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Background The Thailand National Strategic Plan on Antimicrobial Resistance (AMR) 2017–2021, endorsed by the Thai Cabinet in 2016, aims to increase public knowledge about antibiotics and AMR awareness by 20% by 2021. This study assesses the prevalence of antibiotics use, clinical indications and sources; knowledge and access to information related to antibiotics and AMR; and factors related to level of knowledge and access to information among Thai adult population. Methods An AMR module was developed and embedded into the 2017 Health and Welfare Survey; a cross-sectional, two-stage stratified sampling, nationally representative household survey carried out biannually by National Statistical Office. The survey applied a structured interview questionnaire. The survey was conducted in March 2017 where 27,762 Thai adults were interviewed of the AMR module. Data were analyzed using descriptive and inferential statistics. Results The one-month prevalence of antibiotic use was 7.9% for three common conditions; flu (27.0%), fever (19.2%) and sore throat (16.8%). The majority of antibiotics (70.3%) were provided by public or private healthcare facilities, and 26.7% by pharmacies. Thai adults have low levels of knowledge about antibiotics; only 2.6 gave correct answers to all six statements related to antibiotics, while 13.5% gave wrong answers to all six statements. A few factors associated with knowledge and having received information on antibiotics were assessed. People who have higher education levels, and belong to richer wealth quintiles, and receive antibiotics and AMR information have significantly higher levels of knowledge about antibiotics. In the last 12 months, only 17.8% of respondents had heard information about the proper use of antibiotics and AMR; mostly from doctors (36.1%), health workers (24.8%) and pharmacists (17.7%). Conclusions There is a large gap of public knowledge about the use of antibiotics. The main communication channel is through healthcare professionals, which indicates they are key persons in communicating information about the proper use of antibiotics to the public.

Background Thailand, an upper-middle income country, has demonstrated exemplary outcomes of Universal Health Coverage (UHC). The country achieved full population coverage and a high level of financial risk protection since 2002, through implementing three public health insurance schemes. UHC has two explicit goals of improved access to health services and financial protection where use of these services does not create financial hardship. Prior studies in Thailand do not provide evidence of long-term UHC financial risk protection. This study assessed financial risk protection as measured by the incidence of catastrophic health spending and impoverishment in Thai households prior to and after UHC in 2002. Methods We used data from a 15-year series of annual national household socioeconomic surveys (SES) between 1996 and 2015, which were conducted by the National Statistic Office (NSO). The survey covered about 52,000 nationally representative households in each round. Descriptive statistics were used to assess the incidence of catastrophic payment as measured by the share of out-of-pocket payment (OOP) for health by households exceeding 10 and 25% of household total consumption expenditure, and the incidence of impoverishment as determined by the additional number of non-poor households falling below the national and international poverty lines after making health payments. Results Using the 10% threshold, the incidence of catastrophic spending dropped from 6.0% in 1996 to 2% in 2015. This incidence reduced more significantly when the 25% threshold was applied from 1.8 to 0.4% during the same period. The incidence of impoverishment against the national poverty line reduced considerably from 2.2% in 1996 to approximately 0.3% in 2015. When the international poverty line of US$ 3.1 per capita per day was applied, the incidence of impoverishment was 1.4 and 0.4% in 1996 and 2015 respectively; and when US$ 1.9 per day was applied, the incidence was negligibly low. Conclusion The significant decline in the incidence of catastrophic health spending and impoverishment was attributed to the deliberate design of Thailand’s UHC, which provides a comprehensive benefits package and zero co-payment at point of services. The well-founded healthcare delivery system and favourable benefits package concertedly support the achievement of UHC goals of access and financial risk protection.

To assess the marketing of food on Facebook in relation to Government regulations and the industry’s self-regulatory codes in Thailand, Facebook pages of 30 of the most popular food brands with young people in Thailand and consumer engagement (number of likes, shares, and comments) were recorded and had their marketing content transcribed during the month of December 2017. We coded the contents into 17 marketing techniques and conducted content analysis of these posts in relation to Government regulations and the industry’s self-regulatory codes. A total 752 posts were identified in one month. Retail food brand pages had the highest figures for engagement by Facebook viewers. The most common marketing techniques were the use of pictures (632 posts), followed by branding elements (569 posts) and hashtags (438 posts). Out of a total of 228 spot advert posts, all confectionery adverts and almost all (99.5%) soft drink adverts did not display the advertising license number and none of the confectionery adverts displayed the warning messages as required by law. Confectionery, retail food, and soft drink advertising violated the industry’s self-regulatory codes. The food brand Facebook pages in Thailand do not comply with Government regulations and the industry’s self-regulatory codes. The Government, civil society organizations, and academia should monitor these violations and improve enforcement.

Background The World Health Organization (WHO) recommends sugar-sweetened beverage (SSB) taxes to address obesity. Thailand has just launched the new tax rates for SSB in 2017; however, the existing tax rate is not as high as the 20% recommended by the WHO. The objective for this study was to estimate the impacts of an SSB tax on body mass index (BMI) and obesity prevalence in Thailand under three different scenarios based on existing SSB and recommended tax rates. Methods A base model was built to estimate the impacts of an SSB tax on SSB consumption, energy intake, BMI, and obesity prevalence. Literature review was conducted to estimate pass on rate, price elasticity, energy compensation, and energy balance to weight change. Different tax rates (11%, 20% and 25%) were used in the model. The model assumed no substitution effects, model values were based on international data since there was no empirical Thai data available. Differential effects by income groups were not estimated. Findings When applying 11%, 20%, and 25% tax rates together with 100% pass on rate and an -1.30 own-price elasticity, the SSB consumption decreased by 14%, 26%, and 32%, respectively. The 20% and 25% price increase in SSB price tended to reduce higher energy intake, weight status and BMI, when compared with an 11% increase in existing price increase of SSB. The percentage changes of obesity prevalence of 11%, 20% and 25% SSB tax rates were estimated to be 1.73%, 3.83%, and 4.91%, respectively. Conclusions A higher SSB tax (20% and 25%) was estimated to reduce consumption and consequently decrease obesity prevalence. Since Thailand has already endorsed the excise tax structure, the new excise tax structure for SSB should be scaled up to a 20% or 25% tax rate if the SSB consumption change does not meet a favourable goal.

BackgroundFood advertising is a key factor which influences children’s food preferences. This study assessed the rates, nutritional quality and contents of food and beverage advertising in children’s, youth and family television programmes in Thailand.MethodsFree TV was recorded for two weeks in March 2014 from six to ten am and three to eight pm on weekends and three to eight pm on weekdays across all four channels; a total of 344 h recorded. Digital TV was recorded across three channels for one week for 24 h per day in October 2014; a total 504 h recorded.ResultsFor Free TV, 1359 food advertisements were identified, with on average 2.9 non-core food advertisements per hour per channel. The most frequently advertised food products on free TV were sugar-sweetened drinks. The rates of advertisements containing promotional characters and premium offers were significantly higher for non-core than core foods, 1.2 versus 0.03 and 0.6 versus 0.0 per hour respectively. For Digital TV, 693 food advertisements were identified, with an average of one non-core food advertisement per hour per channel. The most frequently advertised food products on digital TV were baby and toddler milk formulae.ConclusionsFood and beverage advertising on Thai television is predominantly unhealthy. Therefore, the Government and related agencies should introduce and enforce policies to address this issue. Current regulations should be adapted to control both the frequency and nature of unhealthy on-air food marketing to protect the health of Thai children.

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Background Extending Universal Health Coverage (UHC) requires identifying and addressing unmet healthcare need and its causes to improve access to essential health services. Unmet need is a useful monitoring indicator to verify if low incidence of catastrophic health spending is not a result of foregone services due to unmet needs. This study assesses the trend, between 2011 and 2019, of prevalence and reasons of unmet healthcare need and identifies population groups who had unmet needs. Method The unmet healthcare need module in the Health and Welfare Survey (HWS) 2011–2019 was used for analysis. HWS is a nationally representative household survey conducted by the National Statistical Office biennially. There are more than 60,000 respondents in each round of survey. The Organisation for Economic Co-operation and Development (OECD) standard questions on unmet need and reasons behind were applied for outpatient (OP), inpatient (IP) and dental services in the past 12 months. Data from samples were weighted to represent the Thai population. Univariate analysis was applied to assess unmet need across socioeconomic profiles. Results The annual prevalence of unmet need between 2011 and 2019 was lower than 3%. The prevalence was 1.3–1.6% for outpatient services, 0.9% - 1.1% for dental services, and lower than 0.2% for inpatient care. A small increasing trend was observed on dental service unmet need, from 0.9% in 2011 to 1.1% in 2019. The poor, the elderly and people living in urban areas had higher unmet needs than their counterparts. Long waiting times was the main reason for unmet need, while cost of treatment was not an issue. Conclusion The low level of unmet need at less than 3% was lower than OECD average (28%), and was the result of UHC since 2002. Regular monitoring using the national representative household survey to estimate annual prevalence and reasons for unmet need can guide policy to sustain and improve access by certain population groups.