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The proposed research will generate and interpret novel Thai data on population risk and health transitions currently underway. The country is moving on from its ‘old agenda' of high maternal and infant mortality and poverty-related environmental and microbial risks, and needs new knowledge about a new set of emerging health problems – chronic disease and injury.

As Thailand modernised, its population adapted to western medical services. Dietary habits are changing, urbanisation and pollution proceed, oncoming population segments are reaching higher education, and scientific capacity is growing. To design appropriate prevention programs, Thais need comprehensive information on trends and determinants of current risk and health transitions. An historical population study of socio-economic and health changes over the last 50 years, and a large prospective cohort study of the general population, would provide the information needed to devise national preventive programs targeting emerging problems.

Examples of risk hierarchy - three levels of analysis for five risk factors

Proximal (downstream) Level 1		Structural (upstream) Level 2	Systemic (distal) Level 3
Diet –cardiovascular disease
Intake of fat, sugar, protein, fruit, carbohydrate, vegetables, alcohol	Social class, income, food costs, household management, transport			Culinary culture, risk perceptions, market-regulation, socio-ecology
Energy expenditure – obesity and diabetes
Housework, shopping, work, recreation, travel to work	Social class, income, transport cost-availability, ease of exercise			Knowledge-perceptions, marketing, built environment, ecology
Motor cycle use – traffic injury
Motorcycle use-alcohol, size-quality, helmet, driver-pillion	Social class, income, transport cost, peers, time-weather, work			Laws, marketing, risk perceptions, roads-vehicles-alcohol
Social integration – mental illness, violence and suicide
Social network, friends, family, positive community, upbringing	Marital status, education, income, employment, health services			Temperament, culture, social capital, urban-rural location
Tobacco – cardio-pulmonary disease
Smoking duration and frequency, addiction, environmental smoke	Social class, income, family size, social cluster effects, work stress			Anti-smoking laws, taxes, marketing, perceptions, knowledge

Thai socio-economic development produced the institutions and the capacity to absorb new information on emerging disease occurrence and causal determinants. Assuming our cohort is durable, co-operative, and large enough to capture relevant variation and ecological trends, and the study is located within a Thai cultural framework - the research should benefit the whole population for decades, and could be as useful in Asia as the long-term studies described above were in the West.

Long-term studies have ‘shorter-term' beginnings. Here we plan for the first 5 years. This will build capacity in Thailand and the region to perform, interpret and respond to large epidemiological studies.