Addressing NCDs: Challenges From Industry Market Promotion and Interferences

Addressing the determinants of non-communicable diseases (NCDs) is challenged by aggressive market promotion by tobacco, alcohol and unhealthy food industries in emerging countries with fast economic development; and interference by these industries in government policies aimed at containing consumption of unhealthy products. This editorial reviews market promotion and industry interference and classifies them into four groups of tactics: (a) interfering with the legislative process; (b) using front groups to act on their behalf; (c) questioning the evidence of tobacco harm and the effectiveness of harm-reduction interventions; and (d) appearing responsible in the eyes of the public, journalists and policy-makers. Despite active implementation of the Framework Convention on Tobacco Control (FCTC), the tobacco, alcohol and unhealthy food industries use similar tactics to aggressively interfere in policies, with the tobacco industry being the most aggressive. Policy interference by industries are effective in the context of poor governance, rampant corruption, conflict of interest among political and government actors, and regulatory capture in all levels of countries from low- to high-income. In addressing these interferences, government requires the practice of good governance, effective mechanisms to counteract conflict of interests among political and policy actors, and prevention of regulatory capture. The World Health Organization (WHO) Framework of Engagement with non-State Actors can be applied to the country context when engaging private entities in the prevention and control of NCDs

Evidence on Child Nutrition Recommendations and Challenges in Crisis Settings: A Scoping Review

Adequate child nutrition is critical to child development, yet child malnutrition is prevalent in crisis settings. However, the intersection of malnutrition and disasters is sparse. This study reviews existing evidence on nutrition responses and outcomes for infants and young children during times of crisis. The scoping review was conducted via two approaches: a systematic search and a purposive search. For the systematic search, two key online databases, PubMed and Science Direct, were utilized. In total, data from 32 studies were extracted and included in the data extraction form. Additionally, seven guidelines and policy documents were included, based on relevance to this study. Overall, the existing evidence demonstrates the negative impacts of crises on nutritional status, diet intake, anthropometric failure, and long-term child development. On the other hand, crisis-related interventions positively affected nutrition-related knowledge and practices. Further studies should be carried out to explore the sustainability of the interventions and the success of existing guidelines. Since this study focuses only on nutrition among children under three, further studies should likewise consider an extended age range from three to five years

A Cross-Sectional Study on Disparities in Unmet Need among Refugees and Asylum Seekers in Thailand in 2019

The health of urban refugees and asylum seekers (URAS) in Thailand has been under-researched compared with other groups of non-Thai populations, especially on the topic of unmet need. The aim of this study is to examine the level of unmet need among URAS in Thailand, focusing on out-patient (OP) and in-patient (IP) care. A cross-sectional study was conducted between October and December 2019. Stratified random sampling was undertaken and a total of 181 participants were included. A bivariate analysis was used to explore the level of unmet need among different URAS groups. Multivariate logistic regression was undertaken to examine the association between potential correlations and unmet need of IP and OP care. The majority of participants were female and aged below 30 years, with a low educational background and poor economic status. Most of them had experienced an illness in the past month before the interview, and some suffered from chronic diseases. The prevalence of both OP and IP unmet needs was more frequent among URAS from Arab countries. Furthermore, being from Arab countries indicated a strong link with OP and IP unmet need. Additionally, having illness over the past six months and chronic diseases were found to be significant determinants of IP unmet need. Our analysis showed that nationality had a strong association with both IP and OP unmet need, especially among those from Arab countries. Therefore, culturally appropriate health services should be considered to promote healthcare access among diverse groups of URAS. Further qualitative studies on barriers to accessing OP and IP care, such as communication, interpretation, and social dimensions, are required

Outcomes of the Health Insurance Card Scheme on Migrants’ Use of Health Services in Ranong Province, Thailand

In 2002, Thailand achieved Universal Health Coverage for all citizens; however, it remains the case that undocumented migrants are not fully covered. The Health Insurance Card Scheme (HICS) of the Ministry of Public Health is the key policy aiming to cover undocumented migrants. This study examined the impact of this policy on the utilisation rate of public health facilities among HICS beneficiaries including undocumented migrants. Facility-based individual records between 2011 and 2015 were purposively retrieved from one provincial hospital, one district hospital, and two health centres in one of the most densely migrant-populated provinces in Thailand. Poisson regression was conducted on inpatient (IP) utilisation, while negative binomial regression was conducted on outpatient (OP) utilisation. Of 74,722 admissions, 19.0% were insured by HICS. About 14.0% of the outpatient records were for HICS beneficiaries. Overall, the HICS utilisation rate in migrants was lower than in Thai patients. Being insured with the HICS significantly increased OP utilisation by 1.7%, and IP utilisation by 11.1% (relative to uninsured). Disease status was the most important factor that positively influenced the utilisation rate. Further studies that explore the differences in health service utilisation among HICS beneficiaries with diverse economic backgrounds are recommende

Self-Reported Anxiety and Depression among Parents of Primary School Children during the COVID-19 Pandemic in Thailand, 2022

One significant concern during the COVID-19 pandemic is parents’ mental health, which may consequently affect children’s health and well-being. The objective of this study is to investigate generalized anxiety and depression in parents of primary-school-aged children and identify risk factors for mental health problems. A cross-sectional survey comprising 701 parents of primary school children in five of Thailand’s major provinces was carried out from January to March 2022. Generalized anxiety and depression levels were assessed using the GAD-7 and PHQ-9. Logistic regression was performed to determine the effects of independent variables on anxiety and depression. Results showed that the prevalence of generalized anxiety and depression was 42.7% and 28.5%, respectively, among Thai parents. Three strong associative factors included: (1) having a youngest child with mental health problems; (2) not assisting their children every day; and (3) drinking alcohol. These findings show that the parents must deal with several difficulties when trying to maintain work and parenting duties while being confined at home during emergency situations. The government should provide sufficient assistance to parents who lack skills in handling children with emotional and behavioral problems. Meanwhile, health promotion to reduce alcohol consumption should continue to be an area of focus

Health Literacy and Its Related Determinants in Migrant Health Workers and Migrant Health Volunteers: A Case Study of Thailand, 2019

Migrant health workers (MHWs) and migrant health volunteers (MHVs) are key health workforce actors who play a substantial role in improving the health of migrants in Thailand. The objective of this study was to explore the factors associated with health literacy in MHWs and MHVs in Thailand. A self-administered questionnaire was conducted from December 2018 to April 2019 in two migrant-populated provinces. A total of 40 MHWs, 78 MHVs, and 116 general migrants were included in the survey. Results showed that a higher education level was associated with a greater health literacy score. MHWs were more likely to have a higher health literacy score (5.59 points difference) than general migrants. The province per se and type of affiliations did not significantly contribute to the difference in the health literacy score of each individual. Most MHWs received health information from health professionals, health staff, and the internet, while MHVs and general migrants received information from health professionals, MHWs/MHVs, family/friends, and posters/leaflets. This study suggests that a higher education level should be used as a criterion for recruitment of MHWs and MHVs. Access to interactive health information like health professionals should be promoted as the main source of information to ensure better health literacy among MHWs and MHVs

Education for non-citizen children in Malaysia during the COVID-19 pandemic: A qualitative study

10.1371/journal.pone.0259546PLoS ONE1612 Decembere025954

Understanding the Problem of Access to Public Health Insurance Schemes among Cross-Border Migrants in Thailand through Systems Thinking

Thailand has become a popular destination for international migrant workers, particularly from Cambodia, Lao PDR, and Myanmar. However, only a fraction of these migrant workers were insured by public health insurance. The objective of this study was to apply systems thinking to explore contextual factors affecting access to public health insurance among cross-border migrants in Thailand. A group model building approach was applied. Participants (n = 20) were encouraged to share ideas about underlying drivers and barriers of migrants’ access to health insurance. The causal loop diagram and stock and flow diagram were synthesised to identify the dynamics of access to migrant health insurance. Results showed that nationality verification is an important mechanism to deal with the precarious citizenship status of undocumented migrants. However, some migrants are still left uninsured. The likely explanations are the semi-voluntary nature of the Health Insurance Card Scheme, administrative delay of the enrollment process, and resistance of some employers to hiring migrants. As a result, findings suggest that effective communication is required to raise acceptance towards insurance among migrants and their employers. A participatory public policy process is needed to create a good balance of migrant policies among diverse authorities

Access to Healthcare and Social Protection among Migrant Workers in Thailand before and during COVID-19 Era: A Qualitative Study

Thailand is a popular host nation for international migrant workers, particularly those from Cambodia, Lao PDR, and Myanmar. Thailand has introduced approaches to protect their rights for health and social welfare, using various mechanisms over many years. However, the implementation of these policies is dynamic and has been influenced by national security, economic necessity, and public health concerns. The aim of this study was to explore how Thailand designs and implements health and social welfare policies for migrants in Thailand, both before and during COVID-19. A qualitative analysis was used alongside interviews with 18 key informants in various sectors in this field. Thematic coding was applied. Results show that there were seven key themes emerging from the analysis, including: (i) sustainability of the HICS; (ii) people dropping out from the Social Security Scheme (SSS); (iii) quality of health screening in the Memorandum of Understanding (MOU) migrants; (iv) health screening problems and state quarantine management in response to COVID-19; (v) managing the migration quota and dependency on migrant workers; (vi) influx of migrants in the backdrop of COVID-19; and (vii) poor living conditions of migrants and the impact of COVID-19. The majority of interviewees agreed that undocumented migrants is a critical concern that impedes access to migrants’ health and social welfare. This situation was especially pronounced during the second wave of COVID-19 in Thailand, which took hold in migrant communities. In the short term, the poor living conditions of migrants urgently need to be addressed in order to contain and mitigate this crisis. In the long term, there needs to be an improved health system design that includes migrants, regardless of their immigration status. This requires intersectoral policy coherence, including the hastening of nationality verification to sustainably mitigate undocumented migrants