Health justice as fundamental human right in academic views
 
When COVID-19 vaccines were scarcely available in Thailand during the first and second wave of the outbreak, migrant workers, for instance, were deprived of access to vaccination and weren’t entitled to receiving COVID-19 relief measures as were their Thai counterparts.
 
And around the time the government had shifted its vaccination distribution policy to focus more on supporting efforts to revive the tourism-based economy, certain groups of even Thai people themselves had to wait longer for their turns to get a COVID-19 shot provided by the government.
 
Also, during a past peak of the COVID-19 outbreak in Bangkok, the hospital bed shortage was largely blamed for resulting in incidents in which a number of COVID-19 infected patients had died at home while waiting for a bed.
 
These are examples of what is referred to as “health injustice” in an academic point of view included into a study being conducted by a group of health and rights academics in Thailand, in a bid to better understand the “health justice” concept through exploring over what had happened in the past couple of years of the COVID-19 pandemic, which may be regarded as problems facing health justice.
 
What is health justice?
 
Spearheaded by Dr Somsak Chunharas, the president of the National Health Foundation, Health Justice Project is an initiative established by a group of Thai health and rights academics with cooperation with their international fellow researchers and activists.
 
Attempting to get the health justice concept across in Thailand, Assoc Prof Borwornsom Leerapan of Faculty of Medicine Ramathibodi Hospital, Mahidol University who serves as a lead author of the project has admitted that this really is a complicated matter as it involves several areas of work.
 
And although it is related to those more familiar terms such as health disparities, health equality and health equity, justice and injustice in health are actually something different, he said.
 
He was speaking at a side meeting of the Prince Mahidol Award Conference 2022 held on Jan 24, 2022 and dedicated to discussions about health justice with the main focus on lessons learned from the COVID-19 pandemic.
 
“COVID-19 has actually provided an opportunity for learning more about health justice” he said.
 
Three areas in Health Justice
 
To give a clearer idea as to what health justice actually is Assoc Prof Borwornsom Leerapan cited a health justice framework drafted under the Health Justice Project.
 
According to the framework, there are three areas of health justice, namely Procedural Justice (PJ), Distributive Justice (DJ) and Corrective Justice (CJ).
 
PJ consists of accuracy, consistency, impartiality, reversibility, transparency and voice, he said.
 
In short, good governance is the key indicator of PJ, he said.
 
“To me, it’s a minimum requirement that the people will have to maintain good governance when they are involved in the policy-making process, regardless of how the outcome of the policy will turn,” he said.
 
In case of COVID-19 containment, for example, if a policy is proved to be successful in controlling the spread of the coronavirus yet lacks transparency in the policy-making process or lacks participation by stakeholders concerned, it could never be regarded as being a just policy, he said.
 
DJ comprises five principles, namely efficiency, necessity, the right to health, affordability and equal opportunities, he said.
 
It’s also the government’s responsibility to ensure how to implement its just policy with an aim to achieve all these principles, he said.
 
An example of CJ in case of the COVID-19 pandemic includes a set of measures created to compensate for any losses caused to any parties as a result of the implementation of a policy, which in this case includes the national vaccination programme, he said.
 
The no-fault financial compensation programme being implemented by the National Health Security Office (NHSO) for the people suffering adverse events following COVID-19 vaccination is recognised as a form of CJ, he said.
 
Still, more could be done to achieve even better CJ in the government’s handling of the COVID-19 outbreak, he said.
 
“Not only healthcare services that determine the outcome of healthcare but also several other factors, including social determinants of health,” he said.
 
Thailand may have last year done well with containing the spread of COVID-19; but it actually hadn’t done well enough in coping with the socioeconomic hardship associated with the outbreak, he said.
 
Three case studies
Aphaluck Bhatiasevi, a medical anthropology scholar with the Health Justice Project, meanwhile, highlighted three case studies which were based on data and information gathered through media reports and via the social media regarding health injustice in Thailand during the past waves of COVID-19.
 
The first one dealt with injustice identified in the national COVID-19 prevention and control, while the second case study dealt with injustice found in Thailand’s public health resource management and COVID-19 vaccine procurement and distribution.
 
The third case study concerned injustice observed in the handling of the country’s workforce, economy and access to healthcare during the past waves of COVID-19.
 
“The government’s COVID-19 responses were largely prescriptive and based on centralized decision-making while the outbreak situation varies in different locations,” said Ms Aphaluck.
 
A clear example of injustice observed in the third case study, for example, is when the informal workers, temporary workers, daily workers and freelance workers were during the third wave of the COVID-19 outbreak denied access to the three-month financial compensation of 5,000 baht each, which was offered exclusively to only those workers registered under the social security system, she said.
 
The fact is there were more than 20.4 million informal workers in the country by then, she said.
 
From her experience in working in the Thai-Myanmar border area in Mae Sot district of Tak province, Dr Nuttagarn Chuancheun of Mae Sot Hospital said she has observed a lot of health justice there.
 
So, to improve health justice in this border area, she said, she and her colleagues share a common mindset that Thai and non-Thai patients should be entitled to receiving the same standard of healthcare despite their different healthcare rights assigned to them by the state.
 
More problems that also need attention
 
As side from the problems highlighted in the three case studies, Assoc Prof Nipon Paopongsakorn of Thailand Development Research Institute (TDRI) said there still are more problems related to the impact of the COVID-19 pandemic which urgently requires attention.
 
They are an increasing proportion of persons opting out of the labour force due to their hopelessness to find a new job during the pandemic and a higher proportion of youths giving up education or training during the same period of time, he said.
 
“What the pandemic has done is [that it] has exposed problems concerning justice and equity in health,” said former prime minister Abhisit Vejjajiva who is actively involved in a global initiative aimed at improving health justice in all parts of the world.
 
Prof Lincoln Chen of the China Medical Board agreed that if these problems had not been exposed by the pandemic, they would continue to have been swept under the carpet.
 
A proof of these problems is social distancing, which in reality is a luxury good that the people living in densely populated communities, migrant workers, and the vulnerable groups cannot afford, said Mr Abhisit.
 
On a global scale, COVID-19 vaccine distribution, for instance, is a key issue that needs to be tackled to ensure fair distribution for the whole world, he said.
 
“What had motivated us to move towards health justice was that the term ‘justice’ has to be action-oriented and dynamic,” he said.
 
More views on how to improve health justice
 
Transparency and public participation are the key to success in ensuring that health justice is treated as a fundamental human right, said Sanitsuda Ekkachai, a columnist with The Bangkok Post.
 
In case of the national COVID-19 vaccine procurement and distribution, for example, if opinions by the people who will have to use the vaccine will never be heard by those officials deciding on this work, the work will never meet the public needs, said Akkarasorn Opilan, a columnist and activist with the Disrupt website.
 
“I certainly hope that we now have a better and clearer idea as to what health justice could do as a fundamental way to improve health inequity,” said Dr Somsak.
 
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