Eating stir fried tofu at a street stall, off the expressway, is quite normal in Bangkok. As is the smell of faecal matter, occasionally wafting past your nose. This is the characteristic smell of a local slum, which in my case is less than three minutes away from my front door.
Slums are in high numbers, dotted around and in between the chaotic roads of Thailand’s capital city. Squeezed between houses, railway lines, roads and pedestrian paths are the homes of many of Thailand’s poor. Some are lucky and have corrugated steel roofs, others not so much. Either way, behind the facade of school children with i-phones and wealthy individuals driving cars, the slums represent a high percentage of the Thai population. They also represent something a few in the aid sector have forgotten - the condition that drives nearly all our global health problems: poverty.
As we specialize within the field of global health and development - addressing issues such as HIV, malaria and TB - programme design can focus on elements such as testing, medication and program sustainability. Workers in these fields focus on targets and with that focus comes the ease to forget what drives health issues worldwide. We can easily say that poverty and climate change are now the biggest threats to global health, yet when one typically meets a USAID worker here (or any other NGO based here, focusing on health) as I have their awareness of these factors appears non existent. This does not represent everyone, and they are not all to blame, but some are. However, sub specialization in any field can result in bypassing the bigger picture, and in our case the bigger picture primarily is poverty.
Isaan (à¸à¸µà¸ªà¸²à¸™), is a very large region in Thailand. It lies in the north east of Thailand, bordered by the Mekong river. Due to its hot climate and susceptibility to drought, agricultural output is poor. As a result of this and a melange of socio economic issues, Isaan is considered the poorest region in Thailand. This is unusual, considering much of Thailand’s rice production is based here, but if one considers that rice is not a ‘cash crop’, incomes here are very low. In Thailand, teachers on average earn 15,000 baht per month and manual labourers earn on average 5-10 Baht per day, which currently equates to 17 to 34 US cents, so the per capita income of $4,400 is misleading.
These low incomes drive many of Isaan’s young girls, not women, to venture off to places such as Bangkok and Pattaya. Here they sell their bodies to Thai men but preferably those of American, German, British and international origin as the income is much higher. Therefore a drive for increased income results in increased risk of exposure to diseases such as HIV. But this is just one example.
Poverty can coincide with poor education. In Thailand, the education is of an extremely poor standard. Yes, many go to school, however, when there is pressure for a family to earn, how many stay focused on study and progress to higher education? This is also not hampered by pressure from the new government on teachers to provide results, causing the inevitable cheating by teachers to fudge results and save their jobs.
A poor education and low socio economic status puts individuals at higher disease risk. This could range from poor water supply to inadequate malarial protection, from increased risk of illegal drug use to lack of disease awareness and misunderstanding, and much, much more. For example, lack of awareness of HIV results in stigma and discrimination, huge problems we currently try to address. Yet, all this results in increased health risk. Of late, Prin Vathesatogkit and colleagues have shown that those in Thailand with poor incomes are at a higher risk of heart disease, the world’s greatest health threat. But this is also the case in Europe and elsewhere in the developed world. If income is low, how does one feed one’s family in the UK? Usually with a family bucket from a fried chicken restaurant, as the cost is cheaper than buying healthier groceries. This leads to increased heart disease and diabetes risk, something Thailand is now facing, due to the availability of cheap, sugary fast food products which can fill the large mouth of the very large body that is Thailand’s impoverished.
All these are pure examples and there are many more, but the list would be longer than the ingredient list for a Krispy Kreme doughnut. Nevertheless, they are all directly linked to poverty. Many with high incomes in Thailand and in other nations turn a blind eye to it and they are not alone. We too, can be guilty of doing the same thing. Double standards are to be seen all over the globe but whether we are distracted by specialized relief and development work or the glossy screens of our ridiculously expensive i-pads, losing sight of poverty is inexcusable.
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(Note to recent rioters in the UK: Poverty is not your excuse. Could you survive on 5-10 baht a day?)
Good article as many people believe poverty is a thing of the past in Thailand, but the slums in Bangkok, parts of Issan, and migrant areas (and especially from surrounding countries) are still very poor and have inadequate access to good services. You are right poverty drives HIV and it can also drive ignorance in terms of stigma and discrimination.
You fail to point out the connection between Isaan and Bangkok slums, the main migration stream in Thailand. Also teachers may have an average age of 15,000 but they start on almost half that and only slowly build up. And daily wages are not as low as you say, few people would get below B60 in rural areas and most likely closer to B100, with the minimum wage of B160-200 per day.
But there should be more articles like this one. Allan