Prevention and Control of Diseases in Thailand’s Juvenile Facilities: The Pahurat’s BathTub Approach (PBA) to Balancing Justice and Health Equity

Abstract

This study proposes a comprehensive framework for disease surveillance, screening, prevention, and control in Thailand’s juvenile detention facilities, emphasizing the impact of social determinants on vulnerable youth’s health. Rooted in social justice and health equity, the approach aligns with the Royal Development Projects' "Good Health, Good Heart" and employs the Pahurat’s BathTub Approach. It recognizes that factors such as overcrowding, limited healthcare access, and social support significantly influence health risks in detention settings.

The model includes systematic health assessments at intake, during detention, and pre-release, categorizing youth into three health statuses: Cold Water (no health threats), Warm Water (under treatment), and Hot Water (unaware of infection). Maintaining youth in the Cold-Water status highlights the importance of addressing social determinants to ensure health protection. Those in Warm Water require ongoing care, while Hot Water cases need targeted screening and treatment to prevent disease transmission and support reintegration.

The framework also considers disease spread via staff (“Towel”) and visitors (“Rainwater”), exacerbated by systemic inequalities. Respiratory diseases like influenza, measles, and chickenpox can transmit silently during incubation periods of 1–21 days, necessitating regular diagnostics and prompt interventions, especially for diseases like tuberculosis. A quarantine period of 5–7 days, coupled with vaccination efforts, is recommended to reduce health disparities.

This approach is based on principles of accessible services, welfare support, inter-agency collaboration, continuous improvement, and equity, aiming to address social determinants, improve health outcomes, and promote justice within detention environments at local, community, and global levels.