In its report “A Healthy Future”, presented on 21 January 2026, the World Bank warns that people in East Asia and the Pacific are living longer, but spending more and more of those years with diabetes, hypertension and heart disease, and that this threatens to overload health systems and slow income growth. The bank sees the answer in strong primary care: by the report’s estimate, every dollar invested in it returns up to 16 dollars. Thailand does better than its neighbours in the region on access to healthcare, but chronic diseases are rising here too: according to the latest national survey, 10.6% of people over 15 have diabetes and almost a third have hypertension.
What has changed in 30 years
Between 1990 and 2023, under-five mortality in the region fell from 57 to 15 per thousand live births, and life expectancy rose from 68 to 77 years. But living longer does not mean living healthier. In 2021 the average person in the region spent 9.3 years in poor health, more than in 2000. In several Pacific countries (Fiji, Kiribati, Micronesia, Solomon Islands and Vanuatu) an adult aged 30–70 has a more than one-in-three chance of dying early from one of the four main non-communicable diseases, and in Kiribati and Micronesia the odds are close to half.
Why there are more chronic diseases
The report names four causes: population ageing, urbanisation, unhealthy lifestyles and the climate. The last one is not abstract: heat, air pollution and extreme weather hit people with chronic conditions directly. In Indonesia, for example, medical visits for cardiovascular disease go up by 14% on hot days, and visits for diabetes by 25%.
Where the bottleneck is
The main weakness, in the bank’s assessment, is primary care, meaning clinics and local doctors. They treat illness once it has set in, while prevention, screening and long-term patient management are less developed. People sense this and go straight to hospitals, which is more expensive both for them and for the system. Without change, spending will rise sharply: Fiji, for example, will have to increase its health spending 2.5-fold by 2050 just to cope with the growth in chronic diseases.
What the World Bank recommends
- equip primary care to deal with chronic diseases, from screening to managing patients over many years;
- monitor the quality of care and reward doctors for results;
- make basic care free, at least for the poor;
- inform people and nudge them towards healthy habits, including through taxes on tobacco, alcohol and sugary drinks.
The economic argument is up to $16 in benefits for every dollar invested, through health, productivity and new jobs: every job in healthcare creates another 3.4 in the economy.
How Thailand is doing
According to the report, Thailand, together with China, is among the best in the region for healthcare coverage: primary care is free for citizens. It relies heavily on village health volunteers, of whom the country has more than a million. But Thailand stands out in one respect: with the same life expectancy as China, a Thai person in 2021 spent 13 years in poor health, against 9.6 for someone in China. The report puts this down to the burden of chronic diseases, and Thailand’s treatment of them lags behind the rest of its healthcare.
The latest National Health Examination Survey for 2024–2025, covering about 30,000 people with blood tests, found the following among people over 15:
- diabetes — 10.6%, up from 9.5% five years earlier; one in four people with it doesn’t know they have it;
- hypertension — 29.5%, up from 25.4%; almost half of them don’t know they have it;
- overweight and obesity — 45%.
Treating chronic diseases cost about 79.5 billion baht in 2024. The tax on sugary drinks has been in place since 2017; the last and highest phase took effect in April 2025. A salt tax has been under discussion since 2019 but still hasn’t been introduced: in February 2026 the Excise Department was only preparing a proposal for the new government.
Meanwhile, Thailand is ageing fast: in 2026 people over 60 already make up more than 20% of the population, so by the Thai classification the country has become a complete aged society.
What this means for an expat
The report’s figures on free primary care describe the system for Thai citizens and do not extend to foreigners: an expat pays for treatment out of pocket or through insurance. There is no reliable data on what it costs a foreigner to treat diabetes or hypertension in Thailand. The practical conclusion is simpler: if chronic conditions already run in the family, choose insurance with outpatient treatment in mind, and a regular check-up after 40 is a sensible habit. How to find a Thai equivalent of a familiar medicine is covered in a separate article.
The bottom line
East Asia has beaten infections and child mortality, but it is losing to chronic diseases, and the point of the World Bank report is that treating them in hospitals costs more than preventing them in clinics. Thailand is better prepared than many of its neighbours, but here too almost one adult in three has high blood pressure, and the population is ageing faster than the system is growing.
