SOC319 Sociology of Health and Healthcare End-of-Course Assessment – July Semester 2025

INSTRUCTIONS TO STUDENTS:

1. This End-of-Course Assessment paper contains 1 question and comprises 9 pages (including the cover page).
2. You are to include the following particulars in your submission: Course Code, Title of the ECA, SUSS PI No., Your Name, and Submission Date.
3. Ensure that you submit your End-of-Course Assessment by the deadline. After the 12-hour grace period, 10% of the total End-of-Course Assessment mark will be deducted for each 24-hour block or part thereof by which your submission is late. Submissions with more than 50 marks deducted will be awarded 0 marks.
4. You are allowed multiple submissions to Turnitin before the deadline. After the deadline, only one submission is allowed, and only if you have not already made a prior submission.
5. If you fail to submit your End-of-Course Assessment, you will be deemed to have withdrawn from the course. 

IMPORTANT NOTE

ECA Submission Deadline: Thursday, 30 October 2025 12:00 pm 

ECA Submission Guidelines

Please read this information before you start working on your ECA.

This ECA carries 40% of the course marks and is a compulsory component. It is to be done individually and not collaboratively with other students.  You must submit it on time.

Submission

You are to submit the end-of-course assessment (ECA) in exactly the same manner as your tutor-marked assignments (TMA), i.e. using Canvas. Submission in any other manner such as hardcopy or any other means will not be accepted. Ensure that you submit your ECA by the deadline. After the 12-hour grace period, 10% of the total ECA mark will be deducted for every 24-hour block or part thereof by which your submission is late. Submissions with more than 50 marks deducted will be awarded 0 marks. You are allowed multiple submissions to Turnitin before the deadline, after which only one submission is allowed, and only if you have not already previously submitted. If you fail to submit your ECA, you will be deemed to have withdrawn from the course.

You are reminded that electronic transmission is not always immediate. It is possible that network traffic may be particularly heavy on the cut-off date, and connections to the system cannot be guaranteed. Hence, you are advised to submit your work no later than the day before the cut-off date in order to make sure that the submission is accepted and in good time.

Once you have submitted your ECA, the status is displayed on the computer screen. You will receive a digital acknowledgement message. Please note that it is the digital time-stamp—and not the acknowledgement message—that indicates that you have submitted your ECA. To ensure a timely submission and to have your ECAs marked, you should therefore not jeopardise your course result by submitting your ECA at the last minute.

Do ensure that you have the correct files for submission.  Any submission, extra files, missing appendices or corrections received separately after the submission of the ECA will not be considered in the grading of your ECA assignment.

Plagiarism and Collusion

The University takes a very serious view of plagiarism (passing off someone else’s ideas as your own, or recycling of contents from your own earlier marked TMA from the same course or another course) and collusion (submitting an assignment which is the same or very similar to another student’s). Both are forms of cheating, and neither is acceptable in any form in a student’s work, including this ECA assignment.

Avoid plagiarism by giving yourself sufficient time to research and understand the material so that you can write up your assignment in your own words, and ensure that you provide appropriate references when necessary. You can avoid collusion by ensuring that your submission is based on your own individual effort.

Penalties for plagiarism and collusion are severe. Serious cases will normally result in the student being referred to SUSS’s Student Disciplinary Group. For other cases, significant marking penalties or expulsion from the course may be imposed. For more information about the University’s policies on plagiarism and collusion, refer to the

Student Handbook (Section 5.2, paragraph 1.3).

(Full marks: 100)

Question 1

Thailand is a diverse country as it is home to several ethnic, language and religious groups. Another less known distinction is the divide between the upland and lowland peoples. The majority of the lowland people constitute the Thai population who are mainly Buddhist; there are indigenous populations residing in the Northern reaches, like the Akha, Hmong and Lisu, to name a few. These ethnic minority groups adhere to a way of life distinct from those living in the lowlands (Vaddhanaphuti 2005) and they engage in swidden cultivation (Bruun et al. 2017). However, the thriving ethnic tourism project with businesses in the northern city of Chiangmai have repackaged the cultures of these ethnic highland minority groups and successfully sold them to tourists (Leepreecha 2005), bringing them into the forefront. In line with this, the Thai government has invested heavily in the infrastructure in the northern reaches where many of these ethnic groups live in an effort to promote ethnic tourism since it helps to grow the country’s economy.

Paradoxically the Thai government has attempted to assimilate these minority groups within the constructs of a “mono-cultural framing of Thailand” (Morton 2016: 3) in spite of exploiting their uniqueness for profit. In response, there has been a movement among these minority ethnic groups to redefine their identity and status in opposition to claims of the Thai state that these ethnic minorities are: “migrants…who by nature and historical background are not indigenous to the country” and therefore cannot be called indigenous peoples (Anaya 2008, as cited in Morton 2016: 4) and are instead “alien, uncivilized and [even] dangerous” (Morton 2016: 4). This marginalization they face and that many of these ethnic minorities live in very remote areas means that access to basic healthcare amongst them has been uneven in spite of the introduction of various facilities bringing about numerous changes to the lives of these people.

Generally residing in mountainous areas for any population makes it difficult to access healthcare services. Reaching the closest healthcare facility can take hours, if not days for those living deep in the mountains: with the rainy season making it even more difficult for them to receive timely and relevant healthcare when needed (Yingtaweesak et al. 2013). Although all Thai citizens are eligible to free healthcare under the Universal Healthcare System, those living in remote areas still have to incur costs such as for transport and food if they wish to access healthcare services. In essence, healthcare is not exactly completely free for them.

Aside from geographic location, numerous other barriers continue to exist for the ethnic minorities in Thailand since many, especially for the elderly amongst these ethnic minorities, do not speak the Thai language. Indigenous communities also face health disadvantages linked to social deprivation because of having lower levels of education (Moonpanane et al. 2022), leading to lower levels of health literacy among them compared with the general Thai population. During times of crisis such as  COVID-19, their marginalization was pronounced when their movements were curtailed further, impacting on healthcare utilization. Furthermore in Thailand, access to healthcare is uneven across rural and urban areas although there is no difference in healthcare values amongst urban and rural residents (Ikai et al. 2016).

It is clear that structural inequalities are the principal factor for many marginalized communities in their access to equitable healthcare. This is more pronounced for many economically disadvantaged countries because of poor infrastructure. Although some have “made strides toward improving healthcare access, rural regions continue to face significant barriers due to socio-economic disparities, geographical challenges, and insufficient healthcare infrastructure” (Sato 2024).

Discuss the following questions based on your research of primary and secondary materials:

A. Review the barriers to healthcare services among urban and rural populations in a less affluent country such as Thailand. (25 marks)

B. In light of Andersen’s model of healthcare utilization, appraise why a multifaceted approach is needed to improve healthcare access, comparing Thailand and a developed country such as the United States. You may cover a total of three concrete solutions their governments have undertaken in responding to barriers their citizens may face in accessing healthcare. (35 marks)

C. As a small country, in contrast to Thailand and the United States, Singaporeans do not face the structural barrier of geographical distance in accessing healthcare services although they might encounter other barriers. In your essay, discuss the common barriers a Singaporean may face in accessing healthcare services. Is ethnic minority status a determining factor in healthcare access or would you say income is a greater barrier in accessing healthcare services in Singapore? (40 marks)

For Part C, you are also expected to undertake face-to-face interviews with two (2) Singaporeans on their views on healthcare access in Singapore. Your respondents may or may not be employed (which could influence their views on how income may impact on healthcare access); they should be from an ethnic minority group in Singapore; and they could be from different income groups – one middle and the other lower income group (for the latter, housing could be used as a proxy). Your essay should incorporate their responses, in particular their self-reported responses on healthcare access in Singapore, as well as their observations of the health policies and programmes the Singapore government has formulated and designed to meet the needs of different groups of Singaporeans.

Students’ Notes:

This ECA requires you to demonstrate your understanding of barriers to healthcare access. You are expected to be familiar with Chapters 2 and 3 of the Study Guide as well as the relevant sections in Chapters 3 and 9 of the textbook The Sociology of Health and Illness by Sarah Nettleton. It is mandatory to cite from the course materials (such as the main textbook and the Study Guide) in your essay.

The following are other sources which you are encouraged to incorporate although you are expected to cite other resources available to you on E-resources @ The Library. In other words, you are expected to do additional research on journal articles and incorporate their main ideas into your essay:

Ahmed, Syed M., Lemkau, Jeanne P., Nealeigh, Nichol and Barbara Mann (2002) “Barriers to Healthcare Access in a Non-Elderly Urban Poor American Population”. Health & Social Care in the Community.

https://onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2524.2001.00318.x

Bruun, Thilde Bech, de Neergaard, Andreas, Burup, Maria Libach, Hepp, Catherine Maria, Larsen, Marianne Nylandsted, Abel, Christin, Aumtong, Supathida, Magid, Jakob and Ole Mertz (2017) “Intensification of Upland Agriculture in Thailand: Development or Degradation?” Land Degradation and Development, 28(1): 83-94.

Coombs, Nicholas C., Meriwether, Wyatt E., Caringi, James and Sophia R. Newcomer (2021) “Barriers to Healthcare Access among U.S. adults with Mental Health Challenges: A Population-Based Study.” SSM – Population Health, 15: 100847.

Coombs, Nicholas C., Campbell, Duncan G., and Jamew Caringi (2022) “A Qualitative Study of Rural Healthcare Providers’ Views of Social, Cultural, and Programmatic Barriers to Healthcare Access.” BMC Health Services Research, 22:438 https://doi.org/10.1186/s12913-022-07829-2

Ikai, Tomoki, Yamtree, Saowalak, Takemoto, Takuji, Tamura, Taro, Kanayama, Hitomi, Sato, Kazuhiro, Kusaka, Yukinori, Hayashi, Hiroyuki and Hidekazu Terasawa (2016) “Medical Care Ideals among Urban and Rural Resident in Thailand: A Qualitative Study.” International Journal for Equity in Health, 15:2. DOI 10.1186/s12939-015-0292-6

Kullanit, Apisat and Nutta Taneepanichskul (2018) “Transportation Barriers on Healthcare Utilization among Elderly Population living in Mahasarakham Province,

Thailand.”      Journal     of      Health     Research,      31(Suppl.2):     S233-8.       DOI: 10.14456/jhr.2017.89 Leepreecha, Prasit (2005) “The Politics of Ethnic Tourism in Northern Thailand.” Paper presented at the Workshop on Mekong Tourism: Learning across Borders. Social Research Institute, Chiang Mai University, 25 February.

Moonpanane, Katemanee, Pitchalard, Khanittha, Thepsaw, Jintana, Singkhorn, Onnalin and Chomnard Potjanamart (2022) “Healthcare Service Utilization of Hill Tribe Children in Underserved Communities in Thailand: Barriers to Access.” BMC Health Services Research, 22:1114. URL:doi.org/10.1186/s12913-022-08494-1>

Morton, F. Micah (2016) “The Indigenous Peoples’ Movement in Thailand Expands.” Perspective, No. 68. ISEAS: Yusof-Ishak Institute.

Rojjananukulpong, Rattanakarun, Ahmad, Mokbul Morshed and Shahab E. Saqib (2021) “Disparities in Physical Accessibility among Rural Thais under University Health Coverage.” American Journal of Tropical Medical Hygiene, 105(3): 837-45.

Sato, Shunsuke (2024) “Access to Healthcare for Marginalized Communities in Rural South Asia: An Analysis of Structural Inequalities in Sri Lanka and Bhutan.” Authorea, 29 October.

Schwarz, Tanja, Schmidt, Andrea E., Babek, Julia and Joy Ladurner (2022) “Barriers to Accessing Health Care for People with Chronic Conditions: A Qualitative Interview Study.”

BMC Health Services Research, 22:1037. https://doi.org/10.1186/s12913-022-08426-z Tongwaranan, Tanyatorn. “Employment Quotas for the Disabled Don’t Always Work.” Bangkok Post, 18 July 2016.

Vaddhanaphutti, Chayan (2005) ‘The Thai State and Ethnic Minorities: From Assimilation to Selective Integration.’ In Ethnic Conflicts in Southeast Asia, edited by K. Snitwongse and W.S. Thompson. Singapore: Institute of Southeast Asian Studies.

Yingtaweesak, Tawatchai, Yoshida, Yoshitoku, Hemhongsa, Pajjuban, Hamajima, Nobuyuki, and Sonngan Chaiyakae (2013) “Accessibility of Health Care Service in Thasongyang, Tak Province, Thailand.” Nagoya Journal of Medical Science, 75(3-4): 243-50.

To provide a good essay, you may apply and discuss the following concepts: a. socioeconomic status

1. cost of healthcare
2. affordability
3. insurance coverage
4. access to healthcare providers / provider shortage
5. stigma
6. enabling resources
7. health beliefs

Your essay need not be limited to addressing these concepts since there are other concepts/arguments/ideas raised in the course materials that may be relevant to your discussion.

It is important that you tackle each question separately and systematically. In other words, there should be three parts: Questions A, B and C in your essay, respectively. You should also include an introduction and a conclusion to the entire essay rather than to each part of the essay.

To start off in your writing, you are advised to compose a general outline. Please note for each question, you should have at least three main points that you can substantively discuss. Also, you are to answer the questions in the sequence they appear.

With regard to the interviews, on meeting your respondents, you should explain the purpose of the interview and answer any questions they might have. You must obtained written informed consent from each respondent using the Participant Consent Form available in Appendix 1 of the ECA booklet. State the full names of the respondents in the forms but use pseudonyms in your essay and other submissions. Note that digital signatures are accepted but type-written ones are not. Securing written consent ensures that your respondents understand the purpose of the interview and voluntarily agree to participate. While you need not audio-record the interview, if you do so, you must receive consent from your respondent. Please save the recording as a passwordprotected file and delete it when the results are released. Be courteous and thank your respondents for their participation. The interviews should take place at a date, time and venue convenient for your respondents.

You are to include the following in an Appendix to your essay: (a) profile of respondents; (b) transcription of interviews; (c) interview question schedule; and (d) participant consent forms. Omitting these items will result in a poorer grade. Participant consent forms should be scanned and attached to your essay — 10 marks will be deducted for incomplete, invalid, or non-submission of the Participant Consent Form(s).

Write your answer in 3,000 words (excluding Appendices and reference list). Please remember to provide the word count, relevant in-text citations and a list of references. Be sure to use appropriate academic sources, including your course materials. 

Make certain to fill in the self-declaration form (a copy is available under your course site on Canvas > L group > Modules) and include the completed form as a cover page for your submission (A penalty of 5 marks deduction will be imposed if this self-declaration form is incomplete, inaccurate, or missing. No appeals concerning the self-declaration form will be entertained).

Appendix:

SOC319 Sociology of Health and Healthcare

PARTICIPANT CONSENT FORM

Student researcher’s name……………………………..

The student researcher named above has briefed me to my satisfaction on the research he or she is conducting. I understand that I have the right to withdraw from the research at any point. I understand that, within the constraints of the research, my rights to anonymity and confidentiality will be respected. I understand that my privacy as an individual will be respected and I will be informed of the purposes of any interview or observations conducted by the researcher.

I agree to having any discussion or interview recorded (delete if not relevant).

Name of participant……………………………….

Signature/thumbprint of participant……………………………….

Date……………………………………………………..

One copy of this form should be retained by the participant(s) and the other by the student researcher.

Students should attach a copy of the consent form(s) to their completed ECA for submission to the University.

—– END OF ECA PAPER —–

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