WALKING down the streets of Cape Town, it all looks so familiar. Almost twelve years ago, health activists from all over the world had come together in Bangladesh, and marched down the streets of Savar, on the outskirts of Dhaka. The People’s Health Movement, which had taken shape at the first People’s Health Assembly in 2000, is today poised to move forward with renewed resolve. Marching to the city centre of Cape Town are hundreds of activists drawn from over 90 countries, joined by activists from several South African organisations.
The University of Western Cape was perhaps an apt venue for an assembly that signals the return of over despair. “Then you better start swimmin’ …. Or you’ll sink like a stone…. For the times they are a-changin,” says Rev.Keith de Vos, welcoming almost a 1000 delegates representing 90 countries, to the UWC. Bob Dylan’s timeless words ring throughout the five days of the Assembly, for the times are changing and changing very fast!
The programme for the Assembly was likened by some exhausted participants to a mini UN General Assembly. By the end of the assembly delegates have been through 8 plenary sessions, over 30 sub-plenaries and over 60 workshops (including a very interesting one organised by the MSP). It’s exhausting, but also fulfilling, listening to people from 45 countries who are officially listed on the programme.
GLOBAL POLITICAL, ECONOMIC AND SOCIAL ARCHITECTURE
Most of the discussions on the first day, devoted to understanding the global political, social and economic architecture, revolve around the many things that need to change. Ron Labonte reminds the delegates about the sheer inequity that governs the global system. Ethiopia has sold leases to 3.4 million hectares of its best farmland to foreign companies and yet relies on 700,000 tonnes of emergency food aid each year. Change is necessary and change is urgent to create a life that is secure, opportunities that are fair, a planet that is liveable and governance that is just. David Woodward cautions that change cannot be cosmetic, for any change that is located in the present global system will only lay the ground for the next crisis. We need change that is informed by new economics based on real value, which maximises benefits to people’s lives, not financial profit and economic growth. Not the economics of neo-liberalism, says Gabriel Garcia, where the health of financial systems is more important than people’s health and their communities.
The supposed drivers of development, trade and aid, contribute to the growing marginalisation of entire communities. Dot Keet speaks to how ‘free’ trade has been promoted as the overriding condition of ‘growth’ and has been used by the dominant governments, and multilateral institutions, as one of the most powerful instruments towards the creation of an ‘open integrated global economy’ in the service of powerful global corporate interests. The oppressive nature of the ‘aid industry,’ explains David Sanders, is typified by the spectacle of Tanzania, in 2000, preparing 2,400 quarterly reports on separate aid-funded projects and hosting 1,000 donor visit meetings a year.
The perverse global system produces and reproduces physical and social environments which destroy health. The second day of the Assembly is spent in analysing how such environments work. Fran Baum speaks about how we are taught to believe that inequities are part of the natural order and that people who do not do well are in some way deficient. Most health policies are based on behaviouralism – with focus on individual and blaming victim for their health status – an approach that is very compatible with neo-liberalism. Will we be able to shift our political, economic and social systems and create democratic states not dominated by profits and which respond to people’s needs and are ecologically sustainable? If we succeed the key indicator is easy – the children of the world including Africa will live in environments that enable them to live healthy, sustainable and flourishing lives.
It is not possible to grant health and welfare for communities surrounded by sick ecosystems, says Fernanda Solis. The loss of health is just the last symptom of a sick and unequal relation between nature and society.
FOR BETTER HEALTH SYSTEMS
The third day is about how change is needed to reverse the systematic manner in which health systems have been torn asunder while being divorced from the essential ‘public’ logic of health and health care. Mauricio Torres talks about the devastating effect this has had in Colombia, destroying public health functions and structures, in systematic violation of the right to health. But the notion of public health systems and the vision of primary health care could not be buried and continues to be an uncomfortable reminder to the votaries of neo-liberalism that things can be done differently – and better! Don Matheson speaks about outstanding examples of actions being taken in different regions, by some countries and communities. The indigenous people’s struggles in Latin America and Australia are testimony to what can become a global movement for inclusive, equitable, accountable health systems. The struggle continues – the time frame is intergenerational!
Lois Reynold argues why primary healthcare shall and must survive. For Primary Healthcare is not a level of healthcare delivery but an approach to health which sees health as a basic human right and a worldwide social goal. It is not just a technical issue but a social and political one based on solidarity and collective values rather than the individual. In its framework, people are active participants rather than ‘clients’ or ‘consumers’ and have both rights and duties to participate.
The current crisis is exacting a toll in regions, hitherto held out as exemplars of social protection policies. Dave McCoy takes us through the story of how the National Health System (NHS) in the UK is being taken apart, brick by brick. Tim Joye talks to the devastation brought about by the ‘austerity’ measures in Greece, leading to 40 per cent cuts in hospital budget and the reduction in public hospitals from 133 to 83. Dave reasons that the goal of universal and equitable health systems is a political struggle and the dismantling of the NHS in UK is a consequence of the lack of a social movement and consciousness to defend the public sector.
Ravi Duggal speaks to the incongruence of models of healthcare that are not built around secured public financing. Global experience provides incontrovertible evidence of the criticality of public financing for equity and universal access to healthcare.
But the assembly is not all about gloom and doom! Eduardo Espinoza, vice minister of El Salvador, speaks to the delegates about the new reforms which guarantee all Salvadorans the right to health, through a National Integrated Health System that continually strengthens public services (including social security) and regulates private services. Paulo Buss from Brazil recounts how the Brazilian social protection system evolved as a part of the struggle against dictatorship — Health is democracy and democracy is health. Suwit Wibulpolprasert from Thailand describes the “long March” to universal healthcare in his country and sums up: “Because we are poor, we cannot afford not to have primary healthcare based universal health coverage.”
BEYOND THE CRISIS
Beyond the Crisis: Mobilising for Health is the call for the fourth day of the assembly. Jaime Breihl talks of the need for overcoming the lineal reductionist perspective about health determination and for an end to the pre-eminence of the biomedical model – born and nurtured in the realms of the entrepreneurial medical-pharmacological complex.
Capitalism in previous decades could hide its flawed essence, overcome its cyclical crisis and compensate its social inefficacy, by incorporating technological innovation, and by controlling the labour market. But the ‘empire’ is crumbling and change is in the air. Testimonies from the Occupy movement in the US, the Arab Spring and the Greek resistance brings the audience to its feet. Armand de Negri describes the empire as the expressions of neo-liberal hegemony in the daily life of people generating fear due to the absence of social, economic, cultural, political and environmental protection. Oscar Feo cautions: revolutions may occur, we can reach the government, but without ending the hegemony of capital we will not have real change. It is not enough to replace the bureaucracy of capitalism by political cadres who become “revolutionary bureaucrats.” Change everything, including us!
It all comes together on the last morning as delegates at the Assembly adopt the Cape Town Call to Action. It outlines an alternative vision that would guide the People’s Health Movement’s work with the words: “Our alternative vision is idealistic. We seek a better world. We believe that transformative and radical change is required and can be achieved.”
THE TIMES THEY ARE A-CHANGING!
These vignettes pass through my mind as we march together. I see resolve and concern, but also the celebration of solidarity, of togetherness, in the faces around me. Similar, yet different from Savar in Bangladesh, 12 years back. Different because what was a dream in Savar, what started emerging as a possibility in the Second Assembly in Cuenca, Ecuador, in 2005, has now matured into the beginnings of a truly global movement. Bob Dylan’s words ring in my ears as I step up to talk to activists of the Treatment Action Campaign:
The line it is drawn
The curse it is cast
The slow one now
Will later be fast
As the present now
Will later be past
The order is
And the first one now
Will later be last
For the times they are a-changin’.