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PREAMBLE
•
End Corporate led Globallwdon
•
End war and occupaUan
•
Implement Comprehensive and sustainable Primary
We. the 700 delegates from 44 countries1, gathered at the
III International Forum for the Defence of the People's
Health at Mumbai on 14th and 15th of January 2004,
reaffirm the validity and relevance of the People's Charter
Health Care
for Health, the foundational document of the People’s
Confront the HIV/AlfJj epidemic with Primary Health
•
Health Movement, which describes increasing and serious
Care and Health Systems approach
threats to health in the early 21 st century.
•
Reverse
Environmental
damage
caused by
unsustainable development strategies
Since the Charter’s adoption in December 2000 at the
first People’s Health Assembly, at GK Savar, Bangladesh, the
End discrimination in the Right to Health
•
health of the world's poor has worsened and more threats
to people's health have emerged.
End corporate-led globalization
and
Corpor-Jtc-l^d globalization continues
environmental threats to health
to be a major threat to health. Since
Social,
political,
economic
identified as the basic causes of ill health
“==-■
and the inequitable distribution of
the People's Charter for Health was
adopted in 2000, the International
health within and between countries
Monetary Fund, the World Bank and
have increased.
the //orld Trade Organisation have
The III International Forum for the Defense
of the People's Health provided
opportunities to hear inspiring testimonies,
contJO*jed to advance the economic
inequitable distribution of
health of corporations at the expense
health within and between
of glot/al health.
countries have increased
from the world's poor and health activists:
The protection of intellectual property
(thro-j^h trade agreements such as the
•
Denouncing the denial of health to
Trade Related aspects of intellectual Property Rights.TRIPS)
their communities and their efforts to overcome this injustice.
•
and unfair trading practices (through the General
Threats to health from the unfair system of global trade
Agreement on Trade in Services. G/-TS) have caused
and the imperialist policies ofdeveloped countries including
enormous damage to peo-ple's health.
unjust wars and efforts to counter them
•
The tobacco industry offers a clear ex2rnple:Tobacco kills,
The Demands for acknowledgement ofhealth as a universal
yet transnational companies continue to target youth and
human right and the implementation of Comprehensive
marginalized communrties r/ith their •pbacco marketing
Primary Health Care as a strategy to achieve Health for All.
strategies. •
The Forum recognized the particular discrimination suffered
The epidemic of privatizatxx'S of v/ater, electricity, education
by many groups which makes achieving Health for All even
and health care, imposed by Structural Adjustment Packages
more difficult. These included women, people with disabilities,
(SAPs), has limited access to or remo'zed the foundation
sex workers, children living in difficult circumstances (including
upon which public hearth ib oujIL
street children), migrant workers, people with mental disorders,
Public-private partnerships, as promoted by World Bank,
Dalit people, Indigenous peoples in rich and poor countries,
and all those affected by wars, disasters and conflicts.
Global Funds and Intematjona/ health agencies including
WHO, have removed responsibility fo< health from the
The Forum demanded Health forAll, Now! and reiterated that
public sector essentially prr/atizjng health and treating it as
Another World in which health is a reality for All is necessary
a commodity rather than a human ri^C User fees have
and possible.
further decreased people’s access to hearth care services.
The Forum brought together all the concerns and
This Declaration;
experiences shared into a Declaration for action, entitled
"The Mumbai Declaration". This Declaration is an update
on the state of people’s health across the globe at the I
beginning of 2004 and calls on People’s Health Movement,
Calls for Action by Peopie'5 Health Movement and Civil
Society to;
•
Civil Society and Governments to evolve action in six key
areas to achieve the goal of Health for All Now!" dream.
'1
Argentina.
Camcnt
— C-.nudu,
■ ••
h'm’h'X AuMralia. Hangla«k-sh. Ik-lgiutn. Hmzil. CamlxKlia. C
;11„er.x>n.
Pressure the World 3ank and
Monetary Fund to ackr^pwdedge ther culpability in the
current health care cnsrs, especially
damage caused
by Structural Adjustn-ierC Programs:
C„|w. Ik.n„wfk. rn.a<l.,r r«-pt
r • Ucrmam.
..... . paki™'
The Mumhni Doclnmlion
International
.......... *.........
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........................................... -2
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!
I
Build the Campaign "NoTo Intellectual Property Rights"
•
Building the global campaign: "No to War, No to
■
m our traditional systems of medicine and our seeds,
WTO. Fight for People’s Health":
to resist the efforts of the WTO and translational
corporations to patent, own and trade in them:
Monitoring the impact of war, occupation, and
■
militarization through a global "Occupation Watch";
Demand the representation and active participation of
•
people's organisations, health workers, and farmers in
Targeting corporations which benefit from the war
■
in Iraq, invasions and military occupations and those
policy-making processes related to Access to Health
that enrich themselves (e.g. arms industry,
•
Expose, shame and stop government officials, academic
pharmaceutical and food companies) by fostering
institutions, and civil society organisations from accepting
ill-health through a "Boycott Bush" campaign;
money from the tobacco and other industries which
undermine public interest initiatives internationally and
Establish peace initiatives at various levels based on
■
justice and equality.
nationally.
Calls for Action by Governments
Calls for Action by Governments
Regulate the entry and behaviour of the corporate
•
and occupations
sector in the social services such as health, education,
transportation, etc., and ensure that public health
Refuse to take part in unjust and imperialist wars
■
■
Work for world peace as a key determinant of health.
concerns always take precedence over trade
Implement Comprehensive and
agreements and corporate profit;
Resist "TRIPS-plus" through bilateral or regional trade
•
Sustainable Primary Health Care
Since 2000, the Global Fund and other
agreements driven by the United
States government
and the
institutions it controls;
•
occupation and militarism
Ensure negotiations on "FreeTrade” '
have become ever more
treaties and the like are transparent
devastating threats to
and democratic and not conducted
people’s health.The
J violent imposition of
behind closed doors;
Resist pressure to privatise health
•
essential industries (health care,
electricity, water and education)
and renationalise these industries;
•
international health programmes of
Since 2000, war,
WHO. UNICEF and World Bank have
continued to promote selective and
vertical health programs which corrupt
and weaken Comprehensive Primary
Health Care as defined in the WHO
Alma Ata Declaration.
imperial will has led to
death, injury, and social
Health professionals educated in the
and environmental
developing world and migrating to the
destruction for untold
developed world represent a transfer
numbers of people.
of billions of dollars from South to
Sign, ratify and implement the
North. This unrequited training
on
investment further burdens health
Framework
Convention
Tobacco Control (FCTC);
systems already suffering from a precarious lack of human
resources. The brain drain" flows not only from developing
Since 2000, war, occupation and militarism have become
to developed countries, but also from the public to the
private sector.
ever more devastating threats to people’s health.The violent
Traditional and alternative systems of medicine are vibrant
imposition of imperial will has led to death, injury, and social
parts of Comprehensive Primary Health Care. Traditional
End War and Occupation
and environmental destruction for untold numbers of people.
Birth Attendants provide the first and often the only access
Actions in support of international law and pro-health and
to reproductive health in many areas of the world. These
against the war in Iraq; the occupation of Iraq and Palestine;,
knowledge and traditions should be validated and their
the construction of the Wall in Palestine are urgently needed
skills reinforced through continuing education, and support
to the revitalization of local health traditions.
This Declaration;
New areas, relevant to Primary Health Care, not adequately
Calls for Action by People's Health Movement and Civil 1
addressed in the Alma Ata Declaration need to be
Society to;
promoted in an integrated way. These include gender,
Strengthen the international anti-war movement through:
environment, disability, mental health and traditional systems
of health.
3 __
I Ih»
n> I
This Declaration;
orphaned by HIV/AIDS and women who are more
vulnerable take a heavy toll.
Calls for Action by People’s Health Movement and Civil
Society to;
•
WHO has recently become stronger in its technical support
Demand that universities and other training institutions
to HIV/AIDS and has made an official commitment to
incorporate Comprehensive Primary Health Care into
pursue its 3 X 5 goal (3 million persons with AIDS receiving
the curriculum for all health professionals updated to
Anti-retroviral Treatment (ARV) treatment by 2005)
address gender, environment, disability, mental health,
through strengthened health systems. Yet addressing the
traditional systems and other issues ;
•
HIV/AIDS epidemic requires contextual solutions.
Lobby for widespread adoption of Community Health
Workers and Traditional Birth Attendants as integral
•
members of multi-disciplinary Primary Health Care teams.
The 3x5 initiative focuses on treatment alone, ignoring
the complexity of the epidemic;
•
Calls for Action by Governments
•
High drug costs can lead to long-term dependency on
donors;
Develop national policies on traditional and alternative
♦
medical systems and include them
HIV/AIDS and civil society in planning,
Involve marginalised sectors in
implementation and evaluation
decision-making regarding policies
that affect them;
•
There is inadequate involvement of
persons living with and affected by
in national health programmes;
•
•
There is inadequate budgetary and
related commitments on improving
Strengthen health systems in the
health systems, particularly Primary
context of access, quality and
health Care to provide drugs and
equity;
general
•
We
are however, particularly concerned that;
Establish Comprehensive Primary
health
services
and
information in the long term.
Health Care services based on the
•
principles and strategies of Alma
There is inadequate attention to life
skill education, women's health
Ata outlined in this declaration
empowerment and utilization of
and related to local needs and
traditional systems of medicine.
updated to address gender,
While endorsing concern about the HIV/
environment, disability, mental
health, traditional systems and other issues.
AIDS epidemic, the need for Primary
Plealth Care oriented and Health Systems strengthening
Calls for Action by WHO
approaches to other communicable and non-communicable
To reaffirm the principles of Alma Ata and ensure that
diseases in an integrated way is urgently required.
comprehensive approaches that focus on primary health
care and strengthen health systems are the basis of all
WHO global and regional strategies.
This Declaration;
Calls for Action by People's Health Movement and Civil
Society to;
Confront the HIV/AIDS epidemic
.
The HIV/AIDS epidemic has continued to worsen since
Continue campaigns for the rights of people in poor
countries to receive ARV treatment delivered through
2000, especially in Africa and increasingly in Asia and
comprehensive PHC services.
elsewhere. Spreading along migration routes related to
globalization and to social and economic distress due to
•
Facilitate Public Interest Litigations to oppose changes
war, global trade and economic policies. HIV/AIDS is now
in Patent laws that is expected to escalate the ART
associated with the resurgence of other communicable
prices.
diseases of poverty, such as tuberculosis.
•
Make the links between the spread of HIV/AIDS and
Access to ARV treatment has increased the life expectancy
the underlying societal determinants such as poverty,
and quality of life of those who can afford it.The majority
war; displacement and participate in efforts to redress
of AIDS patients being impoverished are denied access to
these injustices
x
treatment in violation of the principles of the international
covenant on social, economic and cultural rights. Children
A
Fne Mumbai Daclarahon
■
-r-
Calls for Action by Governments
■
This Declaration;
Develop a comprehensive Primary Health Care
Calls for Action by People's Health Movement and Civil
oriented and health systems' strengthening approach
to address the HIV/AIDS epidemic
Society to:
through
•
interventions, including:
Monitor environmental damage caused by unsustainable
development strategies with specific focus on pesticides,
■
Peer education that includes sexual and reproductive
industrial and military toxic wastes, etc.;
health and rights information;
•
■
Oppose stigma and promote respect of and care
Link PHM with other organisations working for
environmental justice at the grassroots.
for people living with HIV/AIDS;
•
■
national and international levels. Join them in their
Increased access to basic services by people living
struggles and invite them to join in our struggle for the
with HIV/AIDS;
People’s Health,
■
Immediate availability of ARV drugs;
■
Support those affected by the epidemic through
Calls for Action by Governments
empowerment
To evolve a comprehensive
approach emphasizing Primary
Health care and health systems’
strengthening
approaches
including preventive information
and services and ARV treatment;
•
Work towards reduction of high
drug costs;
•
Pass legislation to ensure governments can hold
corporations accountable for environmental damages.
Cails to WHO
•
. •
Women’s right to health,
including sexual and repro
ductive health, is violated
not only by current socio
economic and political
structures but also by
religiousand
cultural fundamentalism/.
Trafficking: of women and |
girts is a majorpublic health f
End Discrimination in the
Right to Health
i he People’s Health Charter asserted
the right to health for all people-. We
reaffirm this by noting that the
marginalized groups listed below suffer
particular and on-going health
problems requiring urgent attention:
«
Around the world, many
Enhance involvement of oeople,
women lack access to basic heaitn
affected communities and civil
care, endangering them and their
society in its planning and
families. Women's right to heaitn,
initiatives through proactive dialogue.
including sexual and reproductive health, is violated not
only by current socio-economic and political structures
Reverse Environmental Destruction
but also by religious and cultural fundamentalism.
The People’s Charter for Health recognized that
Population control policies violated human rignts,
environment, livelihood, and people's health are
including the use of disincentives and such reprehensible
interconnected and environmental degradation is a major
practices as forced sterilization of women. Newer
threat to giooai health. Since 2000, continuing environmental
contraceptives and reproductive technologies often
destruction has had a hignly negative impact on health.
ignore hazards to women's health and other ethical
and moral issues;
Rivers around the world, like the Abra in the Philippines
and the Narmada in India, are in danger of being destroyed,
•
Trafficking of women and girls is a major public health
as are the lives and health of the people and communities
problem, little addressed by governments where the
who depend on these rivers.
trafficking is most rampant;
Toxins in pesticides, fertilizers, defoliants (such as Agent
•
Orange and those of the "War on Drugs" of Plan Colombia),
waste from US Military Bases (such as those in the
Philippines), dust from exploded depleted uranium
•
and exploration for petroleum; are all poisoning our
environment and represent a critical hazard to health.
The rights of sexual minorities and sex workers,
including access to health care, must be respected;
ordinance (such as that used in Iraq, Puerto Rico), and
medical and nuclear waste as well as from mining run-off ;
Sex-selective abortion is a misuse of technology that
discriminates against the girl child;
•
The health and human rights of persons with mental
disorders are currently ignored or inadequately
addressed throughouCthe world. There is an urgent
need to provide effective community based programs
for persons with mental illnesses.
5
11 |M Mllllil >dl I Itil Iril alii Hi
•
The unjust social systems like caste in India and ethnic
This Declaration;
discrimination in other parts of the world have created
Calls for Action by People's health Movement and
a health apartheid and human rights reality for the
Civil Society
socially marginalised;
•
•
Indigenous people in developed and developing
countries suffer health problems at a higher rate than
into their networks and facilitate their access to and
the general population of the country in which they
influence in mainstream discourse.
reside. As they are forced to follow the hegemonic
•
cultural and development paradigms, they are being
systems of medicine and access to basic resources;.
Calls for Action by Governments
The health and other human rights of persons with
•
Make concerted efforts to incorporate the needs of
i
health and development strategies and social policies
disabilities are currently ignored or inadequately
marginalized populations, the "unheard and unseen", in
addressed throughout the world;
•
in a Right's context
Migrant workers living and working in the developed
and developing world suffer poorer health than the
•
Ensure gender equity within the movement and within
their own networks and communities
deprived of traditional knowledge and traditional
•
Make concerted efforts to incorporate all the above
marginalized populations, the "unheard and unseen",
•
Ensure availability of disaggregated data on health status
general population surrounding them.Their basic human
and access to health services for different groups ( age,
rights are denied through lack of access to health,
sex, region, ethnicity etc.,) in the community to make
education, housing, etc.;
discrimination to the right to health more transparent
Children living in difficult circumstances, such as street
and enable actions to be taken.
children, AIDS orphans, children of war, etc. face
increasing discrimination. Corporate-led globalization
only increases the poverty in which they live and robs
them of a dignified future.
IN CONCLUSION
We, the members of the People’s Health--Movement and the participants of the III International Health Forum for the
Defense of People's Health commit ourselves to promoting the People's Charter for Health 2000 and the concerns and
calls for action of the Mumbai Declaration 2004.
•
We believe that an Another World is Possible;
•
A Healthy World is Possible;
•
Health for All Now! is Possible;
Join us - Endorse the People's Charter for Health 2000 - Endorse the Mumbai Declaration 2004
•
SIGN ON AND PROMOTE the People's Charter for Health
(visit http://www.phmovement.org/charter/index.html)
•
SUPPORT the Million Signature Campaign demanding Health for All, Now!
(visit www.TheMillionSignatureCampaign.org)
•
PROMOTE the Mumbai Declaration
i
People’s Health Movement
Global Secretariat,
C/0 CHC,
# 367, Jakkasandra 1st Main, 1st Block, Koramangala, Bangalore - 560 034.
Tei : +91-80-51280009
Fax :+91-80-25525372
Email : secretariat©phmovomoiUorQ
a
Wobslto : www.phmovornnnt.nra
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