1. International Health Policy Program -Thailand 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’ 24-26 June 2008 The Siam City Hotel How to design and implement effective public health to prevent and mitigate the impact of disease: experiences from Thailand and beyond

2. International Health Policy Program -Thailand 2 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

3. Disability adjusted life years (DALY) loss in Thailand by three major categories in 2004 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 MaleFemale Source: Thai Burden of Disease (BOD) Study

4. Top ten: DALY loss in Thailand in 2004 % of Total52.6 42.8 Source: Thai Burden of Disease (BOD) Study

5. Prevalence of regular smoking in Thailand from 1991 to 2006 Source: Tobacco Control Research and Knowledge Management Centre (TRC)

6. 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. Public policies in reducing regular smoking and morbidity in Thailand

7. Smoker Die From Emphysema Cigarette Smoke Kill Cigarette Smoke Cause Lung Cancer Examples of health warning on cigarette packages in 2005

8. International Health Policy Program -Thailand 8 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.

9. Enormous current benefits of prior prevention efforts towards HIV/AIDS control in Thailand Red line represents what might have been if behaviors had not changed Infections prevented

10. Outcome of introducing prevention of mother- to-child transmission of HIV (PMTCT) in 2000 Pediatric AIDS cases in Thailand 1984 – 2003 MOPH Thailand, Epidemiology Division

11. 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%. The majority of health expenditure was for curative services and rehabilitation, 79% in 2001 and 78% in 2004.

12. 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

13. International Health Policy Program -Thailand 13 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 (2 nd 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.