Health wake-up call — Active citizens urged to fight Thailand’s NCD crisis

Thailand is being urged to promote “active citizens” to tackle non-communicable diseases (NCDs) after new findings show they account for 70% of all deaths and impose an economic burden of THB1.6 trillion.

According to the “Report on the Health Status of Thai People, Health Service System and Health Workforce for National Strategy Development”, published in March 2026 by the National Health Foundation with support from the Health Systems Research Institute, the country is undergoing a clear epidemiological transition.

In the past, communicable diseases were the leading cause of death among Thais. Today, the burden has shifted to non-communicable diseases and injuries from accidents.

NCDs have now become the leading cause of death, accounting for as much as 70% of total fatalities, or around 420,000 deaths per year.

The main “killer” diseases include stroke, which recorded 349,126 patients in 2023, followed by diabetes, cardiovascular diseases and cancer.

Cancer is the second leading cause of death in Thailand, with cases expected to rise in line with changing lifestyles and the country’s transition into an ageing society.

Chronic kidney disease also places a heavy economic burden, largely driven by poorly controlled diabetes and high blood pressure.

Why NCDs are dragging down Thailand’s economy

The NCD crisis is not only a public health issue but also a serious economic challenge, with total losses estimated at THB1.6 trillion, linked to several factors.

• Reduced labour productivity, as NCDs often lead to disability or long-term dependency
• Rising public healthcare expenditure, particularly as Thailand entered an “aged society” in 2024, with more than 20% of the population aged over 60, increasing pressure from long-term chronic conditions
• Financial strain on caregivers, as working-age individuals leave the labour force to care for housebound or bedridden elderly patients

The report also notes that current health policies remain focused on treatment rather than prevention, highlighting a structural weakness that requires urgent reform.

Active city model offers a sustainable pathway

One of the key solutions proposed is the concept of an “active city”, which involves designing urban environments to support physical activity and healthier lifestyles.

Key components include:

• Expanding public spaces and parks, such as Bangkok’s “15-minute park” policy, which aims to ensure access to green areas within 800 metres or a 15-minute walk from home
• Efficient public transport systems to encourage walking and cycling instead of private car use
• Safer community design to reduce road accident risks, as Thailand continues to rank among the countries with high road fatality rates

More than 20 pilot “healthy space” areas have already adopted this approach in cities including Bangkok, Hat Yai, Chiang Mai and Chiang Rai.

Developing active cities not only helps reduce NCD incidence but also addresses health inequality by improving equitable access to healthy environments, while reducing stress and strengthening community ties, benefiting mental health.

From active cities to active citizens

However, supportive urban design must be accompanied by the development of “active citizens” — individuals who take an active role in managing their own health, possess health literacy and adopt healthier behaviours.

The report highlights a persistent “gap between knowledge and practice”. For instance, many people with pre-hypertension continue to consume high-sodium diets and avoid exercise due to environmental and cultural factors.

Key mechanisms to drive active citizenship include:

• Village health volunteers, who act as a bridge between the public health system and communities
• Digital health literacy, enabling people, particularly the elderly, to access modern services such as telemedicine and health applications
• Policy reforms, including restructuring the health workforce and strengthening primary care services

To ensure the success of both active city and active citizen approaches, the report recommends several systemic policy measures:

• Strengthening primary care, with a focus on long-term community-based care rather than hospital-centred treatment
• Decentralisation, empowering local administrative organisations to deliver proactive health services and develop healthy spaces at the subdistrict level
• Health workforce reform, with increased production of professionals aligned with ageing society needs, such as physiotherapists, psychologists, geriatric nurses and occupational therapists, which remain in short supply
• New service innovations, including telemedicine systems, home medicine delivery and home-based elderly care, to reduce hospital overcrowding and improve accessibility