contact A publication of the World Council of Churches PEOPLES HEALTH MOVEMENT 2 Editorial 16 Struggle for tomorrow 3 Introduction 19 Promoting and endorsing No 176 Health for all now! the Italian experience January-March 2002 22 Lessons learned a case study Experiences (Printed on 25 Update December 30, 2002) 5 Time to act Trade for people, not people for 8 Poverty and WHO trade 10 At the forefront of the struggle 26 Bible study 12 Towards a healthy The courage to change world Africa 27 Networking 14 Moving ahead Announcements, letter EDITORIAL In communities around Recognizing this, peoples organizations the world, groups from around the world have begun a of people have new mobilization process to ensure that been working comprehensive primary health care together to becomes a reality% Beginning in the late find creative 1990s, in Latin America, Africa, Europe, solutions to and throughout Asia, peoples organiza- their health tions began a process of analysis and care pro- mobilization to pull together ideas for a blems% To Peoples Charter for Health% mobilize In December 2000, nearly 1450 people local and from 92 countries met in Savar, often scar- Bangladesh to review the Charter as a ce resour- strong call for action% Since then, the ces, to put Charter has been translated into more into prac- than 35 languages, and the Peoples tice effec- Health Movement (PHM) has grown% tive, com- munity- This special issue of Contact traces the based and development of the Peoples Health community- Movement, looks at the key points of run health the Charter, and highlights some of the care ser- initiatives in wide range of regions vices% and countries involved in the PHM% D Taylor These include Africa, Latin America, A child receipient of Basic Bangladesh, Italy and India% These are Minimum Needs (BMN) They have been doing this for more than 50 years, or at least from the time that just a few examples% the international health community, The Peoples Health Movement (May particularly under the leadership of the 2002) was the largest delegation at the World Health Organization has been last World Health Assembly in Geneva% striving to identify practices and policies A short report on this event is included that can make a difference% along with some reflections on Poverty and health (Poverty and WHO)% The Countries such as Guatemala, Cuba, get-together of activists in Geneva from Bangladesh, India, Mozambique, all over the world was also an opportunity Tanzania, the Philippines, China and to share visions of the future% many more provided real life experiences and evidences that Finally, this special issue calls for others underpinned the Primary Health Care to join in the movement and to work (PHC) strategy approved at the 1978 together to help put the control of international meeting held at Alma peoples health in peoples hands% Ata% The Health for All by 2000 AD Andrew Chetley & Ravi Narayan evolved at this meeting% In September 2003, nine months from now, the world will reach a milestone the 25th anniversary of the Alma Ata Declaration on Primary Health Care% It is disappointing to see that the international health community has failed miserably to deliver that promise% That Cover failure is being felt most dramatically in Health activists demand health the poorest and most marginalized as a right communities around the world% Credit: Community Health Cell 2 contact n°176 - January-March 2002 INTRODUCTION A PEOPLES CAMPAIGN FOR HEALTH FOR ALL NOW! Introduction The PHA meet at Bangladesh was intended to challenge In 1978, an International Health Assembly at Alma Ata in USSR, (co- health policy makers around the world Ravi Narayan sponsored by the World Health reports on this exciting exercise which was intended to Organization; United Nations Childrens remind international bodies and governments of the Emergency Organization; and others) promises they have failed to keep gave the world a slogan Health for All by 2000 AD and endorsed the famous Alma Ata Declaration that brought people and communities to the centre of health planning and health care strategies% It emphasized the role of community participation, appropriate technology and intersectoral coordination% The declaration was endorsed by all the governments of the world and symbolized a significant paradigm shift in the global understanding of health and health care% A receding dream Twenty-two years later and after much policy rhetoric; some concerted but mostly ad hoc action and a lot of governmental and international health agency amnesia; this declaration WCC remains unfulfilled, as the world comes to terms with the new economic forces of globalization, liberalization and small and big groups, using formal and privatization% informal opportunities% The PHA meet Finally, at the end, a Peoples Health Charter emerged, which was endorsed In December 2000, a Global Peoples by all the participants% This charter has Health Assembly, brought together 1453 now become an expression of common people from 92 countries% It included a concerns; a vision of a better and march for health; meetings at which healthier world and a call for radical people shared their testimonies on the action% health situation from many parts of the world% Parallel workshops to discuss a range of health and health related challenges% Cultural programmes to The Peoples Health Campaign for Health for All - Now! was a symbolize the multiregional, multicultural platform to share the unfulfilled Health for All challenge and multiethnic diversity of the peoples of the world; and group discussion in contact n°176 - January-March 2002 3 INTRODUCTION Thirdly, it underlines the imperative that Health for All means challenging powerful economic interests; opposing globalization in its existing inequitous model; and drastically changing political and economic priorities% Fourthly, it tries to bring in perspectives and voices of the poor and marginalized encouraging people to develop their own local solutions% Finally it encourages people to hold accountable their own local authorities, national governments, international organizations and corporations% The vision and the principles, more than ever before, extricates health from the D Sawyer/TDR/WHO Ravi Narayan Significance of the Peoples Health myopic biomedical-techno manageria- Charter lism of the last two decades and centers it squarely in the context of todays The Peoples Health Charter endorses global socio-economic-political-cultural- health as a socio-economic and political environmental realities% However, the issue and a fundamental human right% most significant gain of the Peoples Secondly, it identifies inequality, poverty, Health Assembly and the Charter is exploitation, violence and injustice as that, for the first time since the Alma Ata the roots of ill-health% Declaration (1978), a Health For All action plan endorses a call for action that tackles the broader determinants of Health for All action plan in the Peoples Health Charter health% v Health as human right% This comprehensive view of health v Economic challenges for health% action, as we enter the new millennium, is probably the most significant gain of v Social and political challenges of health% the Peoples Health Assembly% v Environmental challenges for health% Other gains v Tackling war, violence, conflict and natural disasters% For the first time in decades, health and v Evolving a people-centred health sector% non-health networks came together to v Encouraging peoples participation for a healthy world% evolve global solidarity and collectivity in health% 4 contact n°176 - January-March 2002 FEATURE Another significant development was Health Research (GFHR) and the World the evolving solidarity which found sym- Health Assembly have become the bolic expression in various documents norm% at the global level% These indicated that In addition, public meetings/campaigns people mattered, and these when taken about taking health to the streets as a together represent an unprecedented, Rights issue is gaining popularity% emerging, global consensus% Conclusion It was not just event oriented, but was preceded by a range of grassroot, local The Peoples Health Assembly process and regional initiatives from the different was a rather unusual multiregional, parts of the world% multicultural, and multidisciplinary The most significant development mobilization effort% Bringing together the however, is not what took place before largest collection of activists and pro- the Assembly, but, what seems to be fessionals, civil society representatives going on after the December 2000 and the peoples representatives Assembly% For example, the Peoples themselves, to evolve a global instru- Health Charter has been translated into ment of concern and action, and to several languages which include Dutch, express solidarity with the health French, Greek, Russian, Ukrainian, struggles of people, especially the German, Nepali, Spanish, Urdu, marginalized in todays inequitous and Japanese, Chinese, Arabic, Finnish, unhealthy global economic order% A long Swedish, Tamil, Sinhala, Kannada, road lies ahead in the campaign for Malayalam, Portugese etc% Health for All% Evolving the charter at the assembly in Bangladesh in December Videos have been made for public 2000, was only the end of the beginning% education on the events and issues Ravi Narayan is the Joint Convenor of the National Coordination Committee for Jana Swasthya Abhiyan (PHM-India), Convenor of the WHO-WHA Circle, and the new co-ordinator designate of