27
Jan

The global demographic transition (DT) refers to the shift from high fertility and mortality rates to lower fertility and mortality levels. This transition, while contributing to improved life expectancy and economic opportunities, presents complex challenges for health equity, especially in low- and middle-income countries (LMICs). Vulnerable populations often face disproportionate health risks and reduced access to the benefits of demographic changes.

Declines in fertility and maternal mortality often benefit wealthier groups first, while poor and rural populations continue to face high fertility and maternal/infant mortality rates. This is a result of uneven access to reproductive health services, such as family planning, safe delivery, and neonatal care, which widens inequities. This may create a 'youth bulge' among vulnerable sub-population groups in many LMICs. While this should be an economic opportunity, it places a strain on access to quality education and healthcare systems. Marginalized youth, including those from rural, poor, or conflict-affected areas, face heightened risks of unemployment, violence, and poor mental health outcomes. Additionally, unequal fertility declines intensify gender inequities, as poorer women continue to bear reproductive burdens.

As fertility and mortality decline further, an increasingly aging population without adequate social protection, pensions, or geriatric health services would increase the elderly population in poor households, particularly women, who face heightened risks of exclusion from health and social care.

Whereas LMICs face a dual challenge of persistent infectious diseases alongside rising non-communicable diseases (NCDs), marginalized vulnerable populations are the least equipped to manage this burden due to inadequate resources, prevention, and treatment services, thereby intensifying inequities. On the other hand, DT accelerates urban migration, often resulting in vulnerable populations living in informal settlements with inadequate access to clean water, sanitation, and healthcare. This exacerbates inequities in communicable and environmental diseases.

Civil society organizations (CSOs) are increasingly recognized as crucial actors who play roles in advancing health equity and social justice for vulnerable populations in low- and middle-income countries (LMICs). They amplify marginalized voices, strengthen accountability, deliver essential services, and foster community empowerment. They use a dual policy approach to co-develop contextualized initiatives that target specific needs or obstacles of vulnerable populations to fill the gaps of mainstream policies to enhance health equity.

In Thailand, the Thai Health Promotion Foundation (ThaiHealth) established “Health Promotion for Vulnerable Population Section : Section 9’ to strategically enhance equitable access to health rights and health promotion by engaging the change agents of vulnerable populations, including the elderly, persons with disabilities, homeless people, LGBTQN+, prisoners, ethnic groups, informal workers, and migrant workers, Islamic people,. The principles of their active engagement include the representation of them to ensure that their voices are heard and their needs are understood, policy advocacy and monitoring government commitments in problem-solving, co-design accessible service delivery models, people empowerment to claim rights and entitlements that enhance social justice, and introducing grassroots-driven solutions that governments can adopt and scale up. As many challenges still exist, the PMAC is a great venue where some initiatives and lessons learned should be widely shared for extensive and critical discussion on the outcomes, impacts, and sustainability of the initiatives, particularly on the issues of tokenistic participation with limited influence, political restrictions and shrinking civic space, and adequate and sustainable funding from public sources.

Expected output/outcome

• Participants realize DT impacts and needs of the vulnerable populations, and recognize the roles of CSOs in helping improve health inequity among vulnerable populations.
• Participants are aware of the needs for specific policy initiatives for vulnerable populations when proposing public policies to handle the general DT impacts in particular contries.