The Mekong River, urban health, and sustainable development in northeastern Thailand

ABSTRACT

Rivers are linked to urban health and sustainable development, and yet the literature emphasises environmental science and overlooks the human side. This article presents a human-centred study of urban health and sustainable development in northeastern Thailand in relation to the Mekong River. The study’s framework, the travelogue methodology, brings travel to urban areas near the river (Nakhon Phanom, Bueng Kan, Phon Phisai, Nong Khai, That Phanom, Mukdahan, and Ubon Ratchathani) into the research and knowledge generation process. Data collection in June and July 2023 included observation, photography, note-taking, travel-journaling, and conversations with urban adult residents, analysed in narrative writing. The findings adeptly link the Mekong River to diverse aspects of urban health and sustainable development, including physical activity, social cohesion, food supply and nutrition, water supply, heritage, religious practices, liveability, and sense of place. It also brings to the fore the many threats to the river and, therefore, to human health. By addressing the areas for improvement, future research and practice can build upon these findings to promote healthy, sustainable, and resilient urban environments along the Mekong River and beyond.

KEYWORDS:

• Isan
• Mekong River
• Sustainable Development Goals (SDGs)
• travelogue methodology
• urban health

Introduction

The photograph in Figure 1 sets the scene for this travelogue, a journey to urban areas adorning the Mekong River in northeastern Thailand to explore urban health and sustainable development in relation to the river. In this opening scene, the motorcycle signifies the centrality of travel to the study’s research design – the travelogue methodology (Davey 2023a) – and my predominant mode of travel. The parking and empty seat represent the many stops and conversations I made en route, as well as the gaps in the literature on rivers and urban health even though the Mekong River is the third-longest river in Asia with many human settlements throughout its reach. The green foliage and idyllic scenery in the photograph highlight the necessity of bringing planetary health and sustainable development into discussions about urban health; and the strong sun rays guarantee to lighten up any dull corners of my story and also illustrate the multisensory experience of travel through perception, sensation, and consciousness of being (Davey 2023a).

Figure 1. My red Honda motorcycle parked adjacent to the Mekong River in Phon Phisai town, June 2023. On the right is a private house and garden.

Rivers are inextricably linked to urban health. The historical change from hunting and gathering to agrarian lifestyles and permanent settlements around the time of the Neolithic Revolution (12000 BCE) typically occurred along rivers, as did the subsequent formation and growth of the first human civilizations and cities. Livelihoods and economies continue to depend on rivers, vital sources of fish and water for sustenance as well as water for agricultural irrigation, transportation, and waste disposal, to name just a few examples (Finlayson and D’Cruz 2005, Macklin and Lewin 2020). Rivers have numerous agricultural, commercial, domestic, energy, and industrial uses, and offer significant aesthetic, cultural, educational, recreational, spiritual, and touristic benefits, with many implications for health (Finlayson and D’Cruz 2005). Rivers also underpin a wide range of climatic, ecosystem, and hydrological processes, such as coastal protection; erosion, flood, and natural hazard regulation; nutrient and sediment transport; river and ground water availability and purification; and biodiversity support (Finlayson and D’Cruz 2005). Not surprisingly, then, many cities in the world are situated on the banks of rivers, and rivers continue to be important in urban planning and development and in the social fabric of cities (Macklin and Lewin 2020). Yet rivers also bring challenges to health, oftentimes because of urbanisation and their degradation by people. Pollution, sewage, water withdrawal, land use change, and fish and biodiversity losses diminish the benefits of rivers (Finlayson and D’Cruz 2005, Macklin and Lewin 2020). Threats to human health posed by rivers include water-related vector-borne diseases, for example malaria, filariasis, river-blindness, and yellow fever. Therefore, most work on urban health and rivers has been in environmental science, especially microbiology and toxicology and water quality.

To understand more about the human side of the Mekong River with regard to urban health and sustainable development, this travelogue documents the author’s observations, encounters, reflections and conversations with residents in urban areas in northeastern Thailand. I define ‘health’ broadly and holistically in accordance with the World Health Organization’s constitution, ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ (World Health Organization 2020, p. 1), and with the Ottawa Charter for Health Promotion, ‘To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life … a positive concept emphasizing social and personal resources, as well as physical capacities’ (World Health Organization 1986, p. 1). In this study, these definitions are contextualised in relation to urban areas and urban planning and urbanization and their related characteristics, conditions, resources, and wider determinants of health, all influencing each other and interacting in multiple ways and impacting on human health and planetary health both directly and indirectly (see Barton and Grant 2006, Grant 2023).

The study is also about sustainable development, a global priority within efforts to improve urban health since it is interconnected with numerous sustainability concerns such as poverty, education, inclusivity, inequality, and the protection and conservation of natural environments and resources (United Nations 2015). Specifically, I draw upon the United Nation’s Sustainable Development Goals (SDGs), a plan of action for sustainability that was officially adopted by all Member States in 2015 to collectively address a wide range of economic, environmental, and social challenges (United Nations 2015). Although SDG 3 concerns health and wellbeing, and SDG 6 is about access to clean water and sanitation and protecting and restoring water-related ecosystems (and SDG 14 is about life below water, especially oceans and marine life), the full range of SDGs will be considered in this study to advocate for an integrated approach and to offer directions for building on its findings to promote healthy, sustainable and resilient urban environments.

The travelogue methodology is a framework for bringing travel and hospitality by the researcher into knowledge generation, starting with planning the journey and its route, places and people to be visited and studied, and modes of travel; through to collecting and analysing data including a need for methodological creativity to develop ‘travel research methods’; scrutinising selfhood, representation, and social responsibility through reflexivity, to situate the travel and research within the subjectivity and sense-making of the traveller and others, alongside a commitment to ethical travel; and writing and publishing, since a travelogue is both a research process and an end product with an emphasis on presenting the traveller’s voice in personal accounts and narration (Davey 2023a). Since the travelogue methodology is new, the second aim of the study is to reflect on its application, not only to the research topic but also to the research and knowledge generation process. What kinds of new research and knowledge arise in this travelogue? What lessons can be learnt from seeing the research topic through the eyes of a traveller?

In summary, this article describes an application of the travelogue methodology in an investigation of the Mekong River, urban health, and sustainable development in northeastern Thailand, guided by the following broad research questions:

Based on observations, experiences, reflections, and conversations with adult urban residents (in all age groups, and from all walks of life) while travelling to and within cities and towns in Thailand (a country characterised by rapid urbanization and moderate population growth), in what ways might urban health and sustainable development be interconnected with the Mekong River? How can future research and practice build upon these findings to further understand and promote healthy, sustainable, and resilient urban environments? Through the study’s application of the travelogue methodology, what kinds of understanding and knowledge generation are arising?

Methodology

Overview

The travelogue methodology (Davey 2023a) served as an analytical and empirical framework for the study.

Planning the journey and travel

In June and July 2023, I travelled to, within, and between cities, towns, suburbs, and peri-urban areas (the urban periphery, where urban and rural uses transition) nearby the Mekong River in northeastern Thailand (Isan), mostly by motorcycle. The route and itinerary included Nong Khai, a city in upper northeastern Thailand and the capital of Nong Khai Province; Phon Phisai, a town and district in Nong Khai Province; Bueng Kan, a town and the capital of Bueng Kan Province; Nakhon Phanom, a town and the capital of Nakhon Phanom Province; That Phanom, a town in the southern part of Nakhon Phanom Province; Mukdahan, a town and the capital of Mukdahan Province; and Ubon Ratchathani, a major city in the southeast of Isan. Within this itinerary, the route was emergent and flexible, and it unfolded indiscriminately (Davey 2023a, 2023b).

Collecting and analysing data

Data collection methods included observation, photography, note-taking, journaling, and conversations with urban residents aged 18 and above. I created a travel diary/journal to document the journey, places visited, and experiences, a first-hand account of exploration and observations, thoughts, emotions, senses, interactions, memories, and reflections as well as anything else of relevance. I engaged in ‘small talk’ or chit-chat with people going about their lives near the river, meaningful and yet relatively short and naturalistic informal conversations of about 5-20 minutes. Although I had set out to conduct in-depth interviews, I found them disadvantageous when travelling and stopping en route. ‘Small talk’ was an ordinary, authentic, convenient, polite, and quick way to connect to people demographically different from myself and who might be regarded as difficult to reach, although I still took time to explain the study, check eligibility (i.e. resident near the river, personal experiences of it; purposive sampling and criterion sampling), and obtain informed consent. Although casual and short in duration and no doubt a sacrifice of depth, I found ‘small talk’ rich in information. It began with greetings and questions such as ‘How are you?’ to initiate conversation and build rapport prior to explaining the study. Following informed consent, open-ended questions about the research topic included ‘What are you doing right next to the river?’, ‘Can you please describe your experiences of the river?’, ‘What are the personal consequences of living next to the river?’, ‘How is your daily life influenced by the river?’, ‘What comes to mind when we think about the river and health?’, although fewer questions were asked compared to typical interviewing. Exit questions and parting exchanges gracefully ended each encounter. Cognizant of my multiple forms of difference to the people I met in Isan, I took extra care during conversations to check that I understood their comments and did not impose my own biases when thinking through their answers. Both the travel diary/journal and ‘small talk’ can be regarded as new ‘travel research methods’ for the travelogue methodology (Davey 2023a).

The data were analysed using narrative analysis to construct an overall travel story told by the researcher (traveller), organised deductively by its beginning (arrival), intermediary points (places, stops, scenes, events), and ending (departure, conclusions of the story, reflexivity), and then organised inductively within each of these distinct parts. At certain points in this chronology, I expand upon specific patterns or topics even though they were spread across the journey, to elaborate on findings, for example I discuss fish and fishing in That Phanom in the middle of the journey where it stood out.

Engaging with selfhood, representation, and social responsibility

The travelogue methodology empowers the writer to connect with personal experience and introspection, subjectivity, emotionality, and positionality and bias, and, in doing so, to find their voice (Davey 2023a). Thus, reflexive practice is embedded throughout this article to scrutinise my assumptions, preconceptions, biases, and privileges. A commitment to ethical travel and social causes underpinned the research, including purchasing carbon offsets from Sustainable Travel International to offset any environmental footprint, a one-off donation to the charity International Rivers, and the provision of a privately funded (by the author) full scholarship for the study’s research assistant to enrol on an undergraduate degree as a mature student, since poverty was an obstacle restricting his access to higher education. The study was also approved by a university ethics committee.

Writing the travelogue

In the following sections, I construct and self-narrate a chronological and sequential narrative of the journey based on my own sense-making, while also interpreting stories from urban residents, woven into the fabric of culture and society, a first-person account of real-life scenes and personal experiences and moments, supplemented with other writing styles. Pseudonyms were used for the names of the participants to maintain the confidentiality.

Arriving in Nakhon Phanom: a vibrant waterfront

I arrived at the Mekong River in Nakhon Phanom’s town centre, just as the sun was setting on the horizon. A dull red glow was cast over the river, and a silhouette of the undulating limestone mountains in Thakhek, Laos could be seen in the skyline. I parked the motorcycle at the promenade on the riverfront that improved the river’s accessibility, attractiveness, and safety, encouraging people to visit and to spend time as well as to develop favourable perceptions. The popularity of the river was clear, as people of all ages and abilities were walking, jogging, cycling, skipping, and sitting down, captured in the images below.

In Figure 2(a), people can be seen sitting down and looking out over the river while talking and socialising, most likely bringing it into their conversations and social experiences, like I often do when visiting water bodies. There were designated areas for walking or cycling: Figure 2(b) shows a green-coloured cycle-path and a brown-coloured footpath, both physically separated with railings for safety (and signage prohibiting motor vehicle access); bicycle rental and parking facilities were available nearby. Outdoor gym equipment was a common sight in all the urban areas I visited (e.g. Figure 2(c)), as were play-areas for children. Overall, the promenade and its surroundings were conducive to physical activity, and I saw wheelchair ramps and disabled-access signs, creating an impression of inclusiveness.

Figure 2. The promenade on the riverfront in Nakhon Phanom: (a) people sitting or walking next to the river, (b) designated paths for cycling or walking, and (c) outdoor gym equipment.

I strolled along the promenade on foot while looking for a hotel to stop for the night. Walking Street stood out as a vibrant and multi-use space for walking, entertainment, and socialising, and numerous restaurants and cafés and architectural heritage sites dotted the vicinity, a reminder of the benefits of waterfronts as public places. At night, it turned into a colourful night-market brimming with items for sale, pop-up food stalls, live music, open-air massage booths, and Isan cuisine. On another evening, I was lured back to the waterfront during a festival by bright neon lights, laughter, and people enjoying themselves. All this seemed to enhance the town’s culture, social cohesion, and liveability – the degree to which Nakhon Phanom is suitable for living – all important to health and wellbeing (Davern et al. 2023). My visit to the town, when the worst of the COVID-19 pandemic appeared to be over, contrasted to my residence in Thailand three years previously when lockdowns acted like a sledgehammer on physical activity, social life, and urban health.

The design of the waterfront supports the achievement of several SDGs such as SDG 11.7 (providing universal access to safe, inclusive, and accessible green and public spaces, in particular for women and children, older people and people with disabilities), and SDG 3.4 about reducing premature mortality from noncommunicable diseases through prevention and treatment. It also encourages physical activity (e.g. trips on foot or by bicycle rather than by motorcycle or by car), and therefore enables healthier lifestyles and reduces carbon emissions and air pollution (City of New York 2010, Public Health England 2016). Salvo et al. (2021) argued there are demonstrable benefits of physical activity promotion for achieving other SDGs, especially SDG 9 (industry, innovation, and infrastructure), SDG 11 (sustainable cities and communities), SDG 13 (climate action), and SDG 16 (peace, justice, and strong institutions). Urban planners in other urban areas in Thailand could initiate some of these active design features, for example by providing accessible and safe areas next to the river, and space and appropriate infrastructure (e.g. designated lanes, bicycle parking) to support exercise and physical activity, and by accommodating the needs of all residents (e.g. people with disabilities).

Bueng Kan and Phon Phisai: agriculture and quality of life

We rode northwards towards Bueng Kan and Phon Phisai, towns and peri-urban areas that highlight the river’s importance in water supply and agriculture, as they are located next to the river with prime land for crop production. As I left Nakhon Phanom behind me, the promenade continued for kilometres, but it soon became run-down and unkempt, suggesting that its quality and maintenance and ease-of-use varies.

Driving slowly, I stopped at the blue waterpipe pictured in Figure 3(a) that originated in the river and crossed the promenade to a nearby field for crop irrigation. Water pumps, pipes, sprinklers, and simple irrigation systems were a common sight, reflecting the significance of the river for agricultural irrigation in Isan. I also saw many instances of river water being used for domestic and industrial consumption; for instance, Figure 3(b) is a photograph of a water production station in Nakhon Phanom that produces and distributes water from the river to Bueng Kan, Nakhon Phanom and other places (Provincial Waterworks Authority 2023).

Figure 3. Use of river water: (a) water pumped from the river to irrigate a field, (b) a water production station in Nakhon Phanom.

I chatted about water and agriculture with Nut, a 68-year-old farmer who owned the blue waterpipe. Nut explained that his banana farm was mostly rainfed during the wet season, from June to October, even though I saw the waterpipe in use in June. He used river water for irrigation when rainfall was insufficient, mostly during the dry season lasting for the rest of the year. In his opinion, the yield and quality of crops in the area cannot be sustained without irrigation from the river. Reports in the literature also state that rainfall is unreliable in many areas of Thailand and insufficient for agriculture (The Asia Foundation 2019). It is well known that river water irrigation can improve agricultural productivity, food security, nutrition, and livelihoods and health for local populations, whereas insufficient irrigation can negatively impact human health (Naiman and Dudgeon 2011, Domenech and Ringler 2013, Hurford and Harou 2014, Parker and Oates 2016).

Although access to irrigation water is essential to smallholder farmers’ abilities to increase agricultural productivity, especially in weather dependent environments such as in Isan, the water withdrawals that I saw had been initiated ad hoc by farmers. Could they undermine the sustainability of river water resources, and could their better coordination or regulation save water or increase the proportion of agricultural land under irrigation? Answers to this question are worth exploring further, by evaluating and monitoring water consumption by farmers such as Nut and other users, alongside monitoring river surface water levels, to determine where plans of action need to be developed for SDGs such as SDG 6.4 that aims to increase water-use efficiency and ensure sustainable withdrawals of freshwater to address water scarcity, and SDG 6.5 that aims to implement integrated water resources management by 2030. For example, a more integrated approach to water resources management, with active participation by farmers and others, could improve the efficient use and governance of water resources. Action to strengthen the capacity of agricultural practices to adapt to the weather and water scarcity, for example to achieve SDG 2.4 which is about implementing resilient agricultural practices that strengthen capacity for adaptation to climate change, extreme weather, and drought, might also be worth exploring further.

Throughout Isan, I saw a wide variety of crops being cultivated near the river. In the first photograph in Figure 4, onions and marigolds can be seen on terraces on the riverbank in Phon Phisai. The second photograph, taken at a rubber plantation in Bueng Kan, shows latex being drawn downwards into a collection cup through a groove etched into the bark. I sometimes saw cows grazing on or nearby the riverbank, which I was told requires minimal resources when riparian vegetation is used for cattle feed and river water for watering, freeing up arable or useable land for crop production.

Figure 4. The Mekong River and agriculture: (a) onion and marigold cultivation on the riverbank in Phon Phisai, (b) a rubber plantation in Bueng Kan, (c) eggplant farming in Bueng Kan.

Does agricultural work provide a decent quality of life? I chatted to sisters Buppha and Ngam in Bueng Kan as they were harvesting eggplants on their family-run farm, Figure 4(c); they also grew corn and tomatoes in nearby fields. Aged in their mid-forties, Buppha and Ngam worked all day on the farm, and as a family living together, they earned a combined income of around ฿200,000 annually after deducting ฿100,000 in agricultural expenses including fertilizer, pesticide, and seed. Intermediaries in an agricultural supply chain bought and collected their produce from their farm, and they did not sell it directly to consumers. Although their household income was on par with many other households in northeastern Thailand (Statista 2023), it was much lower than average incomes in the rest of the country (The Asia Foundation 2019, Statista 2023).

Research tells us that urban health is affected by poverty and that the worst health is borne chiefly by the poorest (Franco et al. 2022). The eradication of poverty in all its forms is the first and pivotal SDG, and there is scope for the implementation of various approaches to poverty alleviation in the Lower Mekong River Basin. Reducing inequality (SDG 10) and income inequality (SDG 10.1), and providing social protection measures (SDG 1.3), especially for farmers and women and disadvantaged people, seem essential for any future social policy response. In practical terms, measures for small-scale and family farmers such as Buppha and Ngam could start with increasing their incomes from agricultural activities and fair access to resources and inputs and opportunities (SDG 2.3), for example by improving access to markets or by simplifying the supply chain (or by increasing access to other supply chains locally or globally) rather than selling through the intermediaries they mentioned which likely reduces the prices they receive. Reducing production costs, or working towards SDG 2.a that emphasises increasing investment in rural infrastructure and agricultural research and technology to enhance agricultural productive capacity, will also increase incomes as well as sustainably increase agricultural output. Most of the agricultural practices I saw were traditional with lower levels of technology and energy, and research is needed to consider if they are sustainable practices. I saw showrooms for modern agricultural machinery (e.g. John Deere tractors) on main roads while motorcycling, a sign of things to come for agriculture in the region; now is the time to discuss and promote ways to embed sustainable agriculture and fair supply chains in modern approaches before they take hold.

Nong Khai: the sacred river

The sight of the glistening river was a perfect start to the day as I set off westwards towards Nong Khai, a city in upper northeastern Thailand. Upon arriving, I was in awe of a statue depicting two large nagas: giant serpents and spiritual guardians in Buddhist mythology, depicted in Figure 5(a). Both nagas can be seen decorated in vibrant green and gold and with water spraying from their mouths while supposedly swimming on the surface of the sky-blue Mekong River; the statues are surrounded by a courtyard for public events. The second photograph in Figure 5 is of the Naga Monument in Nakhon Phanom, an elaborate brass statue of a seven-headed naga coiled up on a base. Devotees can be seen in the photograph offering prayers to naga spirits for protection, health, longevity, and subjective wellbeing (Phutthanathanapa et al. 2022). Naga worship, a widespread practice in Thailand, is also important in rites of passage and in fertility beliefs (Hongsuwan 2011, Moonkham 2021), and naga statues are thought to safeguard surrounding urban areas (Hongsuwan 2011). I saw naga symbolism everywhere I looked in Isan, especially in temples and shrines and Buddhist architecture, and in many other places such as on streetlamps, emblematic of both the river’s sacredness, as nagas are believed to live in the Mekong River, and the prominence of Buddhist beliefs and practices in urban health.

Figure 5. The Mekong River and Buddhist beliefs and practices: (a) the Naga Statue in Nong Khai, (b) the Naga Monument in Nakhon Phanom.

I saw Somkiat, a man in his 70s, kneeling beside the river and holding a transparent plastic bag containing a fish that was purchased from a nearby stall selling animals from the river for Buddhist merit-release. His eyes were closed, and his lips were moving in rhythm while murmuring a blessing or a prayer. Somkiat gently dipped the plastic bag into the river and released the fish to save its life or to free it from captivity or suffering, in the belief that performing the good deed (merit-making) generates good karma or ‘merit’ for his own life, leading to favourable circumstances as well as improvement in the mind and the soul towards reincarnation and enlightenment. I decided not to release any of the fish into the river, out of concern that they had been trapped or bred for the purpose of being released and that their release might have potential negative environmental impacts (see Nuweri 2012). Even so, this encounter at the waterfront prompted me to take a moment out of my day to ponder its significance for urban health and for making my life more about merit than demerit.

I chartered a boat on the promenade in Nong Khai to take me to Phrathat La Nong, a stupa located about 180 metres away in the middle of the river (Figure 6). Apparently, the stupa was constructed on the riverbank in 1566 on the orders of King Chaichetth, and later collapsed into the river in 1847 because of riverbank erosion (Hongsuwan 2011, Visarado 2016). According to the Urungga Dhatu legend, Phrathat La Nong enshrines nine foot-bone relics of the Buddha that were supposedly carried from India by Buddhist missionaries propagating Buddhism in the period of King Asoka (Visarado 2016); and the relics are believed to be protected by nagas in the river (Hongsuwan 2011).

Figure 6. Phrathat La Nong in Nong Khai.

The sound of the boat’s hull rolling on the calm and peaceful water plunged me into a state of peace and tranquillity. The skipper docked the boat on the stupa. I walked up to the front of the boat and knelt to pay my respects. Unsure of what to do exactly, I held up some yellow and golden marigold flowers and placed them on the stupa. I sat silently and still, a careful balancing act with the bobbles of the boat. After a moment of silence, the skipper leant over and handed me a piece of laminated paper with an incantation printed on it. In broken Thai, I repeated the incantation three times as I humbly paid homage to the relics of the Buddha. Afterwards, I splashed water from the river on to my face as part of the Buddhist rite, as the river water is revered for its sacredness and cleansing and healing properties.

Phrathat La Nong is just one of the many religious relics, shrines, and temples associated with the Mekong River, and we regularly stopped our motorcycle during the trip for prayer and worship by my research assistant, a follower of Theravada Buddhism. All this underlines the significance of Buddhist healing beliefs and practices in serving the urban population’s emotional and spiritual needs (Jumsai 1998, Moonkham 2019, 2021). Indeed, Nong Khai is a sacred place in Buddhism, and That Phanom, the next town on my itinerary, was named after its temple, Wat Phra That Phanom, an important Buddhist landmark that supposedly enshrines the Buddha’s breastbone and other items thought to be protected by seven nagas (Thailand National Commission on the World Heritage Convention 2017).

These observations have important implications for promoting healthy and sustainable cities in Thailand which are steeped in diverse forms and expressions of tangible and intangible culture and heritage, not only religion but also architecture, crafts, cuisine, history, knowledge, visual arts, and more. SDG 11.4, a target within SDG 11 about sustainable cities and communities, aims to ‘strengthen efforts to protect and safeguard the world’s cultural and natural heritage’, and its indicator (SDG 11.4.1) concerns total per capita expenditure on their preservation, protection, and conservation. There are also references to cultural aspects of sustainable development in SDGs 4.7, 8.3, and 8.9. Disappointingly, none of the SDGs focus exclusively on culture or religion nor capture their richness and significance to urban life and sustainability in the way that I sensed it was in Isan. I argue that this topic should be the mainstay of urban health and sustainability initiatives in Thailand, and should be prominent within the SDGs and not relegated to economic data, to broaden their inclusiveness in global and diverse populations rather than the current approach which I regard as somewhat Eurocentric and oppressive.

Undoubtedly, acknowledging and incorporating beliefs, culture, heritage, and traditions in health and sustainability efforts will be crucial to their success, and those designed for broader populations in other countries might not be appropriate in Thailand. Research is needed on the cultural appropriateness and tailoring (and on any potential conflicts and problems) of proposed solutions prior to implementation and also on the design of emic and indigenous approaches rather than just the replication of methods and explanations that suit Europe and America. Research on specific aspects of religions and cultural contexts, partnerships with urban residents and religious organisations, and a greater representation of diversity among researchers and professionals will also help in achieving this change.

My visit to Phrathat La Nong also highlights what it is about travel that diversifies knowledge generation beyond the stiff and stuffy conventions of academic research. Visiting new places, meeting people, learning about cultures and languages, and enacting different ways of being and doing, all taught me that everything has alternative perspectives and that my view of the world is not universal. This is important when reading the literature on urban health which is dominated by studies of cities in Western countries and WEIRD (western, educated, industrialised, rich, and democratic) participants. Phrathat La Nong was an ideal opportunity to reflect on my own positionality in this study, for example as a non-Buddhist and as a researcher trained in Western public health and health psychology that generally neglect religious and spiritual and humanistic dimensions of health (or even advocate for their incompatibility), a biomedical rationale that is less relevant to Thailand’s and to the majority of the world’s population (this is why broad definitions of health were chosen to foreground the study). The significance of Buddhist beliefs, deities, and practices in health practices in Thailand (indeed, Buddhist medicine is incorporated into its national health care system), calls for a more culturally sensitive mindset that appreciates religion and spirituality (and not only Christianity, a major religion in Western Europe and the United States). Researchers and professionals working in urban health and sustainable development can engage in reflexivity to interrogate how their own beliefs and epistemological positions shape their work.

That Phanom: fishing, household food security, and livelihoods

Next, we headed to That Phanom. I saw fishers on the riverbank, on boats, and in the water, using a variety of fishing methods, verifying the importance of fish and aquatic animals from the river in food consumption, commerce, and leisure. The first photograph in Figure 7, taken in That Phanom at the confluence of the Mekong River and a tributary, the Namkam River, shows a boat-operated drift-net flowing with the current, kept vertical by floats attached along the top, although drift-nets can have high by-catch rates, raising questions about possible destructive and unregulated fishing practices including overfishing. In Figure 7(b) is a fish-farm (cage culture) consisting of open-top floating steel cages encased in mesh and stocked with juvenile fish to be harvested after reaching a certain size.

Figure 7. Fishing and fish production and consumption: (a) a boat-operated drift-net, (b) a fish-farm, and (c) a resident in That Phanom buying fish at a fish-farm.

In That Phanom, I chitchatted with Wisitthisak while he was purchasing fish at a fish-farm. In Figure 7(c), he can be seen using a pulley to haul up fish in blue containers taken from the fish-farm in the river; the fish were then weighed on the orange scales also displayed in the photograph. He told me that he bought fish wholesale at the farm, for about 15 baht per kilo cheaper than the prices in nearby markets. I also visited markets in That Phanom and in other urban areas and saw on sale a wide variety of fish and aquatic animals from the river. Thus, it is obvious that fish from the river are immensely important in the nutrition and health of urban populations (Smith et al. 2005, Kawarazuka and Béné 2011, Martin et al. 2013).

On the water’s edge in That Phanom, I met 46-year-old Basaba while she was untangling sheatfish from a net that she had just hauled in from the river (Figure 8a). She told me:

I catch different amounts of fish each day. I sell them for about 100-150 baht per kilo. I sell them in my village. My income [from fishing] is unstable because on some days I cannot catch any fish, whereas on other days I have a daily income of between 200 and 800 baht. I put the net out in the evening, and I collect it in the morning. I am a rice farmer, and fishing increases my income.

As Basaba explained, she fished part-time to supplement her main income from rice farming. Fishing and farming were complementary, as she was able to cast out the fishing-net in the evening after working on her farm, and then haul it in the following morning before going to the farm. However, the catch size, and therefore her earnings, were unpredictable and unstable, raising questions about fishing as an income source.

Figure 8. Fishing and livelihoods: (a) a female fisher untangling sheatfish from a fishing net, and (b) preserving fish by drying.

Residents in That Phanom and elsewhere told me that they fished regularly (and also grew vegetables and raised livestock and poultry) to meet household food consumption needs and to reduce costs, even though they worked in a variety of occupations – a diversity of livelihood activities such as farming, fishing, and labouring. Taken together, my observations corroborate the view in the literature that locally obtained wild fish can be an important and cost-effective component of diets (Smith et al. 2005, Kawarazuka and Béné 2011, Martin et al. 2013).

As I left That Phanom, I met a group of retired women drying and preserving fish in blue mesh bags hanging on bamboo poles (Figure 8b). They caught the fish for their own consumption and for leisure to pass the time, and larger catch was sold to their neighbours. On the day I visited, they had caught a lot of fish because of heavy rain earlier that morning. One of the women, Praewa (age 70), said:

I am drying fish. We catch the fish every day. During the rainy season we catch a lot, but during the dry season we catch less. The big fish we get will be sold, the small ones will be released back into the river, and the medium size ones will be dried for us to keep and eat … It is more of a hobby and to pass the time, since we are retired, and our children send enough money for our everyday expenses.

I also met other people fishing as a hobby, mostly using rods and reels and tackle and sometimes throw nets, a small net with small weights around its edge.

The findings that people fish part-time to meet food and income needs, and Praewa’s comment about the importance of remittances from adult children migrating for work to support older family members in Isan, all draw attention to the need for decent incomes and employment and the lack of decent jobs. Surveys conducted by The Asia Foundation (2019), for example, found that insufficient incomes were an issue for respondents in Isan, and they wanted to have more job opportunities closer to home. Creating more full-time and stable employment opportunities with fair incomes and job security (for example as envisioned in SDG 8 and SDG 8.5), part-time options, and benefits such as health insurance and pension schemes, is key to reducing poverty and out-migration and enhancing wellbeing.

Mukdahan: a coming ‘Mekong-ocalypse’?

After driving about 40 kilometres southwards to Mukdahan town, I came to a stop at a construction project on the riverbank. I looked at the monstrous sight and shook my head in disbelief at the total destruction of the natural habitat (Figure 9a). I vividly remember that sobering scene of oblivion and nothingness and the smell and taste of pollution emanating from the heavy machinery. A similar sight of bareness and devastation is shown in the second photograph below, a snapshot of sand-dredging on the Laos-side of the river (the Mekong River is an international boundary between Thailand and Laos). These images serve as an apocalyptic warning about unsustainable development and its onslaught on the river and on human health.

Figure 9. Unsustainable development’s impact on the Mekong River: (a) a construction project, (b) sand-dredging, (c) litter and wastewater pollution.

Human activities undeniably cluster in urban areas, and their impact on the river was everywhere to be seen. Though the diversity of land uses I saw along the river endorse its importance in supporting urban communities, large swathes of nature have been converted to built-environment or semi-natural environment. The promenades and riverfront developments had benefits, but their impact on the environment is highly questionable, as illustrated in most of the images in this travelogue. This draws attention to the importance of SDG 15 about protecting, restoring, and sustainably using terrestrial and inland freshwater ecosystems and about halting and reversing their degradation and biodiversity loss. Figure 9 teaches us that we must stop any further land degradation and restore degraded land and ensure that new developments are sustainable. But is this just a dream? It is within the power of government authorities and the private sector to devise policies and initiatives which integrate the sustainable use of ecosystems and biodiversity preservation into planning and development (SDG 15.9).

I saw multiple sources of pollution (e.g. agricultural, domestic, industrial); the photo in Figure 9(c), for example, shows black-coloured wastewater entering the river, and litter on the riverbank, risks to human health (Schwarzenbach et al. 2010, Rani et al. 2021). Therefore, it is important to implement strategies to meet the SDGs which make a commitment to protecting and restoring water-related ecosystems, notably SDG 6.3 about reducing pollution and hazardous chemicals and materials and untreated wastewater, and SDG 6.6 about protecting and restoring water-related ecosystems such as rivers. There are many ways to realise these goals. One frustration I experienced while riding along the river was a shortage of recycling facilities and even standard litter bins. Increasing their number and visibility seems essential for minimising littering and the volume of litter entering the river, and also for boosting participation in recycling, consumption of reusable items rather than single-use items, and market demand for recycling. Every time I came across a recycling bin in Isan, I enthusiastically stopped the motorcycle and picked up any litter in its vicinity as well as disposing of my own litter. Residents near the river could be encouraged to volunteer to do the same and provided with support to develop their own plans and events and projects for sustainable and ethical living. Education and awareness campaigns can be designed to increase awareness about these issues; and SDG 4.7 promotes the acquisition of knowledge and skills needed to promote sustainable development through education. Enforcement of health and safety signage is another practical measure that can be taken (Davey 2023b) as I saw many cases of non-compliance with signage prohibiting littering and tobacco and alcohol consumption.

Riding away from Mukdahan, I began to cry. I cried for the river and for its future. But witnessing its destruction first-hand also fostered a yearning for environmental conservation and social responsibility. Fortunately, I saw conservation and protected areas and initiatives during the journey, for example national parks, endangered fish sanctuaries, and hydrological monitoring and flood forecasting stations, supporting healthy ecosystems which in turn keep people healthy. I visited museums and visitor attractions about the river, such as the Nakhon Phanom Science Center for Education about the river’s ecosystem and rare and endangered fish species, demonstrating its value in conservation education. However, international, and multi-sector engagement by different perspectives and stakeholders, and the inclusion of urban health objectives into transboundary water resource management seems to be essential. The scene in Figure 9(b), and the internationality of the Mekong River, imply that the implementation of any proposed solutions to achieve healthy cities and the SDGs in Thailand would be one-sided if they did consider Laos. The two countries have different characteristics, resources, health determinants, and challenges, but also similarities and long-standing relationships and bridges connecting the two countries, and they are both part of the river (furthermore, Laos is currently maintaining high development, economic growth, and population growth, posing threats to the health of the planet and its people without urgent action).

Similarly, the cities and towns I visited in the travelogue are also interconnected as well as distinct and separate, calling for a ‘trans-city’ perspective to urban health by researching and supporting these links and with rural areas. The SDGs are also inherently interconnected and achieved only when others are also achieved. I found that knowledge generation, too, was linked within and across urban areas and contexts as hubs of knowledge, while also unfolding in an cumulative interpretive process throughout the journey, making travel a fresh conceptual lens for knowledge creation and innovation.

Ubon Ratchathani: coffee with a view

Coffee shops were an important feature of my travel, to get a caffeine fix, stretch my legs, and take a break before getting back on the road. My favourite coffee shop by far is shown in the photograph in Figure 10 taken in Khong Chiam, a district in Ubon Ratchathani, a city in lower northeastern Thailand. In an elated mood, I made myself comfortable at this picturesque spot while enjoying a mug of freshly-brewed coffee – an epitome of ‘coffee with a view’. Coffee tastes so much better in front of the Mekong River!

Figure 10. A coffee shop in Ubon Ratchathani with a panoramic view of the Mekong River.

The photograph also draws attention to the aesthetic and sensory qualities of rivers, typically considered pleasant to view and to sense and to experience. I loved taking time out to relax, enjoy the views, and connect with nature, not only in coffee shops and restaurants but also in the numerous seating and viewing platforms dotted along waterfront in urban areas, underlining the value of the river’s scenic beauty to urban residents. Admiring the sight of river and its wildlife – and even fishers on longtail boats making their journeys back home – may sound incredibly mundane, yet it is a testament to what makes the Mekong River truly special. I discussed this topic with Nut, a 21-year-old fisher, whom I came across lying on a hammock and gazing out at the river after a hard day’s work, Figure 11(a). Shy at first, he told me that laying in a hammock on the riverbank aided relaxation and reduced anxiety and uncertainty over life’s problems. Said Nut:

I am a fisherman. I live and work here. I wake up early in the morning at about 6 am to start work, and in the late afternoon, when I return, I like to come here and relax and look at the beautiful views. I like to sit here next to the river. It is more pleasant than at home. It is relaxing and helps me to forget about my worries.

Figure 11. Urban residents experiencing the Mekong River: (a) a young man lying on a hammock, (b) a couple sitting on the riverbank, (c) a family picnic breakfast.

The couple in Figure 11(b) told me that they often went to the river in Khong Chiam to spend meaningful time together. The family in Figure 11(c) are enjoying a picnic breakfast in the grounds of a temple. There is increasing recognition in the literature about the multiple benefits of exposure to rivers and water habitats for physical and mental health (Kaplan and Kaplan 1989, Scholes et al. 2008, Völker and Kistemann 2011, Gascon et al. 2017) and for family and social relationships (e.g. Völker and Kistemann 2011). It follows, then, that urban residents in Isan, like the people I spoke to on the riverbank, might have positive health and social outcomes from experiencing or living within proximity to the Mekong River. Unfortunately, these benefits to urban health are not fully incorporated in the SDGs, although SDG 11.7 encourages universal access to natural environments in urban areas for women and children, older people and people with disabilities, which I believe should be enshrined in urban health and sustainability policies.

Departing Ubon Ratchathani: thinking about travel

Departing Ubon Ratchathani was an opportunity to draw conclusions from the findings and for engaging in reflection. The findings adeptly link the Mekong River to diverse aspects of urban life and urban health and sustainable development, including physical activity, social cohesion, food supply and nutrition, water supply, economic activity, heritage, religious practices, aesthetics, liveability, and overall sense of place. It also brings to the fore the many threats to the river and, therefore, to human health. By addressing the areas for improvement, future research and practice can build upon these findings to further understand and promote healthy, sustainable, and resilient urban environments along the Mekong River and beyond. The use of the travelogue methodology provides a fresh and human-centred lens through which to deepen our understanding of these complex relationships as well as innovate knowledge generation.

Riding around northeastern Thailand on a motorcycle was an incredible adventure. However, there were downsides. Some of the roads were poorly maintained. The hot weather was a challenge. When leaving Ubon Ratchathani, I witnessed two separate motorcycle accidents within minutes of each other. Seeing the mangled wreckages and the riders lying motionless on the floor, one being attended to by paramedics, brought home the reality that the high prevalence of injuries, disabilities, and deaths from motorcycle accidents are a major public health issue in Thailand, and the leading cause of death globally for people aged between 5 and 29 (World Health Organization 2018).

Yet motorcycling permitted access to the river and nearby areas for the study and was convenient and flexible. The embodied presence and sensory experience of motorcycling along the river was a transformative experience cognitively and affectively. For better or for worse, I saw everything, felt everything (especially the sun, humidity, and heavy rain!), and even smelt everything on a motorcycle, all while getting to intimately know the places I rode through, enhancing my understanding of the research topic.

Finally, although there is a strong engagement with reflexivity throughout the travelogue, it is important to critically evaluate my subjectivity and strategies to mitigate personal biases, and I accept that researchers with different backgrounds or working in other disciplines might have reached different conclusions. The ‘I’ in this travelogue refers to my narration only, as my co-traveller (my driver, assistant, and friend from Isan) declined to contribute to the writing. Therefore, the ‘I’ in my first-person account is white and privileged, which should not be hidden from view. I emphasise ‘white’, not only because I identify as White British, different to the identities I studied, but also because most travel writing is a Western European discourse of journeying to a far-flung place and reporting on the Other. I continuously challenged myself to consider how any underlying assumptions and potential biases might be shaping my analyses and interpretations, including endless discussions with my Thai assistant. Born into a working-class family, growing up initially on a council estate, and being a first-generation university student, I have never thought of myself as particularly privileged. Yet privilege existed in multiple forms vis-a-vis the people I met in the Lower Mekong River Basin. The travelogue was the first time my research assistant had travelled on a plane (prior to our arrival in Nakhon Phanom), stayed in a hotel, and even tried a bathtub; and international travel, let alone being able to write about it, should not be taken for granted either.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Notes on contributors

Gareth Davey

Gareth Davey is a visiting professor in the Faculty of Professional Studies at the University of Bolton in England, United Kingdom.