Social Determinants of Health

The public health crisis on the Thailand-Myanmar border: Struggles of the Karen tribal peoples

“Anada1 was abandoned in the toilet pan at birth. Neighbors discovered her some hours later, and we took her to the hospital. The high level of infection caused cataracts and cornea scarring, leaving her blind.”

Having grown up in the confines of American suburbia, I was shocked when I heard this story. 

I was in conversation with Catherine Ruth-Riley discussing the public health situation on the Thailand-Myanmar border. Having founded a school for orphans, Catherine has worked in the border region for over two decades, driven by her mission of helping the Karen (/kəˈrɛn/) people, who exist at the margins of society on the border between Myanmar and Thailand.  Catherine’s candid depictions of adversity and courage painted a portrait of the Karen people marked by not only their struggles, but also, hope for a path to improvement.

Origins of Oppression: A Still-Alive Colonial Legacy

During colonial control of Myanmar from 1824 to 1948, the British government demarcated territory along geographical boundaries rather than cultural ones determined by natives. As a result, various native groups occupying the territory were clumped together under the same ruling power, creating tension that would later start conflicts.

For example, during World War II, the Burmese and the Karen peoples were allied to opposing world powers, causing the global power struggles to fuel local ones. The resulting damage was largely one-sided. The Burmese military regime oppressed the Karen people through ethnocidal tactics such as forced relocation and free-fire zones2. Even after World War II, such discrimination continued: the Karen peoples were not granted independence, even as the rest of Thailand was. 

This historic decision has set a decades-long precedent for the lack of legal recognition of the Karen peoples, resulting in tremendous inequity across health outcomes, political representation, and socioeconomic structures—some of which I examine in the next section.

A Karen tribal museum created to preserve and document their culture
Source: FredTC, CC BY-SA 4.0, via Wikimedia Commons

Social Determinants of Health and Well-Being

The public health crisis that the Karen community faces, characterized by a lowered lifespan, high rates of untreated visual impairments, and unsafe environments for childbirth, can largely be explained by the social determinants of health. Describing these societal factors, Jeanne Ward at the Women’s Refugee Commission describes how the combination of “military repression…, forced relocations…, and pervasive poverty” has effectively robbed 400,000 people of the human right to health. For instance, the military regime’s campaigns in the 1900s demonstrate the connection between political factors and personal health: families were forced to flee to the forests as internally-displaced peoples, where many were exposed to malaria-bearing mosquitoes and became infected by a disease they didn’t know how to handle.

Today, a similar reality continues in a different manner: many kids are not granted birth certificates, IDs, or other documentation, making it difficult for them to access formal healthcare resources needed to treat life-threatening conditions. Adding to the lack of documentation, widespread poverty greatly hurts those seeking help; due to the lack of available capital for constructing community hospitals, the road to the nearest hospital can take hours (assuming one even has a mode of transportation), hindering emergency care. 

Unfortunately, Catherine says, poverty reappears across generations: “Without solid education, it can be difficult for our kids to escape cyclical poverty and find better lives.” Why is this so? Language barriers between the Karen and Burmese are partly responsible for the cyclical nature of poverty. Because of this gap in communication, many educational, legal, and healthcare resources that are technically “available” are practically inaccessible to the ethnic minority—a disconnection amplified by the cultural stigma of learning the opposing group’s language. Hence, biological reproduction is often paralleled by social reproduction, in which one’s socioeconomic status and disadvantages are passed to the next generation.

Reducing Societal Disparities

The Bamboo School takes an innovative approach to mitigating these inequalities: it equips kids with tools they can use to break the cycle of poverty. For example, by teaching kids multiple languages starting at an early age, the school ensures that inability to understand language does not limit the resources they can access. Furthermore, the school helps them find jobs in health occupations in order to give back to the underprivileged in their own communities. 

Indeed, education is paramount to both individual and communal success. Finding stable and well-paying work—along with understanding multiple languages—tangibly improves the orphans’ lives while also reducing social inequalities. On a broader level, as the Bamboo School inspires many young adults to study in a health occupation, they are able to return to their communities as health professionals, thus expanding the resources available to other Karen peoples. Finally, education is a prerequisite to gaining adequate political representation needed for policy-based reform for inequality.

Solving a decades-long history of discrimination is no easy feat. Yet, through the sustained efforts of dedicated individuals and organizations, our world may gradually transform into a more just place.

Note: While the Bamboo School was created with Christian ideals, Anthro Analyst does not endorse any particular religion. In our interview with the Bamboo School, they emphasized that they do not push their religion on others and instead seek to respect local customs and values. In an environment characterized by great diversity, their respect for religious and cultural freedom is admirable.

1name changed to protect anonymity

2a free-fire zone is a military combat zone in which there are no restrictions on the use of firepower.

Further Reading

Neiman, Amy, et al. “Navigating Telehealth in Limited English Proficiency Populations.” EthnoMed, 1 July 2008,

Perkins, Carrie. “Rethinking Repatriation: Karen Refugees on the Thai-Myanmar Border .” Anthropology Theses and Dissertations, Southern Methodist University, 18 May 2019,

South, Ashley. “Karen Nationalist Communities: The ‘Problem’ of Diversity.” Contemporary Southeast Asia, vol. 29, no. 1, 2007, pp. 55–76. JSTOR,

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