Multisectoral governance for health: challenges in implementing a total ban on chrysotile asbestos in Thailand

Our plain-English summary of Multisectoral governance for health: challenges in implementing a total ban on chrysotile asbestos in Thailand, by C. Kanchanachitra, V. Tangcharoensathien, W. Patcharanarumol, et al (BMJ Global Health, 2018).

The study

• Authors: C. Kanchanachitra, V. Tangcharoensathien, W. Patcharanarumol, T. Posayanonda
• Journal: BMJ Global Health
• Published: 2018;3(Suppl 4):e000383
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Interest in multisectoral governance for health has grown in recent years in response to the limitations of government-centric policy formulation and implementation. This study describes multisectoral governance associated with policy formulation and implementation of a total ban on chrysotile asbestos in Thailand.

Methods: Qualitative methods were applied, including analysis of related literature and media, and in-depth interviews with key informants. Consent was obtained for interview and tape recording; protection of confidentiality was fully assured.

Results: An agenda on total ban of chrysotile asbestos was proposed to the National Health Assembly, where a resolution was adopted in 2010. The resolution was endorsed by the Cabinet in 2011, which mandated the Ministry of Industry to implement the ban immediately. There was uneven interest and ownership by stakeholders in the policy formulation process. Long delays in implementation have been observed. Furthermore, while the policy is likely to affect relatively few industries there has been misinformation on the safe use of chrysotile, and delaying tactics and pressure from major chrysotile-exporting countries.

Conclusion: The National Health Assembly is a useful platform for policy formulation on complex policy issues requiring multisectoral action. However, policy implementation is challenging due to lack of clear policy across sectors. Success in protecting people's health requires participatory policy-making and effective governance of multisectoral action throughout implementation. The Assembly is not designed to enforce implementation, especially when power and authority lie with state actors, but monitoring and public reporting would be powerful tools to drive this agenda.

In plain English

This was a qualitative case study of how Thailand formulated, and tried to carry out, a total ban on chrysotile asbestos. Between September and November 2013 the authors interviewed 16 key informants by telephone: 9 about drafting the policy and 7 about putting it into effect. They also reviewed official documents and analysed coverage in three Thai newspapers and relevant websites from 2010 to 2015. Chrysotile was then a type 3 hazardous substance, which needed Ministry of Industry approval. The National Health Assembly adopted a ban resolution in 2010. Its technical working group had not reached consensus, and private-sector delegates made no interventions. The Cabinet endorsed the resolution on 12 April 2011 and told the Ministry of Industry to list chrysotile as a type 4 hazardous substance by 2011. A report commissioned by the ministry instead proposed banning five products in 2015. The authors reported that exporting countries threatened trade sanctions. They also described newspaper claims that no Thai mesothelioma patients had been reported as misinformation. The authors recommended monitoring and regular public reporting on implementation.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Qualitative case study (policy analysis) using in-depth key informant interviews, literature and document review, media analysis, and stakeholder analysis
• Who was studied: 16 key informants in Thailand from the health, industry and environment sectors (9 on policy formulation, 7 on policy implementation), interviewed September to November 2013; plus Assembly and Cabinet documents and three most-read Thai newspapers and websites, 2010 to 2015
• Exposure: Not a health-exposure study; the subject was Thai policy on chrysotile asbestos, which was classified as a type 3 hazardous substance requiring prior approval from the Ministry of Industry
• Main results:
  • The National Health Assembly adopted a resolution on a total ban of chrysotile asbestos in 2010
  • The technical working group drafting the resolution did not reach consensus; the industry member argued there was no evidence of health impacts on the Thai population
  • The private sector made no intervention during the Assembly deliberation
  • The Cabinet endorsed the resolution on 12 April 2011
  • The Ministry of Industry was mandated to ban chrysotile asbestos products by listing chrysotile as a type 4 hazardous substance by 2011
  • A report commissioned by the Ministry of Industry proposed a ban on five chrysotile-containing products in 2015, 5 years after the 2010 resolution
  • Asbestos-exporting countries exerted political pressure by threatening trade sanctions
  • Newspaper content analysis found that a few affected industries, backed by a pulmonary clinician, stated that no Thai patients were reported to have mesothelioma; the authors described this as misinformation
  • In the stakeholder analysis, the Ministry of Public Health had legitimacy and urgency but not power
  • In the stakeholder analysis, the Ministry of Industry was classified as the dominant stakeholder
  • The authors found implementation was slow because power remained with the Ministry of Industry, which failed to act
  • Annual chrysotile imports into Thailand were 142 000 tonnes before 2007, according to Ministry of Finance customs data reported in the article
• The authors' conclusion: The authors recommended parallel mechanisms to monitor implementation of Cabinet resolutions, and regular public reporting on the issue

Topics

Medical terms in this study, explained in our Lexicon: Chrysotile.

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