The importance of population health and well-being has taken center stage with the ongoing COVID-19 pandemic. Specifically, the coronavirus crisis has demonstrated the impact non-communicable diseases (NCDs), such as cancer or heart disease, and their risk factors, such as tobacco and alcohol, can have on communicable diseases, such as the coronavirus. People with underlying conditions, such as NCDs are at a higher risk of COVID-19 infection and more serious health complications.
Alcohol use along with tobacco use, lack of physical exercise, high sugar and high salt products, and pollution are major risk factors contributing to the NCDs burden the world over. In Thailand, NCDs kill over 1000 people every day. The main NCDs – cancers, cardiovascular diseases, diabetes, and chronic respiratory diseases – kill about 400,000 Thais every year.
Alcohol is a major risk factor for all of these NCDs. Science has shown the links alcohol has with cancer, cardiovascular disease and diabetes.
But NCDs still do not receive the attentions they ought to in Thailand. 90% of the Thais who died due to COVID-19 were elderly or had an underlying chronic disease, often an NCD. Meanwhile the NCDs burden keeps increasing, fuelled by alcohol. And the pandemic has made matters even worse.
Thailand is more vulnerable to NCDs
The health risks posed to the Thai people are higher than in neighbouring countries.
- Thailand has the highest level of alcohol use in the WHO South-East Asia region (twice the regional average).
- Sugar intake is twice higher than the regional average.
- Salt intake is four times higher than the regional average.
- Smoking is a leading cause of death and disease.
- Nine out of ten young people are not getting enough exercise (at least 150-300 minutes per week).
- The prevalence of obesity is the second highest in Asia – some 42% of Thais are overweight.
- Thailand has a fast ageing population. By 2040 one in four Thais will be over the age of 65.
The alcohol burden in Thailand
According to the World Health Organization the total per capita alcohol consumption in Thailand is at 8.3 liters. This is higher than the WHO South-East Asia regional average. Thai men who do consume alcohol consume 26.2 liters of alcohol per capita. Nearly half (47.4%) of young people between 15 to 19 years who consume alcohol engage in binge alcohol use.
The death rate due to alcohol is staggering:
- 10,009 Thais die from liver cirrhosis due to alcohol,
- 6759 Thais die in road traffic crashes due to alcohol, and
- 5680 Thais from cancer due to alcohol.
Literally, the products and practices of the alcohol industry in Thailand lead to death and disease.
Furthermore, 10% of Thai men have an alcohol use disorder, while 3.5% are alcohol dependent.
The economic cost of Thailand’s NCD burden
The NCD burden costs Thai people and communities their future. The annual economic losses from NCDs are estimated to be THB1.6 trillion (US$473 billion), or 9.7% of GDP.
The rising costs of NCDs take up half the budget of the Universal Health Coverage program in Thailand, thus, threatening its sustainability over time.
Government action to tackle NCDs
The Thai government has taken several actions to reduce the NCDs burden in general and the alcohol burden in particular.
- One of the key actions for health promotion is the Thai Health Promotion Foundation (ThaiHealth) which is funded by a 2% surcharge on alcohol and tobacco taxes since 2001.
- In 2020, the The National Alcohol Policy Committee and an international alcohol control assessment team of the World Health Organization (WHO) praised Thailand for their alcohol policy solutions.
- Thailand has launched national plans for the prevention and control of NCDs (2017-2021) and the promotion of physical activity (2018–2030).
- Currently, cigarette packs have plain packaging and must carry large health warnings.
- A tax on sugar sweetened beverages was implemented from 2017.
- And a tax on salt is currently under discussion.
However, still more needs to be done if Thailand is to reach the Agenda 2030 for Sustainable Development target of reducing by one-third premature deaths from NCDs.
Case for investment on NCD prevention in Thailand
The United Nations in Thailand, in collaboration with the Ministry of Public Health, conducted a study on the return of investment investment in NCDs best buy policies in the country.
They found that a targeted investment of THB211 billion (US$ 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 (approx. US$ 13 billion) over 15 years.
The experts also modelled the return on investment for the NCDs risk-factor-specific policy packages. They found that the alcohol policy best buys are projected to have the greatest impact in terms of lives saved (114,764 lives saved). And more than 5.8 million healthy life years could be gained through implementation of high-impact alcohol policy solutions in Thailand.
Alcohol policies, particularly those to prevent alcohol use at an early age and prevent morbidity that would last a lifetime, are expected to have the highest impact on healthy life-years.”Ministry of Public Health of Thailand, World Health Organization, United Nations Development Programme, and the United Nations Inter-Agency Task Force on the Prevention and Control of NCDs
For the investment in the alcohol policy package alone, the total productivity benefits over 15 years would be THB152.56 billion (approx. US$ 4.6 billion) with an ROI of 2.28.
The investment case tackles the effect of commercial and social determinants in creating unhealthy behaviors which drive more NCDs. The case lists six key recommendations:
- Adovocate for additional increases in taxes on health-harming products and introduction of subsidies for healthy products.
- Ensure that standard tax rates are applied to all alcoholic beverage categories, and increase the excise tax regularly, taking inflation and income growth into account.
- Strenghten enforcement of preventive NCD regulations to ensure accountability among sectors and levels. Stronger enforcement is necessary, particularly of bans on the availability of alcohol and prevention of the sale of tobacco and alcohol to minors.
- Use local taxes from alcohol and tobacco to support tobacco and alcohol control, including training officials in all relevant ministries.
- Improve novel policies to implorve access to safe, nutritious food for all.
- Prevent interference from tobacco, alcohol, air polluting and food industries to ensure that the public interest supersedes commercial interests.
- Develop and disseminate official guidelines for national ministries and other public bodies to define appropriate code of conduct in relation to the alcohol, tobacco and food industries.
- Organize workshops or sectoral briefings to raise awareness in other ministries about the risk and implications of industry interference in national NCD prevention and control.
- Establish a multi-partner group led by academia or civil society to monitor industry interference and to release the information publicly at regular intervals.
- Strengthen national leadership, coordination and accountability for preventing and controlling NCDs.
- Support the work of champions and agents of change.
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,” wrote Dr Jos Vandelaer, WHO Representative and Mr Renaud Meyer, Resident Representative, UNDP Thailand, as per The Nation Thailand.Dr Jos Vandelaer, WHO Representative and Mr Renaud Meyer, Resident Representative, UNDP Thailand