An elderly woman from the Mae Tao River basin shows a patient card of the Cadmium Project after suffering from kidney degeneration. A study by the International Water Resources Management Organization (IWRA) from 1998-2003, in collaboration with the Department of Agriculture, found cadmium contamination in water, soil, and rice in the Mae Tao watershed. More than 800 villagers were contaminated with cadmium in their bodies. Many studies have confirmed that cadmium causes the kidneys to overwork, leading to kidney disease and osteoporosis. Hence, living in areas contaminated with pollutants and heavy metals threatens people’s health and well-being.

Mae Tao River basin, Mae Sot district, Tak province
Photo: ©Roengrit Kongmuang


Story: Radda Larpnun/ Roengrit Kongmuang
Photos: Roengrit Kongmuang
The Photo Essay series: SDGs I The Depth of Field
MARCH 13, 2023

According to the World Health Organization (WHO), Thailand has succeeded in expanding access to health services under the Universal Health Coverage (UHC) scheme to 99.6 per cent of the population since 2021, which is the highest coverage in Southeast Asia. 

Thailand has already met the UN Sustainable Development Goal (SDG) on the UHC, which requires introducing a measure to achieve the target of a one-third reduction in the incidence of non-communicable diseases by 2030.

Thailand has been making good progress on most of the health SDG targets. For example, the extent of universal health coverage (SDG3.8) and financial protection increased from 59% of the population in 2010 to 85% in 2019.

However, public health measures and lockdowns have both positive and negative impacts. On the positive side, the ban on alcohol sales and travel during the lockdowns contributed to a 60% decrease in traffic accidents and 20% less particulate matter in the air. Better personal hygiene and health literacy and lower incidence of infectious diseases resulted in a 25% decrease in influenza, a more than 40% fall in dengue and scrub typhus cases, and a nearly two-thirds decrease in measles cases. 

On the negative side, suicide in the first quarter increased by 14% year on year. In addition, mental health problems increased by two-thirds because of stress during the lockdown and impoverishment. Also, the mobilization of resources to cope with COVID-19 disrupted the delivery of standard health service and lowered the quality of care services, especially to the more vulnerable sections of the population.

In terms of the health service, the government plans spending on the health system as part of the stimulus package, making healthcare spending rise by nearly 2%. 

However, a sound health system will respond well to the problem if built on deep foresight. Awareness and the ability to protect yourself and your family from illness are as crucial as access to public health services—the problem of urban poor industrial pollution problems, and social inequality problems. Even extreme poverty in one society directly affects people in another. Issues of one class affect another class. Hence, the insecurity and inaccessibility of a single health and well-being system pose a comprehensive and inevitable problem of health security for all of us.

COVID-19 has revealed many aspects of weaknesses. For example, dimensions of the public health system are the opportunity to access the number of beds for intensive care patients and the dissemination of information which often confuses them. In addition, the arrival of COVID also makes taking care of patients with other diseases all over the system.

Over the years, studies and recommendations from many public health and health scholars have attempted to shed light on new factors and challenges. Unfortunately, that happens in today’s world. Using the old definition of health may not cope with those new challenges.

Health, therefore, has been made to have a broader meaning. It’s not just about illness from infectious diseases taking medicine anymore. Still, it has implications linked to various relationships, including politics, economy, society, agriculture, industry, technology, and environmental resources. In addition, it may be connected to climate change and global warming, social determinants of health (SDH).

Roengrit Kongmuang is a documentary photographer who has worked with Thai public health organizations in both the public and private sectors to explore the possibilities of health in the Thai public health system over the years. Many places have compiled a series of images from various events and periods. Until the end of the COVID outbreak, his shots asked many questions for us to explore together.

A team from a family doctors’ network from Dansai Hospital, Loei province, visited the disabled who were bedridden in a remote village. For low-income rural families, taking caring of the sick or the disabled leads to loss of employment and a lack of income until it becomes a recurring problem that is difficult to deal with. Meanwhile, the doctors had to spend their own resources for travelling.
Dan Sai, Loei province
Photo: ©Roengrit Kongmuang
During the COVID-19 outbreak, the situation was tumultuous, but the primary healthcare facilities for people in Thailand’s Northeast, like Srinakarin Hospital, were fully prepared to deal with it. The number of patients admitted to hospitals across the country may seem lesser than under normal circumstances partly due to efforts to use a mail delivery method for patients with chronic diseases. However, fears of a catastrophic situation and the lack of access to healthcare could result in many vulnerable patients nationwide dropping out of the government’s treatment process.
Mueang district, Khon Kaen province
Photo: ©Roengrit Kongmuang

The hands and legs of a patient being treated for drug addiction are shackled to the bed. A 2018 data report showed that working-age Thais were the most addicted to drugs. Methamphetamine is the number one addictive substance, followed by alcohol. Even though Thailand has an estimated 1.4 million drug users, fewer than 100,000 people undergo drug addiction treatment. The figure could be a reflection on access to the health service system, the awareness of service receivers and the loss of national human resources.

Narcotics Treatment Center, Khon Kaen province
Photo: ©Roengrit Kongmuang

Families living in the capital city’s nooks and crannies are becoming a familiar sight, reflecting the increasing social inequality every year. In 2020, the number of people suffering from severe poverty, social and health deprivation among Thailand’s vulnerable populations rose from 1.28 million to 1.61 million people directly affected by the COVID-19 pandemic. 
Photo: ©Roengrit Kongmuang
On the sandbar and the banks of the Moei River, the Thai-Myanmar border is both a warm home and a temporary refuge for the Myanmar people. But undeniably, some people cross the border to be hired in Thailand as informal labourers, working in farms and gardens and doing work that Thai people do not want to do, which pose risks to health and life. 
Mae Sot district, Tak province
Photo: ©Roengrit Kongmuang

With the help of community leaders and the Kapor Hospital Network team, a family of Muslim women had to relocate with their children to live in a temporary house converted from an old goat shelter after the death of the family leader. Violence and unrest has aggravated in the three deep southern border provinces since 2004. A study at Lampang Rajabhat University revealed that many widows had become victims of structural violence through systemic state mechanisms overlapping with the Malay socio-cultural context that empowers men to lead the family. As a result, the value of the first and subsequent wives is not equal, sometimes leading to physical violence or the exploitation of these widows. Structural, social and political violence are the main factors that cause public health problems.

Kapor district, Pattani province
Photo: ©Roengrit Kongmuang

Power plant smoke-stacks and coal piles are the key drivers of industrial estates in the East. Local fishermen share their concerns about air and sea pollution that have put their health and livelihoods at risk.
Map Ta Phut district, Rayong province
Photo: ©Roengrit Kongmuang

Kham Bon villagers work from morning until night on a garbage mountain in Khon Kaen province. Rummaging through hundreds of thousands of tons of stinking waste from Khon Kaen city is an occupation for many families. Garbage picking has become a job for many families despite the serious health risks posed by the activity. They need to gain knowledge and essential equipment to prevent getting sick. If the government fails to provide knowledge and protect their health, the sickness caused by the nature of their work would increase the cost to the public health system.

Mueang district, Khon Kaen
Photo: ©Roengrit Kongmuang

A team of hospitals in Khon Kaen province took X-rays of the lungs of COVID-19 patients to follow up and evaluate the treatment of elderly people infected with COVID-19. It has been found that medical personnel are at high risk in an epidemic situation. Although efforts have been made to solve the problem of shortage of medical personnel, that’s still not enough, resulting in overworked medics.
Muang district, Khon Kaen province
Photo: ©Roengrit Kongmuang
“Grass Killer”, a herbicide used to eliminate weeds in sugar cane and rubber plantations, have been deployed abundantly in Phu Khieo district, Chaiyaphum province, for many years. Many of the victims of the herbicide developed gangrenous wounds on the legs and feet. Their plight started to improve after the medical team removed the rotten flesh and transplanted a new skin. However, the victims confessed that the months and years of treatment and rehabilitation had affected their income and caused great hardship to their families. For families having a low standard of living, trying to achieve a better life may come at the cost of declining health.
Phu Khiao district, Chaiyaphum province
Photo: ©Roengrit Kongmuang
Every week, migrant workers in Phop Phra district, Tak province, spray chemicals on cabbage fields at the beginning of the rainy season when diseases and pests are prevalent. The foreman talked about the frequency of the use of chemicals on popular vegetables of the Thai people. It is a practice that will expose consumers to the risk of chemical residues. In addition, many informal migrant workers in the area also face danger from using these chemicals.
Phop Phra district, Tak province
Photo: ©Roengrit Kongmuang
A team of multidisciplinary doctors and nurses from Umphang Hospital provided vaccination and other health services to Karen communities in the Thung Yai Naresuan Wildlife Sanctuary. However, the remoteness of the area and the lack of basic infrastructure are hindering the people’s access to well-being. Arranging a mobile unit is, therefore, a special event for the Umphang Hospital team at a time when the societal gap is widening.
Umphang district, Tak province
Photo: ©Roengrit Kongmuang

After the widespread outbreak of COVID-19 in Samut Sakhon province, fishermen arrived for COVID-19 screening. Migrant workers are the leading group to be prioritized behind the line.

Saphan Pla, Samut Sakhon province
Photo: ©Roengrit Kongmuang

Sustainable Development Goals (SDG 3: Good Health and Well-Being)
Ensure healthy lives and promote well-being for all at all ages

Since being conceived in 1992 during the Earth Summit in Rio de Janeiro, Brazil, “sustainable development” has become a buzzword that has helped guide development around the world. The goals have followed a steady trajectory of increased emphasis — from the Millennium Development Goals (MDGs) in 2000 to the Sustainable Development Goals (SDGs) in 2015, strengthening the world’s new development paradigm. At the heart of the SDGs addressed by the UN’s 2030 Agenda for Sustainable Development are 17 key goals that call for action by all countries to end poverty and other deprivations. These must go hand-in-hand with strategies that improve health and education, reduce inequality, and spur economic growth — all while tackling climate change and working to preserve our oceans and forests, according to the UN. The only challenge is: how to translate all those goals into a strong commitment and action. To flesh out the ideas so that people can understand them easily and therefore take action, Bangkok Tribune has come up with a new project: “SDGs I The Depth of Field”, using its signature style of photojournalism — storytelling through photo essays — to interpret and translate the ideas and challenges behind the goals into powerful visual stories told through the lenses of noted photographers.