promoting public health and policies International Health Policy Program -Thailand International Health Policy Program -Thailand Conclusions and policy recommendations • Sustaining positive public policies in controlling tobacco consumption and reducing other major disease burden e.g. alcohol consumption, road traffic accident, diabetes, and hypertension, hyper-lipidemia, etc. • Increasing level of financing health promotion and disease prevention (primary, secondary, and tertiary prevention), • Increasing value of money through applying cost-effective clinical prevention and health promotion suggested by the Disease Control Priority for Developing Countries (2nd edition), • Improving program effectiveness (technical efficiency) in health promotion and disease prevention, • Sustain and accelerate the work of Thai Health Promotion Foundation through: – Increase the level of sin tax from 2% to 5%, – Diversify the portfolio of the THPF to cover more cost-effective interventions, esp. effective coverage of interventions focusing on chronic NCD . 13