PHA-Exchange> Report from WSSD, Johannesburg, South Africa

[Lynette Martin]

Dear Colleagues,

Below follows a report on the Johannesburg World Summit for Sustainable Development (WSSD) some of which I was involved in and attended. The text of my report with the 3 Appendixes is below.

I'm happy to answer any questions although I cannot provide much more detail.

In solidarity,
David Sanders
Southern Africa Coordinator, International Peoples Health Council
Southern Africa focal point, Peoples Health Movement



REPORT FROM WSSD, JOHANNESBURG, SOUTH AFRICA

1)	Overview of WSSD politics

Early this year an unfortunate split occurred within the South African Civil Society/NGO Coordinating Group. The details are complex. Suffice it to say that a few organisations (Rural Development Support Network, Anti-Privatisation Forum etc.) broke away from the group organizing the Global Peoples forum (the official NGO "alternative" WSSD). The latter group contained SANGOCO (South African NGO Coalition), COSATU (the Trade Union Federation) and the South African Council of Churches.

This split undoubtedly contributed to the very last-minute, poor organization of the Global Peoples Forum.

The breakaway group formed the Social Movement Indaba which held its own event (see later) on 24/25 September.

2)	Very late in the process - in early July - some Civil Society health activists were contacted to help develop a draft Declaration on health before the WSSD. (This was belatedly to go into the NGO component of the Bali Declaration. Bali was where the final preparatory meeting for the WSSD took place.) A few of us put together a very hasty Declaration which went forward to the Global Peoples Forum organizers. It is attached to this as Appendix 1. We do not, however, know its fate.

The South African civil society grouping took responsibility for organizing the Health Caucus which met during the Global Peoples Forum, ending with Health Commissions on selected issues. (See 4 below.)

3)	Social Movement Indaba (S.M.I.)

This group, initially a breakaway from the Global Peoples Forum, organized a teach-in on the weekend of August 24/25 and then a large protest march on 31st August.

The teach-in, a two day affair, was held at the University of Witwatersrand and attracted a substantial number of students, young people and militant groups - including the Anti-Privatisation Forum and other groups mobilizing action against service cuts (water, electricity etc.). It was addressed by a wide range of activists including Martin Khor (3rd World Network), Vandana Shiva, Naomi Klein (author of No Logo), and many others. Generally, the input was good but the programme was too full, leaving no time for dialogue.

Mira Shiva spoke on the second day. Although her focus was not primarily on the PHM, she nevertheless mentioned it and we distributed about 100 photocopies of the Peoples Charter for Health which I had brought from Cape Town. Mira's invitation was apparently last minute and she therefore did not bring any PHM materials.

4)	The Global Peoples Forum was held in distant, not very comfortable surroundings. It was extremely poorly organized - both as a result of the earlier split and because very few resources were allocated to Civil Society. Also, the leadership - appointed by unknown mechanisms - were both uninspiring and appeared reformist, watering down many resolutions put forward by the sectoral commissions.

On 30th August the health sector met in two commissions, one of which I chaired together with Bupendra Makan, on behalf of S. African health NGOs. Although the meeting - which lasted 3-4 hours - was only attended by about 60 people, there was a good discussion around globalisation, environmental health and the state. I distributed many copies of the Peoples Charter for Health and disseminated the website address. There were many good interventions - especially by people representing the Brazilian municipal workers - on privatization of basic services - water etc. The Brazilians - some from Porto Alegre - were enthusiastic about PHM's participation in the next WSF. Ghassen, our Palestinian comrade from the UPMRC, participated: it was a pleasant surprise to see him.

We developed a consensus statement (Appendix 2) which went to the G.P.F. leadership for inclusion in the final NGO declaration. If and how it was included is not known at this stage. Certainly, it took some prodding to get them to accept it.

5)	On 31 August there were 2 marches from Alexandra (a poor black township) to Sandton where the official delegations were meeting. One, organized by the S.M.I. attracted many more marchers (between 7 and 15,000) than the G.P.F. march (ANC, South African Communist Party and some NGOs) of approximately 2-3,000. SANGOCO withdrew from the GPF march at the last minute because S.A. government ministers were intending to join this march and because it was addressed in Alexandra by President Thabo Mbeki..

The S.M.I. had had a smaller march on Saturday 24 August during the teach-in. This was brutally attacked by the police, despite the fact that it was a peaceful candlelight-march to the police station where a leader of the S. African Landless Peoples Movement was being held. Several marchers were injured when the police fired stun grenades and one marcher, a journalist, was arrested.

6)	Stakeholder Forum

On the weekend of 24/25 August, at the same time as the G.M.I. I was invited to a very large "talkshop" called "The Stakeholder Forum". It is a coalition of a number of organisations, spearheaded by what used to be called UNEP (United Nations Environment Programme). There were approximately 25 working groups, 4 or 5 on health. I intermittently attended the one on nutrition and food security. The idea was to assemble "stakeholders" to develop an action plan for all the 25 areas. The stakeholders included NGOs, academics, government, private sector etc. Our group was a pretty motley collection, mostly South African, although the most energetic and progressive was someone called Geoffrey Cannon who works as an adviser to the Brazilian Government in Brasilia. We managed to draft a statement which went forward to the Sandton gathering and also has been sent to WHO's nutrition division. (Appendix 3). What its fate will be is not clear.

7)	WHO Symposium

On 31 August WHO and the S. African Ministry of Heath held a one-day symposium on "Health and Sustainable Development". It was a high-level affair with Brundtland, David Nabarro, Andrew Cassels, Yasmin von Schirnding and others from WHO; Carol Bellamy and others from UNICEF; World Bank representatives; Jeffrey Sachs of the Commission on Macroeconomics and Health; USAID; several African Ministers of Health; WHO AFRO Region and many prominent South African health professionals. Approximately 150 people attended.

After too many lengthy and boring official statements, the meeting - all in plenary - consisted of several panel discussions. The panel topics were:
Investing in health: the evidence, the action
Children's health and the environment
Research, human health and sustainable development: innovative partnerships for action
Intersectoral action in practice: programmatic examples of health and sustainable development

I spoke on the first panel, which was chaired by David Nabarro. The subject was: "Investing in Health: the Evidence, the Action". There were several panelists, the most notable being Jeffrey Sachs. He was, as usual, eloquent and apparently radical, castigating the U.S. in particular, for its paltry development assistance allocations, particularly the derisory amounts given to the Global Fund to fight AIDS, TB and Malaria. I had read the CMH report and was able to question Sachs about some of the "silences" in the C.M.H. e.g. no mention of the increasingly unequal trade regime, WTO, GATT and TRIPS, and GATS; insufficient attention to investment in health systems and the fact that GAVI and the GFATM have made very small allocations to health system development; the failure to sufficiently address the brain drain from developing to industrialized countries. I was able to show a couple of slides of declining immunization coverage globally and use them to raise the issue of collapsing and weakened health systems as a result of disinvestments as part of neoliberal policies. A panelist representing USAID who is on the Board of the GFATM took note and said she would raise it at the Board meetings! Finally, there was a lot of support from Africans in the audience for the suggestion I made that the rich countries (U.K., U.S. etc.) reimburse developing countries for the training costs of health professionals who emigrate to "the North". It is estimated, for example, that the USA with 130,000 foreign-trained physicians has saved US$26 bn. on training costs! Perhaps this is a campaign that the PHM should consider taking up?

In summary then, the WSSD was mostly a failure. The final declaration by Governments was very weak and there were no concrete commitments or time frames. The only positive outcome of the Summit, in my view, was the fact that more progressive NGOs were able to highlight through their actions and publicity stunts, that the world is facing a crisis and that unless unhealthy and destructive globalisation is changed, we and the planet are doomed. And, perhaps most importantly, the message that came through, is that globalisation is CAPITALIST globalisation and corporations and big governments are responsible and that many developing country governments are colluding in this.

I hope that this summary is useful for those who are interested. Others - such as Mira, Ghassen and Niclas Hallstrom from Dag Hammerskjold Foundation - may wish to add or subtract from this!


APPENDIX 1

WSSD Global Forum: Health Commissions
30th Aug 2002



Feedback to the Drafting Committee on the discussions on:

a)	The Role of the State 
b)	Water, Sanitation and Primary Health Care in the context of Globalisation


Situational analysis
·	Debt and globalisation are impacting negatively on the distribution of all resources, including environment and health, through their destruction and privatization. 
·	Environmental degradation is increasing the burden of ill health
·	Lack of knowledge about environment and health and hygiene are sorely lacking amongst many citizens, especially children.
·	Environmental services are a basic right which every citizen should enjoy
·	Privatisation of services, including through public private partnerships, has been a very negative experience for many poor people, especially women and children, in countries as diverse as the UK and Argentina
·	War and military occupation both severely restrict access to health and basic services, and conflict and psychological stress are also increasingly a result of struggles for access to these services  


Priority issues
·	Globalisation is driving inequity through privatisation of all public services (water, sanitation, health, and other public services)
·	Public Private Partnerships may reduce government deficits, but are impacting negatively on the health of the poor, and are also affecting the general population through spread of communicable diseases
·	Local involvement and public-public partnerships for provision and governance of basic services should be prioritised: positive lessons can be learnt from Brazil  


Specific recommendations
·	Scrapping of debt is a prerequisite for health improvement in poor countries
·	The negative effects of privatisation of public services must be exposed to both communities and governments through research and advocacy  
·	Governments must be rendered accountable through evidence based advocacy and community mobilization and must assume responsibility for provision of basic services through funded partnerships with local communities
·	Communities need to have control over the provision of health and other social services and play a role in their monitoring
·	The importance of the relationship between environment and health and hygiene needs to be integrated into learning programmes at all levels. 
·	Learning and advocacy should be promoted at global level through interchange between countries, especially South to South
·	Powerful governments must be called to account for continuing military occupation and fuelling of conflict which impact mainly on innocent civilians


Conclusion 
·	Unfettered globalisation threatens the planets environment and population health. Urgent steps must be taken to prevent the spread of re-emerging diseases which will affect us all.



APPENDIX 2

NASREC HEALTH DECLARATION
C. HEALTH

1.	Globalisation has fuelled impoverishment, ill health and marginalisation of the world's poor and in its wake many of the human development gains of  developing countries have been reversed. The powers of international monetary and trade institutions that drive the globalisation agenda and supersede policies of national governments, such as the WTO, IMF and World Bank need to be kept in line with human rights and social development goals. Particular agreements such as TRIPS pose a dire threat to the health of millions of people by blocking access to life-saving drugs for HIV/AIDS/STIs/TB. Declining health status under structural adjustment programmes provide ample evidence of the cost to humanity as national and government capabilities have been eroded. Minimum standards of health and health care are public goods and inalienable human rights for which the state and democratically accountable governments have a responsibility to provide. 

2.	Poverty, unemployment, hunger and ill health constitute a vicious cycle. The greatest challenge for breaking this cycle is in the very limited resources available to developing countries exacerbated by the burden of servicing debt. 
Real poverty alleviation requires cancellation of this debt by all institutions, such as the IMF, World Bank and other creditor countries, coupled with a commitment from beneficiary governments to channel these savings toward social, health, and educational services. 

3.	The Primary Health Care (PHC) Approach as encapsulated by the Alma Ata declaration of 1978 needs to be reaffirmed as the set of guiding principles for revitalising the health systems of developing countries. This includes the provision of accessible and affordable basic services essential for good health including clinical care, water, sanitation, housing, energy and education. 

4.	Health services must be strengthened through new investments in infrastructure, adequate supplies and resources, including appropriate support of health personnel. Formal agreements for compensation are required to limit the active recruitment of health personnel from developing countries and to offset the costs of training personnel who have and continue to migrate to developed countries. 

5.	A focus on equity is required in the development of all health programmes and interventions. Marginalised and disempowered groups should be targeted for priority in the policies and plans of international and national initiatives to improve health, including: women and children, people with disabilities, and indigenous peoples. 

6.	Women and girls bear a disproportionate burden of poverty and ill health as a result of entrenched gender bias and driven by commercial interests. Improving women's health status requires the implementation of programmes marked by an integrated approach and intersectoral collaboration including attention to economic empowerment, and addressing the gender inequities that spur the current unacceptable levels of violence against women.

7.	International efforts to support greater funding for and implementation of HIV/AIDS/STIs/TB interventions need to incorporate ways of strengthening health systems, ensuring sustainability and promoting equity. International strategies must avoid vertical quick-fix solutions and include attention to prevention, reduction in transmission, care and treatment of all HIV positive people 

8.	Children's health and particularly the welfare of orphans needs urgent attention and must include social grants, free access to education, health care and other avenues of socio-economic development. Civil society should be supported in its role to ensure the welfare of children infected and affected by the AIDS disaster.

9.	Adoption of adequately resourced and comprehensive programmes must be fast tracked to control communicable diseases such as measles, malaria, intestinal infections, HIV/AIDS and acute respiratory infections, which are leading causes of death in children.

10.	Health, reproductive and human rights should be provided for people with disabilities including access to appropriate resources and services, implementation of anti-bias programmes to address stigmatisation and legislation to support creation of employment opportunities and workplace equity.

11.	The governments of the world must take cognisance of the incidence and impact of mental health problems on sustainable development and allocate the resources needed for proper research into, treatment of and care for those suffering mental ill health. We further demand that all governments of the world make every effort to remove the root causes that impact on mental ill health including dire poverty and underdevelopment, famine, war and political instability.

12. The effective role of civil society in health and development must be enhanced through support with resources and investment. Community involvement in health planning, monitoring and evaluation can be optimised with the development of critical indicators for monitoring and evaluation.  The attainment of health security is and will continue to be the most significant benchmark of human progress.



APPENDIX 3

The Indaba Declaration
on Food, Nutrition, Health and Sustainable Development


We from Africa, Asia, the Middle East, Latin America, Europe and North America, from government, industry, academia, charitable foundations, the health professions, and civil society, met as participants at the Implementation Conference organised by the Stakeholders' Forum for Our Common Future at the Indaba Centre, Sandton, South Africa, on the occasion of the World Summit on Sustainable Development in August 2002, declare and agree as follows.


In the Zulu language 'Indaba' means 'meeting together for a common purpose, to agree on action'. This is what we have done. 


THE BASICS

·	Good health is a vital input to, and outcome of, sustainable development. 

·	Good health can be achieved only by addressing the underlying and basic causes of disease. 

·	The modifiable causes of health and disease are environmental. 

·	The nature and quality of food systems, and therefore of diet and nutrition, are fundamental determinants of human health and welfare, and that of the whole living and natural world.


THE ISSUES

Levels of environmentally determined diseases now amount to a global emergency, projected to become an irretrievable catastrophe.

The triple burden now borne by almost all middle- and low-income countries of: nutritional deficiencies, infectious diseases including HIV-AIDS, malaria and tuberculosis, and chronic diseases including cancer, heart disease and stroke, and often also of violence, is too heavy for any country to bear. In particular:

·	Nutritional deficiencies and infectious diseases persist throughout the world.

·	The effect of HIV-AIDS most of all in sub-Saharan Africa is catastrophic.

·	Rates of many chronic diseases in middle- and low-income countries are soaring.

·	Cancer, heart disease and stroke are now the leading causes of premature death in almost all countries.

·	Projections show a vast increase of chronic diseases, including obesity and diabetes in early life
 
·	On a population basis, no country has the resources to treat chronic diseases. 

·	In general, current political and economic policies are increasing the global burden of disease.


THE CAUSES

A key immediate cause of all types of disease is grossly inadequate or inappropriate food and nutrition, including food insecurity, and for chronic diseases, use of tobacco and physical inactivity. 

The underlying and basic causes of disease are social, economic and political. These include inadequate maternal and childcare, poor breast-feeding and weaning practices, insufficient health services; lack of education and information; inadequate sanitation, polluted water; poverty, inequality, injustice; personal, communal and national debt; unemployment, dangerous environments, precipitate urbanisation; unsustainable agriculture, land degradation; poor governance, expropriation, dislocation; the effects of colonialism, unfair terms of trade, subsidy of industry in high-income countries; destruction of indigenous and traditional food systems and culture; commodity speculation, unregulated markets, aggressive promotion of degraded, cheapened and energy-dense food and drink; the use of food aid and trade as an instrument of power; and persecution, terror and war.  


THE APPROACHES

On a population basis, the only rational approach to all types of disease is prevention, and most of all the protection and creation of healthy environments, at household, community, municipal, state, national and global levels.

This approach must include the protection, development and creation of food systems that are appropriate, sustainable and dynamic, designed to preserve, strengthen and improve the human and also the living and natural world. 

Information and education, including product labelling, are necessary but insufficient in prevention of disease and promotion of health, and by themselves do not work.

Successful and accepted public policies for example concerning transport, energy, firearms, tobacco, alcohol and water, include legal, regulatory and fiscal instruments designed to balance the interests of civil society with those of industry and government.
The protection and creation of healthy food systems, integral to healthy environments and to human health, also requires the use of law, regulation, and pricing policy, as well as integrated multi-sectoral and multi-disciplinary actions with all stakeholders as partners
 
THE ACHIEVEMENTS

We acknowledge Principle One of the Rio Declaration on Environment and Development, which states 'human beings are at the centre of concerns for sustainable development. They are entitled to a healthy and productive life in harmony with nature'. 

We note that the agenda of the World Summit on Sustainable Development rightly indicates that the control and prevention of all types of disease requires protection or change of environments to keep or make them healthy.

We accept existing frameworks of understanding of causation of health and disease, such as the UNICEF conceptual framework on malnutrition.

We endorse the policy on infant and young child nutrition now adopted by WHO and all relevant UN agencies, which includes the evidence-based agreement that the optimal duration of exclusive breast-feeding is six months. 

We support the WHO Global Strategy on Diet, Physical Activity and Health, and the draft WHO/FAO report on which it is based. We endorse the first principles of the strategy, including stakeholder involvement, advocacy designed to make policy action plans succeed, a life-course approach to health, and emphasis on middle- and low-income countries. We support many of the actions recommended in the draft report, in particular those that address the underlying and basic causes of disease. 

We applaud the decision of the International Union of Nutritional Sciences to set up a special task force on 'eco-nutrition', meaning that nutrition must be concerned with planetary as well as personal and population health, and the decision of the organisers of the next World Congress on Nutrition to be held in Durban in 2005, to include nutrition and the environment as a key theme.  


THE ACTIONS

Many actions can now be taken that will have the effect of controlling and preventing all types of disease. 

We, the signatories to this document, have the capacity to act as follows. Inspired by the Indaba process, we pledge:

·	To support the basic philosophy of the WHO global strategy and the joint FAO/WHO consultation document on diet, nutrition and the prevention of chronic diseases, and to advocate its implementation at all levels including civil society, national governments, and international bodies. 

·	To disseminate this Declaration on relevant websites and journals, in meetings with relevant UN executives and national governments, professional bodies and NGOs, and to recommend that its themes and conclusions be given high priority at further international meetings involving the UN system and nation states. 

·	To use our professional and national networks, and the Stakeholder Forum network, to advocate and disseminate the WHO global food and nutrition strategy. 

·	To advocate that the strategy be amplified, become holistic, and so include all forms of malnutrition. It therefore should also include nutritional deficiency and infectious diseases as well as chronic diseases, and emphasise the underlying and fundamental causes of health and disease, so as to be fully relevant in middle- and low-income countries, where nutritional deficiency and chronic diseases including obesity co-exist at all levels, even in the same household. 

Signed

Benjamin Alli	International Labour Office		Switzerland
Gordon Baker	Stakeholders Forum			UK
Dolline Busalo	Helpage				Kenya
Geoffrey Cannon	World Health Policy Forum		Brazil
Larry Casazza	World Vision			USA
MK Cham		World Health Organization		Switzerland
Yvonne Clemen	Wellness InfoNet			South Africa
Elizabeth Danielyan	Women for Health			Armenia
Farida Dollie	Human Rights                                          South Africa
Timothy Evans	Rockefeller Foundation		USA
Lars Friberg	Stakeholders Forum			Sweden
Christiaan Geldenhuys  Sweetspot			South Africa
John Goss	Cinnabar Global Circle		South Africa
Minu Hemmati	Stakeholders Forum			London
Johann Jerling	Nutrition Society			South Africa
George Kararach	UNICEF		 	                Zimbabwe
George de Klerk	Department of Health		South Africa
Estelle de Klerk	Department of Health		South Africa
Salome Kruger	Potchefstroom University		South Africa
Lam Kok Liang	Consultant			Malaysia
Philip Makhumula-Nkhoma	University of Malawi		Malawi
Paul Rheeder	University of Pretoria		South Africa
David Sanders	University of the Western Cape	South Africa
Louise Sarch	National Heart Forum		UK
Andrew Seiter	Novartis			                Switzerland
Tanay Sidki Uyar	Kados				Turkey
Marthinette Slabber	University of the Free State		South Africa
Louise Smith	Country Women of the World	                South Africa
Peter Smith	Slow Food Movement		South Africa
Nelia Steyn              Medical Research Council		South Africa 
Liz Thebe		Massive Effort			South Africa
Pamela Thole	Zamseed			                Zambia
Anne Till		Anne Till Associates			South Africa
George du Toit	Society for Obesity			South Africa
Jantjie Tumi	Uthingo Management		South Africa
Hester H Vorster	Potchefstroom University		South Africa
Jeroen Warner	Wageningen University		Netherlands

Sandton, South Africa
August 2002

 
Notes

Stakeholders. The stakeholders in this process include civil society, the health professions, charitable foundations, academia, industry, government, and their representative and accountable organisations.   

Food systems. This concept is holistic. Food systems include the whole process of production, manufacture, distribution, sale and consumption of food and drink, and also take account of climate, terrain, history, tradition and culture. Integrated and indefinitely sustainable food systems are the keystone of human health, and also a foundation for the independence of nations and the health of the whole living and natural world. 

Chronic diseases. These are non-communicable diseases, either debilitating, disabling, or deadly. They affect all systems of the body. They include oral diseases including dental caries, gut disorders and diseases, obesity, diabetes, cardiovascular diseases (including high blood pressure, stroke and coronary heart disease), osteoporosis, and cancer. Different chronic diseases have common causes. Chronic diseases are now the chief causes of premature disability and death in almost all countries in the world. The chief immediate causes of chronic diseases are use of tobacco, grossly imbalanced food and nutrition and physical inactivity. 

[not to be printed: includes corrections 3.9 John Goss]




Prof David Sanders/Lynette Martin
School of Public Health
University of the Western Cape
Private Bag X17
Bellville, 7535
Cape, South Africa

Tel: 27-21-959 2132/2402
Fax: 27-21-959 2872
Cell: 082 202 3316