icgw 2026 Session 3

Session 3: Who Gets to Be Well? Ethics, Inequality, and Human Dignity in Healthcare

This session delves into the ethical dilemmas of healthcare disparities in a world of blurred morality, where decisions on resource allocation, commercialization, and treatment prioritization often reflect deep moral inequalities between producers and consumers, doctors and patients, the poor and the wealthy. It examines how societal values shape access to care, questioning whether moral judgments exacerbate divides or if equitable frameworks can bridge them, ultimately aiming to foster discussions on policies that promote true wellness for all amid conflicting interests and systemic biases. Participants will explore practical strategies to balance innovation with ethics, ensuring human-centered care prevails over profit-driven exploitation.

Moderator:

Ms Joann Tiong
Founder and CEO of Le Medica; 1st Runner-Up, Miss Wellness World

Speakers:

1. Prof Chantal Herberholz, PhD
Professor of Economics at Chulalongkorn University

Main idea: Precision health futures and public health measures suffer from severe representation and systemic bias, making it crucial to question whose wellness is actually being measured and prioritized.
Important points:

The Exclusions of Precision Health:
While precision health promises to integrate genetic, biomarker, and lifestyle data via wearables and AI to map health spans, the underlying research mostly represents high-income countries (primarily Europe, North America, and East Asia).
Severe Demographic Gaps in Research:
A review of precision health literature shows a stark lack of reporting on basic demographics, with less than 68% reporting sex/gender, less than 40% reporting race/ethnicity, and only 20% including socioeconomically disadvantaged backgrounds.
Disparities in Clinical Trials:
Even in well-resourced medical landscapes like the US, Black and Hispanic cancer patients face higher mortality and worse symptoms, yet they remain severely underrepresented in clinical trials for new oncology drugs.
Inequities in Public Health Enforcement:
During the COVID-19 lockdowns in Australia, the sudden, strict isolation of public housing towers disproportionately harmed low-income and migrant residents, who lacked translated information, medicine access, and emergency stockpiles.
Barriers to Research Participation:
Disadvantaged populations often do not participate in clinical research due to systemic hurdles, including a lack of physical mobility accommodations, a lack of trust in institutions, and recruitment materials not being translated into regional languages.
Biased Medical Tools:
Basic diagnostic tools, such as pulse oximeters used widely during COVID-19, were developed using narrow demographics and do not perform as accurately on individuals with darker skin tones.

2. Dr John Noel Viana, PhD
Fellow at the Justice and Technoscience Laboratory at Australian National University

Main idea: True global health equity and wellness cannot be achieved through textbooks or top-down mandates alone; it requires deep community trust, real-world experience, and preserving human dignity.
Important points:

The Two Interpretations of Truth:
Using Harvard's historical emblems as an analogy, the speaker notes that while universities can teach academic truth, the final layers of truth must be discovered firsthand through community engagement and real-world practice.
The Goal of Global Health:
True global health is defined by achieving health equity rather than just equality, requiring a collaborative blend of academic research and on-the-ground reality.
The Importance of Fieldwork and Hope:
Drawing from his experience in the Gaza Strip in the 1990s, he highlighted that losing hope is tied to losing life, and that average life expectancy in Gaza has tragically plummeted to nearly 40 years due to the ongoing conflict.
Interpersonal Trust via Volunteers:
In Nepal, even during active armed conflict, under-five mortality rates steadily dropped because female community health volunteers built deep interpersonal trust, allowing them to safely cross conflict lines to deliver care.
The Need for Institutional Trust:
Interpersonal trust must eventually be backed by institutional trust, which is successfully built over decades through structural programs like Universal Health Coverage in Japan and Thailand.
The Human Security Framework:
Wellness relies on human security, which requires three core pillars: freedom from fear (e.g., of disability/disease), freedom from want (economic survival), and freedom to live in dignity.
Defining Dignity Locally:
Using a Nepalese leprosy elimination program as an example, dignity was profoundly illustrated when public buses finally began stopping in front of the leprosy community—proving that dignity is often measured by simple, everyday acts of inclusion.

3. Prof Dr Masamine Jimba
Professor Emeritus of Department of Community and Global Health of The University of Tokyo

Main idea: Thailand’s 20-year implementation of Universal Health Coverage (UHC) serves as a successful global model for achieving significant health outcomes and reducing financial barriers, even as an upper-middle-income country.
Important points:

Alignment with Sustainable Development Goals (SDGs):
Thailand’s UHC policy directly aligns with SDG 3.8, which focuses on providing financial risk protection and access to quality, essential healthcare services for all ages.
High Life Expectancy on a Modest Budget:
Despite spending significantly less per capita on healthcare compared to high-income nations like the US and UK, Thailand achieves a similar life expectancy for its citizens.
The Three Axes of Thailand's UHC Success:
The program covers 99% of the population, provides services that are largely free at the point of delivery (minimizing catastrophic out-of-pocket expenses), and offers a highly comprehensive benefits package that covers expensive surgeries and interventions.
Reduction in Medical Impoverishment and Equity Gaps:
UHC data shows that the scheme primarily benefits the poorest income quintiles, significantly reducing unmet health needs and medical-induced poverty across all provinces.
Successful Disease Elimination:
Integrating specialized treatments into the UHC benefit package enabled Thailand to become the second country globally to eliminate mother-to-child transmission of HIV.
The "Triangle that Moves the Mountain" Framework:
The key to mobilizing and sustaining this difficult policy lies in balancing three powers: political power, people (civil society) power, and academic/research power.
Strong Rural Infrastructure:
A core success factor is the mandatory distribution of medical doctors, nurses, pharmacists, and dentists to rural and remote areas to ensure structural equity.

4. Dr Phusit Prakongsai, MD
Former Director of International Health Policy Program (IHPP)

Main idea: Incorporating quantitative equity metrics into traditional Health Technology Assessments (HTA) allows policy makers to explicitly evaluate how healthcare costs and benefits are distributed across different socioeconomic groups.
Important points:

Explicit vs. Implicit Equity Consideration:
While Thailand has long considered equity and ethical issues subjectively during healthcare decision-making, the process is evolving toward explicitly quantifying equity impacts.
The Dialysis Case Study:
Dialysis serves as a crucial equity case study because it is life-threatening, carries high costs that can bankrupt families, and originally featured stark discrepancies in coverage across Thailand's different insurance schemes.
The "Peritoneal Dialysis (PD) First" Policy:
In 2008, despite a 2006 HTA finding that dialysis was not strictly cost-effective at the time, social pressure from civil society led the government to offer home-based PD for free, which was far more accessible for rural populations than city-based hemodialysis (HD).
Distributional Cost-Effectiveness Analysis (DCEA):
DCEA is an advanced methodology that looks beyond aggregate healthcare costs and benefits to see exactly how they are distributed across different income quintiles, ages, or genders.
Aversion to Health Inequality:
A nationwide survey revealed that while Thai policy makers balance both efficiency and equity (weighted prioritarians), the general public acts as extreme egalitarians, willing to trade off overall life expectancy gains if it means closing the health inequality gap.
Quantifying Equity Changes Decisions:
When equity data was retrospectively integrated into the 2007 dialysis data using DCEA, PD was mathematically proven to be both cost-effective and equity-enhancing, which would have made the original policy decision much more straightforward.

5. Mr Sarin K C
Head of the Environmental Economics Unit at HITAP, Ministry of Public Health of Thailand