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This article reviews inequalities in health risks and outcomes based on a large longitudinal cohort study of distance-learning adult students enrolled at Sukhothai Thammathirat Open University ( n = 87,134). The study began in 2005 and the first follow-up was completed in 2009. Risks analyzed for health inequalities were divided into demographic, socioeconomic, geographical, behavioral, and environmental groups. Unequal risks and outcomes identified that would be amenable to policy interventions in transitional Thailand include the following: heat stress —contributing to many adverse outcomes, including occupational injury, psychological distress, and kidney disease; urbanization —unhealthy eating, sedentary lifestyles, low social capital, and poor mental health; obesity —increasingly common especially with rising income and age among men; and injury —big problem for young males and associated with excessive alcohol and dangerous transport. These substantial inequalities require attention from multisectoral policy makers to reduce the gaps and improve health of the Thai population.