PHA-Exchange> Extracts from book "Perspective on Global Development and Technology".

[PHM - Secretariat]

Dear Friends,

Greetings from the PHM Global Secretariat!

Here are the extracts from a recent book on Globalization which comments on the significance of PHM and should inspire us all to doing more to strengthen globalization from below.

Best wishes,

PHM Secretariat  team


People's Health Movement: An independent assessment - 

Some extracts from a recently published book 

"Perspective on Global Development and Technology". Edited by Richard L. Harris and Melinda J. Seid 

 

Globalization and Health in New Millennium

 

"Since 1980s, the shift in global health strategy that has accompanied the promotion of neo-liberal policies by the IMF and the World Bank has replaced the goal of providing comprehensive primary health care, reducing government budgets for health and other social services, downsizing the public health sector, privatizing hospitals and clinics, charging fees for health and other public services, eliminating or greatly reducing food subsidies; and freeing the prices of drugs and health services to that they are no longer within the reach of large sectors of the population (Devaraj 2000; Hillary 2001; Walt 2000). Many critical observes and activists (Devraj 2000; Khor 1995; Shrestha, Shrestha, and Maskey 2002; Walt 2000) have criticized the World Bank for this shift in strategy and for the adverse health effects of the neo-liberal policies this shift in global health strategy has caused. They argue that the Bank's promotion of neo-liberal policies has placed the burden of health care costs on the shoulders of the poor, drastically reduced public health services, turned over to private doctors and businesses most of the health services that used to be provided free or on a subsidized basis, and priced many medical interventions beyond the capability to pay of those who have the greatest need for these interventions..

 

The World Bank's market-oriented health policies have come under sever criticism from health activists in new People's Health Movement (PHM), who accuse the Bank of having contributed to the deterioration of health conditions around the world. They also charge that the World Bank has 'hijacked health' from the WHO (Devraj 2000), since the Bank now provides more funds for health-related programs than the WHO. The PHM is an international movement that has affiliates in five continents. It represents a primary example of what has been called "globalization from below', that is, the kind of global solidarity and collaboration that occurs when groups of people at the grassroots level around the world link up to protect their interests against the forces of globalization from above (Brecher, Costello and Smith 2000)..

 

The PHM emerged out of the People's Health Assembly (PHA) that brought health activists from some 92 countries together in Savar, Bangaldesh, in December 2000 (Mokhiber and Weissman 2000). This international assembly produced a People's Charter for Health (PHA 2000), which has since been translated into 35 languages. The Charter is aimed at combating the negative effects of globalization and at making health a fundamental human right that is respected by all national governments and intergovernmental organizations..

 

The PHM advocates comprehensive primary health care for all (as envisioned in the Alma Ata Declaration); calls for the radical transformation of the World Bank, the IMF, WTO, and the WHO to make them more responsive to poverty alleviation and promoting health for all; demands that the foreign debts of the developing countries be cancelled; calls on national governments to protect the health rights of their citizens; demands that transnational corporations (particularly those involved in health) be effectively regulated so that they do not exploit or harm people's health; opposes the privatization and commodification of health care; and calls for the establishment of people's organizations and movements top work at the global, national and community world order (PHA 2000). Representatives of the PHM met with the WHO Direct-General at the May 2001 World Health Assembly in Geneva and the PHM sent the largest civil society delegation to the May 2002 World Health Assembly (Chetley and Narayan 2002). It is engaged in organizing regional and country 'circles' to build awareness about and mobilize support for the movement around the world. The PHA Charter concludes that although governments are responsible for promoting health equality, people's organizations are required to force them to meet this responsibility (PHA 2000)..."

 

Trade Liberalization and the Privatization of Health Care:

 

"In the present context of increasing privatization and the promotion of neo-liberal policies at both global and the national levels by the IMF, World Bank and the WTO, national government responsibility for providing basic health care for all members of the population has been replaced by so-called selective primary health care, public-private partnerships, and the privatization of health services and health care facilities. As the essay by Narayan and Schuftan (2004) indicates, this shift in responsibility for providing health care is considered by many critics of globalization and the current trends in health to be a betrayal of the international commitment made in the late seventies to provide primary health care for all by the year 2000. This was the official commitment made by the most of the governments represented at the 1978 International Health Assembly held at Alma - Ata in the Central Asian republic of what was then the Union of Soviet Socialist Republics (PHA 2000:1)..."

 

The Health Effects of the Inequities Promoted by Globalization
 

"The PHM, as Narayan and Schuftan's (2004) essay explains, sees a direct relationship between existing health inequalities and globalization. The members of this global movement consider inequality, poverty, exploitation, violence and injustice as the root causes of ill health in the world today. As Narayan and Schuftan (2004) make clear in their discussion of the People's Charter for Health, achievement of the PHM's goal of "Health for All - Now!" requires 'challenging, the powerful economic interests that dominant the existing global order, opposing globalization in its existing iniquitous form, and drastically changing the political and economic priorities at all levels of the global system..."

 

Community Health Care, Grassroots Action, and Globalization from below
 

"Narayan and Schuftan's (2004) essay on the People's Health Movement (PHM) reveals the emphasis this new movement gives to community control of health care, grassroots action, and global action based on the use of international health advocacy networks. These are important elements in the movement's global campaign to combat the health inequalities associated with globalization and to make sure that universal access to comprehensive primary health care is provided everywhere in the world. This movement is engaged in what amounts to "globalization from below" as it builds support for its global Health for All - Now strategy, lobbies at the global level, and mobilizes a grassroots - based campaign to realize the vision and achieve the goals of the People's Charter for Health..

 

The Charter, which is the PHM's visionary statement of goals and its main tool for advocacy, calls for "a people-centered health sector that is democratic and accountable" (PHA 2000:9). The Charter calls on the people of the world to: (1) build and strengthen people's organizations as a basis for analysis and action; (2) promote, support and engage in actions that encourage people's involvement in decision-making in public services at all levels; (3) demand that people's organizations be represented in local, national and international for a that are relevant to health; and (4) support local initiatives towards participatory democracy through the establishment of people-centered solidarity networks across the world (PHA 2000:10). One of the primary principles of the Charter is the proposition that 'the participation of people and people's organizations is essential to the formulation, implementation and evaluation of all health and social policies and programs" (PHA 2000:4)..

 

McIntyre, Thomas, and Cleary conclude in their essay that "the growth in number, size and power of civil society organizations combined with the increased networking of these organizations across national boundaries" is having a 'countervailing effect' on the negative health impacts of globalization. They give the example of how civil society organizations in South Africa gained the support of civil society groups in the United States to pressure the US government into dropping its efforts to convince the South African government to change its policy relating to the importation of medicines so that it would not contravene the TRIPS agreement. They show how these groups in South Africa also teamed up with International groups such as Medecins Sans Frontieres and Health Action International to oppose the efforts of the transnational pharmaceutical corporations (with the support of their host governments) to pressure the South Africa government and governments of other developing countries (such as Thailand) into restricting their use of certain provisions in the TRIPS agreement that permit governments to obtain urgently needed patented medicines at reduced price..

 

The adverse effects of existing international trade agreements on health, human rights, and the environment have been subjected to increasing public criticism in recent years. As Labonte notes in his essay, these agreements have "become the focus for progressive social movements". The global networking and collaboration that have developed among these social movements, such as the PHM, represent a form of 'globalization from below" that is rising up to challenge the "globalization from above", imposed by the transnational corporations and their allies in the IMF, World Bank, WTO, the Group 8 governments (led by the US government), and certain large international non-governmental organizations that are closely associated with these forces.."

 

Alternatives to the Globalization of Health from above
 

"The People's Health Movement (PHM) is clear evidence that the existing linkages between globalization and health are contestable. In fact, most of the essays in this collection indicate that the adverse health effects of globalization are being challenged at the global, national, and local levels. The People's Health Movement and the People's Charter for Health provide a significant expression of alternatives "from below" to the present globalization, privatization and commercialization of health coming "from above". As Narayan and Schuftan (2004) state in their essay, this People's Charter for Health provides a vision of a better and healthier world, a call for radical action, a tool for advocacy for people's health, and a rallying point for building a global health movement based on international networks and coalition building...

 

The People's Charter for Health lays out a blue print for the transformation of the existing global order through democratization at all levels of the existing system and through what some people in the global social justice movement call "globalization from below" (Brecher, Costello, and Smith 2000). It is based on the fundamental, but radical, assumption that "to ensure health, people's basic needs for food, water, sanitation, housing, health services, education, employment and security must be met" in the present time frame (PHA 2000:1). In addition, it is based on the assumptions that global decision must be democratized and that people's organizations and organized grass roots action can bring about an "alternative vision of development - one that promotes human and environmental well-being" (PHA 2001:3). To achieve this vision, the PHM is pursuing the democratization of health decision and outcome at all levels...

 

According to Narayan and Schuftan, (2004) the Charter for People's Health calls upon national governments and global institutions to recognize health as a fundamental human right and as a social, economic and political exploitation, violence and injustice as the roots of ill-health and it makes clear that the achievement of universal access to primary health care requires challenging powerful economic interests; opposing privatization and globalization (in its present inequitable form); and drastically changing the prevailing political and economic priorities at all levels in the global order...

 

The Charter also makes it clear that the PHM wants the poor and marginalized (rarely heard) people's throughout the world to participate in health decision-making and develop their own local solutions to their health problems. The movement encourages people to hold local authorities, national governments and international organizations and corporations accountable for ensuring that the goal of Health for All is achieved now, not at some distant point in the future. However, even though the PHM firmly believes national governments have the primary responsibility for promoting an equitable approach to health and human rights, the movement knows that it will take pressure from people's organizations to force their governments to meet this responsibility. This statement reflects one of the most important strategic assumptions held by the PHM: that it will take organized grassroots action as well as concerted action at the global level to bring about the profound social changes that are needed to achieve the sweeping vision and radical goals of the movement.."

 

Reference: 

 

  1.. Devaraj, Ranjit 2000; Hillary 2001; Walt 2000. "World Bank's Health Policies Hurting Nations, say critics." Third World Network. Retrieved March 15, 2003 (http://www.twnside.org.sg/title/hurting.htm)
 

  2.. Hillary, John 2001,"The World Bank's Private Sector Review: Does the Private sector Development strategy Threaten Children's Right to health?" Save the Children Position Paper. Retrieved on March 15, 2oo3 (http://www.challengeglobalization.org/html/tools/WB_private_sector.pdf)
 

  3.. Walt, Gill 2000. "Globalization and health." Paper presented at the Medact Meeting, May 13, 2000. Retrieved Dec. 9, 2002 (http://phmovement.org/pubs/issuepapers/walt.thml)
 

  4.. Devraj 2000; Khor 1995; Shrestha, Shrestha, and Maskey 2002; Walt 2000
 

  5.. Khor, Martin 1995. "Experts Attack Shift in Global Health Strategy." Third World Network. Retrieved March 15, 2003 (http://wwwtwnside.org.sg/title/exp-ch.htm).
 

  6.. Shrestha, Mathura, Indira Shrestha and Manesh Maskey 2000. "New Paradigm of Globalization: Replacing the existing one of Unequal Relations among Peoples and Nations with a Humane Form." Paper prepared for the People's Health Assembly, Dec. 4-8, Savar, Bangladesh, Retrieved Dec. 9, 2002 (http://phmovement,org/pubs/issuepapers/shrestha1.html).
 

  7.. Brecher, Costello and Smith 2000. Globalization from below. Boston: South End Press
 

  8.. Mokhiber and Weissman 2000. "The people's Health." Retrieved march 16, 2003, 20033 (http://lists.essential.org/pipermail/corp-focus/2000/00052.html)
 

  9.. Chetley, Andrew and Narayan, Ravi 2002. "The People's Health Movement." Contact 176, (January - March 2002): 1-2
 

  10.. Narayan, Ravi and Schuftan, Claudio 2004. "The People's Health Movement: A People's  Campaign for "Health for All  - Now!". Perspectives on Global Development and Technology, Vol. 3, No. 1-2, 2004. PP 235 - 243

Source: Perspectives on Global Development and Technology, Vol. 3, No. 1-2, 2004.

The Subscription price of Vol. 3 (2004) is EUR 84.-(US$97.50) for individuals, EUR 169.- n(US$196.-) for institution, inclusive of postage and handling charges and online subscription. ISSN 1569-1500 (Print version). ISSN 1569-1497 (Online version)

 

Email address: cs at brill.nl (The Netherlands)

                        cs at brillusa.com (North America)



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