A) Important Situations related to Main Health Risk Factors

1) Important Situations related to Health Promotion in 2009

a. Tobacco Smoking

In 2001 to 2007 the number of smokers in Thailand who

smoked daily decreased from 10.57 million people to 9.48
million people. As of 2008, total sales of cigarettes have
dropped from 2.054 billion packs to 1.841 billion packs.

b. Alcohol Consumption

The average quantity of alcoholic

beverages consumed per capita in
Thailand decreased from 51 liters
per person per year in 2007 to 45
liters per person per year in 2008.

c. Traffic Accidents

The number of traffic fatalities

from 2003 to 2008 decreased from
14,063 people to 11,267 people. In
addition, traffic accident cases
related to alcoholic beverages
decreased from 5,472 cases in
2007 to 3,571 cases in 2008.
d. Exercise
In the 5 year period
between 2003 and 2007,
the number of Thai
people age 11 years or
older who exercised
increased from 29% of
the total population to
29.6% of the total
population.

B) Management of the Thai Health Promotion Foundation (ThaiHealth)

In the 2008 fiscal year the Thai Health Promotion Foundation Board approved
3.651 billion Baht to support various health promotion projects, with disbursement of
3.296 billion Baht in that year. 831 million Baht of disbursement, or 25.21 percent of the
total budget disbursement, was used to support projects to reduce main health risk factors.

Figure showing approved and disbursed budget to support projects in the 2008
fiscal year

Other health promotion issues, 74.79%

Main health risk factor reduction issues,

25.21% (831 million Baht)
C) Key Accomplishments
1) Reduction of Tobacco Consumption

Situation
a. Smoking – During the last 15 years there has been a decreasing trend in the number of
smokers in Thailand, as can be seen from the number of smokers and the number of
frequent smokers, which have both decreased. From 1991 to 2007 the number of smokers
decreased from 12.26 million smokers to 10.85 million smokers. The number of frequent
smokers dropped from 11.67 million people to 9.48 million people over the same period.
Frequent smoking rates dropped from 30.4% to 18.54%, with the frequent smoking rate
among male smokers and female smokers decreasing from 55.63% to 36.55%, and 4.6%
to 1.9%, respectively.1

b. Sales of cigarette packs – Cigarettes sold in the 2008 fiscal year totaled 1.841 billion
packs, a decrease of 213 million cigarettes from the quantity sold in the 2007 fiscal year.

c. Tobacco tax – In the 2008 fiscal year the Excise Department collected tobacco tax
worth 41.83209 billion Baht, an increase of 0.02% from 2007 when the tobacco tax
collected totaled 41.823 billion Baht.

c. Warning images on cigarette packaging – The Ministry of Public Health released its
2009 Announcement on Rules, Procedures and Conditions of Cigarette Labeling and
Label Content (based on the Tobacco Products Control Act of 1992). The ministry
increased the number of warning images allowed on packaging from 9 images to 10
images, and also featured the telephone hotline number 1600 where information on how
to quit smoking can be found in accordance with Article 11 of the World Health
Organization Framework Convention on Tobacco Control.

Figure showing smokers and frequent smokers who are 15 years of age or older

1
The National Statistic Office. A Survey of Smoking Behavior among Thai Populations 15 Years and Older from 1991 to 2007, 2008.
* ThaiHealth promoted public health occupational networks to organize services to help
smokers quit smoking, which could be conveniently and cost – effectively accessed by
the general public throughout the nation. These services comprised:

• A National “Quitline,” also known as the 1600 hotline number to quit

smoking, provided services to the general public over the last one year
since its establishment. The hotline provided assistance 19,476 times.
• About 4,000 health service centers, such as hospitals, clinics, pharmacies,
etc. provided free services to help the general public quit smoking. 644
hospitals (73% of the number of hospitals nationwide) opened Quit
Smoking Clinics, while advice on how to quit smoking was also provided
at 2,910 pharmacies, 155 dental clinics, and 60 physical therapy centers.

* ThaiHealth expanded smoke – free zones, totaling 3,091 locations, as well as

promoting new model smoke – free sites at government agencies at one province in each
region, including Phra Nakhon Si Ayutthaya, Chiang Mai, Nakhon Ratchasima, and
Nakhon Si Thammarat. The foundation also promoted implementation of the Smoke –
Free Province Policy, the first policy of its kind in Thailand, beginning in Sukhothai
Province.

* ThaiHealth promoted the dissemination of information and campaign to create non –

smoking values among all groups of citizens through:

• The Video and Film Classification Division of the Ministry of Culture,

which worked to prevent smoking advertisements in films. Health
promotion partners also worked together to draft a manual on how to rate
the appropriateness of films based on cigarette content in order to provide
guidelines in accordance with the Film and Video Act of 2008, which has
been in effect since June 3, 2008.
• ThaiHealth promoted the production and dissemination of media that
opposes smoking through the Foundation for Anti-Smoking Campaign in
order to reach approximately 4,200 organizations over the year, in
addition to cooperating with Provincial Public Health Offices in every
province to spread public relations media related to tobacco laws in order
to allow all citizens to receive that information.
• ThaiHealth developed and spread media to campaign to create non –
smoking values and publicizing tobacco control laws through all media
channels. An evaluation found that media campaigns influenced an
average of up to 75% of both smokers and nonsmokers. Media campaigns
 also created awareness of the dangers of cigarettes among 94% of smokers,
and also enticed 75% of smokers to aim to quit smoking.

* ThaiHealth advocated hospitals throughout Thailand to implement the Smoke – Free

Hospital Plan continuously. In 2009, the number of all hospitals from both the public and
private sectors that implemented the Smoke – Free Hospital Plan expanded to reach 80%
(925 hospitals from 1,140 total hospitals).

* ThaiHealth promoted cooperation between the public sector and civil society in
enforcing tobacco control laws efficiently through the Call Center for Tobacco Control
and Alcoholic Beverage Laws, which was operated continuously for the 2nd year by the
Department of Disease Control. 423 calls reporting noncompliance with tobacco laws
were received, and the center coordinated with relevant authorities to warn or prosecute
violators in every case over the year.

* Thailand’s tobacco control measures have been continuously developed in accordance

with international principles, including the Framework on Convention for Tobacco
Control: FCTC, to the point in which Thailand can now be considered to be a progressive
nation in tobacco control. The following developments occurred:

• Support was provided to the Tobacco Control Research and Knowledge

Management Center, Mahidol University, in preparing the Thailand
Tobacco Control Country Profile for use as an information source to
evaluate the capability of Thailand to control tobacco under the FCTC.
Thailand is one of 6 nations to complete its Tobacco Control Country
Profile during the past year.
• Support was provided to the Ministry of Public Health to develop tobacco
control laws in Thailand to be more in accordance with international
principles. On June 29, 2009, the Ministry of Public Health’s 2009
Announcement on Rules, Procedures and Conditions of Cigarette
Labeling and Label Content was released in accordance with the Tobacco
Products Control Act of 1992. The rules, procedures, and conditions were
enforced from that period onwards, resulting in the number of warning
images on cigarette packaging increasing from 9 images to 10 images. The
telephone hotline number 1600 was also printed on cigarette packaging to
provide information on how to quit smoking in accordance with Article 11
of the FCTC.

2) Reduction of Alcoholic Beverage Consumption

Situation
a. Consumption – The quantity of alcoholic beverages consumed per capita decreased
from 51 liters per person per year in 2007 to 45.7 liters per person per year in 2008.2

b. Consumer group – During the last 11 years, from 1996 to 2007, the number of youths
15 to 19 years of age who consumed alcoholic beverages frequently increased by 70%. In
2007, 2.33 million youths 15 years and older drank liquor, with female drinkers
accounting for 10% of this number.3

c. Retail sources – From a survey of areas around academic institutions in 2009, it was
found that there are more than 2,000 liquor stores that are located near universities. These
stores sell a variety of alcoholic beverages, including blended alcoholic drinks, and
alcohol served in buckets, which have been mixed to cater to the tastes of female
drinkers.4

d. Liquor tax – In 2009 the Excise Department adjusted its tax on alcohol, including
liquor, beer, spirits and mixed drinks, resulting in the price of beer increasing by 4 to 6
Baht. However, from January 1, 2010, onwards, Thailand’s free trade agreements may
result in the price of alcohol imported from foreign nations being lower than those
produced in Thailand (such as beer from China, which are expected to be sold at prices of
50 Baht or less for 3 bottles).

* ThaiHealth participated in supporting campaigns centered around religious institutions,

which encouraged Buddhists throughout the nation to reduce or abstain from alcohol.
During the past year, Maha Sarakham Province announced the 12 / 2009 Maha Sarakham
Resolution, Resolution 262 / 2009, which called for the Office of National Buddhism to
promote important Buddhist dates in Thailand as days in which alcohol should not be
sold. Monks throughout the nation were also asked to lead campaigns to promote public
awareness of the importance of the National Day of No Alcoholic Drinks at Temples,
which coincides with the beginning of Buddhist Lent each year.

* ThaiHealth supported the enforcement of the Alcohol Control Act of 2008 by:

• Supporting the Office of the Alcohol Control Committee in thoroughly

enacting laws under the Alcohol Control Act of 2008. In 2009 relevant
agencies enacted 7 additional laws that were announced in the
Government Gazette. An announcement from the Prime Minister’s Office
on the National Day of No Alcoholic Drinks at Temples was also made on
July 4, 2009, which forbade the sale of alcoholic beverages on important
Buddhist dates that fall on government holidays.

2
National Statistic Office.
3
Recently cited.
4
National Statistic Office, 2008, cited in the document Reason, Necessity, and
Policy Recommendations for Measures to Control the Sale of Blended Liquor and
Liquor Stores near Academic Institutions, the Center for Alcohol Studies, 2008.

• Supporting adherence to the Alcohol Control Act of 2008 by:

- Promoting the establishment of Provincial Alcohol Control Committee
Offices, resulting in these offices being situated in every province during
the past year. The offices began working as mechanisms to monitor and
promote adherence to the Alcohol Control Act of 2008 and other laws
related to the control of alcoholic beverages in every area throughout the
nation.
- Promoting the Ministry of Education in enacting measures to forbid the
sale of alcoholic beverages within academic institutions or dormitories, the
sale of alcohol to youths younger than 20 years of age, or the drinking of
alcohol on the campus of academic institutions throughout the nation. The
ministry also announced its decree on adhered to the Alcohol Control Act
of 2008 in academic institutions on July 23, 2009, and publicized the
decree for understanding among students.
- Promoting cooperation between the public sector and civil society in
efficiently enforcing laws related to alcoholic beverages through the Call
Center for Tobacco Control and Alcoholic Beverage Laws, which has
been operated continuously over the last 2 years by the Department of
Disease Control. 490 calls reporting noncompliance with alcohol laws
were received, and the center coordinated with relevant authorities to warn
or prosecute violators in every case over the year

* ThaiHealth supported the dissemination of information and campaigns to create values

to reduce the consumption of alcohol among all groups of citizens through:

• The Center for Alcohol Studies, which produced and disseminated 24

reports during the past year containing information from research that
showed impacts from alcohol consumption, as well as measures to
continuously prevent these impacts to society.
• Developing and disseminating media to campaign for reduction in alcohol
consumption, including the printing of postage stamps and postcards
under the Children calling on Fathers to Quit Drinking Campaign, the
“Giving Alcohol = Cursing” Campaign during the New Year, and the
Reduce Alcohol Consumption during Buddhist Lent Campaign 2008. A
survey by the AC Nielsen Company (Thailand) in 2009 found that 92% of
populations 15 to 55 years of age were aware of the Reduce Alcohol
Consumption during Buddhist Lent Campaign, while there was a tendency
 among 61% of drinkers to change their drinking behavior after receiving
the campaign’s message.
The “Alcohol during Buddhist Festivals = Sin” Campaign was also
conducted. An assessment found that 61% to 75% of both non – drinkers
and drinkers who were exposed to these campaigns’ messages had a
tendency to change their behavior. For instance 40% of non – drinkers no
longer purchased alcohol as New Year gifts.

3) Preventing Traffic Accidents

Situation
a. Fatalities and injuries – Statistics showed a decreasing trend in the number of traffic
accident fatalities from 2003 to 2008, with the number of fatalities decreasing from
16,063 people to 11,267 people, respectively. The rate of traffic fatalities per 100,000
population over the same time period decreased by 19.86%, and, when calculated as the
traffic fatality rate per 10,000 vehicles, this rate is equivalent to a decrease from 6.02
fatalities per 100,000 population in 2003 to 4.30 per 100,000 population in 2008, a 27%
reduction. Meanwhile the traffic injury rate per 100,000 population from 2003 to 2008
decreased by 17%, while the traffic injury rate per 10,000 vehicles dropped 32% over the
same time period.
b. Important causes – Important factors that leads to traffic accidents and injuries are
alcohol consumption and motorcyclists not wearing safety helmets. It was also found that
economic factors are linked to traffic accident occurrence.5
c. The number of alcohol – related traffic accidents decreased – The latest information
related to the number of land traffic accidents arising from drunk driving indicated that
there is a decreasing trend of such accidents from 2006 onwards, resulting in the number
of fatalities and injuries from this preventable cause dropping correspondingly, as
depicted in the figure below.

Figure showing the number of drunk driving cases, and the number of injuries and
fatalities from land traffic accidents from 2004 to 2008

Source: Land traffic statistics, Royal Thai Police, cited by the Alcohol Studies Office in its Liquor Situation Report 2009.
5
Bureau of Epidemiology, Ministry of Public Health.

* ThaiHealth promoted pilot projects to reduce traffic accidents, which have been carried
out continuously for the 2nd year in 64 provinces, resulting in clear positive change.
Provinces under phase 1 and 2 of the pilot project showed a marked reduction in the
number of traffic fatalities (2.8 – 5.2 times) when compared to provinces that were not in
the project. Following the initiation of this project, the number of participating provinces
where 70% or more motorcyclists wore safety helmets increased from 10 provinces to 25
provinces. Additionally, participating provinces where 70% or more motorists wore
safety belts increased from 5 provinces to 13 provinces.

* ThaiHealth supported the dissemination of information and campaigns to create values

to reduce traffic accidents among all groups of citizens by:
• Producing campaign media through all media channels. From a survey by
the AC Nielsen Company (Thailand), it was found that 92% of
populations 15 to 55 years of age were aware of campaigns to reduce
traffic accidents through media promoted by the Thai Health Promotion
Foundation. 84.5% of people who were aware of these campaigns had a
tendency to change their traffic behavior.
• Campaigning through activities to create safety awareness among
motorists, reaching more than 10 million people throughout the nation
through cooperation with main partner organizations, such as the Don’t
Drive Drunk Foundation and the Consumer Foundation.

* ThaiHealth participated in promoting the production of the Master Plan for Road Safety
2009 – 2012, which involves reformed cooperation from all sectors of society. The plan
set a national objective to reduce the number of traffic accident fatalities to 14.15 per
100,000 population by 2012, expanding upon past success in reducing traffic fatalities
from 22.2 fatalities per 100,000 population in 2004 to 17.8 fatalities per 100,000
population in 2008.

* ThaiHealth participated in promoting framework and operational system development

of the Road Safety Center, in order to allow the center to serve as a national level agency
in efficiently supervising road safety. In 2009 the Prime Minister Office’s Regulation on
Prevention and Reduction of Road Accidents was completed and presented to the Cabinet
in 2010.
* ThaiHealth supported the integration of road safety information and knowledge into the
academic curriculum of youths nationwide, beginning with local primary school curricula.
There was also expansion of the Safe Model University Development Project to reach
universities nationwide through joint implementation by the Thai Health Promotion
Foundation (ThaiHealth), Naresuan University, and the Office of the Higher Education
Commission.

* ThaiHealth participated in the development and strengthening of measures to reduce

traffic accidents caused by drunk drivers. As part of these measures, the Ministry of
Transport announced its policy that drivers of public transportation vehicles should
always have blood alcohol levels of 0 milligram – percent while on duty. Violators of this
policy can face job termination, mandatory resignation, or salary reduction. The policy
has been in effect since the Songkran Festival period of 2009.

* ThaiHealth also supported the Academic Center for Road Safety’s recommendations on
elevation of standards in public transportation vehicles for consideration by national level
transportation policymakers. These recommendations were received and acknowledged
by the National Economic and Social Development Board and the Department of Land
Transport, and were also discussed during Thailand's Second National Health Assembly.
The recommendations cover the development of monitoring and assessment systems for
public transportation vehicles in order to improve safety for passengers.

* ThaiHealth supported research on the information systems formation and knowledge

development that will lead to prevention of traffic accidents and disasters through various
plans. Over the last year, the Road Safety Group Thailand, which is a core academic
organization providing traffic accident data that is supported by ThaiHealth, presented
about 30 new research work related to road safety. The center also hosted the 9th National
Seminar on Traffic Accidents from August 20 to 21, 2009. More than 2,000 members of
traffic accident prevention networks and academics from throughout the nation attended
the seminar. Continuous presentation of information related to traffic accident prevention
was also made via the media throughout the year.

4) Promoting Exercise and Sports for Health

Situation
a. Exercise trends - The results of the latest survey on exercising behavior among
populations 11 years and older6 found that, over a 5 year period from 2003 to 2007, the
number of people who exercised increased from 29% to 29.6%. The number of people
who exercised regularly 3 to 5 times a week accounted for the largest proportion of
people who exercised at 38.2%. More than half of people who exercised did so for 21 to
60 minutes each time.

b. Exercise groups – The group that exercised the most are children 11 to 14 years of age,
and those that exercised the least are in the working population group from 25 to 59 years
of age.
Table showing the rate of exercise among populations 11 years and older,
categorized according to gender and administrative area

Figure showing the rate of exercise among populations 11 years and older,
categorized according to age and gender in 2007
6
The National Statistic Office, Thai Population Exercise Behavior Survey
2007.

* ThaiHealth participated in promoting the establishment of daily exercise venues that

citizens of all age can conveniently access, and:
• Collaborated with the Bangkok Metropolitan Administration in organizing
the Exercise in Gardens Activity at 10 public parks in Bangkok and
vicinities.
• Collaborated with the Bangkok Metropolitan Administration and the
Expressway Authority of Thailand, communities located under
expressways, and crowded communities in the Bangkok Metropolitan area
in organizing exercise activities at 68 locations under expressways.
• Collaborated with the Office of the Basic Education Commission and
Local Administrative Organizations in carrying out 50 Afterschool
Exercise Programs at primary and secondary schools under the
supervision of the Ministry of Education and Local Administrative
Organizations, resulting in large numbers of students being able to
conduct exercise activities in their free time under the guidance of
physical education instructors. Other activities were also organized to
provide families and community members the opportunity to use school
facilities to exercise and play sports with youths.
• Participated with 5 major industrial estates in carrying out the Afterwork
Exercise Venue at workplaces.
• Campaigned to create an exercise trend through various media campaigns,
through cooperation with the entertainment industry sector in using
celebrities and their families as positive role models for youths through
songs and dance that promoted exercise. ThaiHealth collaborated with 9
major business retailers in organizing exercise activities to prevent colds at
300 department store locations nationwide for a period of 3 months.
ThaiHealth also collaborated with sports media in organizing the Exercise
is Medicine Project. From a general perspective, the project encouraged
people to pay more attention to their health, and more than 20,000 people
participated in exercise activities as a result.

* ThaiHealth supported all forms of activities that provided opportunities for members of
the public of all ages and gender to exercise more, especially on important dates. These
activities include campaigns for a Car Free Day, campaigns for more exercise on May 5th
(Coronation Day), fast – walking for health on Visakha Puja Day, etc. Over the past year,
more than 550,000 people participated in exercise activities supported by the Thai Health
Promotion Foundation.

* ThaiHealth supported Local Administrative Organizations in recognizing the

importance of exercise and sports promotion for health. ThaiHealth worked with the
Department of Local Administration, Local Administrative Organizations, Provincial
Administrative Organizations, Tambon Administrative Organizations, and the National
Municipal League of Thailand in establishing a memorandum of understanding on
projects to promote exercise and sports for health in order to increase the number of
exercise areas and activities, in addition to increasing the number of daily exercises in
every community. 700 Local Administrative Organizations from the 5 regions of
Thailand participated under the memorandum of understanding.

* ThaiHealth promoted the invention of new forms of exercise activities that

corresponded with the readiness of local areas and the preference of diverse population
groups. ThaiHealth also promoted the development of modified traditional sports and
Thai folk wisdom sports, which incorporated daily activities and local culture into sports
in order to create more enjoyment while exercising, as well as to allow that form of
exercise to be carried out daily and to be introduced throughout the nation. These
modified sports include meditative fast – walking, Buddhist exercises, and the Ngom
Haew (งมแห้ว) dance for senior citizens in many agricultural communities in the central
region.

5) Creating Well - Being among Organizations and Communities throughout Thailand

Situation
a. Debt condition – During the first 6 months of 2009, it was found that 61.8% of
households surveyed were in debt, with average debt totaling 133,293 Baht per household.
When considering the trend over the last 4 years since 2006, it was found that the
proportion of households that were in debt decreased. However, the amount of debt
showed an increasing trend.7

b. Senior citizens – A survey of senior citizens in 2007 found that 7.7% of senior citizens
lived alone, while the difficulty in caring for senior citizens by their families had
increased, resulting in dependency on external caregivers. The average cost of hiring
outside care to bolster family care for 1 senior citizen is 20,100 Baht per year. Senior
citizens with high dependency levels who must rely entirely on outside care paid an
average of 140,000 Baht per person per year.8

c. Economic crisis – Despite facing an economic crisis that has caused damage to
populations in many areas, whether in income reduction or increase in debt, Thai people
have adjusted to the problem through application of the self – sufficiency economic
principle in their daily lives, as can be seen from the increase in rational purchase
decisions for consumer goods, increases in income, debt reduction, and greater tendency
to save money.9
d. Unregistered labor force – Presently Thailand has an estimated 24.1 million
unregistered workers, and 13.7 million registered workers. In 2009, it was found that 1.3
million workers are from the Bangkok area alone. Problems that unregistered workers
face most frequently are: (1) Low wages. (2) Fatigue from bodily movement during work.
(3) Exposure to poisonous chemicals at work. (4) Intermittent work schedule. (5) Hard
work. (6) Dust and smoke. (7) Insufficient light. (8) Hazardous tools and machinery. (9)
Unhygienic workplace. (10) Danger to eyes or ears from exposure to dangerous
chemicals due to lack of proper protective equipment, as well as environmental problems
within the workplace, and lack of knowledge and understanding of personal health and
safety.10

Table showing adjustment in persons with minimum income during an economic

crisis, categorized by target groups (percentage)

Adjustment Agriculturists Senior Workers < 15,000 Workers > 15,000

Citizens Baht in income Baht in income
No adjustment 29.5 57.4 37.6 30.8
Adjustment 70.5 42.6 62.4 69.2
- Increase in 45.3 38.0 25.5 28.6
income
- Reduction in 81.9 85.8 86.9 83.7
expense
- Usage of 14.0 38.9 21.1 17.4
savings
- Borrowing 4.7 1.5 2.5 2.7
loans from
financial
institutions
- Borrowing 0.9 0.9 0.6 1.1
loans from
unregistered
lenders
- Sample 792 792 789 789
group (number
of people)
Source: The National Economic and Social Development Board, cited in the First Quarter Report on the Condition of Thai Society in
2009.
7
The National Statistic Office. A Survey of the Socioeconomic Conditions of Households during the First 6 Months of 2009.
8
Financial and Monetary Research Project on the Long – Term Care of Senior Citizens in the Bangkok Metropolitan Area and
Vicinities, 2009.
9
The National Economic and Social Development Board. First Quarter Report on the Condition of Thai Society in 2009
10
The National Statistic Office, 2008.

* ThaiHealth supported Local Administrative Organizations and organizations from all

sectors in implementing health promotion projects such as:

• Over 20 river and canal conservation and rehabilitation projects at

Tambon Administrative Organizations and Tambon Municipalities were
conducted during the past year, with continuous conservation policies for
local water sources incorporated into plans for the 2010 fiscal year.
• Local Administrative Organization networks to develop the Thai Health
Promotion Foundation’s well - being policies, involving support in the
establishment of Local Administrative Organization networks that possess
public policies to reform the well - being of local areas, with field trips
and exchange of experience to develop and expand on results. More than
500 Local Administrative Organizations participated in network activities.
• Weight – control policies by Local Administrative Organizations, and
public and private sector organizations, involving the setting of policies
and environmental management at the organization level, in addition to
personnel capacity development to support weight control among
members of over 1,000 organizations, covering more than 3 million people.

* ThaiHealth promoted work operations under the Well - Being Tambon (Pleasant
Tambon) Project, as well as expansion of results at 336 tambons (subdstricts) to cover
over 1.7 million people. Reformed development of these Well - Being Tambons was
carried out for all 4 dimensions of well - being, under the concept of friends helping
friends, and stronger people helping weaker people.

* ThaiHealth promoted the establishment of 3 tambon training centers for community

well - being systems managed by communities in order to provide services to develop
leaders and test real – world operations in local areas that wish to develop themselves
into “pleasant tambons.” One training center can provide services to 100 tambons, and it
is expected that these training centers will be established and spread throughout all the
regions of Thailand by 2011.

* ThaiHealth promoted volunteer caregivers for senior citizens, with at least 6,000 senior
citizens receiving care from volunteers during the past year. 204 Tambon Administrative
Organizations have also established policy to continuously support volunteer caregivers
for senior citizens.

* Support for the capacity development of about 2,000 leaders who will bring change and
create well - being at the community level also took place.

* ThaiHealth promoted the operation of the Federation of Community Radio, particularly

for radio programs involving well - being development. During the past year, the
federation had 303 radio stations and 43 partner organizations as members. The radio
medium is useful in supporting solutions to burdens and preventing risks to the public.

* ThaiHealth promoted the creation of Self – Sufficient Villages for Sustainable

Grassroots Health, with more than 100 leaders from 55 villages that have the capacity to
be self – sufficient participating. The project’s operations were expanded to cover well -
being promotion in nearby villages, through 20 model villages spread throughout each
region of Thailand, serving as learning sources for other areas.

* ThaiHealth supported all types of agencies and organizations in implementing well -

being promotion policy, and in expanding progressive results to society. During the past
year, 250 model well - being organizations expanded their achievements to society,
including Tambon Administrative Organizations, academic institutions, police stations,
and hotels.

6) Promotion of Child and Youth Well - Being

Situation
a. Accidents – Drowning is one of the most important causes of death among Thai
children. A 2008 report indicated that 1,624 Thai children 0 to 17 years of age lost their
lives due to drowning, accounting for 8.7 deaths per 100,000 population, or 27% of
deaths due to injuries. Children 1 to 4 years of age who drowned account for 53% of total
deaths for this age range. Meanwhile, the proportion of children 5 to 9 years of age who
drowned increased to 56% of the total number of deaths.11

b. Well – being – A survey of problems that seem to have a rising trend among Thai
youths from 2007 to 2008 indicated that there are 4 important problems including: (1)
Teenage pregnancy, of which 68,385 cases were recorded in 2008. (2) 42,102 Youths
being sent to Juvenile Observation and Protection Centers in 2007, and increase of 2,000.
(3) An increase in the amount of time spent with information and communications
technology, at 6 to 7 hours per day. This is particularly true of mobile phones, which are
being increasingly used, rising from an average of 80 minutes per day to 90 minutes per
day. (4) Stress, which was found to affect 30% of youths in 2008, resulting in symptoms
such as headaches, headaches, and insomnia. Stress is believed to increase
correspondingly to education level, with 40% of students reporting being stressed from
studying, competition, and violence.12

c. Food and nutrition – At present, the sugar consumption of Thai children is increasing
rapidly, with the most important source of sugar being sweet beverages and carbonated
beverages. Information from a situational study of the sale of carbonated beverages near
pilot site schools in 19 provinces found that 20% of primary schools sold carbonated
beverages, and children at these schools drank an average of 1 carbonated beverage per
day, and as many as 3 per day. The average quantity consumed per serving was 200
milliliters, or almost 1 can, resulting in the individual child consumer receiving an
average of 29.6 grams of sugar, or 7.4 teaspoons worth, per serving. This quantity is in
excess of the daily requirements of the body, which is no more than 6 teaspoons.13

d. Volunteer spirit – A survey of the life capital of children and youths found that the
current generation of Thai youths lacked the skills to be givers, with only 34%
participating in activities such as helping others, or doing housework. Experts stated that
if this trend continues, Thai society will begin to see less generosity, and experience more
selfishness.14

Figure showing fatality rate from drowning among children of different age groups

Source: Child Safety Promotion and Injury Prevention Research Center, Ramathibodi Hospital.
11
Child Safety Promotion and Injury Prevention Research Center, Ramathibodi Hospital , at http://www.thaihealth.or.th/node/5090
12
Child Watch Program, Ramajitti Institute, 2009.
13
Dental Health Bureau, Department of Health, Ministry of Public Health, and the Office of the Basic Education Commission. A
Study of Carbonated Beverage Sales at Pilot Site Schools under the Thai Children don’t Eat Sweets Program in 14 Provinces.
14
Child and Youth Well – being Plan. Results of test analysis of 20,892 youths 12 – 15 years of age in 18 provinces, 2009.

* ThaiHealth supported children and youths to grow up with good quality of life, and to
be protected from preventable accidents and injuries. ThaiHealth achieved these goals by:

• Participating in developing policies to promote child health, protect child

rights, and prevent child injuries. More than 200 organizations agreed with
the policies and implemented them, including 92 social organizations, 30
community organizations, 30 schools, 30 child development centers, as
well as the Network of Schools against Violence, and Juvenile
Observation and Protection Centers.
• Participating in developing child injury prevention systems with
implementation of these systems in communities, encompassing injury
surveillance systems in 11 communities in 11 provinces, with child injury
surveillance systems in 29 schools and 45 child development centers.
ThaiHealth also contributed to the development of safety systems for
children’s toys and playgrounds through the establishment of an academic
subcommittee to ensure the safety of children’s playgrounds, toys, and
exercise equipment. ThaiHealth collaborated with the Office of the
Consumer Protection Board and created tools to supervise children during
their playtime in playgrounds at child development centers in Bangkok.

* ThaiHealth supported Thai children and youths to gain values and behaviors to
consume appropriate food through numerous important work plans and projects such as:

• The Thai Children don’t Eat Sweets Program, which was conducted in 25
provinces, with joint assembly work between every region, and emphasis
on interdisciplinary cooperation with public health personnel and others.
Promotion of child development centers, academic institutions, and Local
Administrative Organizations, was conducted, resulting in awareness and
implementation of supportive policy for children and youths to avoid
excessively oily, salty, or sweet food in order to create good health. This
led to more than 200 pilot child development centers, and public and
private schools following the Schools without Carbonated Beverages
Policy during the past year.
• The Food and Nutrition Plan, which was implemented by the Department
of Health, developed knowledge and more than 10 manuals for teachers
and child nutritionists in order to promote nutrition work in schools in
society during the past year.

* ThaiHealth promoted youths in schools to live creative lives, with well - being and a
volunteering spirit, through various plans and projects such as:
 • The Alcohol – Free University Initiation Project, with the cooperation of
universities in campaigning for alcohol – free initiation of freshmen
students, resulted in a reduction in alcohol consumption during university
initiations from 53.7% in 2006 to 8.9% in 2008.
• The “Health@Camp,” or Well – Being Creation Camp Project, 2009, with
the cooperation of the Komol Keem Thong Foundation, promoted 100
volunteer development camps in modernizing their structure in
conjunction with supporting learning and working together with
communities with a volunteering spirit and without alcohol or cigarettes.
More than 2,000 youths participated in activities at the camps.
• The Health Map Project, which promoted 700 students from 130 schools
to be leaders in developing the environment in schools and around schools.
The project involved surveys of safe and risky areas for youth well – being,
and brought back information to create a “health map.” Continuous
implementation of the project in its first year at 90 schools resulted in the
transfer of concepts and processes of health mapping to students. Schools
under the project were developed creatively in order to “increase healthy
areas and reduce risky areas” in and around schools.

* ThaiHealth promoted the creation of national policies, measures, and projects to

support well – being of children and youths through strengthening of the family
institution by:

• Participating in supporting the establishment of 2008 Regulations of the

Prime Minister’s Office on Promotion and Coordination with the National
Family Institution. The regulations stipulated the establishment of a
National Family Planning Committee headed by the Prime Minister,
which worked to set national policies, strategies, and plans related to the
promotion and coordination of family institutions in order to host meetings
of provincial and national family assemblies at least once a year. A Family
Development and Promotion Committee also carried out work as set by
the National Family Institution.
• Supporting reading in order to develop well – being in families following
the Regulation of the Government to Promote Reading as a National
Agenda, through the First Book Program, which invited parents
throughout the nation to read to their children in order to develop their
child’s reading abilities while forging stronger relations in the family.
Following implementation of the program, it was found that 83.5% of
families developed well in every area and had warmer relationships. In
addition, the Thai Health Promotion Foundation participated as an
important force in creating a reading promotion network by developing
venues to read and volunteers to promote reading, expanding these
activities to the tambon level throughout the nation.
 • Participated in implementation of Thailand’s first commercial and
commerce – free Radio Station for Children, Youths, and Families. The
station is a joint venture between the Public Relations Department, the
Thai Public Broadcasting Service, and the Thai Health Promotion
Foundation and is broadcasted on the 105 megahertz frequency.
• Promoted the drafting of the Thai Public Broadcasting and
Telecommunications Signal Management Decree. The draft is currently
being considered by the legislative branch, along with the draft of the
Creative Media Foundation Decree, which was proposed by the Safe and
Creative Media Committee.
• Local Administrative Organizations under the Pleasant Tambon Network
worked on the “Regulation on Learning of Children and Youths,”
especially under the issue of “child development centers” and
“supplementary education to fill the gap in mainstream education” in more
than 200 tambons.

7) Protecting Consumer Health

Situation
a. 5 problems receiving the most complaints – The Thai Food and Drug Administration
(FDA) stated that the issues that received the most complaints from consumers from
October 1, 2008, to November 30, 2009, ranked from first to fifth are as follows: (1)
Unrealistically advertising the quality of food, and that fail to mention whether these
products have been approved by the Food and Drug Administration or not. (2) Food
labels not showing the day, month, or year of production or expiration, and food labels
lacking information on ingredients. (3) Milk that spoiled before their expiration date, is
contaminated, or of suspected quality. (4) Businesses selling medicine without
authorization, businesses lacking pharmacists, as well as unregistered or over – the –
counter medicine. (5) Unrealistically advertising the quality of medicine, and
advertisements whose authorization remains unverified.

b. Unrealistic advertisements – Studies of direct and indirect advertising in free television

programs for 24 hours each day from September 25 to 27, 2009, found that every
television channel, except for Channel 11 and the Thai TV Channel, all broadcast
commercials beyond their allotted time limit set by Article 13 of the 2008 Broadcasting
Activity Decree, which governs the proportion of advertisements to programs. It was also
found that indirect advertisements are broadcasted by every channel.15
15
Media Monitoring and Knowledge Development for Societal Well – Being Project, Results of a study on direct and indirect
advertising on free television channels, 2009.
* ThaiHealth promoted media monitoring through continuous studies, research, and
presentations of information that are important to society, in order to report problems and
situations in a timely manner and to make sure that the media adheres to regulatory
measures that have been announced to supervise media content to ensure that they
provide creative content for consumers.

* ThaiHealth participated in supporting the development of measures and campaigns to

promote the consumption of appropriate food, including:

• The Department of Health’s Announcement on Regulations to Certify

Foods which have reduced their Sugar, Fat, and Sodium by 25%, in order
to serve as a healthy alternative to snacks that are health risks in schools
and communities. The announcement has been in effect since February 26,
2009.
• The Ministry of Public Health’s 305th Announcement on Nutrition
Labeling of some Types of Instant Food Products, in order to reduce the
problem of obesity from excess nutrition. Labels telling consumers to
“consume in moderation, and exercise for health” will also be included on
some food product’s packaging. The announcement has been in effect
since December 19, 2009, and labels were featured on 80% of all products
fitting the regulation’s criteria.

* ThaiHealth supported the enforcement of the 2008 Decree on Liability for Damages
from Unsafe Products, which has been in effect since February, 2009. A Thai Health
Promotion Foundation subcommittee worked with the Ministry of Public Health in
spreading correct knowledge on the decree to society.

8) Develop Offensive Health Systems

Situation
a. Diseases that require monitoring – The World Health Organization warned the medical
profession and public health ministries throughout the world to be alert for epidemics
from 10 new and reemerging diseases, including SARs, Avian Flu, Chikungunya,
Tuberculosis Hand, foot and mouth disease (HFMD), West Nile Virus, Ebola, Nipah
Virus, Human monkey – pox, and Streptococcus suis. In addition, there are 3 disease
where viral mutations are a risk, with the potential for severe impacts, including SARs,
Avian Flue, and the 2009 Influenza.
b. Mental health – A survey of mental health among Thai people in 2009 found that,
when compared with 2008, Thai people’s overall mental health improved and they were
at reduced risk of facing psychological problems, with the proportion of people with good
mental health increasing by 7.4% (from 27.7% to 35.1%). The proportion of people at
risk of psychological problems decreased by 3.1% (from 17.8% to 14.7%), except for
populations in the Bangkok area, who faced an increase in the risk of psychological
problems from 15.5% to 17.5%.16

c. Policies that support well-being – A meeting of the 2nd National Health Assembly in
2009 involved discussions of 11 agendas related to development of public policy and
measures to promote health. These include: (1) Development of mechanisms to drive
participation in the well – being of children, youths, and families. (2) Reemerging
infectious diseases. (3) Development of long term processes for senior citizens who are in
a dependent state. (4) Development of primary service management to allow for public
access to quality health services. (5) Hazardous waste management in communities
through participation from all sectors. (6) Development of traditional Thai medicine,
household medicine, and alternative medicine to become a main health service system of
Thailand in parallel with modern medicine. (7) Solving road accident problems. (8) End
unethical sales of medicine in order to reduce economic and health losses of patients. (9)
Management of obesity. (10) A national alcohol strategy. (11) A sustainable development
plan for the restive south of Thailand based on the foundation of economic,
environmental, and social self – sufficiency.

* ThaiHealth and the Ministry of Public Health promoted the Thai government’s public
policy to establish Health Promoting Tambon Hospitals. In September 2009, about 1,000
health centers and community health centers were elevated to the position of Health
Promoting Tambon Hospitals. Relevant public relation manuals on concepts and
practices were also provided to public health personnel and members of the public
throughout the nation.

* ThaiHealth participated in supporting the establishment of a National Health Assembly

to serve as a forum to develop public policy that supports health. During the 2nd National
Health Assembly in 2009, many policy recommendations were made in reducing main
health risks, including control of alcoholic beverages, prevention of road accidents,
reduction of risk factors for chronic diseases, as well as other related health promotion
issues such as a national strategy for public access to medicine.
16 Department of Mental Health, the National Statistic Office, the Ministry of Information and Communications Technology, Institute
for Population and Social Research, Mahidol University, and the Thai Health Promotion Foundation. Mental Health Situation Report
Program, 2009.
The assembly considered all these recommendations and conveyed its resolutions to the
National Health Commission Office of Thailand. Resolutions that were discussed during
the 1st National Health Assembly in 2008 were also passed on to the office. The Thai
Health Promotion Foundation supported the conveyance of resolutions made during the
assemblies into the public policy development process. Progress was made on 9 issues,
such as policies to manage herbicides and pesticides to reduce their impacts on human
health, policy recommendations on the economic crisis and protection of the Thai
population’s well – being, policy recommendations on universal access to medicine for
the Thai population, policy recommendations to promote relations between patients, their
relatives, and medical personnel, policy recommendations on impacts from industries at
the Map Ta Phut Industrial Estate and in Rayong Province, recommendations on a
national health constitution, strategic recommendations on creative media for children,
youths, and families, recommendations on the establishment of a National Creative and
Safe Media Committee, and recommendations on the establishment of measures to
regulate gaming shops and internet cafes.

* ThaiHealth participated in promoting the development of health management systems

that cover the 4 dimensions of health, such as the Meditation Therapy Project, which
integrates the principle of reformed meditation as part of patient services at healthcare
facilities. During the past year, 19 pilot Meditation Therapy Centers were established at
hospitals and primary care units. It was found that these centers reduced the stress of
more than 10,000 patients and relatives.

* ThaiHealth cooperated with 14 academic institutions in developing the health service

systems of communities in 44 tambons throughout the 5 regions of Thailand to serve as
models for expansion of results. ThaiHealth worked with Local Administrative
Organizations, health service centers, and other organizations in local areas.

* ThaiHealth participated in developing medical service management forms to include

traditional folk wisdom options. This activity was carried out with Local Administrative
Organizations, resulting in concrete sources of learning, which were successfully
expanded at 10 pilot sites.

* ThaiHealth promoted the inclusion of well – being issues into academic curricula under
all branches of public health. During the past year, the Thailand Nursing and Midwifery
Council announced the accreditation of the Health Communications Course as part of the
nursing curriculum in Thailand. Master’s Degree in Health Communications programs
were also accredited at the faculty of communication arts at several universities.

* ThaiHealth worked to prevent increase in the number of psychiatric patients, from

predictions that psychological problems will become a major global problem. The Thai
Health Promotion Foundation supported the National Health Security Board in setting
policy to allow 2 types of psychiatric medicine (Sertrarine, and Risperridol) to be
included into the National List of Essential Drugs.
Sertrarine is used to treat depression, while
Risperridol is used to treat schizophrenia. The 2 drugs
are covered as part of national health security
benefits, allowing for psychiatric patients to
receive university coverage.

* ThaiHealth participated in supporting the drafting of the Decree on Promotion of Zakat

Foundation Activities. The decree was presented to parliament in order to promote well –
being of followers of Islam by using social funds to assist in reducing economic
inequality.

9) Promote the Creation of “Innovation” for Well – Being

During the past year, the Thai Health Promotion Foundation supported projects that
aimed to build innovation for the creation of well – being, and also supported sets of
projects and offensive plans that aimed to stimulate well – being research and innovation.
This resulted in numerous well – being innovation that are appropriate models for
expansion of results and follow – ups at no less than 1,000 projects, including:

The results of research on model electricity – generating bicycles

* The Research and Development Project on “Alternative Energy / Energy Choice for
Community Health“Project, which allowed for expansion of results in many other
subsequent, related projects.
* The Goodness begins with Youths Project, which cooperated with the Youth Network
for Development, promoted new forms of volunteer work among children and youths that
emphasized participation and linkage of relationships among local communities, in order
to create partners to successfully support youths’ work. The project was implemented in
50 schools, with over 1,000 participating students.

* The Innovation Application to Create Healthy Habits and Behavior among School –
Age Children Project initiated the production of local language animated films to
promote healthy habits among Thai children, according to the 10 rules of the National
Health Provision. The provision was used in campaigns to promote healthy habits to
prevent the spread of the 2009 influenza.

* The Cooperative Pilot Program for the Science for Better Health Project, Phase 2,
cooperated with the National Science and Technology Development Agency to develop
the thinking skills of youths, based on the principle of scientific rationality, through a
process of youth participation in science projects that are linked to health promotion. In
2009 the pilot program was conducted at 130 schools.

* ThaiHealth also worked to promote the Routine to Research Program, which created
innovations in health promotion work such as the “magical pants,” which can be used by
ladies to self – test for cervical cancer. The pants were invented by nurses in a
community in Suphan Buri Province to solve the issue of embarrassment among female
patients receiving cervical cancer tests, as well as to reduce overall test time at healthcare
centers.

* The Exercise Innovation Program designed exercise equipment that are appropriate for
exercisers in each age group, which can be easily manufactured from material found in
local communities, such as wooden staffs that can be used by senior citizens for exercise,
bicycles made from recycled material, flotation devices for obese swimmers, and
equipment produced completely from environmentally – friendly material.
 Evaluation Report
Operations of the Thai Health Promotion Foundation for the 2009 Fiscal Year
(October 2008 – September 2009)
Prepared by the Committee to Evaluate the Performance of the Thai Health
Promotion Foundation (ThaiHealth)

Introduction
By virtue of the contents of Article 37 of the Thai Health Promotion Foundation
Act of 2001, the Cabinet resolved to appoint a Committee to Evaluate the Performance of
the Thai Health Promotion Foundation (ThaiHealth). The committee has the authority
and duty to evaluate the policy, activities, and operational results of the Thai Health
Promotion Foundation, and to report its evaluation and recommendations to the Thai
Health Promotion Foundation Board on a yearly basis.

Issues to be Evaluated
In the 2009 fiscal year, the Committee to Evaluate the Performance of the Thai
Health Promotion Foundation established 3 issues to be evaluated, which are: 1)
Performance based on indicator framework set by the Thai Health Promotion Foundation
and pledged to the evaluation committee; 2) Operational results of 13 major plans; 3)
Evaluation of the operational results and impacts of the Thai Health Promotion
Foundation’s work to control tobacco smoking, alcohol consumption, and traffic
accidents. The evaluation committee gathered information from:

• the report on ThaiHealth’s performance based on indicator framework set

by the organization for the 2009 fiscal year
• Reports on performance in line with 13 major plans
• Reports on the Thai Health Promotion Foundation’s Board meeting
• Reports from the administrative committees of 7 plans
• Reports from the Internal Audit Subcommittee
• Reports on the operational results and impacts of the Thai Health
Promotion Foundation’s work to control tobacco smoking, alcohol
consumption, and traffic accidents
• Reports on meetings between ThaiHealth’s Evaluation Committee, and its
Advisory Subcommittee
• Other relevant information sources, including documents and observation
of some issues

From the aforementioned information sources, the Evaluation Committee analyzed and
prepared a report on the performance of the Thai Health Promotion Foundation. The
committee also considered additional information received from the foundation and its
personnel before making conclusions. Important contents of the Evaluation Committee’s
report are as follows.

1) Performance in line with the indicator framework for the 2009 fiscal year
Evaluation of the Thai Health Promotion Foundation’s performance was based on
the foundation’s performance indicator framework developed for the 2009 fiscal year,
and pledged to the Evaluation Committee. The evaluation was made according to 5 main
performance indicators, which are:

a. Fiscal and budgetary management, comprised of budget allocation and

disbursement according to set plans;

b. Organizational development and supervision, comprised of committee roles,

internal audit and supervisory systems, risk management systems, information systems,
and personnel management systems;

c. Stakeholders, comprised of work operation that responds to the policies of the

government, recommendation made by Parliament and the Evaluation Committee, the
Thai Health Promotion Foundation’s image, and the number of new people receiving
funding by the foundation;

d. Internal processes, comprised of project screening and funding approval

processes, monitoring and evaluation processes, and processes to ensure projects are
implemented and completed within timeframes;

e. Results, comprised of accomplishments made in enhancing the ability to

promote health among communities and organizations, communications and campaigns,
research and experimental development, policy promotion, and changing behaviors and
environment to be more conducive to well - being.

The results of the evaluation found the following important issues under each of
the 5 main areas:

1.1) Fiscal and budgetary management

In the 2009 fiscal year, the Thai Health Promotion Foundation had 2.859 billion
Baht worth of revenue. The foundation disbursed a total of 3.296 billion Baht to various
projects using funds from 2009 and previous fiscal years. Fund allocation approval for
new projects in the 2009 fiscal year was made for 1,015 contracts, amounting to a total of
3.651 billion Baht.

The Thai Health Promotion Foundation set fiscal policy to maintain its fund’s
liquidity, to ensure reserve funds are at appropriate levels, and to generate appropriate
returns on funds that have yet to be disbursed. It was found that in the 2009 fiscal year,
the Thai Health Promotion Foundation had good management of its funds, being able to
reduce reserve funds from previously high levels in 2008 to appropriate levels in 2009.
The foundation was also able to generate appropriate returns on its reserve funds.

1.2) Organizational development and supervision

1.2.1) Roles of committees
The operations of various committees, including Fund Committees, Plan
Administration Committees, and the Internal Audit Subcommittee including regular
meetings, with almost every committee members generally present. The average
proportion of attendance by committee members was at 80 - 85%, with meeting
proceedings following set agenda according to the role and responsibilities of each
committee, and serious safeguards established to prevent conflicts of interests.

1.2.2) Internal audit and supervisory systems

From reports made by the Internal Audit Subcommittee, it was found that the Thai
Health Promotion Foundation’s budget reporting was correct and trustworthy, its
accounting practices were correct, and its spending of funds was in accordance with its
main duties. However, recommendations were made to the Thai Health Promotion
Foundation to adjust its accounting, financial, and procurement practices and standards to
become clearer. It was also recommended that the foundation develop its information
technology systems and to improve monitoring and evaluation of organizations receiving
funding.

1.2.3) Risk management systems

ThaiHealth possesses a risk management committee and plans, but due to the new
nature of risk management to stakeholders involved, operations in this area proceeded
slower than originally planned.

1.2.4) Information technology management systems

Work operations were conducted until the establishment of a main plan for
development of information technology systems to support ThaiHealth’s operations in
various areas. The systems are expected to be highly beneficial in the next 1 year due to
the current need to improve some information systems, software, equipment and relevant
personnel.

1.2.5) Human resource management systems

ThaiHealth has good systems for evaluating the work of personnel, for
appropriately linking evaluation results to salary adjustments, and for using evaluations
as tools in increasing work effectiveness and developing human resource capacity. Since
many of ThaiHealth’s exeuctives come from the academic sector, further human resource
development processes for them will allow for improved operations through combined
enhancement of both management and academic skills.
1.3) Stakeholders
1.3.1) Responding to the recommenations of Members of Parliament
The Thai Health Promotion Foundation provided additional information in
response to observations made by Members of Parliament. Improvements were made
based on various recommendations from Parliament, especially on important issues such
as support for enforcement of laws related to traffic safety, enforcement of laws on
advertisement of snacks for children, as well as development and solutions for solving
sexual well - being problems related to children, youths, and families. The Thai Health
Promotion Foundation invested in promoting, strengthening and expanding partnerships,
especially partnerships at local levels, such as Tambon Administrative Organizations and
local organizations.

1.3.2) Work operations based on recommendations by the Evaluation Committee

included in the Thai Health Promotion Foundation’s Performance Report for the 2008
Fiscal Year
The Thai Health Promotion Foundation conducted operations to improve itself
based on 5 recommendations, which are: 1) The inclusion of statements on output,
outcome, and impacts in project proposals in order to allow for more efficient monitoring
and evaluation. The Thai Health Promotion Foundation conducted work in this area until
subsequently achieving clear progress; 2) Development of information systems to include
important core information in accordance with ThaiHealth’s main work processes, and
usage of information technology to assist in managing project information (from the start
of funding, to monitoring of progress, to reporting of results, to the completion of the
project). Considerable work was conducted in the area of information systems, but these
systems are not yet ready to adequately support the main work processes of ThaiHealth;
3 – 5) Operations related to development of the capacity of ThaiHealth personnel and
partners in evaluating projects were found to have progressed considerably; 6) Support of
local communities and organizations, especially Local Administrative Organizations that
possess authority under the law, to be able to conduct definite, sustainable well - being
promotion work. ThaiHealth also helped local organizations to be more accepted by
residents, and to receive sufficient budget. It was found that ThaiHealth promoted the
well – being management abilities of several hundred Local Administrative
Organizations throughout Thailand.

1.3.3) The image of the Thai Health Promotion Foundation, and expansion of
organizations receiving funding from the foundation
From a report on a survey of public awareness and acceptance of the Thai Health
Promotion Foundation’s image, it was found that sample groups of citizens from
throughout the nation, as well as ThaiHealth partners, understood and accepted the
organization as an innovative well – being organization. ThaiHealth was perceived as
working in goodwill with its partners, and was rated as good in terms of being a
transparent funding organization. It was recommended that if ThaiHealth increased its
public relations, and created more concrete achievements, then it will likely earn a very
good rating. As for expansion of organizations funded by ThaiHealth in the 2009 fiscal
year, it was found that 2,036 new organizations received funds, making the total number
of organizations funded by ThaiHealth 6,847.
1.4) Fund allocation process
The Thai Health Promotion Foundation has a project proposal development
process that allowed for the majority of projects approved for funding to be rated as good.
ThaiHealth’s fiscal audits, accounting, and overall performance in these areas were also
considered to be streamlined and adequate. Only some issues required improvement such
as monitoring and evaluation of projects in order to improve their efficiency and
effectiveness, and reportage of project progress in a timely manner.

1.5) Results
Results, both in terms of production and impacts, comprised achievements in
promoting the capacity of communities and organizations at various levels to promote
health, communications and campaigns, academic work, policy promotion, and changing
behaviors and environments to make them more conducive to well – being. Overall
ThaiHealth was rated as good in achieving planned objectives, according to operational
reports of its 13 main plans, which are as follows:

2) Performance of 13 main plans

The Thai Health Promotion Foundation conducted work with adherence to its
strive to be an organization that initiates, encourages, and catalyzes in order support
processes to promote health in Thailand through 13 main plans comprised of: 1) A
tobacco control plan; 2) An alcohol control plan; 3) A traffic accident and disaster
prevention plan; 4) A health risk control plan; 5) A well – being plan for special
population groups; 6) A community well – being plan; 7) A well – being plan for children,
youths, and families; 8) A well – being promotion plan for organizations; 9) A plan to
promote exercise and sports for health; 10) A social marketing communications plan; 11)
A plan to support open admission programs and innovation; 12) A plan to support health
promotion through health service systems; 13) A plan to develop mechanisms and
systems to promote health.

These plans can be divided into 3 groups: 1) Plans involving various risk factors
such as tobacco, alcohol, traffic accidents, nutrition, exercise, the environment,
populations categorized by age, and special risk population groups; 2) Plans that strive to
promote health in local areas, organizations, and communities; and 3) Plans that promote
various other plans using marketing communications and relevant systems development.
Each of these plans is designed to support one another during their implementation.

The Thai Health Promotion Foundation has 7 committees to administer its major
plans, each taking responsibility for a number of these plans. Various work plans and
projects fall under the purview and mission statement of major plans. Those receiving
funding from ThaiHealth to conduct health promotion projects include partner
organizations and networks from the public and private sectors, public interest
organizations, individuals who promote health, and academics. Implementation by
ThaiHealth partners created results in many important areas, including:
2.1) Partnership networks, comprising both organizations and individuals from the local
to national levels, had increased capacity to implement health promotion under various
issues. In the 2009 fiscal year, partners that received capacity enhancement at the
organizational level totaled 6,899 organizations – issues, while partners at the individual
leadership level who received capacity enhancement totaled 82,492 people – issues.

2.2) About 6 million local residents in areas with projects supported by ThaiHealth
gained skills to change their behaviors and to manage the environment, in order to better
promote well – being. Examples of skills gained include: 1) Skills to change eating
behavior to consume more hygienic food, exercise skills that are appropriate for each age,
quitting smoking, control of emotions and stress, operating a motor vehicle safely,
working and conducting one’s occupation safely, as well as caring for children and
handicapped persons in families or communities; 2) Skills to adjust household,
organizations, or community environments to become safe and conducive to well – being
behavior.

2.3) Creating a social wave in the area of health issues, serving as one factor contributing
to changes in thought and values, leading to changes in the policies of governments,
organizations, and communities, as well as changes in the behavior of individuals in
smoking, drinking, driving, exercising, and weight control.

2.4) Production of documents and publications that are beneficial to health promotion,
including information packets, statistics, research work, academic knowledge, operational
manuals, media for campaigns, and periodicals to spread news containing health
knowledge.

2.5) Joint collaboration between the Thai Health Promotion Foundation and its partners
has resulted in changes to various policies that have created positive impacts to the well –
being of the public. Policy changes took place at over 1,000 organizations – issues,
including Tambon Administrative Organizations, municipalities, schools, temples, and
businesses. This resulted in behavioral changes among members of communities near
these organizations, as well as improvements to the safety of the physical environment,
and greater generosity, unity, and strength in society.

2.6) Creating environments that are more conducive to well – being, such as smoke – free
zones and over 4,000 smoke – free organizations, more than 200 exercise venues in
communities, and more than 80 schools and child development centers that have received
safety certification.

Despite the Thai Health Promotion Foundation and its partners creating
widespread results in many areas via funded projects, several issues that can still be
improved for greater efficiency and effectiveness are as follows:

• While the smoking rate of the total population has decreased, smoking in
population groups from 19 to 24 years of age has increased, therefore the
 Thai Health Promotion Foundation should emphasize implementation in
this particularly group.
• ThaiHealth should increase traffic accident and disaster prevention at the
community and local levels due to traffic accident rates still being high
for roads that are not on main highways. Traffic disasters in communities
are also still an important problem to the quality of life of rural residents.
• Under the well – being plan for special population groups, there should be
reformed method to coordinate power among groups of different ages, in
order to serve as a foundation for collaborative problem – solving through
the work plans of various projects under ThaiHealth and other sectors.
There should also be promotion and support for Local Administrative
Organizations to play a role in caring for handicapped people and high
risk population groups in their respective jurisdiction.
• Under the community well – being plan, there should be sufficiently clear
indication of the impacts or benefits that target groups will receive in
order to allow for monitoring plans to easily determine progress and long
term success.
• Under the well – being promotion through health service systems plan,
there should be consideration of the involvement of other sectors besides
the public health sector, because other sectors such as the public
communications sector, the industrial sector, and the academic sector can
also play important roles in health service provision.
• Every work plan, especially work plans to promote well – being among
Muslim communities in Thailand, should seek to obtain government
funding slated for the southern region as these funds are in the tens of
billions of Baht. These funds can be used to conduct well – being work
for citizens in the southern region.
• All plans should seek to promote work in various areas, including
reduction of risk factors and increase of health – promoting factors
targeted at communities that will directly receive these benefits.
Organizations at the community level such as Local Administrative
Organizations can be drawn to play a larger role as the owners and
administrators of these plans.

3) Evaluation of the Thai Health Promotion Foundation’s operational results in the

areas of tobacco control, alcohol control, and traffic accident reduction

The Evaluation Committee conducted evaluation on the Thai Health Promotion

Foundation’s role in controlling tobacco smoking, alcohol consumption, and traffic
accident reduction in 2007. The committee also evaluated ThaiHealth’s role in promoting
the capacity and strength of its partnership networks in 2008. However, these studies only
showed the results of ThaiHealth’s work at the output and outcome levels. Therefore, in
order to allow for a complete view of ThaiHealth’s accomplishments, the Evaluation
Committee organized an evaluation of the results and impacts of ThaiHealth’s work in
2009. Over a period of 8 years since its establishment, ThaiHealth worked with its
partnership networks in developing networks, information, and knowledge to
communicate, campaign, and promote policies and laws, resulting in the following
important results and impacts:

3.1) Results and impacts from control of tobacco smoking

• The creation of ministry laws that allowed for the enforcement of the
Tobacco Products Control Act of 1992 and the Non-Smokers' Health
Protection Act of 1992. More than 10 ministry laws were enacted during
the Thai Health Promotion Foundation’s existence, including laws to
increase taxes on public smoking, laws forbidding the advertisement or
sales promotion of cigarettes, laws to put warning labels on cigarette
packaging, and the appointment of officials to enforce these laws.
• The establishment of widespread smoke – free zones in public places,
temples, universities, schools, hospitals, hotels, movie theatres, restaurants,
public and private sector organizations, and public transportation vehicles.
• Cigarette consumption decreased from 39.099 billion cigarettes in 1991 to
35.162 billion cigarettes in 2006. When considering the number of
smokers, total smokers decreased from 12.2 million people in 1991 to
10.86 million people in 2007, while the national population increased.
• From estimated information using the Thailand SimSmoke Simulation
Model, it was found that tobacco control measures in Thailand from 1991
to 2006 was able to prevent mortality among 31,867 people, equivalent to
2,124 people per year.

3.2) Results and impacts from control of alcohol consumption

• ThaiHealth’s work in this area contributed to the enactment of the Alcohol
Control Act of 2008, as well as the Cabinet’s policy to establish a National
Day of No Alcoholic Drinks at Temples, which coincides with the
beginning of Buddhist Lent each year. It also resulted in the Mahathera
Council establishing temples as alcohol – free zones, and the Bangkok
Metropolitan Administration establishing 23 public parks to be areas
where alcohol cannot be sold or consumed.
• The creation of areas free from alcohol under applicable laws and policies.
• The number of alcohol drinkers nationwide decreased from 16.2 million
people in 2004 to 14.9 million people in 2007. The number of new female
drinkers decreased from 5.6% in 2003 to 1.8% in 2007, while the number
of new male drinkers also decreased from 33.5% in 2003 to 23.2% in 2007.
• Traffic accidents caused by alcohol consumption decreased continuously
from 9,279 cases in 2004 to 3,589 cases in 2008. In terms of injuries and
fatalities, the number of traffic fatalities from all causes decreased from
21.9 per 100,000 populations in 2003 to 17.8 per 100,000 populations in
2008.
• A study found that domestic violence can decrease from 70 to 100% once
alcohol drinkers quit drinking.

3.3) Results and impacts from traffic accident reduction

 • 6 laws were created in the period from 2003 to 2008, dealing with turning
on motorcycle headlights even during the daytime if visibility is limited,
incorporating automatic systems to turn on motorcycle headlights if
visibility is limited, arrest of drunk drivers, narcotics testing of drivers,
increasing the punishment of drivers who drive while drunk or intoxicated,
and forbidding the usage of mobile phones while driving.
• From 2003 to 2006, more motorcyclists wore helmets, and more drivers
fastened their seatbelts, even though the total number of compliant
motorists was still not high.
• The rate of driving after drinking alcohol was reduced from 48% in 2003
to 41% in 2006.
• From 2005 to 2008, the total number of traffic accidents dropped from
122,040 cases to 88,713 cases, when compared with the period from 1998
to 2004, when total traffic accidents increased from 73,737 cases to
124,530 cases.
• The number of traffic accident fatalities decreased from 21.9 people per
100,000 populations in 2003 to 17.8 people per 100,000 populations in
2008.
• Economic estimates found that losses from traffic accidents decreased by
about 9.2 billion Baht due to the reduction in the number of traffic injuries
and fatalities from 2006 to 2008.

Recommendations of the Evaluation Committee

The Thai Health Promotion Foundation is an organization with vision that aims to
see “Thai people possess sustainable well – being,” and the intent to reduce risk factors
and support health – promoting factors. The Thai Health Promotion Foundation works
through supporting and promoting the strength of its partnership networks to allow them
to conduct operations in knowledge creation, policy promotion, and expansion of well –
being results to organizations, communities, and various other areas. Throughout 2009,
the Thai Health Promotion Foundation, which is an innovative organization, created
many new ideas and adjusted itself accordingly to current situations and the
recommendations of Parliament, the Cabinet, and the ThaiHealth Evaluation Committee.

However, there are many issues that the Thai Health Promotion Foundation can
work to develop for added strength and efficiency in work operations according to its
mission. The Evaluation Committee views that the Thai Health Promotion Foundation
should place importance on the following issues:

1) The Thai Health Promotion Foundation should set its organizational direction t
place importance on creating results and impacts that clearly shows changes in public
behavior, changes in the physical environment, changes in society, as well as
improvement in public well – being, which are adequate for stakeholders to understand
and accept.
 2) In order to create results that cover the national population, the Thai Health
Promotion Foundation should set objects at the result and impact levels that are clearly
beneficial to public well – being, over a period of 3, 5, and 10 years. ThaiHealth should
also organize a strategic plan that is appropriate to accommodate its objectives. Strategies
or measures can be adjusted to suit the situation during each moment in time, and annual
operational plans that can be implemented immediately should be created at all levels

3) In order to improve the health and quality of life of rural residents who live in
distant areas, the Thai Health Promotion Foundation should expedite reform in those
areas by promoting local agencies, especially Local Administrative Organizations and
communities, to have policies to conduct well – being promotion for local residents in
their respective areas. ThaiHealth should also encourage the development of measures to
exchange knowledge and create competition between areas to expedite the expansion of
well – being promotion and quality – of – life improvement to become important parts of
the roles of local organizations.

4) In order to protect against health impacts from neighboring countries, the Thai
Health Promotion Foundation should increase its support for projects that involve
cooperation with neighboring countries.

Report of the Internal Audit Subcommittee

In 2009, the Internal Audit Subcommittee improved its various components. This
included the Thai Health Promotion Foundation Board issuing the 8 / 2009 Directive on
July 2, 2009, to appoint Mr. Somboon Chatchawan as the Chairman of the Internal Audit
Subcommittee in place of Mr. Dusit Nontanakorn, who asked to resign after being
appointed to become Chairman of the Thai Chamber of Commerce Board and Chairman
of the Board of Trade of Thailand.

The Internal Audit Subcommittee carried out its duties as set by the Thai Health
Promotion Foundation’s 2005 Regulation on Internal Audits of Finance, Accounts, and
Procurement with impartiality and precision, and was able to provide independent
opinions and recommendations for positive work operations that are in accordance with
the vision and mission of the Thai Health Promotion Foundation. The subcommittee’s
work was carried out in a transparent and accountable manner, with all legal objectives
accomplished. In the 2009 fiscal year, the subcommittee had 12 total meetings and also
participated in meetings with ThaiHealth executives and external auditors to consider the
results of its audit of various ThaiHealth operations. The Internal Audit Subcommittee
also provided recommendations to develop the efficiency of work administration to be in
accordance and responsive to current events. The results of the subcommittee’s work can
be concluded as follows:

1) Financial statement audits, comprised of

a. The audit covered ThaiHealth’s accounts and financial statement, and resulted in an
Evaluation Report on ThaiHealth’s Spending and Assets for the 2009 Fiscal Year by the
Office of the Auditor General (OAG). The report was presented to the ThaiHealth Board
for further recommendations. The Internal Audit Subcommittee followed up on
operations based on the board’s recommendations, as well as recommendations made in
the Financial Statement Audits Report for the 2009 Fiscal Year.

b. The audit found that the overall financial statement and its important contents were in
line with rules, regulations and generally accepted principles of accounting. The
statement provided sufficient and reliable information. There are a few recommendations
for improvements to increase efficiency and increase clarity in the internal control of the
Thai Health Promotion Foundation.

2) Supervision, recommendations in duty implementation, and the Internal

Auditor’s Statement on Audit Results, involving studies, audits, and recommendations
made to ThaiHealth, as well as follow up on the implementation results of recommended
improvements for the development of management systems for increased efficiency in
accordance with the rules and regulations of the Thai Health Promotion Foundation.

a. Establishment of work operation plans, annual internal audits, and the hiring of
external auditors to support internal auditors.
b. Review and establishment of a charter for the 2009 internal audit of the Thai Health
Promotion Foundation to be in accordance with current situations.
c. Financial statement audits, covering audits of accounting and budgets to ensure
correctness and adherence to regulations.
d. Audit of fund management system in order to ascertain that the system follows
ThaiHealth policy, and is managed transparently and appropriately.
e. Evaluation of internal audit and risk management systems, in order to develop work
operations to meet standards, to establish an internal audit system that is good and
capable of reducing risk that may occur. Recommendations on organizational
development were also made.
f. Study of the academic work of Thai Health Promotion Foundation personnel to gain
benefits in dissemination of lessons learned, and to use experiences from work operations
in organizational development

3) The Internal Audit Subcommittee conducted visits to various well – being project
/ work plan sites funded by ThaiHealth, such as work plan sites involving exercise and
sports for health, well – being promotion work involving children and handicapped
people in Thai society, private organization well – being, reformed well – being tambons,
and the development of public health academic institutions to become well – being
promotion organizations. The subcommittee received information on success factors, and
problems and obstacles in the projects’ work operations. The subcommittee also
exchanged knowledge and made recommendations for Thai Health Promotion
Foundation projects to aid in achievement of ThaiHealth’s objectives. The
recommendations are as follows:

a. The Thai Health Promotion Foundation should manage and compile knowledge from
projects that have good concepts and beneficial results to the public. This knowledge
should be synthesized into categories that are appropriate to citizens of each age group
and type, before being disseminated to the public to allow for said knowledge to create
benefits for society, and for members of society to learn.

b. Projects involving children and youths that have schools as the focal point of drive
should implement well – being promotion policy and transfer these operations to local
communities. If the Thai Health Promotion Foundation coordinates with the Ministry of
Education to organize well – being as a main policy of academic institutions in Thailand,
it will allow for implementation to be continuous and sustainable.

c. Regarding well – being work in private sector organizations, the Thai Health
Promotion Foundation can make policy recommendations and coordinate with the
Ministry of Labor and the Ministry of Industry to become a host for various private
organizations to respond to well – being policies, and to create social responsibility
among these organizations, which will lead to sustainability and a happy society.

d. Well – being work related to all groups of citizens in communities, including infants,
senior citizens, and underprivileged persons, with community leaders or monks leading
well – being promotion in communities is one implementation pathway that has achieved
good results. However, if the public sector can support the implementation of well –
being work to become stronger in communities through greater cooperation and
responsibility from agencies such as Local Administrative Organizations, or community
health centers, this will serve as a foundation for improving the quality of life of
community members, especially underprivileged persons, ultimately resulting in a
“peaceful and happy society.”

The Internal Audit Subcommittee believes that work implementation by the Thai Health
Promotion Foundation has been managed appropriately, with continuous development
and improvement in accordance, and in response to, the environment of current situations.

Mr. Suraphon Supaporn

Chairman of the Internal Audit Subcommittee
December 15, 2009