Paper short abstract:

We challenge global health discourse and speak to the theme of global inequalities through a study of the manifestations and determinants of treatment-seeking behaviour. Our comparative study draws on survey data from 2,400 Thai and Lao villagers and 60 supplementary cognitive interviews.

Paper long abstract:

Inequality enters the global health discourse typically through considerations of "diseases of poverty" and through "social determinants of health"-both of which portray poverty as a risk factor for morbidity and mortality. Much of the language surrounding the underlying mechanisms revolves around information deficits, economic rationality, and psychological arguments, but complementary anthropological and sociological perspectives of structural factors that deprive people of choice, or that ascribe meaning to different healthcare choices, continue to remain peripheral in the global health discourse. By focusing on the constraints of marginalised groups, and the solutions at their disposal to overcome them, this paper contributes to the global health discourse against the thematic backdrop of global health inequalities.

We study the case of treatment seeking in rural Thailand and Lao PDR and investigate the question "What are the manifestations and determinants of treatment seeking in rural Thailand and Lao PDR?" Our analytical framework considers psychological as well as structural factors underlying "problematic behaviour," from which we derive two hypotheses:

H1. Marginalised groups have fewer means to access formal treatment, which increases their likelihood to rely on over-the-counter medicines as an alternative solution.

H2. Technology use increases formal healthcare access but is directed towards for-profit providers.

We test these hypotheses with primary data from a district-level representative health behaviour survey among 2,400 villagers, supplemented with qualitative data from 60 cognitive interviews. The comparative analysis of two neighbouring countries at different stages of economic and health system development thereby offers lessons for development policy.