
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
BEYOND THE PANDEMIC
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.

Dan Sai, Loei province
Photo: ©Roengrit Kongmuang

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

Bangkok
Photo: ©Roengrit Kongmuang

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

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

Muang district, Khon Kaen province
Photo: ©Roengrit Kongmuang

Phu Khiao district, Chaiyaphum province
Photo: ©Roengrit Kongmuang

Phop Phra district, Tak province
Photo: ©Roengrit Kongmuang

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

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.
