The law and policy review revealed several deviations between international mechanisms and national laws and policies in both enshrinement and enforcement, with the Royal Thai Government (RTG) often overlooking the interests of the UL when formulating laws and policies. Additionally, land grabbing and living conditions were identified as dire issues on Ko Lipe. In all three communities, education and livelihoods were found to be the most critical determinants. All data collected was analyzed and coded utilizing HyperRESEARCH. In addition, a comprehensive literature review of relevant international mechanisms, national laws, and national policies was conducted. Interviews, household surveys, and focus group discussions were utilized to gather primary data from 71 subjects in three different UL communities in southern Thailand.
Utilizing the SDH framework as a guide, this qualitative study sought to identify which specific determinants are most significant and present the greatest risk to the health and well-being of the Urak Lawoi’ (UL), a “sea nomad” group indigenous to southern Thailand. These factors include structural mechanisms, such as laws and policies socio-economic conditions, such as education and occupation and intermediary circumstances, such as living and working conditions. This model views health as a function of many circumstantial and environmental factors that are continuously and simultaneously interacting across multiple domains. The WHO’s “Social Determinants of Health” (SDH) framework, however, takes a broader ecological perspective that suggests that interventions must occur at multiple levels in order for good health to be achieved on an equitable basis. Traditionally, most Western models of health viewed sickness and disease as a product of individual factors such as personal behaviors and genetic predisposition consequently, healthcare interventions were largely focused on fixing the individual, with little attention placed on contributing external factors.