Health and Well-being: Cases from Southeast Asia

As Southeast Asia continues its fast-paced growth trajectory, SMU Assistant Professor Bussarawan “Puk” Teerawichitchainan is working with a team of researchers from around the globe to understand the impact of these societal and policy changes.

Photo Credit: Darren Yau

By Dora Yip

SMU Office of Research (13 Dec 2013) – In the last twenty years, a wave of societal and policy changes have transformed many parts of Southeast Asia. The resulting impact on the health and well-being of individuals and households in this region has been profound.

Assistant Professor Bussarawan “Puk” Teerawichitchainan from the Singapore Management University (SMU) School of Social Sciences is particularly interested in the intersection of family demography and sociology, population health, life course and aging, and social stratification in the region.

Her early research focused on inter-generational relations and family-related behaviours in Southeast Asia. In Malaysia, Thailand and Indonesia, she looked at how economic development has affected divorce trends. In Vietnam, she studied how policy unintentionally constructed a new category of female household headship, and how the practice of marriage payment (such as dowry and bride price) has changed in the past four decades.

The military’s influence on the Vietnamese population

An active area of interest by Dr Teerawichitchainan is the influence of the military on the Vietnamese population. The research was motivated by her interest in how early life events and social institutions shape life course trajectories. During a year-long fellowship in Vietnam in the early 2000s, she found remnants of the American War (as it is referred to in Vietnam) still lingering.

“Many of the middle-aged and older people I spoke to told me anecdotal stories about hardship and their time in the military. The evidence was based primarily on memoirs and narratives,” she said. “The military is a potentially transforming social institution that tends to engage people in their early adulthood and can have significant short- and long-ranging effects on veterans’ social, economic, and health outcomes. Vietnam provides a particularly illustrative setting to address this research topic.”

With its involvement in continuous wars, Vietnam is considered one of the most highly mobilised societies in contemporary history. Yet, little empirical data is available on how the war has affected the Vietnamese population. The paucity of research on the impact of war from the Vietnamese perspective motivated Dr Teerawichitchainan to focus on the country.

“War has a long-term effect, and Vietnam has been under-researched which is why I’m interested in studying it,” she said.

For her PhD dissertation, Dr Teerawichitchainan examined the extent to which military service affected the socio-economic transition of northern Vietnamese men into adulthood. She pursued her studies using statistical analyses and a mixed-method approach combining population-level surveys with fieldwork and interviews.

In the summer of 2010, Dr Teerawichitchainan collaborated with Associate Professor Kim Korinek from the University of Utah’s Sociology Department, as well as researchers from the Vietnam Academy of Social Science, on a pilot study of the long-ranging impact of war on health and well-being of northern Vietnamese population.  Based on this pilot study, they published an article in Social Science & Medicine that examined the association between war involvement early in life and later-life physical and mental health outcomes in northern Vietnam.

One interesting finding was that in northern Vietnam, there was no significant difference in terms of health status at older age between civilians and war veterans. This could be due to the all-encompassing nature of war, in that even those who were civilians had a high chance of experiencing trauma. Veterans may have also received a head start in social mobility, as they were more likely to get state jobs during post-war years and, through a variety of social networks gained during the service years, to become entrepreneurs after Vietnam’s market reform. A forthcoming article by Drs Teerawichitchainan and Korinek will delve into the effect of various types of wartime trauma on health, and how individuals report their health symptoms.

In collaboration with Professor Zachary Zimmer from the University of California San Francisco, Drs Teerawichitchainan and Korinek now plan to further the study by examining the dynamic linkages between war, stress exposure and social relationships on health in later adulthood within the ageing Vietnamese population. The longitudinal dataset will couple social science and anthropometric measures such as blood pressure, weight, height and grip strength.

“It is widely accepted that human behaviour is influenced not just by the environment, but by one’s genetic programming as well. With this in mind, we are interested in how stress exposure earlier in one’s life course has long term health implications. Most of the existing literature is based on developed countries. We need more understanding of how people in developing countries adapt to trauma, and how they stay resilient,” she said.

Health and wellbeing of Southeast Asia’s elderly

Dr Teerawichitchainan’s emerging research agenda involves cross-national comparative assessments of the health and wellbeing of older persons in Myanmar, Thailand and Vietnam. She is collaborating with Professor John Knodel, Research Professor Emeritus at the University of Michigan’s Population Studies Centre, and Dr Wiraporn Pothisiri, a lecturer at the College of Population Studies at Chulalongkorn University, as well as researchers from the three countries on these projects.

Dr Teerawichitchainan notes that the survey of older adults in Myanmar is the first of its kind. “Because of the political situation in Myanmar, the last census before the one to be conducted in 2014 was carried out in 1983. Data from the last 30 years is not reliable. Our survey will help fill in gaps of what we know of the population in Myanmar,” she said.

And it is her long-term goal to provide policy makers in Southeast Asia with rigorous and comprehensive data-based evidence that motivates Dr Teerawichitchainan to carry out her projects.

“My hope is for my empirical work to help policy makers when they design policies. That’s one of the contributions of social demographers – to provide solid, evidence-based information that can guide policy planning,” she said.