The social determinants of health of the Urak Lawoi’ of southern Thailand

Abstract

Background: Traditionally, most Western models of health viewed sickness and disease as a product of individual factors such as personal behaviors and genetic predisposition; consequently, healthcare interventions were largely focused on fixing the individual, with little attention placed on contributing external factors. The WHO's "Social Determinants of Health" (SDH) framework, however, takes a broader ecological perspective that suggests that interventions must occur at multiple levels in order for good health to be achieved on an equitable basis. This model views health as a function of many circumstantial and environmental factors that are continuously and simultaneously interacting across multiple domains. These factors include structural mechanisms, such as laws and policies; socioeconomic conditions, such as education and occupation; and intermediary circumstances, such as living and working conditions. Utilizing the SDH framework as a guide, this qualitative study sought to identify which specific determinants are most significant and present the greatest risk to the health and well-being of the Urak Lawoi' (UL), a "sea nomad" group indigenous to southern Thailand. Methods: Interviews, household surveys, and focus group discussions were utilized to gather primary data from 71 subjects in three different UL communities in southern Thailand. In addition, a comprehensive literature review of relevant international mechanisms, national laws, and national policies was conducted. All data collected was analyzed and coded utilizing HyperRESEARCH. Results: In all three communities, education and livelihoods were found to be the most critical determinants. Additionally, land grabbing and living conditions were identified as dire issues on Ko Lipe. The law and policy review revealed several deviations between international mechanisms and national laws and policies in both enshrinement and enforcement, with the Royal Thai Government (RTG) often overlooking the interests of the UL when formulating laws and policies. Conclusions: The above-mentioned determinants, along other structural and intermediary determinants, are synergizing, thereby placing the UL at increased risk of poorer health and health outcomes compared to other Thais living in the same vicinities. To rectify this, the RTG must reform national laws and policies that harm the UL, and civil society must hold them accountable. Several recommendations are offered to achieve a better future for the Urak Lawoi'.

Nutritional inequalities among under-5 children: An analysis of cross-country and within-country hotspots and cold spots in the developing world

“…Collectively, these circumstances are known as the "Social Determinants of Health" (SDH) and include laws, policies, economics, livelihood, education, living conditions, etc. (Reap et al, 2020). Within each society, those who hold power and resources determine which specific circumstances are valued and which are not.…”

“…This model views health as a function of many circumstantial and environmental factors that are continuously and simultaneously interacting across multiple domains. These factors include structural mechanisms, such as laws and policies; socio-economic conditions, such as education and occupation; and intermediary circumstances, such as living and working conditions (Reap et al, 2020).…”

“…This reduction in job opportunities may result in lower income potential, thereby reducing the ability to make choices regarding living conditions and nutrition. With fewer options available, the marginalized population may have to settle for inferior housing or unhealthy foods, resulting in serious health consequences (Reap et al, 2020).…”

Etnoeducación: educación para la salud desde la diversidad cultural

“…Según la Organización Mundial de la Salud (OMS), las diferencias en salud y bienestar son atribuibles a circunstancias específicas en las que "las personas nacen, crecen, viven, trabajan y envejecen", circunstancias que se conocen como los "determinantes sociales de salud" e incluyen leyes, políticas, economía, educación, condiciones de vida, etc. (2).…”

“…En 2009, la Organización de las Naciones Unidas (ONU) publicó un documento de análisis exhaustivo titulado "El estado de los pueblos indígenas del mundo", los resultados de este análisis ilustraron que el estado socioeconómico de las poblaciones indígenas en las naciones y territorios a nivel mundial es sustancialmente más bajo que el de otros que viven dentro de la misma zona. Los pueblos indígenas son menos educados que sus vecinos no indígenas y tienen menos oportunidades de medios de vida decentes disponibles para ellos (2).…”