Abstract
Background and Significance: The expansion of urbanization in Thailand has created new
challenges for community health system development. The 3rd National Health Charter of
2022 established directions for urban health system development aiming toward an "equitable
health system," encompassing access for vulnerable groups, responsive services, healthconducive environments, and participatory policies. However, efficient progress indicators
remain lacking.
Research Methodology: This study employed mixed-methods research using the RAND/UCLA
Appropriateness Method to develop indicators based on three dimensions: social reflection
power, change-driving monitoring, and clear collaborative direction. Analysis divided areas into
26 highly urbanized provinces and urbanizing areas, reflecting the principle that "distributing
prosperity must begin with recognizing problems and opportunities in local areas."
Results: Significant gaps were found between highly urbanized and urbanizing areas: (1)
Maternal health—highly urbanized areas had repeat teenage pregnancies at 15.15% compared
to 13.4% in developing areas; (2) Childhood vaccination—35.4% of 5-year-olds in urban areas
had incomplete vaccinations versus 17.9% in developing areas; (3) Communicable diseases—
urban areas had dengue fever rates 3.5 times higher; (4) Non-communicable diseases—new
cases of diabetes and hypertension in urban areas were significantly higher; (5) Violence—
urban areas had 60% more cases of abused children and youth.
Discussion and Recommendations: Analysis using causal loop diagrams revealed three
reinforcing archetypes driving inequity: "success to the successful," "shifting the burden," and
"limits to growth." Current data systems inadequately reflect urban health complexity, rely on
administrative boundaries, produce delayed data, lack integration, and have weak participatory
mechanisms. The researchers propose indicator sets to dismantle system traps: (1) indicators
addressing resource distribution equity; (2) indicators optimizing prevention and treatment; (3)
indicators promoting inclusive participation; (4) data system improvement indicators; and (5)
indicators for working smarter rather than harder. These tools will drive equitable urban health
development by revealing disparities and enabling targeted resource allocation to create a
health systems that leaves no one behind.
