Elderly care, the upcoming social problem in Thailand?

Family relations differ per culture.[1] Every culture has its norms, values and customs that forms a fundamental basis for the concept of family and the relationship between family members. In this blog we will dive into Thai family relations and obligations, and how Thai culture influences this.

Let’s begin with understanding the Thai cultural influences on the concept of family. Buddhism is the main religion in this South East Asian country. About 85-95% of the Thai population is Theravada Buddhist.[2] So, this belief has its expected impact on the Thai culture, and even on family level. It teaches children to treat their parents well by respecting and listening to them. When they do this, he or she will receive good Karma.[3]

‘Khaorop’ (respect) holds an important position in Thai culture and also in family relations. The child is supposed to value the parent’s knowledge and protection.[4] In principles, the parent (or elder) is never wrong. But ‘khaorop’ should also be shown in physical ways. For instance, you cannot touch the head of your elders. This – as it is in Buddhism as well – is the most sacred body part. Even touching someone else’s hair comes across as offensive in the Thai culture.[6] Furthermore, towards your elder you should be the one doing the Thai greeting called ‘waai’ first and lower your head deeper than you would towards a friend your age. This is to show the hierarchical higher position of your senior.

A token of respect by the child to the mother. You might see this on August 12, what is the Thai national Mother’s day. Source: Speak Thai with Noi Naa [5]

 

There is a Thai saying that indicates this hierarchy among generations:

‘Chán ab-náam róon maa kon’

This literally means ‘I have taken a hot bath before’.[4] It explains that I (the elder) have more life experience than you (the younger person).[4] But, as a second generation Thai said “this norm is heavily dependent on the openness of the parents. How strict they are in this hierarchical structure”.[4]

Among other things, this can be influenced by westernization and the level of education of the child.[4] About the first one can be said that it holds individual rights as one of its key elements.[7] Westerners see freedom of speech, freedom to express yourself, etcetera as examples of those rights. This can explain the higher degree of allowance of children questioning their parents in Western cultures. This westernization is mainly seen in the urban areas.[8]

Regarding the level of education, children nowadays in Thailand become more educated than their parents. The School Life Expectancy rate in tertiary education is much higher than a few decades ago.[9] The second generation Thai respondent added that in his student period – being 1983 until 1990 – higher education was mostly settled in the big cities.[4] He, originating from a village in a Thai rural area, had to travel more than 900 kilometres to get to the nearest higher education facility. From 1990 on, multiple higher educations were established in the North, Northeast, Southeast, and the South of Thailand.[10] Increasing the possibilities of children to obtain knowledge in contrast to their  older family members.

Source: The World Bank [11] [12]

The graph above shows the big increase in the percentage females and males enrolling in Thai tertiary education in the period 1976 untill 2016. In the last few years, a decrease occured in this percentage. This is caused by the decline in the Thai population growth which is expected to persist.[13]

Even though the hierarchical structure may become more horizontal through westernization and the increased level of education, there is still a division of roles within the Thai family.[8] The husband is seen as the leader who takes care of the family’s issues. The wife supports her husband by taking care of the family’s needs. Another Thai saying, that describes this division of roles is:

‘Saă-mee bpen chaáng taô naâ, pan-rá-yaa bpen cháang tâo lăng’

This literally means the husband is the front leg of the elephant, which indicates his leading role, and the wife being the back leg of the elephant, which indicates the supporting role and her hierarchical lower position. The children, as said before, in principle have to be respectful and show respectful behaviour towards their parents and listen to them throughout their lifetime. Thus, also when they reach the life stage of adulthood.

When the children become adults and their parents grow old, there is a switch in obligations. It is at that time expected of the children to take care of their parents. Bechstedt described this as a ‘moral obligation’ [14]:

“Children are raised in a spirit of moral obligation giving the impression that their upbringing creates a kind of debt which the children have to repay by taking care of their parents when they are old”

Bechstedt

There are different ways of fulfilling this moral obligation. One may do this through financial funding, the other one by offering assistance.[15] Due to the small number of facilities and services offered by the government, elderly are dependent on their children to take care of them.[1] This is partly caused by the Thai pension system that includes different programs for different groups of workers.[16] The Thai pension system dates back to the late 1990s, with some additions over the past period of time. [17] But, civil servants have enjoyed a pension scheme since 1902. The current system results in great differences between the monthly income of retirees. The civil servants are best off once retired. A rapport of The World Bank stated that “former civil servants are the least likely group to live in poverty following retirement and are the only group that currently receives an adequate pension”.[16] In contrast, there are elderly who receive 700 baht (€19) or less per month from the government out of the social pension.[4][16] 

As it is for the pension funds, the medical scheme also has different programs for different groups of workers. For the civil servants, there is the Civil Servant Medical Benefit Scheme which also provides billable health care for the servants’ parents and children.[18] These two arrangements result in a lot of Thai being forced to try to obtain a governmental profession. Those who do not manage to reach this ‘goal’, probably have to support their parents out of their own pockets. Also, due to the small amount of retirement homes in Thailand compared to the size of the country, the grown up children have to take care of their parents by themselves. Thereby, those facilities are not freely accessible for every elder. It is meant for those who are homeless, the ones who do not have family member who can take care of them or those who cannot live with their family.[19] Due to this duty of care, some grown up children rethink their wish to have children.[20]

Granddaughter taking care of her grandmother
Source:
NPR[21]

That might be why it is common to have three generations living in the same house. This makes it easier for the grown up children to take care of their parents and own children at the same time. The grandchildren may even assist in the care of their grandparents. And the grandparents in turn can take care of their (young) grandchildren when the parents are working.

In 2013, 33.6% of the Thai households consisted out of three generations.[22] This amount has increased since 1987, while the amount of nuclear families in that same period decreased. It is mainly the daughter and her husband who will move in with her parents.[15] Some daughters will move out of their parental home once married, but in principle, she will settle close to her parent’s house so she will still be able to take care of her mother and father. As for the sons, they are expected to help their parents with their work and support them financially.

A Nuclear Family
Source: UNFPA Thailand. [23]

But due to the development of transport and globalization, it is no longer naturally for children to settle near their parents. A man from the South of Thailand might meet a woman from the North in Bangkok and eventually settle there because that is where their jobs are located. This decreases the ability of the grown up children to take care of their parents. This can cause a social problem for Thailand if its elderly support system remains as it is.

Because of the great distance and the lack of access to retirement or nursing houses, the elderly have to remain self-sufficient. Additionally, the Thai population has aged in a rapid pace, and is expected to age even further.[24] Thereby, a intense drop in births occured in the past decades. The fertility rate decreased from 6.15 in 1960 to 1.53 children in 2017 due to the National Family Planning Program which originates out of the late 1960s.[25][26] This program was implemented because of the negative affect that the rapid population growth of Thailand would have on its economic development. It helped to break through the taboo topic of sexuality what prevailed in Thai society, aiming to reduce the population growth in a short period of time.

Source: The World Bank[25]

With today’s growth of the retirees group and a shrinking working group that pays the pension funds, this might also include a financial problem. Those who work have to pay more taxes but still have to financially support their parents. So, how while the upcoming generation manage to have a comfortable lifestyle with all their responsibilities and this moral obligation that is deeply rooted in Thai society?

Sources

[1] Komjakraphan, P., Isalamalai, S., Boonyasopun, U., Schneider, J. (2019, June). Development of the Thai Family Support Scale for Elderly Parents. Retrieved March 18, 2021, from https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/6439/5615

[2] U.S. Department of State. (n.d.). Thailand 2018 International Religious Freedom Report. Retrieved March 25, 2021, from https://www.state.gov/wp-content/uploads/2019/05/THAILAND-2018-INTERNATIONAL-RELIGIOUS-FREEDOM-REPORT.pdf

[3] Charoenthaweesub, M. & Hale, C.L. (2011, June). Thai Family Communication Patterns: Parent-Adolescent Communication and the Well-Being of Thai Families. Retrieved March 17, 2021, from http://www.ijcim.th.org/SpecialEditions/v19nSP1/02_84_16E_Mathurada%20Charoenthaweesub_[6].pdf

[4] Personal communication. (2021, March 18).

[5] Speak Thai with Noi Naa. (2013, November 14). Mother’s Day in Thailand. Retrieved March 27, 2021, from http://speakthaiwithnoinaa.blogspot.com/2013/11/mothers-day-in-thailand.html

[6] Responsible Thailand. (n.d.). 7 dos and don’t’s of Thai cultural etiquette. Retrieved March 27, 2021, from http://www.responsiblethailand.co.uk/green-tourism/7-dos-and-don-ts-of-thai-cultural-etiquette/

[7] Sullivan, N. (n.d.). Modern Western Culture & Social Life. Retrieved March 21, 2021, from https://study.com/academy/lesson/modern-western-culture-social-life.html

[8] Pinyuchon, M. & Gray, L.A. (1997). Understanding Thai Families: A Cultural Context for Therapists Using a Structural Approach. Retrieved March 21, 2021, from https://link.springer.com/article/10.1023/A:1026119202888

[9] Knoema. (n.d.). Thailand – School life expectancy in tertiary education. Retrieved March 26, 2021, from https://knoema.com/atlas/Thailand/topics/Education/Tertiary-Education/School-life-expectancy-in-tertiary-education

[10] State University. (2021). Thailand Higher Education. Retrieved March 21, 2021, from https://education.stateuniversity.com/pages/1529/Thailand-HIGHER-EDUCATION.html

[11] The World Bank. (2020, September). School enrollment, tertiary, male (% gross) – Thailand. Retrieved March 27, 2021, from https://data.worldbank.org/indicator/SE.TER.ENRR.MA?locations=TH

[12] The World Bank. (2020, September). School enrollment, tertiary, female (% gross) – Thailand. Retrieved March 27, 2021, from https://data.worldbank.org/indicator/SE.TER.ENRR.FE?locations=TH

[13] Bangkok Post. (2019, January 4). Thai universities struggle to keep up. Retrieved March 27, 2021, from https://www.bangkokpost.com/thailand/general/1604990/thai-unis-struggle-to-keep-up

[14] Reynolds, Craig J. (2002). National Identity and Its Defenders: Thailand Today. Retrieved March 19, 2021.

[15] Morita, L. (2007, January).  Religion and family of the China and Thai in Thailand and influences. Retrieved March 19, 2021, from https://www.researchgate.net/profile/Liang-Morita-2/publication/37510008_Religion_and_family_of_the_Chinese_and_Thai_in_Thailand_and_influences/links/5af162c8458515c283754c79/Religion-and-family-of-the-Chinese-and-Thai-in-Thailand-and-influences.pdf

[16] The World Bank. (2012, October). Reducing Elderly Poverty in Thailand: The Role of Thailand’s Pension and Social Assistance Programs. Retrieved March 26, 2021, from http://documents1.worldbank.org/curated/en/949741468120871479/pdf/805270WP0P14350Box0379805B00PUBLIC0.pdf

[17] Government Pension Fund. (2012). Thai Pension System. Retrieved March 26, 2021, from https://www3.gpf.or.th/eng2012/about_thaipension.asp

[18] Jindapol, N., Kunupatham, P., Theerasilp, P., Kitikannakorn, N. (2014). Crisis of Health Insurance under Thai Civil Servant Medical Benefit Scheme (CSMBS). Retrieved March 26, 2021, from https://li01.tci-thaijo.org/index.php/SRIMEDJ/article/view/18275#:~:text=Civil%20Servant%20Medical%20Benefit%20Scheme%20(CSMBS)%20in%20Thailand%20provides%20health,and%20up%20to%20three%20children).&text=Moreover%2C%20we%20need%20federal%20law,the%20low%2Dincome%20civil%20servants.

[19] Chunharas, S. (2002, September). The system of care for the elderly in Thailand. Capitalizing form an integrated community-based health system through reform. Retrieved March 27, 2021, from https://www.researchgate.net/publication/11009095_The_system_of_care_for_the_elderly_in_Thailand_Capitalizing_from_an_integrated_community-based_health_system_through_reform

[20] Personal communication. (2021, March 25).

[21] NPR. (2021, February 3). How The Pandemic Has Upended The Lives Of Thailand’s Sex Workers. Retrieved March 27, 2021, from https://www.npr.org/sections/goatsandsoda/2021/02/03/960848011/how-the-pandemic-has-upended-the-lives-of-thailands-sex-workers

[22] Peek, C., Im-em, W. & Tangthanaseth, P. (2015). The State of Thailand’s Population 2015 – Features of Thai Families in the Era of Low Fertility and Longevity. Retrieved March 21, 2021, from https://thailand.unfpa.org/sites/default/files/pub-pdf/State%20of%20Thailand%20Population%20report%202015-Thai%20Family_en.pdf

[23] UNFPA Thailand. (2015). The State of Thailand’s Population 2015 “Features of Thai Families in the Era of Low Fertility and Longevity”. Retrieved March 27, 2021, from  https://thailand.unfpa.org/sites/default/files/pub-pdf/State%20of%20Thailand%20Population%20report%202015-Thai%20Family_en.pdf

[24] Prachuabmoh, V. (n.d.). Using Different Measure of aging: Country Case Studies. Retrieved March 27, 2021, from https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/unpd_egm_201902_s3_vipanprachuabmoh.pdf

[25] The World Bank. (n.d.). Fertility rate, total (births per woman) – Thailand. Retrieved March 26, 2021, from https://data.worldbank.org/indicator/SP.DYN.TFRT.IN?end=2018&locations=TH&start=1960&view=chart

[26] The Overpopulation Project. (2019, November 28). Thailand’s success story – Family planning with creativity and humor. Retrieved March 27, 2021, from https://overpopulation-project.com/thailand-success-story-family-planning-with-creativity-and-humor/

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