The UNESCO Highland Peoples Surveys: Tracing Inequalities in Health Care Access and Provision in Northern Thailand

Abstract

Thailand’s public health system is lauded globally for its broad access and coverage, but significant gaps in health outcomes, health care availability, and health care access persist for ethno-linguistically diverse highlanders who have historically resided along the country’s vast international border with Lao PDR and Myanmar. Yet, Thailand’s census data do not tabulate ethnicity, and therefore preclude national assessments of health barriers and progress that highlanders experience, in particular. Moreover, state surveys of highlanders, often undertaken for surveillance purposes in the mid-to-late 20th century, never included measures of health, educational attainment, wealth, or other indices of inequality. To address these gaps, UNESCO undertook partnerships with the Royal Thai Government’s Bureau of Social Development and Human Security in 2005 and 2010 to assess the extent of citizenship and birth registration, the lack thereof, and associated inequalities in highland border villages. In the HPS I (2006), more than 60,000 people in nearly 200 villages in 3 provinces were surveyed, and in the HPS II (2010), more than 70,000 people representing 18 ethnic groups in over 300 villages in 5 provinces were surveyed. In addition to providing a detailed overview of the unique utility of the UNESCO surveys for ascertaining complex dynamics of ethnicity, legal status, wealth, and health care availability among highlanders, this article presents a broad exploration of health access detected in the 2010 survey, and thus provides a much-needed baseline of health inequalities among highlander communities from which future comparative analyses of highlander health may be drawn.