Tailoring tobacco control efforts to the country: the example of Thailand.

Abstract

The need for tobacco control in Thailand is evident in the statistics. Among Thailand’s 62 million inhabitants, fewer than 5 percent of females smoke, but 39 percent of males do (National Statistics Office 1999). Although the recent economic downturn and increases in cigarette taxes contributed to a decline in consumption from 48 billion cigarettes in 1997 to 37 billion in 2001, the toll from tobacco use is still heavy. It has been estimated that in 1993, 42,000 Thais died of tobacco-attributable disease (Ekplakorn, Wongkraisrithong, and Tangchareonsin 1991). Lung cancer is the number one cancer in Thai males except in the northeastern region, where endemic liver fluke disease makes liver cancer more common (Deerasamee and others 1999). Understanding Thailand’s efforts to work toward successful tobacco control requires an appreciation of the complex sociocultural, political, and even personal dynamics that interact to shape Thai thinking and policymaking. These dynamics cannot be captured in a short case study and are not fully described in this deeply personal account, in which the political, social, and human factors are intimately entwined. The narrative shows that while similarities exist between the Thai experience and that of other countries, the success of tobacco control in Thailand must also be attributed to a unique historical struggle set in the rich context of Thai politics and culture (Muscat 1992). Furthermore, it is a story grounded in the rational, iterative world of medical investigation and the sometimes chaotic world of political process. Combined, these ingredients make for a fascinating story. The Story Begins: Small Steps Forward The best-known incident in tobacco control in Thailand is the wellpublicized case in the late 1980s when the U.S. tobacco industry used