Health crises extend beyond just "COVID-19"; planning research to develop a public health system that can adapt to changes in the "world" and "diseases" must keep pace with every situation.

Medicine and public health are among the top priorities for improving the quality of life for populations. This includes ensuring access to healthcare systems, providing health insurance for all demographics, developing technologies to treat various diseases, and establishing robust disease prevention systems. The outbreak of the 2019 novel coronavirus or 'COVID-19' has highlighted the urgent need for advancements in this field. The lack of necessary data to respond effectively has shown to have devastating effects on lifestyles, health, and the economy. Researching vaccines to combat diseases has become the most crucial factor in alleviating this pandemic.

Thus, research in public health and medicine is an indicator of a country's capacity to handle health system-related challenges. Generally, research in this area can be categorized into two types: research aimed at developing service systems and research focused on medical advancements. Thailand has consistently pursued both types of research.

Dr. Nopporn Chuenklang, Director of the Health Systems Research Institute (HSRI) provides an example of how Thailand effectively managed the COVID-19 outbreak due to a strong foundation in service system research, such as the establishment of the National Health Security Office (NHSO), the Health Promotion Foundation (ThaiHealth), and the Hospital Accreditation Institute (HAI), which also includes the development of local public health systems.

“Today, tuberculosis remains a problem in Thailand, indicating that medical advancements alone cannot solve issues; there must also be effective public health management. In the case of COVID-19, we have skilled doctors treating patients, but without a good patient tracking system, effective surveillance, and management systems, we wouldn't have the current statistics. It's like the left leg and the right leg working together,” Dr. Nopporn stated.

The public health system, developed through trial and error, has enabled Thailand to have community health volunteers (CHVs), health-promoting hospitals, and various agencies overseeing health matters, which collectively support the overall functioning of the public health system. Dr. Nopporn acknowledges that while Thailand's medical research may not yet match that of leading countries like the United States or the United Kingdom, once a drug is discovered or developed, Thai researchers can quickly replicate it, indicating that Thailand is not lagging in medical advancements.

  • Adapting Research to Evolving Needs

The emergence of COVID-19 clearly demonstrates that the challenges facing the medical and public health sectors stem from changes in the world and societal contexts. Such evolution has always been present. In Thailand, this is evident from the shift in diseases affecting the population; for instance, 40 years ago, Thais died from infectious diseases like tuberculosis, diarrhea, and malaria, which medical research has now progressed to manage. However, new causes of death have emerged, such as cancer, heart disease, hypertension, and even road accidents.

“We must develop a public health system that can accommodate changes in social contexts, including population structure, occupations, income levels, and urbanization. The changing world leads to global warming, increased carbon dioxide, more toxins, and a rise in fast food consumption and alcohol availability. Therefore, the system must evolve accordingly. If you ask what we lack, we will always lack something as long as humanity continues to progress. We must keep developing the system,” Dr. Nopporn remarked.

Moreover, the demand for medical and public health services from patients will also change. Therefore, addressing patient expectations is equally important. Dr. Nopporn believes that patient expectations will continue to rise; for example, where it used to take a day to see a doctor at a hospital, it has now reduced to half a day, and in the future, patients will expect even more convenient and quicker services, as well as higher quality in treatment and services, such as the quality of medications and healthcare providers. Thus, both system research and technological advancements must work together to bridge these gaps.

 

  • The Next Step: Research for 'Prevention'

Furthermore, as contexts change, healthcare costs will become an increasing problem. This means that treatment costs will rise due to advancing technologies. Therefore, in addition to developing research systems to ensure access to healthcare and medical research to treat diseases, future research must also focus on reducing treatment costs, such as creating disease prevention systems and ensuring healthcare coverage at the local level.

“Infectious diseases that were once curable are now chronic conditions, such as diabetes and hypertension, requiring lifelong medication. Therefore, we must ensure easier access to healthcare. We need to consider whether it is possible to provide treatment for infectious diseases and chronic communicable diseases at local hospitals, or whether we need to create spaces for exercise. How can we encourage people to exercise to prevent diseases?” Dr. Nopporn suggested.

To align with this direction, HSRI has revised its working methods by establishing a framework to identify current knowledge gaps. HSRI will take responsibility for recruiting researchers to form teams to prevent future problems without waiting for researchers to propose what they want to study.

“The problems persist. Solving them requires development and the discovery of new things. If we have issues with ventilators, masks, or negative pressure rooms, we encourage researchers to collaborate on these matters,” he added.

However, Dr. Nopporn acknowledges that the global research community's challenging task now is to cultivate new researchers due to a lack of sufficient motivation for individuals to engage in this work, such as strict working methods or the requirement for prior research output to assess competence.

  • Research Funding Must Be Flexible and Non-Redundant

Currently, research funding in Thailand remains relatively low, at less than 3 percent of GDP. Public health and health research still receive limited funding. Additionally, past issues with research funding include annual budget allocations that must be set two years in advance, leading Dr. Nopporn to view the previous budgeting methods as misaligned with current contexts and situations. This was evident during the COVID-19 outbreak, where no budget had been allocated for such urgent cases, forcing HSRI to adjust its normal budget by 10-15 percent to conduct research on this issue.

“Currently, our accident mortality rate is the second highest in the world. We will research how to prevent this. However, if the high-speed train is completed next year, the situation may change. Next year, we may face global warming and new diseases that we are unaware of. Therefore, the budget must be flexible and allocated in a way that empowers responses to immediate issues. Secondly, research does not conclude in one year; thus, funding must be able to extend over two or three years. Thirdly, health research is not about procuring materials; the context of the fiscal year-end cannot be applied here,” he explained.

As a leader in public health research, he further explained that these issues are currently being addressed through long-term funding from the Office of the National Science, Research and Innovation Policy Council (NSTDA), which better meets researchers' needs and reduces redundancy in research efforts, as there is a mediator overseeing and approving research budgets.

“Previously, the Research Council had a broad mandate and could address all issues in Thailand, whether in medicine or social sciences. Centralizing efforts allows for better visibility of ongoing projects, such as agriculture, and tracking the total public research budget. The use of OKR (Objectives and Key Results) is a positive development,” he concluded.

Dr. Nopporn emphasized that while research does not guarantee 100 percent applicability, we must not forget that human resources are the primary resource for development. Thus, investing in research for the health system of the population is crucial for the country's strategic development.

SOURCE: www.bangkokbiznews.com