Globalisation and the Indian people

Item

Title
Globalisation and
the Indian people
extracted text
Globalisation and
the Indian people

All India Peoples Science Network

prAjasakti book house

Globalisation and the Indian People

ASSAULT ON
PUBLIC HEALTH

All India Peoples Science Network

Prajasakti Book House
Hyderabad

Assault on Public Health

prepared by the All India Peoples Science Network for the World
Social Forum Process in India

Price: Rs.20
November. 2002

Publication No : 740
Copies: 2000

Acknowledgments: This booklet has been prepared by Amit Sen
Gupta with the help of liberal inputs from members of the Jana
Swasthya Abhiyan. Special thanks to Evelyn Hong from the
Third World Network, whose paper titled “Globalisation and
the Impact on Health: A Third World View” prepared for the
Peoples Health assembly in 2000 has been especially usefid in
preparing this booklet.

Material in this booklet can be freely reproduced, shared or
translated. Acknowledgment of the source will be appreciated
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Assault on Public Health
lobalisation is not a new phenomenon, neither is it necessarily

G

an evil force. However what we see today in the garb of
globalisation is something that is unique and unprecedented. Not­
withstanding the rhetoric, globalisation has come to mean the legitimisation of
neo-imperialist loot. Globalisation, as is being practiced today, docs not encour­
age free flow of goods, ideas and people across the globe. On the contrary it
perpetuates and increases monopoly control over resources, technology, knowl­
edge and capital. The tools used are multinational corporations and finance
capital, aided by the institutions of globalisation - the IMF and the World Bank.
with the WTO functioning as the lawmaker who constantly changes the rules of
the game to favour the rich and the powerful. We need to make a distinction
between this form of globalisation and true globalisation - which would mean
unhindered flow of technology, knowledge and resources to those corners of
the globe which need it most. The globalisation that we see today is global only
in regard to the vastly increased ability of imperialism to interfere in governance
and decision-making in sovereign nations. What we have is not interdepen­
dence, but increasing dependence on a few who control productive resources
and capital.

This kind of globalisation is plagued with a fundamental contradiction
- in an age when restrictions on information flow and flow of goods,
services and capital are sought to be removed, there is a greater con­
centration of wealth and knowledge in a few hands. Such concentration
is manifest in growing inequalities. More than a decade back the UNICEF
took note of the initial signals: “Great change is in the air as the 1990s
begin ... And great change is needed if a century of unprecedented
progress is not to end in a decade of decline and despair for half the
nations of the world. In many countries poverty, child malnutrition and
ill-health are advancing again after decades of steady retreat. And al­
though the reasons are many and complex, overshadowing all is the fact
that the governments of the developing world as a whole have now
reached the point of devoting half of their total annual expenditures to
the maintenance of the military and the servicing of debt”. Such appeals
obviously went unheeded and in the last decade of the past millennium
actual per capita incomes fell in over 80 countries. This is what is unique
1

about the present phase - the fact that the consequences of current
policies are being felt at an unprecedented scale. Such wide-ranging
reversals of social and economic gains have never happened in the his­
tory of human civilisation.

Balance Sheet of Globalisation
❖ The United Nations Development Program (UNDP) estimates that
the world's 225 richest people have a combined wealth of over $1
trillion, an amount equal to the annual income of the poorest 47% of
the world's people or 2.5 billion individuals.
❖ At least one-fifth of the world's population (1.3 billion people) live in
absolute poverty with 70% of them composed of women.

❖ Ninety percent of the global disease burden are carried by the devel­
oping world which has access to only 10 percent of the resources for
health.

❖ About 93% of the world's burden of preventable deaths occur in
developing countries.
❖ Ten million children under the age of 5 and 7.4% of adults between
ages of 20 and 49 die each year, the majority of whom live in devel­
oping countries
❖ In Europe, the risk of dying from a pregnancy-related illness is one in
1,400. In Asia, it is 1 in 65. and in Africa, it is 1 in 16.
❖ Millions of people like those in sub-Saharan Africa and Asia still die
from communicable but preventable diseases like tuberculosis, ma­
laria and schistosomiasis. About one-third of the world’s population is
infected with tuberculosis with almost 2/3 of them living in Asia. In
the developing world, more women of childbearing age die from TB
than from causes related with pregnancy and childbirth.
❖ In the developing world. 1.2 billion people lack access to safe water.
adequate sanitation and poor housing; 800 million people lack access
to health services.

2

IMF/Workl Bank Dictated Policies
The seeds of this process was sown a quarter of a century back when
the International Monetary Fund (IMF) introduced its infamous Struc­
tural Adjustment Programmes (SAP) in poor countries of Latin America,
Africa and Asia. In brief, the Structural Adjustment Programme (SAP)
was designed to:
•

Cut government spending — this means big cuts in health care,
education and subsidies to farmers and the poor.

• Privatisation — state owned industries and services must be sold
off to private corporations. Often foreign multinationals are the
buyers. Many workers lose their jobs as government industries
close down. Services like transportation and power become more
expensive.
■

Devalue the local currency — for example, in India the rupee
should be worth less and less compared to the American dollar.
The World Bank and IMF demand this so that what the country
exports is cheaper in the international market. The World Bank
and IMF say this will increase the country’s exports so it can earn
foreign dollars — and pay back the loans! But farmers and local
industries get less for their goods. And prices of imports go up!

•

Export more — the country should export more to pay back loans.
The agricultural sector should turn to commercial farming for the
market and for export, rather than food production for local con­
sumption.

•

Open the door to foreign multinational companies

•

Reduce duties and tariffs on imports — in this way foreign multina­
tionals can more easily sell their products in a country like India.
Local industries find it hard to compete with cheaper imports.

Recorded information proves that SAP has been detrimental to nation states in
every region. In spite of this experience, the same prescriptions were applied
later to nations such as India and the result have been predictable: rising prices,

3

inflation, rising unemployment, change in cropping patterns, loss of food secu­
rity, withdrawal of subsidies on public welfare services such as public health,
education and the public distribution system. These have directly and selec­
tively affected the already disadvantaged in our country. Combined with this
is the larger issue of loss ot sovereignty since our Parliament can no longer
make policies favoring our people but at the behest of WB/IMF.
SAP induced policies led many countries to pile up huge debts which were
underwritten by large capitalist banks and multilateral lending institutions. The
subsequent story is strewn with even larger disasters. As country after country
got caught up in a debt trap, the IMF forced further squeeze on the financing of
social services. By the mid 1980s the Third World was already a net exporters of
money, i.e. debt servicing was higher than the total inflow of loans, bilateral and
multilateral aid. and Foreign Direct Investment. The results were felt most se­
verely in the social sectors - health, education, food security, etc. In Tanzania,
for example, debt service payments are 9 times the expenditure on primary health
care and 4 times the expenditure on education. In Peru per capita food intake fell
by 25% between 1975 and 1985. Somalia was ravaged by a famine that was
entirely a result of IMF dictated policies (and not civil war and drought as
claimed by foreign “experts") Between 1975 and 1989 health expenditure was
cut by 78%. Meanwhile cheap wheat from the US and beef and diary products
from the European Union disrupted the country’s agriculture which had been
dependant on indigenously grown maize and sorghum and local livestock. It is
possible to go and on in the same vein. It has been estimated that at least six
million children under five years of age have died each year since 1982 in Africa,
Asia and Latin America because of SAP. The magical words of globalisation.
privatisation and liberalisation have led to absolute impoverishment of millions
in the third world.
Bank and IMF dictated policies also placed primacy on the necessity to be
“competitive” in the global market. In order to do so poor countries were told
that the poor were a liability and, at best, could be provided a “safety net”. The
purpose of such a net is not to provide comprehensive social security cover but
to provide “minimum” facilities and services that could contain social unrest
and political instability. Countries, as a result, are increasingly resorting to “so­
cial dumping", where the poor are insulated from the mainstream and kept in a
permanent state of penury. Poverty figures in India, for example, indicate that
rural poverty has increased in the “reform” years while at the same time the
government exults over benefits of reforms that have accrued to a small affluent
section. Clearly policy making today targets this small section and ignores 80%
of the population.

4

Public Health-a Casualty
Public health is an obvious casualty of this process. There is a clear
contradiction between the principal tenets of public health and nco-liberal economic theory that permeates policy making today. The former
posits that public health is “pviblic good", i.e. its benefits cannot be indi­
vidually appropriated or computed, but have to be seen in the context of
benefits that accrue to the public. Thus public health outcomes are shared.
and their accumulation lead to better living conditions. Such goods never
mechanically translate into visible economic determinants, viz. income
levels or rates of economic growth. Kerala, for example, has one of the
lowest per capita incomes in the country but its public health parameters
rival those in many developed countries. The Infant Mortality Rate in
Kerala is less than a third of any other large state in the country. But
neo-liberal economic policies are loath to even acknowledge such ben­
efits. The current economic policies would rather view health as a pri­
vate good that is accessed by the medium of the market. SAP induced
economic policies had the following specific consequences for the health
sector:

i.

A cut in the welfare investment, leading to gradual dismantling of the
public health services.

ii.

Introduction of service charges in public institutions, which has now
making the services inaccessible to the poor.

iii.

Handing over the responsibility of health service to the private sector
and undermining the rationality of public health. The private sector on
the other hand focused only on curative care. India for instance, was
forced to reduce its public health expenditure in health and to recover
the cost of health services from its users by international banks.

iv.

The voluntary sector, which has also stepped in to provide health
services is forced to concentrate and prioritise only those areas where
international aid is made available - like AIDS, population control.
etc.

These “fundamentals" were more sharply focused upon in 1987 by the
World Bank document titled "Financing Health Services in Developing
5

countries'' The document recommended that developing countries should:
1)

Increase amounts paid by patients.

2)

Develop private health insurance mechanisms (this requires a dis­
mantling of state supported health services as if free or low cost
health care is available there is little interest in private insurance).

3)

Expand the participation of the private sector.

4)

Decentralise government health care services (not real decentralisation
but an euphemism for "rolling back” of state responsibility and pass­
ing on the burden to local communities).

These recommendations were further ‘’fine-tuned’' and reiterated by
the Bank’s World Development Report, 1993 titled “Investing in Health”.
This document represents the Bank's major foray into health policy for­
mulation. Today the Bank is the decisive voice in this regard, and
organisations such as the WHO and UNICEF have been reduced to
playing the role of “drum beaters” of the Bank. As a Bank economist
candidly reflected: “Policy lending is where the bank really has powerI mean brute force. When countries really have their backs against the
wall, they can be pushed into reforming things at a broad policy level
(which) normally, in the context of projects, they can’t. The health sec­
tor can be caught up in this issue of conditionality”
In almost every developing country, these prescriptions have been
avidly lapped up. In Philippines health expenditure fell from 3.45% of
GDP in 1985 to 2% in 1993; and in Mexico from 4.7% of GDP to 2.7%
in the decade of the 80s. Even developing countries with a strong tradi­
tion of providing comprehensive welfare benefits to its people were not
spared (with the exception of Cuba). In China health expenditure is re­
ported to have fallen to 1% of GDP and 1.5 million TB cases are be­
lieved to have been left untreated since the country introduced mecha­
nisms for cost recovery. In Vietnam the number of villages with clinics
and maternity centres fell from 93.1% to 75%.

Health Sector Reform in India
India embarked on its present path of economic liberalisation, on inslruc6

lions from the Bank and IMF, relatively late. But in 1991 the infamous
Manmohan Singh budget set things in motion. The immediate fallout
was a savage cut in budgetary support to the Health sector. The cuts
were severe in the first two years of the reform process, followed by
some restoration in the following years. Between 1990-91 and 1993-94,
there was a fall, in real terms, of expenditure on Health care both for the
Centre and the states, though it was much more pronounced in the case
of the states. In this period there was a compression of total develop­
mental expenditure of state governments. Thus expenditure, in real terms.
for state governments plummeted in 1991 -92 and 1992-93. and just about
touched the level of 1990-91 in 1993-94. This squeeze on the resources
of states was distributed in a fairly secular fashion over expenditures
incurred under all developmental heads. Healthcare was a major casu­
alty, as the share of states constitutes a major portion of expenditure. A
similar kind of squeeze in resource allocation was felt in all programmes,
largely Financed by the states, including water supply and sanitation. In
contrast even in the worst “resource crunch” years, the almost exclu­
sively centrally funded family planning programme fared much better.
Expenditure patterns on health care are grossly skewed in favour of
urban areas. Expenditure cuts further distort this picture with the axe on
investment falling first on rural health services. Asa result of this rolling
back of state support to health care the first major casualty in
infrastructure development has been the rural health sector. There has
been a perceptible slowing down in infrastructure creation in rural areas.

Compression of funds available with states has had a number of far
reaching effects. Generally, expenditures on salaries tend to take up an
inordinately large part of total expenditure. Salaries constitute 70-80%
of expenditure for most major programmes, and the trend is most dis­
torted in the case of rural programmes, viz. rural hospitals and primary
health centres. Faced with limited funds, while salaries still require to be
maintained at previous levels, the burden of cutbacks are increasingly
placed on supplies and materials. Ultimately a skeletal structure sur­
vives, incapable of contributing in any meaningful manner to ameliora­
tion of ill-health. We arc now seeing this as a major contributory factor
to the disruption of the rural primary health care system. In GDP terns
7

health expenditure in the country (already one of the lowest in the world)
has declined from 1.3% in 1990to0.9%in 1999. While Central budget­
ary allocation has remained stagnant at 1.3% of total outlay, the budget­
ary allocation to health in state budgets (which account for over 70% of
total health care expenditure of the country) has fallen in this period
from 7.0% to 5.5%.7 This is a direct consequence of the squeeze im­
posed on the finances of the states by the economic liberalisation poli­
cies. In reaction to this, desperate state governments are queuing up in
front of the World Bank to receive Bank aided projects. This is proving
even more disastrous as these projects impose strict conditionalities like
cost recovery.

Cost Recovery and Health Expenditure
Cost recovery is the lynchpin of the Bank sponsored policies in the country,
in spite of irrefutable evidence that such schemes, without fail, result in
the exclusion of the poorest. The case for the utility of user fees uses the
particularly seductive argument of equity. Seen in abstract it appears to
make sense that those who can pay should, and the benefits would be
shared by those who cannot. Unfortunately user fees do not work in this
manner in the real world. The concept of user fees, rather, is used to
legitimise the withdrawal of the state. Let us remember that the user fee
argument is being forwarded in a situation where public funding of health
care expenditure has fallen from 22% in the early nineties to 16% in
2000. India has one of the most privatised health systems in the world
(see Table). To harp on user fees while not arguing for a quantum jump
in health care expenditure by the state lets the state of the hook and
shifts the basic terrain of debate on health care expenditure.
The concept of user fees uses the old and tested model of cross
subsidization — some pay more to subsidise expenditure for those who
pay less or nothing. This model has been used successfully in infrastruc­
ture sectors like power, telecom, air transport etc. For the model to be
successful there is an assumption that a majority of users are part of the
public funded system. In health care in India this is far from the case.
Public facilities are utilised by those who do not have any other recourse
or a powerful elite who can milk the public funded system. To expect
that the latter will pay is unrealistic. As we move towards greater
8

privatisation, those who
can pay (even to a lim­
ited extent) move in­
creasingly to the private
USA
44
sector. This further un­
UK
96
dermines the quality of
Spain
70
care in the public funded
Norway
82
system, as the relatively
Japan
80
vocal sections have lesser
Germany
78
stakes in its survival.
France
76
Moreover the concept
72
Canada
of user fees is a thin end
Australia
72
of the wedge, used to
Vietnam
20
legitimise greater levels of
Pakistan
23
private expenditure in
Nigeria
28
health care. Let us not
Myanmar
16
forget that the whole ar­
India
16
gument used in favour of
Georgia
13
private participation in
Ethiopia
36
physical infrastructure
Cote 1 voire
38
(power, telecom, etc.)
Cameroon
20
was built around the claim
Cambodia
14
that it would free scarce
Burkina Faso
31
resources for social infra­
Source: World Health Organisation,
structure — health, edu­
~7U0TT
cation, PDS. In all these
sectors we see a rolling
back of the state and reduced expenditure. Any mechanism of cross
subsidy requires an arbiter who consciously works in favour of the poor.
To believe that the present Indian state is going to play this role is to
delude us.

Table:

Public Sector Expenditure
as Percent of Total
Health Expenditure

Penetration of the Private Sector
The abandonment of the Indian Government’s basic duty in providing
health care facilities has greatly enhanced the ability of the private sec­
tor to penetrate into the health sector. The distinction between health
9

care and medical care is important and needs to be noted. Health care
involves a lot more than just medical care, i.e. diagnosis and treatment of
illnesses. Health care involves nutrition, drinking water and sanitation
facilities, good housing, and a lot more. These aspects of health, for
obvious reasons cannot be catered to by the private sector. But what of
the medical care that is provided by the private sector? There is a funda­
mental contradiction that exists in the concept of private medical care.
By definition private medical care can survive only if it is profitable.
What logically follows is that a private medical care provider stands to
profit from ill-health — the more people fall ill and the longer they re­
main ill. the larger the profit for the care provider! The fundamental
inconsistency can also be illustrated by the simple demand and supply
logic of the market place. It can be legitimately argued that the demand
for health care will always be infinite, for there is really no limit that one
can set on good health. Thus, the demand for health care will always
outstrip supply, and hence, under “free market" conditions, the cost of
health care will always rise exponentially! We have commented earlier
about the fact that developed Capitalist economics continue to pledge
resources on public funded health care — to the tunc of 70-80% of total
health care costs. They do so, not out of any altruistic motives, but be­
cause conventional wisdom dictates that health care in the private sec­
tor is expensive and inefficient. And yet. our Government wishes to
argue that privatisation of health care leads to more efficient utilisation
of resources!
In spite of all the virtues of the “free-market’’ that are being sought to be
foregrounded, the private sector is thriving because of a host of direct
and indirect subsidies it receives from the Government. It is ironical that
a Government which declares that it makes poor economic sense to
“subsidise" health care for the poor, provides such subsidies to the Pri­
vate and Corporate Medical Sector, which cater exclusively to the needs
of the rich. Thus, after providing medical education at a very nominal
cost the Government provides concessions and subsidies to private medi­
cal professionals and hospitals to set up private practice and hospitals. It
may be recalled that the Apollo Hospital in Delhi was built on land pro­
vided by the Delhi Government at a throwaway price! The Government
also provides incentives, tax holidays, and subsidies to private pharma­
10

ceutical and medical equipment industry. It allows exemptions in taxes
and duties in importing medical equipment and drugs, especially forexpensive new medical technologies. The government has allowed the highly
profitable private hospital sector to function as trusts which are exempt
from taxes, thereby exempting them from contributing to the state ex­
chequereven while being allowed to make huge profits. Moreover, medi­
cal and pharmaceutical research and development is largely carried out
in public funded institutions but the major beneficiary is the private sec­
tor. Many private practitioners are given honorary positions in public
hospitals, which they use openly to promote their personal interests.
The decade of the nineties has seen another transition taking place in
the private health sector. Prior to this, the private sector consisted of a
large number of individual practitioners and private hospitals and nursing
homes run by medical professionals. For the first time, today, we see the
entry of the organised corporate sector in medical care. As the practice
of medicine becomes more technology intensive, the role of the medical
professional is becoming narrower. The control of technology has thus
become the key factor in determining who or which entity controls pri­
vate medical care. Corporate entities, given their ability to invest in “state
of the art" medical technologies, are fast wresting control of the medical
care “industry". Henceforth, the return on investment made by such
corporations, and not any esoteric concept of professional ethics, will
determine the kind of care provided. As corporates try to maximise profits
they will attempt to further push up cost of medical costs by introducing
high cost technologies, and expensive diagnostic aids and medicines.
This is not merely an imaginary futuristic scenario. In the United States,
such an approach to medical care has lead to health care costs being the
highest in the world.
Alongside the move towards reduced support to health care facilities.
the government’s new-found fascination with health insurance is de­
signed to facilitate privatisation of the health sector. Wary, that a total
collapse of the public health infrastructure would also affect the more
vocal sections of the people — the elite and the middle class — health
insurance is seen as a useful ploy to replace the Govt, health sector. But
such a system addresses the needs of a small fraction, because, when
the Govt, today talks of health insurance, it means private health insur­
11

ance. All countries with a developed health care infrastructure have
health insurance, but in most the major share is made up of by Govt.
supported health insurance. For example, in Japan. France. Canada.
England and Netherlands the whole or majority of the population is cov­
ered by Govt, funded health insurance. The only large country where
private health insurance is dominant, is the United States — a country
that has the most inefficient and expensive health care system in the
developed World.

Resurgence of Communicable Diseases
In addition to the key area of IMF/Bank induced health sector reforms.
globalisation impinges on the health sector in myriad other ways. Globalisation
leads to transnationalisation of public health risks. A major effect has been the
resurgence of communicable diseases across the globe. Every phase of human
civilisation that has seen a rapid expansion in exchange of populations across
national borders has been characterised by a spread of communicable diseases.
The early settlers in America, who came from Europe, carried with them small
pox and measles that decimated the indigenous population of Native Ameri­
cans. Plague traveled to Europe from the orient in the middle ages, often killing
more than a quarter of the population of cities in Europe (like the plague epi­
demic in London in the fifteenth century). This is a natural consequence of
exposure to local populations to exotic diseases, to which they have little or no
natural immunity.
Today what incubates in a tropical rainforest can emerge in a temperate
suburb in affluent Europe, and likewise what festers in a metropolitan ghetto of
the global North can emerge in a sleepy village in Asia - within weeks or days.
However those that are most badly affected are the poorest that live in develop­
ing countries, because their immunity is compromised by under nutrition and
because they have little or no access to health facilities. In the case of AIDS the
combination of global mobility and cuts in health facilities has been lethal for
many developing countries - a whole generation has been ravaged by the
disease in Africa, and now in Asia. Let us not forget that AIDS first manifest
itself in the US. but it was Africa that feels the real force of its wrath. In the 1960s
scientists were exulting over the possible conquest to be achieved over com­
municable diseases. Forty years later a whole new scenario is unfolding. AIDS
is its most acute manifestation. We also have resurgence of cholera, yellow
fever and malaria in Sub-Saharan Africa, malaria and dengue in South America,
multi-drug resistant TB. plague, dengue and malaria in India. We see the emer­
gence of exotic viral diseases, like those caused by the Ebola and the Hanta

12

virus. Globalisation that forces migration of labour across large distances, that
has spawned a huge “market" on commercial sex, that has changed the environ­
ment and helped produce “freak" microbes, has contributed enormously to the
resurgence.

No Medicines Tor the Poor
While unleashing new horrors in the form of disease, globalisation has
also compromised people’s ability to combat them. The WTO agree­
ment on Patents (called the Trade Related Intellectual Property Rights TRIPS) has sanctified monopoly rent incomes by pharmaceutical MNCs.
The WTO defines ‘Intellectual Property Rights’ as, “the rights given to
persons over the creations of their minds. They usually give the creator
an exclusive right over the use of his/her creation for a certain period of
time." TRIPS protects the interests of big biotechnology, pharmaceuti­
cal, computer software and other businesses and imposes the cost of
policing on cash-strapped governments, while slowing down or prevent­
ing altogether the transfer of useful technology.
The Trade Related Intellectual Property Rights (TRIPS) agreement,
signed as a part of the WTO agreement, was the most bitterly fought
during the GATT negotiations. Till 1989 countries like India, Brazil, Ar­
gentine, Thailand and others had opposed even the inclusion of the is­
sues in TRIPS in the negotiating agenda. They did so based on the sound
argument that Intellectual Property Rights — which includes Patents
over medicines — is a non-trade issue. India and others had argued that
rights pro\ ided in domestic laws regarding intellectual property should
not be linked with trade. They had further argued that the history of
IPRs shows that all countries have evolved their domestic laws in con­
sonance with the stage of economic development and development of
S&T capabilities. Laws that provide strong Patent protection limit the
ability of developing countries to enhance their S&T capabilities and
retard dissemination of knowledge. Japan, for example, was able to en­
hance its domestic capabilities through the medium of weak patent pro­
tection for decades — well into the second half of the twentieth century.
Italy changed to a stronger protection regime only in 1978 and Canada
as late as in 1992. Il was thus natural that many countries like India had
domestic laws that did not favour strong protection to Patents before the
WTO agreement was signed. It was illogical to thrust a single patent

structure on all countries of the globe, irrespective of their stage of de­
velopment.
These arguments were however systematically subverted during the
GATT negotiations, leading to the signing of the TRIPS agreement. The
TRIPS agreement required countries like India to change over to a strong
patent protection regime. A regime that would no longer allow countries
to continue with domestic laws that enabled domestic companies to
manufacture new drugs invented elsewhere, al prices that were any­
thing between one twentieth and one hundredth of global prices. It may
be recalled that it was the 1970 Patent Act which, by encouraging In­
dian companies to develop new processes for patented drugs, also facili­
tated the development of world class manufacturing facilities in a devel­
oping country' like India.
The TRIPS agreement has placed enormous power in the hands of
MNCs, by virtue of the monopoly that they have over knowledge. They
have generated super profits through the patenting of top selling drugs.
But drugs which sell in the market may have little to do with the actual
health needs of the global population — for, often, there is nobody to pay
for drugs required to treat diseases in the poorest countries. Research
and patenting in pharmaceuticals are driven, not so much by actual thera­
peutic needs, but by the need of companies to maintain their super prof­
its at present levels. Simultaneously, new drug development has become
more expensive because of more stringent regulatory laws. This is a
major reason for the trend towards global mergers, as individual Cos.
wishing to retain the huge growth rates of the 1970s and 80s, are trying
to pool resources for R&D. As a consequence, we are looking to a new
situation, where 10-12 large Transnational conglomerates will survive as
“research based” Cos., that is Cos. that will be in the business of drug
development and patenting.
Given their monopoly over knowledge, these companies will decide the kind
of drugs that will be developed — drugs that can be sold to people with the
money to buy them. Thus on one hand we have the development of'‘life-style"
drugs, i.e. drugs like viagra, which target illusory ailments of the rich. On the
other hand we have a large number of “orphan” drugs — drugs that can cure
life-threatening diseases in Asia and Africa, but are not produced because the
poor cannot pay for them. Today's medical research is highly skewed in favour
of heart diseases and cancer as compared to other diseases like malaria, cholera,

14

dengue fever and AIDS which kill many more people — especially in develop­
ing countries. Just four per cent of drug research money is devoted to develop­
ing new pharmaceuticals specifically for diseases prevalent in the developing
countries. To put it another way, less than 10% of the $56 billion spent each year
globally on medical research is aimed at the health problems affecting 90% of
the world's population. Some drugs developed in the 1950s and 1960s to treat
tropical diseases, on the other hand, have begun to disappear from the market
altogether because they are seldom or never used in the developed world.

Promoting Further Privatisation through the WTO
The General Agreement on Trade in Services (GATS)
Historically trade agreements involved reducing tariffs, eliminating trade barri­
ers like quotas on imports on goods produced in a country and sold elsewhere.
However, this has changed drastically in recent years in as, in developed coun­
tries, manufacturing has ceased to be profitable because of global competition.
Presently, the services sectors have expanded and are growing at the fastest
rates in these countries. The service sectors accounts for two thirds of economy
and jobs in the European Union (EU). almost a quarter of theEU’s total exports
and a half of all foreign investment flowing from the Union toother parts of the
world. In the US, more than a third of economic growth over the past five years
has been because of service exports.

As the service sectors of the economies of developed countries grew,
trade in various types of services were exported. Multinational Corpora­
tions started lobbying for new trading rules that will expand their share
of the global market in services as governments everywhere spend a
considerable amount of their budget on social services.
This is what the General Agreement on Trade in Services (GATS)
under the WTO is targetting today. GATS covers some 160 separate
sectors. In the WTO meeting in Seattle, the US specifically wanted to
focus on free trade in services in the professions, health and education.
The GATS as in all the other agreements contains provisions which
allow further deregulation of any national legislation which is seen to be
hostile to free trade. GATS identify the specific commitments of mem­
ber states that indicate on a sector by sector basis the extent foreigners'
may supply services in the country. The negotiating process in GATS
allows forcountries todecide, through 'requestoffer’ negotiations, which
service sectors they will agree to cover under GATS rules. This refers
to the extent to which member states want their services like health and
15

education to be open up to free trade.
Today private insurance companies, managed (health) care firms.
health care technology companies and the pharmaceutical industry of
the developed countries are looking for opportunities to expand health
care markets. In the Third World, much of private health services were
by and large provided by non-governmental organisations like charities.
religious societies and community oriented associations which were not
entirely profit driven. This will change when health services and invest­
ments in health expand and the corporate sector is poised to play a promi­
nent role especially in countries where there is an affluent elite willing to
pay or where there exists a private health service base: like in India.
This move to open up the health and social sectors to allow for privatisation
and competition from the private sector will mean private corporations
taking over the health and social services of countries for profit under­
mining the equitable distribution of health care.
The 'Agreement ’ On Government Procurement

Under the proposed ‘Agreement on Government Procurement Policy'
the developed countries wants to introduce a process in the WTO whereby
their companies are able to obtain a large share of the lucrative business
of providing supplies to and winning contracts for projects of the public
sector in the Third World. The aim is to bring government spending
policies, decisions and procedures of all member countries under the
umbrella of the WTO. where the principle of ‘national treatment’ will
apply. Under this principle, governments would no longer be able to give
preferences or advantages to citizens or local firms. Through the gov­
ernment procurement issue, the North will enable its corporate bodies to
tap the vast public resources available in the health and social services
sector and dismantle the public provision of health care. Public procure­
ment will be the golden goose providing the crucial link to open up the
services sector.
The 'Agreement' on Competition Policy

Privatisation of health care will also be facilitated under the proposed
‘Agreement on Competition Policy’. Member states ‘will have to con­
sider making reforms to their regulator}' regimes’ such that national regu­
lations should have four central attributes: adequacy, impartiality, least
16

intrusiveness and transparency’, towards corporate interests. Under such
an agreement. Third World countries would be forced to establish do­
mestic competition policies and certain type of laws. Distinctions that
favour local firms and investors would not be allowed. For example, if
there are policies that give importing or distribution rights (or more
favourable rights) to local pharmaceutical companies (including govern­
ment agencies or enterprises), or if there are practices among local firms
that give them superior marketing channels, these are likely to be tar­
geted and even banned. If smaller Third World enterprises were treated
on par with the large foreign conglomerates, they would not be able to
survive. The North will insist that their giant firms be provided a ‘level
playing field' to compete equally with smaller domestic companies. Com­
petition of this type will invariably lead to foreign monopolisation of Third
World markets.
The ‘Agreement’ on Investment

Similarly on the investment issue, the Northern governments want to
introduce new rules that make it legal to give foreign investors the right
to enter and establish themselves with 100 percent ownership. Govern­
ments then will lose the right to regulate investment to achieve and pro­
tect social, environmental and health well being in the national interest
both long term and short term.
Corporations Shape Health

Already policies promoted by the IMF and the world Bank have created
the conditions for the expansion of privatised health care and the dis­
mantling of public health services in the Third World. Different provi­
sions under the WTO that are still being negotiated will force countries
to remove all barriers to foreign participation in their health and social
services sector.
If Third World countries commit to fully cover health services under the
existing GATS rules, this will lead to irreversible changes in the financing and
delivery of health and social services. Governments will have to open up their
health sectors to foreign health service providers. Foreign health suppliers are
guaranteed access to the health services market, which includes the right to
invest, to provide health services from abroad and to send health professionals
to practise. Any preferential treatment for local hospitals, nursing and handi­
capped homes, etc. will have to be eliminated or given to foreign service provid­

17

ers. Requirements that first preference be given to locals will be eliminated.
Conditions must be created for the private health sector to provide or supply
any service (like resorts, spas, exotic therapies, laundry, food catering, cleaning.
health management consultancies, etc.); the private sector will effectively tap
funds that the government spends on health by directing government spend­
ing towards the private sector in this way funding the privatised health ser­
vices.

Targeting Women in A Globalised World
Public Health professionals have consistently argued that women's health
is not just considerations related to pregnancy, child birth and control of
fertility. However it is precisely these concents that drive government
programmes and approaches towards women's health. This drive has,
in fact, accelerated in recent years. Thus the key thrust in policies re­
main in the area of Family Planning, and now in what is termed as "Re­
productive Health".
Development is the Best Contraceptive
Experiences within, as well as outside the country, show that a reduction
in population growth rates follow overall socio-economic development.
Except in conditions of war and famine they seldom precede such de­
velopment. Yet this has largely been ignored during our planning pro­
cess, possibly as it prevents our planners from blaming the country’s
tardy development rates on the pressures posed by population increase.
As a result family planning strategies have tended to be paternalistic.
prescriptive and coercive. It is a strategy which starts from the belief
that the poor breed prodigiously and it is the nation’s duty to cap their
unbridled fertility. Thus programmes are aimed at the poorest sections.
and more specifically at women. Tubectomy rates in the country arc
fifty to hundred times higher than vasectomy rates, though the latter is a
far simpler and safer procedure. Hormonal methods aimed at women
find precedence over propagation of condoms, in spite of widespread
reports that the former are associated with a large number of health
hazards. In this whole process the supposed beneficiary - the impover­
ished rural woman - has virtually no choice. She is at the receiving end
of technologies which the state or society believe are necessary. Such
programmes are inappropriate not only because they victimise women,
18

but also because they do not work.
Such a strategy has undermined the effcctivity of the general health
care infrastructure as well as the faith that women have in this infra­
structure to address their real concerns. Most programmes, have tended
to view women as assembly line appendages required to produce ba­
bies. Thus a woman’s health becomes important only when she is preg­
nant or lactating. But in India 65% of deaths in women are due to
infection related causes and only 2.5% of deaths are related to child­
birth. Even among women in the reproductive age group only 12.5% of
deaths are due to childbirth associated causes.

Chain of Coercion
Population policies funded or dictated by the North, look for numbers as
the ultimate bottom-line, not at esoteric statistics of empowerment and
development. This agenda on population control, flows from fears in the
Developed countries of North America and Europe that the resources
of the planet will not be able to keep pace with the current rate of con­
sumption. We are being made to believe that large population growth
rates in the South is responsible. Yet the hidden agenda is related to the
fact that the developed North is unable or even unwilling to curb the
consumption patterns in their countries. Each child bom in North America
consumes as much energy as 3 Japanese. 6 Mexicans, 12 Chinese, 33
Indians. 147 Bangladeshis, 281 Tanzanians or 422 Ethiopians. The key
factor in determining population impact on environment and other global
resources is the number of households, rather than the number of people,
because an increase in households correlates to a dramatic increase in
energy use, which drains resources and compounds pollution. House­
hold numbers are on the rise in the developed world, due to divorce,
increased life expectancies, and more elderly and single people living
alone.
Yet we are told that the poor nations of the Third World are the
culprits who must listen to the voice of reason emanating from the cor­
ridors of power in Europe and America. The locus of coercion does not
stop here. Third World nations, eager to implement population policies,
pass on the burden of these programme to the poorest sections. All part
of the familiar argument that the poor ‘breed’ too fast and that is the root
19

cause of their poverty. Finally, the ultimate victims (not beneficiaries) of
population programmes are poor illiterate women. Thus a bulk of strate­
gies for population control target women. This completes the chain of
coercion - from the global North to the underdeveloped nations of the
South, from the Govts, of these nations to the poorest communities, and
ultimately women in these communities.

Reproductive and Child Health
In an attempt to legitimise the population programme in the country, the
Ministry of Health and Family Welfare now claims to have adopted a
target free approach. It now talks of a new Reproductive and Child
Health (RCH) package, which shall replace earlier mechanisms. The
essential coercive content of the family planning programme has, thus.
been kept intact. As the name itself suggests, the concerns are with
reproduction and not health. The gaze of the programme is still Firmly
fixed at women as targets.
The “new” approach to women’s health has actually been borrowed
from the World Bank Report ‘‘India's Family Welfare Program: To­
ward a Reproductive and Child Health Approach" (1995). Policies
of sovereign Governments are today dictated by World Bank, and it is
hence important to understand the thrust of this document to understand
the real motivations of the Govt.'s policy. As is the Bank’s forte today.
the document borrows heavily from terms in vogue among serious crit­
ics of India’s Family Planning Programme. Unfortunately this does not
translate easily into sharing the same concerns.
The real intent of the “new" approach becomes transparent when
the goals are seen to be subservient to “broad social policy” and "demo­
graphic objectives" in the following manner in the World Bank docu­
ment :

“The new consensus recognizes that an important goal of repro­
ductive health programs should be to reduce unwanted fertility
safely, thereby responding to the needs of individuals for high
quality services, as well as to demographic objectives. "
“While fertility reduction concents can be addressed at the level
of broad social policy, the design and management of reproduc20

live health programs need to be directed primarily at the needs of
actual and potential clients. ”

This is the crucial place where the Bank's prescriptions fundamentally
differ from the concept of Reproductive Health as conceived by the
feminist movement in the West. In the latter case Reproductive Health,
as a genuine concern among a large body of women, stands on its own
and is not seen as a means to an end. Here the logic is turned on its head
and under the guise of addressing women's concerns the agenda of
Reproductive Health is seen as a method of attaining objectives set by
faceless financial institutions and governments. The program thus fails
in its first test of being able to break the first link in the chain of coercion.
The links in the chain of coercion in fact are sought to be strengthened
and not weakened.
The report needs to be commended for the remarkable consistency
in approach with the Bank's World Development Report 1993, Invest­
ing in Health. There too the primary concerns were cost effectiveness
and targeting. The concern, clearly articulated in both documents is to
choose interventions which provide best value for money and not neces­
sarily where the burden of disease is the greatest.
Thus anaemia is seen as a problem for women only when they are pregnant
or lactating. On the other hand growth monitoring and supplementary feeding
are not cost-effective. This needs to be viewed in the context that 88% of
women in India are anaemic and 53% of children under five suffer from some
degree of malnutrition - both figures are the highest in the world with the pos­
sible exception of Bangladesh. Anaemia in women is not just a consequence of
reproductive ill-health - it is a function of diverse factors including discrimina­
tion of the girl child, undernulrition and social taboos. Child malnutrition is
possibly the greatest tragedy of post-independent India with 2/3rds of its popu­
lation being maimed in its initial formative years and being consigned to a
handicapped existence the rest of their lives. What in essence the Bank is
proposing is a caricature of Reproductive and Child Health designed according
to its peculiar logic.

The Child Health Programme was added to the Family Planning
Programme in the post-Emergency days when a major refurbishing of
the image of the programme had become a necessity for its very sur­
vival. The only real component of the Child Health Programme has been

the possible exception of the largely ineffective diarrhoeal disease con­
trol programme).
Instead of strengthening existing health infrastructure, the World Bank
report recommends drawing away more resources from it for family
planning. The document, again consistent with the Bank's old positions,
makes a strong plea for greater role for the private sector - including
privatisation of Primary Health Centres and involvement of PMPs. Con­
tracting out PHCs to the private sector can only allow profiteering. Flow
this shall serve the so called “client" base identified by the Bank is ob­
scure.

Flawed Policy on Women’s Health
Finally, a word about the basic philosophy that guides policies for im­
proving women’s health - the basic assumption that women’s health sta­
tus in India is low because they bear too many children. The Table gives
comparisons of some Developing nations as regards fertility rates (i.e.
average no. of children bom to women), maternal mortality rate (no. of
maternal deaths due to child birth for 100,000 births), prevalence of
anaemia among women and prevalence of child malnutrition. The latter
(child malnutrition) is a direct consequence of maternal malnutrition, and
is a sensitive indicator of the nutritional status of women.
The figures clearly show that developing countries from S.America,
Asia and Africa with significantly higher fertility rates are able to dem­
onstrate much better health conditions fortheir women. But policy mak­
ers at the highest levels in this country are supremely indefferent to­
wards such evidence. For. their concerns and perceptions are no differ­
ent from those of foreign donor agencies and developed nations of the
West. Forthem. the bogey of population is a convenient ploy to hide the
class and social bias of the Indian state, which discriminates against
poor women, both because they are poor and because they are women.

Assault on Food Security
The present phase of globalisation also has grave consequences for food secu­
rity. which is an integral part of good health. The Agreement on Agriculture
(AoA), under WTO has further skewed the balance against developing coun­
tries. India is just beginning to feel the rigours of the Agreement on Agriculture
that was part of the WTO agreement of 1995. Specifically, the lifting of restric-

22

Table: Comparitive Statistics on Women and Child Health
Fertility
Rate

Algeria
Botswana
El Salvador
Guatemala
Honduras
Nicaragua
Paraguay
Saudi Arabia
Syria
Malayasta
Vietnam
Zimbabwe
S.Africa
Egypt
Iraq
Libya
Pakistan
India

3.6
4.7
3.8
5.1
4.6
4.8
4.1
6.2
5.6
3.4
3.7
4.8
4.0
3.7
5.5
6.2
5.9
3.6

Maternal
Mortality
Rate

% of women
suffering fron
anaemia

Percent of
children below

160
250
300
200
220
160
160
130
180
80
160
570
230
170
310
220
340
570

—
—

13
15
11

14
—
—
—
—

23
—
36
—
—
—
75
—
—
—

88

5 years who are
malnourished

Z1
18
12
4
—
12
23
45
16
9
9
12
5
38
53

Note : — denotes figures not available
Source: Human Development Report. 1997
lions on imports, as required by the AoA has resulted in widespread disruption
of the rural economy. The spate of suicides by farmers in many states is a
testimony to the grim situation that is fast unfolding before us. The AoA en­
sured that subsidies provided to domestic agriculture by developing countries
would be phased out while those being provided by developed countries would
be retained. This has resulted in exports of primary commodities by developing
countries becoming uncompetitive while their domestic markets are being flooded
by subsidized imports from developed countries. This has been compounded
by pressures of the SAP induced policies to produce for the export market. As
a result vast tracts in India now grow “cash” crops like cotton, tobacco, sun-

23

flower, etc. We in India would recall the devastation and violent reactions that
were provoked by forced indigo cultivation in Bengal in the nineteenth century.
The actors have not changed, only the excuses offered have! Because the
global rules of the game are controlled by a few developed countries, in the past
decades the global prices of agriculture exports from developing countries have
fallen steadily. As a result farmers get less and less for their products, while the
growth in production of staple food grains has fallen sharply. All these pose a
major threat to the sustainability of agriculture in the Third World and to the
safeguarding of food security.
Control over global agriculture is sought to be exercised by other means too.
MNCs are pushing through a regime that will allow Patenting of seeds. At the
same time they are using Biotechnology to research new varieties that are ge­
netically modified. These two measures can allow virtual monopoly to such
MNCs over seed production, and consequently total control over agriculture. If
allowed, a handful of companies will decide who will grow what and what will be
consumed in the globe. The implications are clear!

Environmental Degradation and Unhealthy Lifestyles
Globalisation has also set in motion a variety of unsafe and hazardous
practices. The present global division of labour has led to the dumping of
hazardous wastes and the whole scale relocation of hazardous indus­
tries to developing countries. A World Bank economist, Lawrence Sum­
mers, aptly sums up the trend: “I think the economic logic behind dump­
ing a load of toxic waste in the lowest wage country is impeccable...
I've always thought that under populated countries in Africa are vastly
under polluted; their air quality is vastly inefficiently low compared to
Los Angeles or Mexico City"
The consumerist culture that is encouraged by corporate led globalisation
has also put the long-term sustainability of the planet in jeopardy. Excessive
fossil fuel use has already led to the threat of “global warming”. Unregulated
use of refrigerants has led to depletion of the protective ozone layer, exposing
people to the deadly effects of the sun’s radiation. Alongside this, corporates
continue to pillage the biological resources of the globe, leading to the disap­
pearance of a number of species of plants and animals. This has disrupted the
ecology of the land and the sea. If the trend continues, the globe as we know it,
may cease to exist a hundred years from now.
The same consumerist culture has led to unhealthy lifestyles - sedentary
habits, preference for unhealthy “junk foods”, over-indulgence in addictions
like tobacco and alcohol, etc. Globalisation encourages trade in unhealthy prod24

ucts - alcohol, tobacco, baby foods. As a consequence people in the third
world are suffering from the ill effects of “development" superimposed on the
problems of underdevelopment.

Reversing the Trend
Can these trends be reversed? We sincerely believe that they can. Primarily
because of the contradiction that we talked about in the beginning of the book­
let. Precisely because we are in an age when communications and exchange is
so much easier, the contradiction can be resolved only if we move towards true
globalisation. Globalisation of ideas, knowledge and resources that are con­
trolled by a majority for the majority. It is only this which can counter what is
being called globalisation today, but which is in essence its antithesis.

References:
State of the World's Children, 1990, p.l, UNICEF, 1991
Human Development Report, UNDP, 1999

Evelyn Hong, Globalisation and the Impact on Health: A Third World View,
Third World Network, 2000, for the Peoples Health Assembly
National Health Policy, MOHFW.2001
World Health Organisation, 2000

25

ANNEXURE

Policy Guidelines for
World Social Forum — India
1.

The World Social Forum is an open meeting place for reflective thinking, democratic
debate of ideas, formulation of proposals, free exchange of experiences and
interlinking for effective action, by groups and movements of civil society that arc
opposed toneo-hberalism and to domination of the world by capital and any form
of imperialism, and are committed to building a world order centred on the human
person.

2.

The World Social Forum at Porto Alegre - held from January 25"'- 30"'. 2001, was
an event localized in lime and place. With the Porto Alegre Proclamation that
"another world is possible", it becomes a permanent process of seeking and
building alternatives, which cannot be reduced to the events supporting it.

3.

The World Social Forum is a world process. All the meetings that arc held as part
of this process have an international dimension.

4.

The alternatives proposed at the World Social Forum stand in opposition to a
process of capitalist globalisation commanded by the large multinational
corporations and by the governments and international institutions at the service
of those corporations' interests. They are designed to ensure that globalisation in
solidarity will prevail as a new stage in world history. This will respect universal
human rights, and those of all citizens - men and women - of all nations and the
environment and will rest on democratic international systems and institutions at
the service of social justice, equality and the sovereignty of peoples.

5.

The World Social Forum brings together and interlinks only organisations and
movements of civil society from all the countries in the world, but intends neither
to be a body representing world civil society nor to exclude from the debates it
promotes those in positions of political responsibility, mandated by their peoples.
who decide to enter into the commitments resulting from those debates.

6.

The meetings of the World Social Forum do not deliberate on behalf of the World
Social Forum as a body. No one. therefore, will be authorized, on behalf of any of
the editions of the Forum, to express positions claiming to be those of all its
participants. The participants in the Forum shall not be called on to lake decisions
as a body, whether by vote or acclamation, on declarations or proposals for action
that would commit all. or the majority, of them and that propose to be taken as
establishing positions of the Forum as a body.

7.

Nonetheless, organisations or groups of organisations that participate in the Forum's
meetings must be assured the right, during such meetings, to deliberate on
declarations or actions they may decide on. whether singly or in coordination with
other participants. The World Social Forum undertakes to circulate such decisions
widely by the means at its disposal, without directing, creating hierarchies, censuring

26

or restricting them, but as deliberations of the organisations or groups of
organisations that made the decisions.
8.

The World Social Forum is a plural, diversified, non-confcssional. non­
governmental and non-party context that, in a decentralized fashion, interrelates
organisations and movements engaged in concrete action at levels

— from the local to the international — to built another world. It thus docs not constitute
a locus of power to be disputed by the participants in its meetings, nor docs it
intend to constitute the only option for interrelation and action by the organisations
and movements that participate in it

9.

The World Social Forum asserts democracy as the avenue to resolving society's
problems politically Asa meeting place, it is open to pluralism and to the diversity
of activities and ways of engaging of the organisations and movements that decide
to participate in it. as well as the diversity of genders, races, ethnicities and
cultures.

10.

The World Social Forum is opposed to all authoritarian and reductionist views of
history and to the use of violence as a means of social control by the State It
upholds respect for Human Rights, for peaceful relations, in equality and solidarity,
among people, races, genders and peoples, and condemns all forms of domination
and all subjection of one person by another.

11.

The meetings of the World Social Forum are always open to all those who wish to
take part in them, except organisations that seek to take people's lives as a method
of political action and those organisations that exclude groups/ communities based
on ethnic, racial, religious or caste consideration from the democratic world.

12.

The WSF process in India must necessarily make space for all struggling sections
of society to come together and articulate their struggles and visions, individually
and collectively, against the neo- liberal economic agenda of the world and national
elite, which is breaking down the very fabric of the lives of ordinary people all
over the world and marginalizing the majority ofthc world people, keeping profits
as the main criteria of development rather than society and destroying the free­
doms and rights of all women, men, and children to live in peace, security, and
dignity. It must make space tor workers, peasants, indigenous peoples, dalits,
women, hawkers, minorities, immigrants, students, academicians, artisans, artists
and other members ofthc creative world, professionals, the media, and for local
businessmen and industrialists, as well as for parliamentarians, sympathetic bu­
reaucrats and other concerned sections from within and outside the state. Most
importantly, it must make space for all the 'sections’ of society that remain less
visible, marginalized, unrecognised, and oppressed.

13

In India today, all civil and political organisations/groups that arc organising around
people’s issues — economic, political, social, and cultural — are being profoundly
challenged by the religious and political intolerance that is raging in the country,
and increasingly across the world. There is the threat of growing communal fascism

27

and fundamentalism. The WSF India will strive to encourage a process that allows
all of those who arc combating communal fascism and fundamentalism to come
together, to hear and understand each other, to explore areas of common interest.
and also our differences, and to Icam from the experiences and struggles of people
here and in other countries.
14.

The WSF India process involves not only events but also different activities
across the country. These processes, in the spirit of the WSF. would be open,
inclusive and flexible and designed to build capabilities of local groups and
movements. The process should also be designed to seek and draw out peoples'
perceptions regarding the impact of nco-liberal economic policies and imperialism
on their daily lives. The language of dissent and resistance towards these will have
to be informed by local idioms and forms.

15.

As a forum for debate, the World Social Forum is a movement of ideas that
prompts reflection, and the maximum possible transparent circulation of the results
of that reflection, on the mechanisms and instruments of domination by capital.
on means and actions to resist and overcome that domination, and on the alternatives
that can be proposed to solve the problems of exclusion and inequality that the
process of capitalist globalisation currently prevalent is creating or aggravating.
internationally and within countries.

16.

Asa framework for the exchange of experiences, the World Social Forum encourages
understanding and mutual recognition among its participant organisations and
movements, and places special value on all that society is building to centre
economic activity and political action on meeting the needs of people and respecting
nature.

17.

As a context for interrelations, the World Social Forum seeks to strengthen and
create new national and international links among organisations and movements of
civil society, that - in both public and private life - will increase the capacity for
social resistance to the process of dehumanisation the world is undergoing and
reinforce the humanizing measures being taken by the action of these movements
and organisations.

1S.

The World Social Forum is a process that encourages its participant organisations
and movements to situate their actions as issues of world citizenship, and to
introduce onto the global agenda the change-inducing practices drat they arc
experimenting in building a new world.

28

Gtobalis|Boh.: and
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In this Series...
Globalisation :
What Does it Mean? Rs.20/.

Assault on
public Health

Rs.20Z-

Food Security

Rs.20Z-

Religion, Culture
and Communalism

Rs.40Z-

Woman

Rs.20Z-

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