The Peoples Health Movement: A People’s Campaign for HEALTH FOR ALL - NOW! · Community Health

The Peoples Health Movement: A People’s Campaign for HEALTH FOR ALL - NOW!

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Title: The Peoples Health Movement: A People’s Campaign
for HEALTH FOR ALL - NOW!
extracted text: CH-2-V

The Peoples Health Movement: A People’s Campaign
for HEALTH FOR ALL - NOW!
By Dr Ravi Narayan*
Background

In 1978, in Alma-Ata, the universal slogan Health
\for AH by the year 2000 was coined.
Simultaneously, the famous Alma Ata Declaration
was overwhelmingly approved, putting people and
communities at the center of health planning and
health care strategies and emphasizing the role of
community participation, appropriate technology
and inter-sectoral coordination. The Declaration
was endorsed by most of the governments of the
world and symbolized a significant paradigm shift
in the global understanding of Health and Health
care. (WHO - UNICEF, 1978).

Twenty five years later, after much policy rhetoric
§ some concerted but mostly ad-hoc action
§ quite a bit of misplaced euphoria
§ distortions brought about by the growing
role of the market economy that affected
health
§ a fair dose of governmental and
international health agencies’ amnesia and,
§ this Declaration remains unfulfilled and
mdstly forgotten, as the world comes to
terms with the new economic forces of
globalization, liberalization and privatization
which have made Health for All a receding
dream.
The People’s Health Assembly in Savar,
Bangladesh in December 2000, and the People’s
Health Movement that evolved from it were both a
civil society’s effort to counter this global laissez
faire and to challenge health policy makers around
the world with a Peoples Health Campaign for
Health for All-Now!

Lead Article
* The People’s Health Movement: A People’s
Campaign for HEALTH FOR ALL - NOW

Network News
* Access to Essential Medicines in the Western
Pacific Region in Penang
* US seeks further restrictions on Generic Medicines
for Developing Countries
* Dr Samlee Plianbangchang, the next Regional
Director of SEARO
* Assured Quality and Lowest Prices: What the Global
Fund requires for buying medicines
* Patents at any price or drugs for all?
* Life-sized board game on Access to ARVs
* People’s tribunal on access to ARVs
- Journal Scan
* New Research and Campaign news from physicians i
for a National Health Program
* Doctors call for National Health Insurance Journal
of the American Medical Association
. * New hope for WTO talks
* Zoellick vows to work for TRIPS deal, lays out US
conditions
* Mozambique to get AIDS drug plant
* Hand in hand with industry?
* CERS exposes misleading claims of healthcare
product company
* New TB superbug discovered in South Africa

b • Resources
* Good Practices in public-health-sensitive policy
measures and patent laws
* Health opportunities in development
* Poverty, health and development - health
cooperation papers
Other
* HAI Africa’s official website launched
* WHO-SEARO oublication notice

HAi^M
HA! News reports on
developments in national and interna
tional campaigns on health for all. This
newsletter highlights activities of
network contacts involved in improving
access to medicines, rational drug use
and poverty eradication.
HAI News is produced by
HAI Asia-Pacific
Coordinating Office

Editors
K.Bala, Passanna Gunasekera
Health Action International
(HAI) is a network of
individuals and NGOs involved
in health and pharmaceutical
issues.
, Website: http://www.haiap.org

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I

The People’s Health Assembly

The Global People’s Health Assembly brought together 1450
people from 75 countries, and resulted in an unusual five-day
event in which people shared concerns about the unfulfilled
Health for All challenge. The Assembly program included a
variety of interactive dialogue opportunities for all the health
professionals and activists who gathered for this significant
event. These events included:
«=> a rally for Health;
«4> meetings in which the testimonies on the health situation
from many parts of the world and struggles of people
were shared and commented upon by multidisciplinary
resource persons; (People’s Health Movement 2002)
«=i> parallel workshops to discuss a range of health and
health related challenges;
cultural programmes to symbolize the multi-cultural and V
multiethnic diversity of the people of the world;
o exhibitions and video/film shows; and
an abundance of dialogue, in small and big groups,
using formal and informal opportunities.

The People’s Health Assembly was preceded by a series of
pre-assembly events all over the world. The mobilization in India
was a significant example among many such initiatives. For
nearly nine months preceding the Assembly, there were
grassroots, local and regional initiatives of people’s health
enquiries and audits all over India; health songs and popular
theater; sub-districts and district level seminars; policy
dialogues and translations of national consensus booklets on
health into regional languages and campaigns to challenge
medical professionals and the health system to become more
Health for All oriented. Finally, over 2500 delegates converged
on Kolkata (Calcutta), mostly coming by five people’s health(|)
trains, and brought ideas and perspectives from seventeen
state conventions and 250 district conventions. In Kolkata, the
assembly endorsed the Indian People’s Health Charter after
the two days of conferences, parallel workshops, exhibitions,
two public rallies for health and cultural programmes. About
300 delegates from this Assembly then traveled to Bangladesh,
to attend the global Assembly. Similar preparatory initiatives,
though less intense, took place in Bangladesh, Nepal, Sri Lanka,
Cambodia, Philippines, Japan in Asia and other parts of the
world, including Latin America, Europe, Africa and Australia.
The Latin American region was another hotspot of intense
mobilization building on the long history of people’s health
campaigns and community health programmes in that region.
The People’s Charter for Health
Finally, at the end of a full year ot riiuonuciiioii ana five aays or
very intense and interactive work in Savar, a Global People’s
Charter for Health emerged which was endorsed by all the

participants (People’s Health Assembly 2000a).
This Charter has now become:
*=> an expression of our common concerns;
a vision for a better and healthier world;
•=> a call for more radical action;
«=> a tool for advocacy for people’s health; and
*=> a worldwide rallying manifesto for global health
movements, as well as for networking and
coalition building.

The significance of this Global People’s Charter is
multiple:
«=t> it endorses Health as a social/economic and
political issue and as a fundamental human
right;
it identifies inequality, poverty, illiteracy,
exploitation, violence and injustice as the roots
*
of ill-health;
it underlines the imperative that Health for All
means challenging powerful economic
interests, opposing globalization and drastically
changing political and economic priorities;
<> it tries to bring in new perspective and voices
from the poor and the marginalized (the rarely
heard) encouraging people to develop their own
local solutions; and
<=> it encourages people to hold accountable their
own local authorities, national governments,
international organizations and national and
transnational corporations.

The vision and the principles of the Charter, more
than any other document preceding it, extricates
Health from the myopic biomedical-techno
managerialist approach it has fostered in the last
two decades —with its vertical, selective magicbullets-approach to health— and centers it squarely
in the more comprehensive context of today’s global
socioeconomic-political-cultural-environmental
realities. However, the most significant gain of the
People’s Health Assembly and the Charter is that,
for the first time since Alma Ata, a Health For All
action-plan unambiguously endorses a call for action
that tackles the broader determinants of health.
These include:

° Health as human right;
■ Economic challenges for health;
■ Social and political challenges in health;
° Environmental challenges for health;
° Tackling war, violence, conflict and natural
disasters;
° Evolving a people-centered health sector;
a Encouraging people's participation for a
healthy world.
In a nutshell, the People’s Health Movement
promotes a wide range of approaches and initiatives
to combat the ill-effects of the triple assault by the
forces of globalization, liberalization and privatization
on health, health systems and health care initiatives.
In more detail, these include calls for a wide range
of action to tackle the determinants of health and
build health systems that are primary health care
focused and Health For All oriented.

Action Initiatives in the People’s Charter for Health
■=>

combating the negative impacts of Globalization as a worldwide economic and political ideology and
process;
significantly reforming the International Financial Institutions and the WTO to make them more
responsive to poverty alleviation and the Health for All Now Movement;

a forgiveness of the foreign debt of least developed countries and use of its equivalent for poverty
reduction, health and education activities;
<=>

greater checks and restraints of the freewheeling powers of transitional corporations, especially
pharmaceutical houses (and mechanisms to ensure their compliance);

<=>

greater and more equitable household food security.

ci>

some type of a Tobin tax that taxes runaway international financial transfers;

unconditionally supporting the emancipation of women and the respect of their full rights;

putting health higher in the development agenda of governments;
■=>

promoting the health (and other) rights of displaced people;
Contd.

Action Initiatives in the People’s Charter for Health (Contd.)

*=>

halting the process of privatization of public health facilities and working towards greater controls of
the already installed private health sector;
more equitable, just and empowered people’s participation in health and development matters;
a greater focus on poverty alleviation in national and international development plans;

«=>

greater and unconditional access of the poor to the health services and treatment regardless of their
ability to pay;

strengthening public institutions, political parties and trade unions involved, as we are, in the struggle
of the poor;

opposing restricted and dogmatic fundamentalist views of the development process; greater vigilance
and activism in matters of water and air pollution, the dumping of toxics, waste disposal, climate
changes and CO2 emissions, soil erosion and other attacks on the environment;
•=>

militant opposition to the unsustainable exploitation of natural resources and the destruction of forests;

protecting biodiversity and opposing biopiracy and the indiscriminate use of genetically modified
seeds;
*=>

holding violators of environmental crimes accountable;

•=>

systematically applying environmental assessments of development projects and people centered
environmental audits;

=0

opposing war and the current USA - led, blind ‘anti-terrorist’ campaigns;

•=>

categorically opposing the Israeli invasion of Palestinian towns (having, among other, a sizeable
negative impact on the health of the Palestinian people);

*=> the democratization of the UN bodies and especially of the Security Council;
*=>

getting more actively involved in actions addressing the silent epidemic of violence against women;
more prompt responses and preventive/rehabilitative measures in cases of natural disasters;

■=>

making a renewed call for a comprehensive, a more democratic People’s Health Care that is given
the resources needed and holding governments accountable in this task;
vehemently opposing the commoditization and privatization of health care (and the sale of public
facilities);

<=>

independent national drug policies focused around essential, generic drugs;
the transformation of WHO, making sure it remains accountable to civil society;
assuring WHO stays staunchly independent from corporate interests;

•=>

sustaining and promoting the defense of effective patient’s rights;
an expansion and incorporation into People’s Health Care of traditional systems of medicine;

«=>

changes in the training of health personnel to assure it covers the great issues of our time as
depicted in our People’s Charter for Health;

==>

public health-oriented (and not for-profit) health research worldwide;
strong people’s organizations and a global movement working on health issues;

«=>

more proactive countering of the media that are at the service of the globalization process;
people’s empowerment leading to their greater control of the health services they need and get;

creating the bases for a better analysis and better concerted actions by its members through greater
involvement of them in the PHM’s website and list-server (pha-exchange);
fostering a global solidarity network that can support and reach out to fellow members when facing
disasters, emergencies or acute repressive situations.
- People’s Charter for Health, 2000

As we enter the new millennium, this
comprehensive view of actions for Health, is
probably the most significant contribution of the
People’s Health Assembly and the evolving People’s
Health Movement. (Schuftan, 2002).

a
■

■

Significant Gains made by the People’s Health
Assembly and the Movement:

Noteworthy are the ongoing and growing
mobilization process at global level, the Assembly
as a historic first gathering and the movement that
is evolving. In more detail, the gains include the
following:
For the first time in decades, health and non
health networks have come together to work
on global solidarity in health. These networks
include the International People’s Health
Council (IPHC); Health Action International
(HAI); Consumers International (Cl); the Asian
Community Health Action Network (ACHAN);
the Third World Network (TWN); the Women’s
Global Network for Reproductive Rights
(WGNRR); Gonoshasthya Kendra (GK) and
the Dag Hammaeskjold Foundation (DHF). In
the last couple of years, new networks like the
Global Equity Gauge Alliance (GEGA) and the
Social Forum Network have linked with us.

Even at country level, in some regions, this is
beginning to happen. In India, for instance, this
national collective now includes the science
movements: the women’s movements; the
alliance of people’s movements; the health
networks and associations; some research
and policy networks and even some trade
unions. In Latin America, the pre PHA
networking has been further strengthened. In
Bangladesh and Italy new networks are
growing.

Another significant development has been the
evolving solidarity PHM has found for its various
collective documents at the global level
(People’s Health Assembly 2000b & c). These
have included themes such as:
Health in the era of globalization: from victims
to protagonists;
The political economy of the assault on
health;
Equity and Inequity Today, some
contributing social factors;

The medicalization of Health Care and the
challenge of Health for All;
The environmental crisis: threats to health
and ways forward;
Communication as if people mattered:
adapting health promotion and social action
to the global imbalances of the 21st century.

Taken together, these documents represent an
unprecedented, emerging, global consensus.

♦

❖

At country level also, such consensus
documents to support public education and
policy advocacy have been upcoming. In India,
for instance, five little booklets, now translated
into most Indian languages, are available on the
following five themes:
> What globalization means to people’s
health;
> Whatever happened to Health for All by the
year 2000;
> Making life worth living by meeting the
basic needs of all;
> A world where we matter: focus on health
care issues of women, children, street kids,
the disabled and the aged; and,
> Confronting the commercialization of
health care.
These booklets have been published by 18
national networks which form the national
coordination committee in India and represent
unprecedented consensus, the first of its kind
in five decades!

❖

The People’s Health Assembly itself was an
unusual international health meeting expressing
and symbolizing an alternative health and
development culture of dialogue and
celebration. An extract from the report of two
participants in the adjacent box describes this
alternative dialogue.

♦

Another significant gain has been the translation
of the People’s Charter for Health into nearly
forty languages worldwide. These include
Arabic, Bangla, Chinese, Danish, English,
Farsi, Finnish, Flemish, French, German,
Greek, Hindi, Indonesian, Italian, Japanese,
Kannada, Malayalam, Ndebele, Nepalese,
Philippine, Portuguese, Russian, Shona,
Sinhala, Spanish, Swahili, Swedish, Tamil,
Urdu, Ukrainian and now in the process of being
transtated in to Tonga, Lithuanian, Norwegian,
Welsh ,Thai, Cambodian, Vietnamese, Pastun,

------------------------------- ®-------------------------------

HAi^M
The People’s Health Assembly - An Alternative Culture of Dialogue
“TO GIVE THE VOICELESS A VOICE” was a
foremost goal of the People’s Health Assembly.
And indeed, the PHA had strong representation
from a wide spectrum of marginalized and un
derprivileged groups, many of whom had never
before had a chance to speak at a local council,
much less at an international forum. Speakers
from all corners of the earth represented every
one: from community health workers to traditional
birth attendants, from mother’s clubs to a col
lective of unemployed alcoholics (from Scotland),
from tribals to ethnic minorities, from migrant
workers to refugees, and from commercial sex

workers to activists with AIDS..........
The PHA was a marvelous forum for sharing ex
periences and exchanging ideas. Events were
enlivened by role plays, music, dancing and poster
sessions. Dramatic ‘testimonials’ of personal hard
ships - many of which brought tears to the eyes
- portrayed the setbacks that people were suffer
ing due to social injustice, unfair laws, and global
ization. To give more people a chance to speak
out, literally hundreds of relatively small concur
rent sessions were held, ranging from women’s
rights to genetic engineering and everything else
under the sun”.
(Werner and Sanders, 2000)

Dhari and Creole. An audio tape in English with
Braille titles is also available. All these have
been translated by volunteers, committed to
the People’s Health Movement. Audio Visual
aids including videos for public education,
exhibitions, slides, and other forms of
communication are coming up. The BBC Life
Series video on the Health Protesters was a
good example.
❖

The movement itself has evolved a
communications strategy which includes a
website (www.phmovementorq ); the e-list
server group for exchange and discussion
(phaexchange@kabissa.org); news briefs
(nine since January 2001) and a host of press
releases on a wide variety of themes and on
special events and crises.

0

Presentations of the Peoples Health Charter,
are constantly taking place in national, regional
and international fora which have included the
World Health Organization, the Global Forum
for Health Research (GFHR - Forum 5 & 6)
and the World Health Assembly.
> The development of the evolving dialogue
between the PHM and WHO is particularly
interesting.
> In April 2001, the very effective and assertive
in-house lobbying by a visiting PHM Activist
to a WHO research seminar resulted in the
formation of the WHO Civil Society Initiative
announced at the World Health Assembly,
in Mav 2001. Six PHM leaders were invited

to meet and dialogue with the Director
General.
> By May 2002, WHO CSI invited PHM to
present the People’s Charter for Health as a
Technical Briefing in the World Heath
Assembly. 35 PHM members participated.
> In May 2003, over 80 PHM delegates from
30 countries attended the Assembly; made
statements on Primary Health Care, TRIPS
and other issues and were invited to meet
the DG designate, who welcomed a greater
dialogue with PHM members at all levels so
that WHO could be in touch with the realities
of the lives of the poor and the marginalized.
The Assembly was preceded by a PHM
Geneva meeting for the 25th Alma Ata$
Anniversary, which was attended by some
WHO staff, including the PAHO Regional
Director.
> In July 2003, the new WHO-DG Dr. Lee, who
had met 6 PHM activists at the WHA 2003
wrote to the coordinator suggesting further
dialogue and critical collaboration. This has
been followed up through a series of informal
meetings.
> In January 2004, team of WHO staff will be
attending the PHM facilitated International
Health Forum in Mumbai, January 2004 to
listen to the voices of Civil Society.
These are all small, but incremental movements
towards a critical dialogue of PHM with WHO and
efforts to bring WHO that was derailed by the
Investing in health campaign’ of the mid 1990s to
its original commitment to Health for All, Now.

♦

o

❖
I

❖

I

In many countries of the world, emerging
country level PHM circles are beginning to
organize public meetings and campaigns which
include taking health to the streets as a Rights
issue. Discussions on the charter by
professional associations and public health
schools; and articles and editorials in medical/
health journals are also beginning to increase.

Policy dialogues and action research circles
on WHO/WHA; poverty and AIDS; women’s
access to heath; health research; access to
essential drugs; macroeconomics and health;
public-private partnerships; food and nutrition
security issues are beginning their work.
In 2003, PHM decided to focus on the Alma Ata
Anniversary as a theme for action initiatives. A
million signatures for Health for All campaign
was launched on the internet; an Alma Ata
Anniversary packet of reflections, press
releases and other documents were released
and published; Alma Ata Anniversary reflections
were held all over the world at national and state
levels and also facilitated in NGOI civil society
meetings and conferences.

In January 2004, PHM is facilitating an
International Health Forum in Defense of
People’s Health in Mumbai, which will take
stock of all the initiatives, campaigns and action
towards Health for All Now, all over the world
since the people’s health movement evolved
in Bangladesh in December 2003. This forum
will just precede the World Social Forum 2004
an alternative annual global gathering of
activists who wish to emphasize and celebrate
that Another World is possible. It will be an
important milestone to take stock of the road
travelled.

Conclusion
To conclude, the People’s Health Assembly and the
People’s Health Movement that has emerged from
it has been an unprecedented development in the
journey towards the “Health for All” goal. The
movement:

is a multi-regional, multi-cultural, and multi
disciplinary mobilization effort;
is bringing together the largest gathering of
activists and professionals, civil society
representatives and the peoples representatives
themselves,

«=> is evolving global instruments of concern and
action, and
is involved in solidarity with the health struggles
of people, especially the poor and the
marginalized affected by the current global
economic order.

Recognizing that we need a continous,
sustained, collective effort, the People’s Health
Movement process must remind us, through the
People’s Health Charter that a’ long march’ lies
ahead in the campaign for Health for All, Now.
References:
1.
WHO-UNICEF (1978),
Primary Health Care, Report of the International
Conference on Primary Health Care, 6-12 September,
1978, Alma Ata - USSR.
2.

People’s Health Movement (2002),
Voices of the Unheard - Testimonies from the People’s
Health Assembly, December 2000, GK Savar Bangladesh.

3.

People’s Health Assembly (2000a),
People’s Charter for Health, People’s Health Assembly,
8 December 2000, GK Savar - Bangladesh.

4.

Schuftan, Claudio (2002),
The People's Health Movement (PHM) in 2002: Still at
the fore front of the Struggle for "Health for All Now”; issue
paper-2 for World Health Assembly, May 2002, People’s
Health Movement

5.

People’s Health Assembly (2000b)
Discussion papers prepared by PHA Drafting group, PHA
Secretariat, GK Savar, Dhaka -Bangladesh

6.

People’s Health Assembly (2000c),
Health in the era of Globalization, From victims to
protagonists - A discussion paper by PGA Drafting
group, PHA Secretariat, GK Savar, Dhaka - angladesh.

7.

Narayan, Ravi (2000)
The People's Health Assembly - A People's Campaign
for Health forAll Now, Asian Exchange Vol. 16, NO. 2., P6-17, 2000

8.

Werner, David and Sanders, David (2000)
Liberation from What? A Critical reflection on the People’s
Health Assembly 2000, Asian Exchange, Vol. 16, No. 2.,
p 18-30, 2000

*The writer is the Coordinator of the People’s
Health Movement Secretariat (Global). For
further information, please visit:
www.phmovement.org, www. wsfindia.orq,
www.sochara.org

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