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Thai Health-Risk Transition: A National Cohort Study

AIMS

This study is a unique opportunity for collaborative public health research between Thailand and Australia that tackles important issues for population health. The partnership is developing new research capacity in Thai and Australian universities. We aim to have a substantial long-term impact on regional population health by enabling Thailand and similar middle-income countries to understand and mitigate emerging disease trends. The research began in 2004 and is documenting changes in health risk and disease patterns over time and seeking information to enable feasible interventions to reduce disease burdens.

In summary, the Thai Cohort Study will map the changing health-risks and focus on upstream processes and proximal risk factors, on secular health trends and the potential for interventions. Economic, cultural, social, behavioural and environmental changes shifting the overall risk of the Thai population are being studied to inform preventive programs, boost regional research capacity, and create a regional partnership.

BACKGROUND

Thailand 's dynamic economic development has been accompanied by great changes in cultural, social, environmental and other forces that shape population health in ways that are poorly understood. Socio-economic development in Thailand is already causing profound changes in population health - some positive, but others such as emerging diabetes, heart disease and injuries are of great concern.

FUNDING

The National Health and Medical Research Council (NHMRC) of Australia and The Wellcome Trust in the United Kingdom (UK) have funded this large study of the complex health-risk transition in Thailand, to enable understanding of causal phenomena which affect many other populations.

THE STUDY

The study comprises both historical and prospective aspects and uses an array of methods, including observation of a large national cohort. We began the study in 2004 by noting the Thai context; studying the social, economic, risk factor and health changes in the whole population over the last 50 years using existing historical socio-economic and health data. We then began to follow a large cohort of Thai students enrolled at Sukhothai Thammathirat Open University (STOU) - an accessible group likely to experience change in material circumstances. STOU students are not affluent but are upwardly mobile, live throughout the country and can take about seven years to complete their degrees.

All students of STOU were mailed a 20 page questionnaire in 2005 covering socio-demographic details, local environment, income and work, health, injuries and health service use, social networks and well-being, diet, physical activity, and tobacco and alcohol consumption. In all 87,134 STOU students responded and now make up our baseline cohort.

Contact with the cohort was maintained over the following 3 years through a series of newspaper articles and reports in periodic STOU student newsletters. A 12 page follow-up questionnaire was sent out to the cohort beginning in late 2008 and continuing through 2009. This follow-up had an emphasis on work, social demography, weight, height and overall health, wellbeing and mental health, diet and physical activity, injuries and fractures, and 24 specific diseases. We aim to measure the distribution and changes over time (ie the 'risk transition') in many proximal ('downstream') health-risk factors such as working-living conditions, and personal lifestyle and behaviours. By September 2009 the response rate for this 4-year cohort follow-up was reaching 70% (60,000 responses).

During the four-years between baseline and follow-up, several ancillary and PhD studies have investigated 'upstream' influences on risk transitions: structural factors (eg social stratification, occupation, wealth and resource redistribution) and systemic factors (eg the Thai environment, human ecology, food and social system, specific cultural influences).

RESULTS

The data provided by our baseline questionnaire has allowed us to begin analysing the distribution of risk and health status among sub-groups of the STOU population (eg young/old, rural/urban, rich/poor). As the data from our 4-year follow-up questionnaire (2009) become available we will be able to begin longitudinal analysis on the health-transition process, its relationship with risk factors, and how they link to specific disease outcomes. This process will allow us to determine what evidence-based interventions are needed in Thailand to substantially reduce future disease burdens.

RESEARCHERS

The research team is headed by two principal investigators, with 13 co-investigators from five universities and two Thai government institutions: National Centre for Epidemiology and Population Health, The Australian National University; School of Population Health, The University of Queensland; Accident Research Centre, Monash University; School of Human Ecology, Sukhothai Thammathirat Open University; Chiang Mai University; Thai Ministry of Public Health; Office of National Economic and Social Development Board.

PhD research scholarships were awarded in the early stages of the project to three Thai and two Australian researchers whose research topics include sexual health transition, projecting future health outcomes for the STOU cohort, birthing and maternal health transition, transport transitions and automobility and, economic modelling of the inequalities of the health transition. Two of these researchers had graduated by mid-2009.

Contact: Adrian Sleigh