Located in northeastern Thailand, Isan is the country’s largest and most populous region, home to roughly 22 million people. Despite national declines in poverty, research from The Asia Foundation in 2019, based on surveys and in-depth interviews with 1,400 residents, shows that Isan continues to face the highest poverty rate and the lowest average income in Thailand. In 2018, the average monthly income in the central region reached 12,818 baht (about $407), nearly double the 6,790 baht ($216) reported in the Isan region.

The study also found that although 87% of households in Isan own land, land ownership alone has not guaranteed stable or sufficient livelihoods.

Budget and Health Care Inequality and Intra-Regional Disparity

Inequality persists in Thailand, particularly in the Isan region, when compared to more affluent areas such as Bangkok. In 2024, the Thai government allocated only 5.54% of its 3.48-trillion-baht (roughly $111 billion) national budget to Isan. In contrast, it allocated almost 10 times that amount, 1.85 trillion baht ($59.2 billion), to Bangkok, despite the capital having less than half of Isan’s population (around 11 million people).

Health care distribution also reflects this inequality. In 2023, Thailand had 37,559 doctors nationwide, but only 8,447 worked in Isan. Inequalities also exist within the region itself. Khon Kaen, one of Isan’s major cities, has a significantly lower doctor-to-patient ratio, with one doctor serving approximately 1,080 people, compared to Bueng Kan, where one doctor serves 5,003 people.

Discrimination

According to Manushya, urban populations in wealthier regions have long perpetuated negative stereotypes about Isan people, mocking them as poor, backward or as “mia farang” (meaning a white foreigner’s wife). The Asia Foundation also notes that some believe “there is no future in Isan,” leading to the assumption that people must migrate to Bangkok for “good prospects.” However, the study shows major shifts in migration patterns.

Young people in Isan are increasingly choosing to enroll in local institutions, such as Khon Kaen University, rather than moving to Bangkok. As a result, students are becoming more interested in pursuing entrepreneurship in Isan rather than seeking work in the capital. These findings show that the negative stereotypes stem from outdated or poorly informed assumptions.

Universal Health Coverage

Thailand introduced the Universal Health Coverage (UHC) Scheme, often referred to as the “30-baht Scheme,” in 2001 to provide health care access for residents not covered by other public health schemes. The Asia Foundation identifies UHC as the most widely used social safety net in Isan, with 97% of surveyed respondents expressing high satisfaction. Before the scheme began, around 80% of the population lacked adequate health care coverage or faced prohibitive medical costs.

UHC has reduced this burden significantly. By 2015, household health care expenditure in Thailand had decreased by 11.8%, easing financial pressure on low-income households and contributing to a reduction in poverty.

Manushya and Advocacy Efforts

Founded in 2017 by Emilie Palamy Paradichit, Manushya is an intersectional feminist organization dedicated to promoting equality and human rights. Manushya worked with several Thai civil society organizations to prepare the Isan UPR factsheet for Thailand’s third Universal Periodic Review (UPR) in 2021. These partners included the Thai CSOs Coalition for the UPR, the Human Rights Violations in Isaan Monitoring Group, the Sai Thong Rak Pah Network, the Amnat Charoen Friend of Women Center and the Isaan Gender Diversity Network (IGDN).

The factsheet highlighted discrimination against Isan residents, such as unequal budget allocation, employment in low-paying jobs and negative stereotypes describing people as “poor,” “backward,” or “lower-class.” Manushya also included these concerns in its shadow civil society report for Thailand’s Convention on the Elimination of Racial Discrimination (CERD) review and participated in two sessions with CERD committee members to ensure that issues affecting Isan were addressed.

Progress and Opportunities in Isan

Efforts to reduce inequality in Isan demonstrate how targeted policies and strong community engagement can lead to meaningful change. Programs such as the UHC have expanded access to essential services, while organizations like Manushya continue to advocate for fair resource distribution and human rights protections. Growing interest in local education and entrepreneurship also reflects a generation investing in the region’s future.

With continued cooperation among government agencies, civil society groups and local communities, progress toward addressing inequality in Isan can accelerate, supporting more secure and sustainable livelihoods.

– Sammi Li

Sammi is based in London, UK and focuses on Good News for The Borgen Project.

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