Guns or doctors? | Bangkok Post: learning

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Guns or doctors?

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Thailand suffers from a doctor shortage but not a shortage of soldiers. Military spending eats up money for health care. 

MRI imaging

"Guns versus butter" is used in introductory economics to teach the idea of  tradeoffs.

The citizens of a country have to choose the right combination of: 1. guns (investment in the military and weapons), and 2. butter (investment in the production of goods) (See Wikipedia).

That voters in Thailand now face a similar tradeoff between health security and military security was the essence of the Bangkok Post editorial on Friday last week.

In other words, the latest life-saving and life-extending medical technologies like MRI medical imaging (in photo above) cost money just like the latest military technologies.

The editorial spells out in great detail the tradeoff that voters are currently making but may not yet be aware of.

Click button to listen to Doctor Shortage and rightclick to download

EDITORIAL: Putting money in wrong place (3/06/2011)


This is scandalous. When the country is facing a serious shortage of physicians and is in dire need of budgetary support to improve the public health system, our military budget, when compared to the size of the economy, is one of the world's highest.

Last week, the Public Health Ministry revealed that the country needs about 40,000 physicians and is still about 10,000 short. According to acting Public Health Minister Jurin Laksanavisit, one-third of the 30,000 physicians are now breaking their backs to serve the majority of the population in the public health system. Another one-third are in universities or other state agencies, and the final third work in the private sector.

According to the World Health Organisation, the acceptable patients per doctor ratio is at 1:5,000. In Thailand it is 1:7,000. The breakdown is even more shocking in the northeastern province of Loei, where the ratio is 1:14,000. In Bangkok it is 1:850.

This shortage of doctors and the resulting heavy workload is one of the reasons for the high incidence of medical error and strained patient-doctor relations.

Of course, producing more physicians alone cannot solve this problem nor lead to the citizens' general well-being. Respect for patients' rights aside, preventive care and such basics as proper hygiene, nutrition, exercise and a toxic-free environment are all crucial. Still, easy and equal access to public health services is indispensable for people's quality of life. And that requires a high investment in both human resources and infrastructure. It is unfortunate that providing people with health security has a lower priority than military might in this country.

After the 2006 coup, which plunged the country into deep political division, the military budget rose by 50%, apparently because the Abhisit government dared not raise its voice. According to economics professor Pasuk Phongpaichit, the military budget accounts for 1.8% of our gross domestic product. This is higher than Germany's, the largest economy in Europe, with a military budget at 1.3% of GDP, and higher than Japan's 1%. When it comes to the soldier per population ratio, it is 7.9:1,000 in the United States and 2.2:1,000 in Japan. In Thailand, it is 10:1,000. Should we feel safe, angry or sad?

A strong political will to contain the military's ferocious appetite for war-toys is sorely needed in order to channel the money to strengthen the public health and welfare system. Sadly, even when election campaigning is in high gear, discussing a military budget cut is not on any political party's agenda.

At the meet-the-media forum co-organised by the Thai Journalists Association and the Thai Broadcast Journalists Association over last weekend, representatives from the Democrat, Pheu Thai, and other political parties were even defensive about the military. All were in agreement that the question of military budget is not about how much, but how it is used.

This is greatly disappointing.

All political parties are now competing to win votes through handout policies. No matter who wins, the need to finance the populist schemes will be huge. With the currently small tax base, the difficulty to push for progressive land and property taxes, and the politicians' reluctance to agitate the military, it is most likely that the financing of populist and mega projects will eat into the budgets for social and welfare benefits. Ordinary citizens will then have to continue suffering from the shortage of doctors, and public health must take a back seat to military might.

(Source: Bangkok Post, EDITORIAL, Putting money in wrong place, 3/06/2011, link

trade off - economic tradeoff, give up one thing to get another, sacrifice one thing you could have in order to get something else you value more (See Wikipedia)

security - the activity of making safety and protecting from attack, harm and damage ความปลอดภัย
military security - the activity of making safe or protecting from harm
health security - a valuable item that you promise to give if you cannot pay back a loan (protection for lender)
food security - protecting from harm or damage

essence
- the most important and basic fact about something (that provides it with an independent identity) จุดสำคัญ, แก่น, แก่นสาร, สิ่งที่ยั่งยืนถาวร, หลักที่ควรยึดถือ

MRI - a type of medical imaging in which the patient lies in a large tube and the body or part is magnetized while pictures are taken, allows evaluation of tissues and fluid in addition to bone, provides two dimensional cuts (planes) through the body part being study which allows a physician to develop a three dimensional sense of the anatomy of that part, MRI has much greater soft tissue contrast than Computed tomography (CT) making it especially useful in neurology (See Wikipedia)

medical imaging -
"the technique and process used to create images of the human body (or parts and function thereof) for clinical purposes (medical procedures seeking to reveal, diagnose or examine disease) or medical science (including the study of normal anatomy and physiology)" (See Wikipedia)

spell out - describe (in detail) 

scandalous - making people shocked and upset ซึ่งเสื่อมเสียชื่อเสียง, อื้อฉาว

shortage - when there is not enough of something การขาดแคลน
physician - medical doctor (See Wikipedia)

dire - very serious or extreme เลวร้ายมาก แย่มาก เลวร้ายมาก
in dire need of - needs very much

support - help, by giving money, for example สนับสนุน
improve - to make better ทำให้ดีขึ้น

budget - the amounts of money that an organisation has available to spend on different things during a period (See Wikipedia) งบประมาณ
public health system - in Thailand this includes all the government run hospitals (in other countries such as the United States most hospitals are not run by the government)
military
budget - government spending on the military (army, navy, air force) during the year

revealed - made known or showed something that was surprising or that was previously secret เปิดเผย
breaking their backs - working very hard 
majority - more than 50% of a group, more than half of the people in a group ส่วนมาก,  เสียงส่วนมาก
population - all the people who live in an area, a city or the whole country
sector - a part of the economy ภาคเศรษฐกิจของประเทศ (public sector = government, private sector = all businesses, household sector = families and consumers, banking sector,...) (See Wikipedia)

breakdown -
split a number or statistic into parts (that add up to the number) (example: The president of the company requested a detailed breakdown of sales in each store by product group.)
workload - the amount of work that a worker must do each day ปริมาณงานที่คนหรือเครื่องจักรทำได้ระยะเวลาหนึ่ง

high incidence -
happens a lot

strained - being put under pressure, business has become more difficult
patient - someone who is receiving medical treatment คนป่วย, คนไข้

well-being - the health and happiness of a person (or animal)
rights - things that people must or should have as a matter of law or morals, things they are entitled to (See Wikipedia) สิทธิ์

preventive care -
preventive medicine, measures taken to prevent diseases (or injuries) rather than curing them or treating their symptoms, examples include hand washing and immunizations, early examinations and screening tests for cancers, genetic tests so that people can adjust their behaviours (See Wikipedia)

hygiene
- keeping your body and surroundings clean so that you are not infected with a disease สุขลักษณะ
proper hygiene - keeping things clean in the right way (to avoid health problems and disease)

nutrition
- providing the materials necessary to your body so it can grow and be healthy, many common health problems can be prevented or alleviated with good nutrition (See Wikipedia)

toxic
- poisonous and harmful to people, animals or the environment เป็นพิษ
environment - the natural world of land, sea, plants, and animals

crucial
- very important (because it effects the result of something)( สำคัญยิ่ง
access - the ability to get something สิทธิหรือโอกาสในการใช้

dispensable - don't completely need (if you don't have it, you can still function properly)
indispensable - need completely (if you don't have it, you can't function properly)

quality of life - an individual’s total wellbeing, "includes all emotional, social, and physical aspects of the individual’s life. However, when the phrase is used in reference to medicine and healthcare ...it refers to how the individual’s wellbeing may be impacted over time by a disease, a disability, or a disorder" (See Wikipedia on Quality of Life and Quality of Life (healthcare))

investment - taking your money and putting it into projects to make a profit or earn interest (buying stock shares, bonds, real estate)
resources - things such as money, workers and equipment that can be used to help achieve something ทรัพยากร
human resources - the people in an organization (their collective skills and knowledge that help the organization achieve its goals)

infrastructure - The basic facilities, services, and installations needed for the functioning of the community, such as transportation and communications systems, water and power lines, and public institutions including schools, post offices, and prisons (See Google Definitions) สาธารณูปโภค

unfortunate - unlucky โชคร้าย, เคราะห์ไม่ดี

priority - importance; something important that must be done first or needs more attention than anything else การให้ลำดับความสำคัญ, สิ่งที่ได้รับความสนใจมากกว่า

plunge into -
fall into (example: She dove from the high rock and plunged into the river below.)

divide -
cut into pieces (example: Please divide the cake into pieces, so everyone gets some.)
division -
one of the many pieces that exists after cutting something up (examples: The large company was divided into many large divisions, each with very wide responsibilities.)
political division
- a situation in a country when the country is divided into groups with very different political beliefs

apparently - based only on what you have heard or think, not on what you are certain is true; seemingly ตามที่ได้รู้มา

daring - bravery, courage ความกล้าหาญ
dare to - are brave enough to do Y
dare not Y - not brave enough to do Y, do not have enough courage to do Y

voice - to express your feelings or opinions ออกความคิด
dared not raise its voice - was not brave enough to say what they really thought (to express their true opinion)
gross domestic product (GDP) - the total value of all goods and services produced by a country in one year

will -
 wanting very strongly for something to happen (which helps push it forward into actually happening), determination, resolution ความตั้งใจ, ความมุ่งมั่น, ปณิธาน
political will
- a strong desrire to achieve a certain goal or result

appetite - the desire to get things, to consume things (originally: the natural feeling of wanting to eat น้ำย่อย ความอยากอาหาร\
ferocious appetite - when you are very very hungry
ferocious animal - a very dangerous and violent animal

sorely needed - need very much
channel - to direct something into a particular place or situation ใช้ไปในทาง
welfare - help given, especially by the state or an organization, to people who need it; good care and living conditions สวัสดิภาพ

election
- the process of choosing a person or a group of person for a position, especially by voting elect (v) electoral (adj) synonym: the polls การเลือกตั้ง
election campaigning - before the election, all the activities that politicians do to get votes, that politicians do (speeches, appearances, posters, cars with speakers on them, etc)
in high gear - working very hard (activity intense)
agenda - a list of goals or issues to be discussed at a meeting; list of goals to achieve in the future วาระ ระเบียบวาระ กำหนดการ

media - radio, television, newspaper, the Internet, considered as a group สื่อ
co-organised - organise together other people or organisations (co-organisers)
forum - a place where people can express their ideas and opinions and debate issues การประชุมแสดงความคิดเห็น
political parties - a group of politicians who join together to win votes during an election campaign 
defensive -
defending yourself in the way that you talk or behave (as if you are being attacked or threatened)

handout - something such as food, clothing or money that is given free to someone who has a great need for it ของให้ทาน
No matter who wins ... Y - Y will happen or be true whoever wins .. (Y does not depend on who wins)
finance - to provide money for something จัดหาเงินทุนให้
populist - a politician who claims to care about the interests and opinion of ordinary people (may or may not be good for the country)
schemes - systems for achieving some goal
small tax base - situation with few people paying taxes in the country

land and property tax -
a tax that people pay on the value of the land they own (See Wikipedia)
progressive tax -
a percentage tax with percentage increasing the higher the amount (meaning: the richer you are, the higher the tax you pay) (See Wikipedia)
reluctance - not willing to do something ลังเล, ความไม่เต็มใจ,ความไม่สมัครใจ
agitate - make angry
eat into the budget -
use up money in the limited budget (that could be used for other things)

social and welfare benefits - money, services, or goods you receive from a government or company programme เงินช่วยเหลือ
benefits - things like health insurance that employees receives in addition to their salary and wages

suffering - physical or mental pain or problems ความทุกข์ทรมาน
X takes a back seat to Y - X is less important than Y
military might -
military power determined by the number of solidiers, weapons and the level of their training and skill in warfare and military operations)

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