The silent killers that threaten Thailand’s future

Exacerbating the crisis, Thailand is also still facing another epidemic that kills over 1,000 people every day: noncommunicable diseases (NCDs). The main NCDs—cancers, cardiovascular diseases, diabetes, and chronic respiratory diseases—kill some 400,000 people in Thailand every year. About half of these deaths are premature (occurring at the ages of 30-70). The good news is that most of these premature deaths are preventable.

NCDs place an enormous burden on the Thai economy and society. Ever-present and far deadlier than Covid-19, they have not been given attention commensurate with their devastating impact. Thailand’s response to Covid-19 has shown how prioritising a major public health crisis can save lives. The government created new institutional mechanisms to coordinate the Covid-19 response at the highest level, empowered policymakers, and made money available. But what about the NCDs that account for three out of four deaths, year after year?

NCDs are associated with increased globalisation and consumerism, aggressive marketing of unhealthy foods, sugary drinks, alcohol and tobacco products, a lack of physical activity, air pollution, and ageing societies. Thailand is more vulnerable than its neighbours. It has the highest level of alcohol use in the WHO South-East Asia region (twice the regional average). Salt and sugar intake are two and four times, respectively, the WHO-recommended amount. Smoking remains the leading cause of disease and death. Nine out of ten youths are not getting enough exercise (at least 150-300 minutes per week). The prevalence of obesity is the second highest in Asia—some 42 per cent of Thais are overweight.

These behavioural and metabolic risks have been further accentuated due to increased consumption of fast food, physical inactivity and disruption to health promotion services during the Covid-19 epidemic. Thailand’s “super-ageing” society will push up further the prevalence of NCDs. By 2040, one in four Thais will be over 65 (compared with one in eight presently).

Reducing the burden of NCDs is vital to people's health and Thailand’s future. The annual economic losses from NCDs are estimated to be THB1.6 trillion (US$473 billion), or 9.7 per cent of GDP. The rising cost of treating NCDs threatens the sustainability of Thailand's highly successful Universal Health Coverage System (NCDs already gobble up half of its budget). NCDs also place a major burden on the business sector. Every day, some 74,000 Thais are absent from work because of an NCD. Lastly, NCDs make people vulnerable: nearly 90 per cent of people who have died of Covid-19 in Thailand were elderly or had an underlying chronic disease, often an NCD.

The government has taken various measures to tackle the unfolding NCD epidemic. It has launched national plans for the prevention and control of NCDs (2017-2021) and the promotion of physical activity (2018–2030). The Thai Health Promotion Foundation (ThaiHealth), funded by a 2 per cent surcharge on alcohol and tobacco excise taxes since 2001, plays a central role in health promotion. Cigarette packs are sold in plain packaging and carry large graphic health warnings. In 2017, the government introduced a tax on sugar-sweetened beverages; a tax on salt is in the works. 

But much more needs to be done if Thailand is to reduce by one-third premature deaths from NCDs by 2030—one of the United Nations Sustainable Development Goals. To support further NCD action in Thailand, the United Nations in Thailand in collaboration with the Ministry of Public Health recently conducted an economic analysis of the cost of NCDs and the return on NCD investment.

The results show that a targeted investment of THB211 billion (US$6.2 billion) in the areas of salt reduction, tobacco and alcohol control and physical activity would save 310,000 lives and generate economic benefits worth THB430 billion over fifteen years. In short, the case for investing in NCD prevention and treatment is overwhelming.

While most NCDs are related to unhealthy behaviours—tobacco and alcohol use, too much salt, sugar, and fats, and too little physical activity—these are deeply shaped by underlying commercial and social determinants. Behaviour change therefore requires an enabling environment that makes adopting a healthy lifestyle an easy choice. 

A mix of better enforcement of existing laws, policies to promote exercise and nutritious food, and measures that put public health above commercial interests are needed. Fiscal and regulatory measures aimed at reducing tobacco and alcohol use and salt and sugar intake will remain instrumental tools. Equally vital are improvements in early detection and interventions against NCDs at the primary health care level. Going forward, the private sector will have to play a bigger role in combatting NCDs and shaping healthier lifestyles.

The illnesses rooted in underlying social and commercial factors and rapidly changing lifestyles will not go away. But change is possible. Countries like Finland, where policies for health promotion and early detection and treatment of NCDs have led to a significant drop in mortality, have shown the way.

The Covid-19 pandemic has demonstrated that minimizing a major public health threat requires individual action, a coordinated response from all sectors of government and society, and decisive political leadership.

If Thailand was able to rapidly respond to and control the Covid-19 epidemic, it surely can do the same with a threat that causes more deaths and damage to the economy.

By Dr Jos Vandelaer, WHO Representative and Mr Renaud Meyer, Resident Representative, UNDP Thailand