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ศ.นพ.ประเวศ วะสี ได้ เขียนเอกสารประกอบการประชุมวิชาการ IUHPE World Conference on Health Promotion ครั้งที่ 21 เรื่อง Health Promotion As a Tool for Great Reform จัดที่ พัทยา ประเทศไทย25 สิงหาคม 2556

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# Health Promotion As a Tool for Great Reform By Prawase Wasi Chairman, National Health Foundation Thailand A Keynote at the 21st IUHPE World Conference on Health Promotion Pattaya, Thailand, 25 August, 2013 1 Health and well-being of mankind around the world is the noblest goal. It is now known that health is not merely on absence of diseases, but a state of complete well being, physically, mentally, socially and spiritually. Thus health is the whole. It is integral in total human and social development. Presently we are facing very complex and difficult health challenges, the compound economic, social, ecological and political crises. Inequality has become prevalent world wide, greatly contributing to health and social problems. Richard Wilkinson and Kate Pickett have collected data from developed countries around the world, showing tight association between health and social problems against income inequality. The widest gap is in the US. This is supported by Joseph E. Stiglitz, the American Nobel Prize - winning economist in his book entitled "The Price of Inequality: How Today's Divided Society Endangers Our Future". Inequality around the world, instead of health and well-being, particularly in advanced and well-established democracies like the US, United Kingdom and France, raises disturbing questions of why and how to proceed further. These are talks of the need for Reform in the US, and even another revolution in France. It remains unclear as how to proceed this reform or revolution. We may look at health promotion as a tool for great reform. The problem with present world development model is that it is fragmented or compartmentalized development. Its emphasis on economy, especially in the more narrow sense of it, the money, leads to unbalanced development. Social and environmental crises are the results of the lopsided development. Maximum profit practices easily fall victims to greed and corruptions, as have occurred with financial institutions in the US. The powerful, but incorrect, force of western model of development has led to the extremes of social divide and climate changes. The former to the phenomenon of extreme richness of one percent of the population is America, while the poor have not benefited in the last three decades of development. Global warming is associated with increased severity and frequencies of natural disasters, such as strong winds like hurricane or tornado, floods, drought, earthquakes and tsunami. These disasters associated with global warming will devastate lives and well-being of mankind in colossal scales. Some call the present world crisis a civilization crisis. A turning point or a great reform is needed. But the reform is extremely difficult, next to impossible, because the civilization model is deeply ingrained. Turn to health promotion. Health is the whole. Health development, contrary to economic development, must be an integrated and sustainable development. New health development transcends traditional disease prevention to total human and social development. As ministries of public health in most countries have been set up the work in the old public health paradigm, health systems reform or new health development paradigm needs new tools. Since bureaucratic institution will not be flexible and efficient enough to deal with new health development, the new tools must be non-bureaucratic and independent organizations. 2 In Thailand in order to implement health systems reforms several non-bureaucratic and independent organizations have been created by laws. They are: 1. **The Health Systems Research Institute (HSRI)** to create system knowledge to be used for health systems reform. Without system knowledge, only with technical knowledge, systems reform is not possible. 2. **The Thai Health Promotion Foundation (ThaiHealth).** One major reform is to change the passive strategy of waiting to deal with bad health to active strategy of promoting good health. Most determinants of good health lie outside the traditional public health sphere. Thus a new tool is needed. A law was promulgated that two percent of alcohol and tobacco taxes automatically flow to the chase of newly established ThaiHealth. ThaiHealth which is the host of this 21^st World Conference on Health Promotion, is a great tool for promoting and supporting social innovations for health throughout the country. 3. **National Health Security Office (NHSO)** has been created to handle universal health insurance coverage. Nearly entire population has health security provided by the government through the NHSO. 4. **National Health Commission Office of Thailand (NHCO)** has been created to deal with good public policies promotions. Healthy public policies are essential for good health, but extremely difficult to implement. NHCO has been created, with the Prime Minister as the chairperson of the commission, as a tool to implement this difficult task. One of the great merits of the independent organizations is its freedom to ask "who are the best", while in the bureaucratic system such flexibility is absent. The four independent organizations, the HSRI, the ThaiHealth, the NHSO, and the NHCO have worked together on the most ambitious health systems reform in Thailand. The effect for health and well-being of the people around the country, health promotion being a major part of it, has become a tool for great reform. Because it has to deal with all aspects of development, economic, social, environmental, spiritual, political, administrative, etc in an integrated manner. **Integrated development for health and well-being of mankind** must be area-based, not institution-based. It relies on social capital, not money capital. Empowerment of the people and their community and local organizations to be able to self manage is the key. Community democracy is inherent. The process leads to social cohesion and healing. The number of communities and localities with health and well-being is increasing and there is inter-community and inter-locality learning to expand. In addition to promoting management capability of the community and the local organizations in integrated development, the people are being empowered in public policy development through the process of **National Health Assembly**. Innovative health 3 assembly process which has been going on in Thailand is a process that all sectors come together to identify problems, etiologies and formulate policy solution. Actually there are various resources usable for health development. But the existing vertical structures prevent integrated development. The non-bureaucratic, independent new tools for health development, the HSRI, the ThaiHealth, The NHSO and the NHCO can facilitate integrative works of both government's and non-government's structures. 'Social weaving' makes the impossible possible. 'New health development represents a paradigm shift. The economic paradigm and the health paradigm fundamentally differ in ways of thinking and practices as summarised in the following table. <table><tr><td>Economic Paradigm</td><td>Health Paradigm</td></tr><tr><td>Greed is good</td><td>Health is good</td></tr><tr><td>Money capital</td><td>Social capital</td></tr><tr><td>Fragmented, top down</td><td>Integrated, bottom up</td></tr><tr><td>Unbalanced, social divide</td><td>Living together</td></tr><tr><td>"Homo economicus"</td><td>"Homo holisticus"</td></tr></table> The two paradigms differ so much from consciousness to social organizations and even to transformation of human species from "Homo economicus" to "Homo holisticus". A shift from Economic Paradigm to Health Paradigm is thus a great reform. As the world is running into deeper crises with present economic development paradigm, attention should be paid that new health paradigm may be a tool for great reform. With that I would like to congratulate all the participants who work for health and well-being of mankind around the world for their noble roles of helping to heal the world. 4 PGET # Health Promotion As a Tool for Great Reform [การส่งเสริมสุขภาพเป็นเครื่องมือในการปฏิรูปครั้งใหญ่] ## ประเวศ วะสี 

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