BETWEEN December 4 to 8, a major International Conference on Health was held in Dhaka, Bangladesh. The event was the culmination of a two-year long co-ordinated International effort. It was attended by about 1,500 delegates from 94 countries. The Indian delegation, consisting of 383 participants, was the largest and a majority of them represented a year long process in India that involved mobilisation of people on the central slogan of Health For All—Now. The Indian process culminated in a very successful National Health Assembly at Calcutta, on November 30 and December 1. We have reported in this column, earlier, about the activities leading to the build up to the Calcutta Health Assembly. A brief account of the People’s Health Assembly, at Dhaka, is related below.
The People’s Health Assembly (PHA) is an international initiative aimed at bringing together individuals, groups, organisations, networks and movements long involved in the struggle for health. The idea started 15 years ago when people’s organisation realised that the World Health Assembly of the World Health Organisation (WHO) was unable to hear the people’s voice and a new forum was required. But it is only now that we are seeing the fructification of this idea.
The PHA beleives that health is a fundamental human right that cannot be fulfilled without commitment to equity and social justice. The prime objective of the PHA is to give a ‘voice to the people and make their voices heard” in decisions affecting their health and well-being. It was felt that it is through collective action that changes can be brought about in the unfair and unsustainable top-down process of globalisation – and its current negative impact on health.
The Dhaka Assembly was preceded by pre-Assembly activities across the globe.These include local, regional and national mobilisation, focusing on the problems affecting different people and communities, and their struggles for change.
The PHA is currently coordinated by representatives of eight convening international organisations, which represent groups and networks actively involved in promoting health and people’s empowerment around the world. It is expected that after the Dhaka Conference, this co-ordinating group will be expanded to include a larger number of representatives from participating countries and regions.
FIGHT THE NEGATIVE IMPACT OF GLOBALISATION
The PHA was preceded, on December 3, by a march by hundreds of international delegates to Bangladesh’s national monument, built in honour of the heroes of its Liberation War in 1971. ‘People not Profits’, ‘Down with Drug Multinationals’ and ‘Down with Globalisation’ were some of the slogans that rent the air in Bangla, Hindi, English, Spanish and Arabic.
The People’s Health Assembly got off to a rousing start on December 4. with a call for the people’s health movement to evolve a clear strategy to fight the negative impact of globalisation on health systems around the world.
Dr N H Antia, Chairman of the Indian Preparatory Committee, chaired the inaugural session. He said, “The new process of globalisation, liberalisation and privatisation, have rang the death knell of Health for All, and it would also be the death knell of the planet if we don’t take adequate corrective measures at this stage”. P Govinda Pillai, a member of the Indian delegation, related the experience of Kerala. He pointed out that though Kerala was considered poor in terms of traditional economic indicators it was the most progressive state in India in terms of social development indicators such as health care and education. “We achieved this through mobilisation of the masses at the grassroot level” he explained. The gains of the ‘Kerala model’, which has been praised throughout the world however was under threat he said from cuts in subsidies for services such as health care under pressure from international funding agencies.”
James Orbinski of the Nobel Peace Prize winning Medecins Sans Frontieres (Doctors without Borders) said that for PHA 2000 to be the beginning of a genuine global movement for primary healthcare it needs a clear vision, sense of action and voice. “Today we substitute charity for duty” he said “This is simply not good enough” NGOs, he said, have accepted this principle and not fought hard enough for change.
The inaugural session also heard the testimonies of common people from Tanzania, Ecuador, Bangladesh and the United Kingdom about the problems that ordinary people go through due to the dehumanisation of the health system, worldwide.
INEQUALITY, POVERTY AND HEALTH
The second day of the Conference saw the delegates strongly endorsing calls by the Cuban and Iraqi delegations for the immediate lifting of sanctions against their countries. The Cuban experience in particular, of providing health care to its citizens despite all the hardships of facing a hostile United States got a thundering ovation from the participants. To shouts of ‘Long live Cuba’ and ‘Down with US Imperialism’ participants at the PHA 2000 denounced the United States embargo against this small Caribbean country which has achieved some of the best health indicators in all of Latin America and the developing world. “Only the justice of the Revolution, our people’s capacity to resist, Fidel (Castro)’s leadership and the politics based in broad consensus have allowed us to be where we are” said Ramon Collado, speaking on behalf of the Cuban delegation. According to him, the US blockade over the past three decades had cost his country over 67 billion dollars till now, and the cost was increasing every year.
“If at last this absurd politics of US against Cuba would cease” he said Cuba’s impressive record on the health front would be much more impressive. Other speakers at the forum on ‘Inequality, Poverty and Health’ also expressed admiration for the Cuban model of focusing on primary health care and social welfare. “No other country has been as consistent in taking measures towards achieving the goal of ‘Health for All’ as Cuba” said Halfdan Mahler, former director-general of the World Health Organisation.
Salma Jabu, from Iraq, called for an end to UN and US sanctions imposed on Iraq after the Gulf War in 1991 — which, she said, had resulted in massive destruction of infrastructure and affected health care seriously. Between 1988 and 1999, she said, the infant mortality rate in Iraq had gone up by a massive 660 per cent.
Boshi Mohlala from South Africa compared the phenomenon of globalisation to that of slavery and said that it had taken 300 years to end the slave trade because many African chiefs had collaborated with the colonialists. Similarly in the contemporary world, he said, third world leaders were collaborating with international institutions to rob their own people of their resources.
WORLD BANK POLICIES ON HEALTH IS BLASTED
The highlight of the third day of the Conference was the battering received by the World Bank from delegates. Richard Lee Skolnik, a World bank official, who had come to defend the Bank’s policies was blasted by delegate after delegate, who blamed the Bank’s policies for the devastation of Third World economies, public health systems and the lives of the poor. And at the end of a special four hour session on ‘The World Bank Faces the People’ hundreds of delegates raised their hands to say “yes” when asked whether the Bank was guilty of pursuing policies detrimental to the health of poor people around the globe.
“The World Bank must be dismantled” said Antonio Tujan from the Philippines. He pointed out how the Bank’s promotion of neo-liberal economic policies in his country had only resulted in the commercialisation of health-care and benefited drug multinationals. “No medicine is better than bad medicine” he said, calling for a rejection of the Bank’s policy prescriptions. “We don’t need charity but justice” said Charles Mutasa of Zimbabwe, blaming the World Bank for a global economic system because of which Africa was now caught in a debt trap. “The money spent by African countries on servicing debt is now four times the amount they spend on health and education” he said, accusing the Bank of helping transfer resources from the poor to the rich. Muzaffar Ahamed of Bangladesh accused institutions like the World Bank of co-opting politicians, bureaucrats, NGOs and making them into compradors. The NGO’s, he said, were being funded and pushed by the World Bank as the main provider of health services to the public and the role and responsibility of governments was being undermined. “The New World Order is structured in ways that discriminate against poor countries” said David Legge of Australia pointing out that the World Bank was a key operator in the running of the global economic system that kept large portions of the world in perpetual poverty.
Delegates also pointed out that the World Bank’s policies aimed at promoting privatisation of state-owned companies, cut in subsidies to infrastructure projects and putting profits before people had affected the health of the poor all over the world. World Bank loans, they said, came with strings attached that weakened the role of the government and allowed only private corporations to flourish at the expense of the people. The four-hour session was frequently punctuated with slogans against the Bank’s policies and applause for speakers who countered Skolnik’s defence of the Bank.
PEOPLE’S CHARTER FOR HEALTH ADOPTED
The PHA culminated with the unanimous adoption of a new vision of ‘Health for All’ based on abolition of all political, social and economic inequalities. To cries of ‘Health for All—Now !’ the PHA 2000 participants from 94 countries endorsed a new People’s Charter for Health.
“Inequality, poverty, exploitation, violence and injustice are at the root
of ill-health and the deaths of poor and marginalised people” declares the new Charter calling upon the people of the world to build popular movements to pressure governments to recognise Health as a fundamental human right.
‘Health for All’, it says “means that powerful interests have to be challenged, that globalisation has to be opposed, and that political economic priorities have to be drastically changed.”
The Charter also calls for a reiteration of the demands for a universal, comprehensive Primary Health Care envisioned in the 1978 Alma Ata declaration as the basis for formulating policies related to health. ”Governments have a fundamental responsibility to ensure universal access to quality health care, education and other social services according to the people’s needs, not according to their ability to pay,” the charter laid down as a basic principle.
Leading a list of demands set out by the charter is one that calls for ”transformation of the global trading system so that it ceases to violate social, environmental, economic and health rights of people and begins to discriminate positively in favour of countries of the South.”
The Charter also demands the cancellation of Third World debt, the radical transformation of the World Bank and International Monetary Fund and the effective regulation of Transnational Corporations. Very significantly the Charter calls upon the people of the world to ‘challenge growth-centred economic theories and replace them with alternatives that create humane and sustainable societies’.
The organisers of the PHA 2000 plan to include representatives of all major regions around the world within their consultative group to carry on with the post-PHA 2000 activities. These activities will include, among other things, campaigns to frame and adopt Health Charters at the national and local levels addressing specific public health issues.