This paper presents a review of the Thai government’s evolving role in increasing national awareness of aging, developing legislation, and designing and implementing national aging plans over the past two decades. The focus on issues relating to the elderly started with the organization of a national Elderly Council and the development of a national plan for older person in 1982. It was a visionary move then, even before the increase in the aging population in Thailand became apparent, but little progress was made for the next 15 years. It was not until the aging agenda was included in the new constitution of Thailand in 1997, along with the influence of the United Nations promotion of aging awareness, that aging issues began to receive deserved attention in the central government. In 2002, the Second National Plan for Older Persons was developed, including a comprehensive list of goals and objectives. Since then, numerous programs have been developed at many levels of the society, with increasing evidence supporting an active role that a government can and should play in promoting the welfare of elders in an aging nation.

Development of Policies and Plans Concerning the Elderly

Councils and Committees, 1982–1999

The United Nations held the World Conference of Aged Population in Vienna, Austria in 1982, in which a long-term international action plan was set with respect to the elderly. Member countries were encouraged to develop and implement policies and programming relating to the elderly. Thailand, at that time, had established its first National Elderly Council. In 1991, the United Nations Assembly recognized elderly rights with respect to autonomy, involvement, care, self-satisfaction and esteem. Thailand celebrated the new Constitution of the Kingdom of Thailand in 1997, in which two sections were devoted to the elderly: the first indicating that persons 60 years of age or older who earn no income have the right to receive aid from the State; and the second indicating that the State must support the elderly, the poor, and disabled so that they can have a better standard of living.

The United Nations pronounced 1999 as the International Elderly Year in which activities celebrating the elderly would be held throughout the world. At the same time in Thailand, the goal of promoting programs and policies concerning the elderly was pushed forward by the Office of the Prime Minister, leading to the establishment of a permanent committee—the National Committee of Senior Citizens. This committee consists of delegates from various ministries, departments and organizations as well as qualified individuals from private and public sectors.

The Declaration of Thai Senior Citizens, 1999

The Declaration of Thai Senior Citizens was also launched in 1999 and signified the commitment of the Prime Minister and representatives of all political parties in Thailand to elevating the standard of living of the elderly and protecting their rights (see Box 1). See Table 1 for a timeline of the major events described in this paper.

Table 1 Timeline of activities concerning aging population in Thailand, in relation to UN activities
Full size table

Elderly Act of 2003

In 2003, Thailand passed the Elderly Act, having worked on issues relating to it for the better part of a decade. The movement for the elderly laws began in 1995 when the Cabinet agreed with the notice and suggestion of the Assembly of Women, Youth, and Elderly Affairs of the Senate that specialized laws for the elderly protection should be provided, and the advice of the Ministry of Labor and Social Welfare to accelerate the enactment of the Elderly Act. The support coming from the United Nations (UN) announcement of 1999 as the International Elderly Year supported this focus. The Cabinet entrusted the Institute of Elderly Medical Science, Department of Medical Service, Ministry of Public Health, to be the core team working on the Elderly Act, in collaboration with the Assembly of Woman, Youth, and Elderly Affairs, senators and representatives, Ministry of Labor and Social Welfare, Ministry of Education, Ministry of University Affairs, the National Elderly Council, qualified individuals, academic elites, and private and public organizations. After the promulgation of the Act of Ministry and Department Amendment in 2002, the mission of protecting and promoting elderly rights was transferred to the Ministry of Social Development and Human Security.

The First National Plan for Older Persons, 1982–2001

In addition to developing the First Elderly Council, the National Committee of Senior Citizens, the Declaration of Thai Senior Citizens and the Elderly Act, the government perceived the need to develop a planning document and agenda to address the needs of a rapidly increasing elderly population. The government recognized the need to develop the social and health service system in order to meet the needs of the growing elderly population.

The First National Plan for Older Persons (1982–2001) was developed as a guideline for the treatment of the elderly. The foundation of the plan emphasized the importance of the elderly co-residing with their families, and the values of respect for and taking care of the elderly by their children. The Plan addressed (1) Health (2) Education (3) Social and income security (4) Social and cultural integration, and (5) Social welfare provisions. The plan emphasized cordial co-residing of the elderly and their families, as well as paying respect and providing care to elderly parents. It also promoted societal protection for those who cannot rely on themselves and their families. Although the plan identified general directions for supporting the elderly, there were no specific goals, strategies, action plans, or suggested outcomes. Nevertheless, the Plan’s focus on promoting the development of programs and services for Thai senior citizens influenced the development and enactment of the Declaration of Thai Senior Citizens in 1999.

The Second National Plan for Older Persons, 2002–2021

The United Nations convened the Second World Assembly on Ageing in Madrid, Spain in 2002 and the Madrid International Plan of Action on Aging was adopted. Member countries were required to address three areas: (1) older persons and development (2) advancing health and well-being into old age; and (3) ensuring an enabling and supportive environment. In the same year, Thailand developed its Second National Plan for Older Person (2002–2021), partially because it was ready to advance beyond the First National Plan, and partially to respond to the Madrid International Plan of Action. See Box 3 for the goals and objectives of the plan. See Box 4 for the key domains and activities of the Plan.

Implementation of the Second National Plan for Older Persons: Programs and Activities

Monitoring and evaluation of the implementation of the Second National Plan for Older Persons occurs every 5 years, using a top-down review and assessment and bottom-up participatory approach. Below we describe the three selected areas with the most significant progress in the past 5 to 7 years: (1) promoting a positive attitude toward aging and older persons; (2) promoting health in the elderly; and (3) social protection for the elderly.

  1. 1.

    Promoting a Positive Attitude Toward Aging and Older Persons

The Thai government realizes the importance of recognizing older persons who promote Thai culture. The Ministry of Culture gives awards each year to elderly persons, naming them National Artists or recognizing them for their work on culture that has national or international acclaim. There are currently 114 elderly people named as the National Artists, and 130 who received the cultural prize. All recipients receive a monthly allowance and other forms of welfare from the Culture Work Promotion Fund of the Office of the National Cultural Commission. The local cultural agencies (Ministry of Social Development and Human Security) also designate any older persons well-known for their knowledge, intellect and skills of respective communities/area to join and act as members of councils of local cultural administration committees.

Older Persons’ Brain Bank

The Older Persons’ Brain Bank was established on the occasion of Her Majesty the Queen’s Birthday in 2000 as a coordinating and information center linking retired older persons with a particular skill or expertise with organizations and individuals who need these skills and services. The Cabinet designated the Office of the National Economic and Social Development Board to be in charge of the Brain Bank; provincial brain bank networks are established in all 75 provinces to promote the service on a more regional basis. Currently, there are 2,819 older persons registered as members of the Brain Bank.

Annual Fair on the National Day of Older Persons

In 1982 the Cabinet approved the 13th of April to be the National Day of Older Persons, coinciding with the Thai new year day national holiday. The Ministry of Social Development and Human Security is the agency in charge of coordinating with other agencies and the public and private sectors to arrange a festival and launch a week-long campaign in recognition of the elderly. Events and activities promoting older persons include promoting factual knowledge about the elderly, health examinations, sports and recreation for the elderly, exhibits about elderly wisdom, religious and cultural activities, recognition of Outstanding Older Persons of the Year, selection and awarding Outstanding Families with three generations (young, working and older adults) living together in the same family. These activities encourage community-wide participation, thereby enhancing the sense of self-pride among older persons.

  1. 2.

    Promoting Health in the Elderly

Ensuring the quality of life of the elderly, including independent living, health and well-being

In 2005, “Healthy Thailand” was announced as a national agenda. It prescribes that Thais of all ages fully develop their potential in the physical, mental, social or spiritual areas. With respect to older persons, Healthy Thailand promotes that the elderly achieve a peaceful and happy life with their family members, access due care, practice health strengthening activities (i.e., exercise), participate in their community's activities, and join in elderly representative clubs in their communities.

Promotion and support of the elderly integration and participation in their representative clubs

In accordance with the announcement of Healthy Thailand as a national agenda in 2005, the Ministry of Public Health began to support the establishment of elderly clubs, providing a wide range of health promotion activities (aerobics, lectures on health and mental health care, cultural activities), in every sub-district, with target of a minimum of 50% of older persons in each sub-district becoming members of elderly clubs in their communities. Elderly clubs have been established in almost all sub-districts of all provinces (97%; 12,000 clubs), with nearly 4,000,000 older persons as members (64% of the total older population). Each year the Ministry of Public Health holds a conference to promote elderly health, and representatives from elderly clubs and networks throughout the country are invited to attend. Outstanding clubs and models are recognized.

Sports/Recreation and Health Promotion in the Elderly

The Ministry of Tourism and Sports arranges sports activities to specifically promote health and recreation among the elderly through its collaboration and joint activities with the Offices of Sports and the Institutes of Physical Education. Facilities and equipment are made available, for example, health parks, exercise devices, fitness centers, Petong courts, exercise classes for aerobics/Taikek/Chigung, aerobics/baton aerobics, and sole/foot massage. Older persons are encouraged to get together and form their own exercise group. Medical care centers in communities and elderly clubs coordinate to arrange mobile units to provide information about practicing exercise, checking physical fitness, and assessing the health of older persons in communities.

Health Promotion Temple Project

The Department of Health carries out a health promotion temple project with a target of covering all 875 districts in all 75 provinces of the country; one temple in each district is designated for the project. The main purpose of this project is to promote elderly health by integrating health care knowledge into religious activities, as a temple is a community center where people, especially the elderly, gather in large numbers to join in religious activities. As an incentive for the participating temples, the Department of Health conducts activities to identify the “Outstanding Health Promotion Temple.” The best practice model of the health promoting temple is publicized to all interested parties.

The Project Dentures Conferred in the Services of His Majesty the King

In recognition of His Majesty’s 60 years Accession to the Throne coupled with the occasion of His Majesty‘s 80th Birthday in the year 2007, the Department of Health, Ministry of Public Health launched the “Return Smiles to the Elderly” project in 2005. The project aimed to give dentures and oral health care accessories to 80,000 older persons across the country by the year 2007. The Department of Health set as a target for the campaign the promotion and rehabilitation of oral health for at least 50% of older persons; the goal was to insert and fix dentures for 80,000 cases of toothless older persons during the period of 2005–2007.

  1. 3.

    Social Protection for the Elderly

As part of the Second National Plan for Older Persons (2001–2021), a social protection system for the elderly was established.

Providing assistance to older persons who face social problems

The government provides temporary or long-term assistance to older persons who encounter social difficulties. Assistance includes support for temporary or emergency housing, food, clothing, medical treatment and care and rehabilitation to the ill, consultation and help in legal proceedings, counseling services, and admission to an elderly home for those who have no relatives or caregivers. The agency directly in charge of providing services and assistance to older persons in-need is the Ministry of Social Development and Human Security through cooperation and interaction with the Ministry of Public Health and the Ministry of Justice.

Ensuring a supportive environment and respect for the elderly

Throughout Thai history, there has been a strong tradition of respecting and honoring older persons in the family and in the community. Older persons are taken care of, paid attention to, and provided with opportunities to participate in family activities, share opinions and make decision on family affairs. The following programmatic actions were taken:

  1. (a)

    National campaign to promote family relationships: The Office of Family Institution Promotion, the Ministry of Social Development and Human Security, takes steps to promote and support a national campaign aimed at encouraging families and communities to take care of and support individuals of all ages(including the elderly), and enabling family members to live together with happiness. The campaign called “Sunday, the Family Day”, focuses on enhancing love, relationships and care among family members. It has been conducted nationwide since 2006, with budget support to all 75 provinces from the Office of Family Institution Promotion. Major activities promoting the campaign are public relations, dissemination of news and information via various forms of media and materials such as television and radio spots, stickers, leaflets, printed matter, including sizable posters posted in public places. It is expected that the campaign will promote the idea that the elderly should receive proper care from their children, grandchildren and other family members, as it is the best way for the elderly to retain mental acumen and a feeling of security.

  2. (b)

    Developing Multipurpose Senior Citizen Center in the community. The Bureau of Empowerment for Older Persons has initiated the Pilot Project “Multipurpose Senior Citizen Center” in four regions of the country. This center will serve as a community center for a variety of activities including care-giving, elderly support and development, focusing on the physical, mental or social well-being of individuals. The four regions include one to two provinces in each, i.e., Chiangmai and Phitsanulik in the northern, Sakolnakhon and Khonkaen in the north-eastern, Phathalung in the southern, Cholburi and Phetchaburi in the central.

  3. (c)

    The Bureau of Empowerment for Older Persons and academics of educational institutes are responsible for providing knowledge to agencies and networks involved, by organizing meetings in the community to promote an understanding of the concept and operating model of the center. The local agencies involved (local administration organizations, health centers, community hospitals, elderly clubs) implement the project following suggested procedures. The implementation of this project is underway; in each pilot area, there is good feedback and cooperation from the agencies involved—local administration organizations, municipalities, community hospitals and health centers, and elderly networks are working together, to push forward the center and make progress for their own communities.

  4. (d)

    Developing social services through improving Homes for the Elderly: Homes for the Elderly are the last choice of residence for Thai elders. Previously there were 20 homes for the elderly throughout the country, operated under the supervision of the Department of Social Development and Welfare, Ministry of Social Development and Human Security. The government developed a policy to transfer the administration of these homes to local organizations to operate and supervise. After transferring, there were eight homes for the elderly remained; that all have the capacity to provide assistance and care to cover approximately 3,000 older persons in the country. The services in the elderly homes include medical services, physical therapy, physical and mental health care, social welfare, recreation, occupational rehabilitation, religious activities and arrangement of funerals. In 2006, these eight homes for the elderly were improved and they became “Social Welfare Development Center(s) for the Elderly, Regular services of the center include health care, physical therapy, social welfare services, income-generating activities, recreation, educational tours, knowledge program, and religious activities. In addition, they provide day care services as needed to those older persons who stay with their families.

  5. (e)

    Providing house repair service for the elderly in communities. In 2006, the Department of Social Development and Welfare initiated budget support for elderly house repair in the community, including the repair of activity facilities for the elderly. Local administrative agencies collaborate and provide resources for these services. Older persons who are faced with housing problems or live in improper housing are identified, and financial support is given on priority basis.

Discussion

The Second National Plan for Older Persons in Thailand is being successfully implemented and progress has been made at many levels toward building an aging-friendly society. Presently, Thailand is continuing with the implementation of the plan to prepare for the aging society. To do so, the Thai government plays an active role in facilitating the implementation and, more importantly, in gaining commitments from all participating sectors (public, private, municipalities) in order to achieve the aims set forth in the plan.

Looking back on the Thai government’s major activities concerning the aging affairs in the past decades (see Table 1), we identify two general lessons that might be helpful for those who intend to develop a similar approach. First, we come to appreciate the importance of contextual support in determining the consequence and impact of an initiative. Why did the First National Plan for Older Persons have only limited impact while the Second National Plan gained tremendous momentum? Inclusion of the aging agenda in a nation’s constitution greatly elevated the political status of the aging issue. Also, the quick response to the United Nations’ call for increasing awareness of aging utilized the influence of an international context to help develop and launch the national initiative.

Second, the experience of implementing the Second National Plan for Older Persons in the past 5 to 7 years has demonstrated the importance of the internal organization of a program in determining the progress and success of the program. Compared with the First National Plan, the Second National Plan has a set of comprehensive and clearly stated goals and strategies as well as mechanisms to ensure monitoring of progress, and coordinated support from many different government entities. The program activities described above show successful collaboration between central government branches and local community and service sectors.

Looking toward the next decade, we anticipated that programs and policies focused on the elderly will continue to gain contextual support. For instance, the recently developed 10th National Economic and Social Development Plan: 2007–2011, continues to aim its 5-year plan to prepare for an aging society. In this Plan, a number of developmental strategies are identified based upon the Second National Plan for Older Persons, and all social sectors, especially the public agencies, are urged to adopt these strategies and focus on successful implementation.

With regard to the programs developed under the Second National Aging Plan, it is crucial to strengthen the evaluation component by developing comprehensive progress indicators and outcome measures in order to assess the short- and long-term impacts of these promising programs designed to improve the quality of life of elderly persons in Thailand. The evidence generated through the evaluation effort will help people both in Thailand and from other countries decide whether to adopt a particular program model or strategy—thus further placing the Thailand experience of aging in the larger context of global aging.