By Asian standards, the level of public health in Thailand was relatively good. In 1986 the life expectancy for men was 61 years; for women it was 65 years. In 1960 for both sexes life expectancy had been only 51 years. In 1984 deaths among children under age 4 averaged 4 per 1,000, while infant mortality for the same year was 47.7 per 1,000. The crude death rate for the population as a whole declined fairly consistently between 1920 and 1984, from 31.3 to 7.7 per 1,000. Much of the decline was a reflection of the successful struggle against malaria, which once had been the single greatest cause of illness and death. The expansion of the public health system in general, however, was also an undeniable factor in the improved health picture.
Health and related social welfare services received an allocation of 10.3 percent of the total 1984 budget. Of this amount, about 50 percent was assigned to public health activities; the remainder went to social security and welfare, housing, and community services. Although a disproportionate number of health care facilities were concentrated in the Bangkok area, Western-style medical treatment was provided throughout the country by a network of hospitals, regional health centers, and other clinics. In 1981 there were 359 hospitals, with 1 bed per 734 people and 1 physician per 6,951 people. In the same year, the nation registered 1,142 dentists and more than 50,000 nurses and midwives.
Despite progress in lengthening life expectancy, combating disease, and building public health facilities, Thailand in the late 1980s faced a bleak public health situation. One of the most critical national health problems was the water supply. In the mid-1970s, little more than 20 percent of the population, most of that portion being urban dwellers, was reported to have access to safe water. Even in Bangkok, where the proportion with such access was highest, only about 60 percent of the population had access to potable public water. In the countryside, inhabitants depended on shallow wells, roof drainage, rivers, and canals.
Throughout Thailand, but especially in Bangkok, the traditional skyline with its Buddhist temples was becoming overshadowed by Western-style buildings and skyscrapers. Construction was done mostly by laborers who usually lived on site with their families. In 1980 there were more than 373,000 construction workers (79 percent of whom had once been farmers) living in temporary housing, which typically measured only 3 to 4 meters square and had a door but no windows. Workers’ compensation and paid sick leave were almost nonexistent, and illness and inadequate sanitation were common in these shantytowns. Although public and private agencies were becoming aware of the seriousness of the problem from both a health and a legal point of view, the transient nature of the burgeoning construction community made this population difficult to serve. In the urban areas, modern development and outward prosperity often masked deficiencies in basic infrastructure that arose from rapid and unplanned growth. Urban planners were confronted with traffic congestion, housing shortages, and air, water, and noise pollution.
The development of an international consumer economy brought new challenges and Western diseases, particularly for urban dwellers. Prostitution and narcotics use, which had been part of Thai culture for centuries, took on new dimensions as health hazards. With the worldwide spread of acquired immune deficiency syndrome (AIDS) and new strains of venereal diseases, Thailand became concerned about the welfare of its female citizens and the effects on tourism. By mid-1987 eleven people in Thailand were reported to have AIDS and about another eighty to be AIDS carriers. The government had begun to take such action as testing homosexuals and drug addicts for AIDS, testing donated blood supplies, sponsoring public information campaigns, and funding the development of an inexpensive AIDS testing kit by Mahidol University.
In the mid-nineteenth century, narcotics were seen as a domestic problem, but one limited mostly to the Chinese. By the 1960s, drug use was considered a security or a foreign affairs issue. Only by the late 1970s did Thailand recognize drugs as a growing domestic problem. By that time, in addition to organic narcotic production, there was a dramatic rise in the production and use of synthetic drugs. Narcotics-related crimes ranked third among all types of criminal activity in 1983. In that year, there were 28,992 convictions for drug offenses nationally and 11,777 in Bangkok, which resulted in the overcrowding of prisons and detention centers. To combat the problem, the government instituted both public information campaigns and drug treatment centers. The national media began to make daily announcements about the social effects of drug use, and even in small provincial cities billboards were used to carry the message. Some traditional social systems were also employed in an innovative fashion. For example, Wat Tam Krabok, in Sara Buri Province, became one of the most important centers for the treatment of opiate addiction. Moreover, the government responded to the increase in health-related problems by placing new emphasis on meeting basic social needs in its economic and social development planning.