PHA-Exchange> some late thoughts : Bangkok Charter

Sun Jul 10 00:38:08 PDT 2005

Dear all,

Some additional points about the Bangkok charter for consideration by Alison in NZ.  I am not mentioning the points others have made with which I agree. 

1) Ottawa charter already introduced the idea of health as a resource above (and instead of) Health as a Human Right.  This utilitarian concept has been reinforced over past decades, esp. Sachs school in which health is an input for capitalist production. Invest in health for growth. Health as "capital". PHM would surely reject both. Health as a Human Right is an absolute value needing no justification in terms of its contribution to productivity/growth. (There is a certain amount of humbug in the "health as a resource for society" plea. Keeping slaves or workers in appalling conditions did not and does not always hinder profits. They were and are extremely cheap. Early deaths and untreated disease matter little, there are plenty more to exploit. And keeping whole communities on their knees allows the rich and powerful to plunder in relative peace).

2) Reinforce Ronald's point about neutral use of term globalization and assumption that it is inevitable. The globalization that is being referred to is a neoliberal, capitalist, corporate driven, neocolonial project. There are powerful interests behind it. These are resisted because by and large they harm the interests of popular majorities. This impossibly dishonest "neutral" language (langue de bois) serves to disguise root causes, major actors and interests - and conflicts between these. Perhaps PHM would like to have the term internationalism in the charter: the internationalization of rights and social justice. Nothing imposed from above (the glob)! But support and solidarity between peoples, communities and regions. The draft charter talks about an "increasingly interdependent world". Again, glib and dishonest. Through corporate globalization", fatal dependencies are deepened through the age-old patriarchal game of dominance and submission.  

3) "Weakened government control over a growing number of health determinants" 3rd section of charter. The myth of the weak state is perpetuated. It is only weak today in terms of its responsibilities to the people. The state is still extremely powerful and used to the full by TNCs. If it were not, we would never have seen the aggression on Iraq and the subsequent colonial takeover of the entire economy of a nation at the speed of lightening.          

4) "Central importance of health for poverty reduction" (3rd section). The reversal of public health history and logic. Health is not central for poverty reduction. It plays a serious exacerbating role in existing conditions of poverty which are determined by macroeconomic factors way beyond the control of communities and even nations. 

5) On our partners for health. Let us once and for all talk about people and not stakeholders. This language of financial investment again reinforces the idea that life on earth exists to serve capitalist production. As for active participation (2nd section), it is almost a heresy but I'll say it anyway " Why the private sector". Why not the public sector?  Why not people's movements and people's representatives?  Trade unions should be there up front. Social justice political parties and movements. Let us deconstruct these terms: the private sector means 3000 Chief Executive Officers of the world's most powerful economic entities (TNCs). The public sector means not only all public sector workers providing services but all recipients - millions and billions of really existing people! 

6) The private sector is not a partner for global or national public health policy. Partners share goals. We need various interactions with the private sector who like any other actors in society are called on to provide services for the general public good. Example: Companies manufacturing plumbing equipment are not partners in formulating policy to achieve the right to water! TNC influence in public policy making is illegitimate.  Individual people employed in the private sector (or those owning vast parts of it) have the same right of influence in health matters - NO more No less - than any other citizen employed anywhere else.  Furthermore, if they have a financial material interest in a health  matter, they should be excluded from discussions and policy formulation for reasons of conflict of interest. (So I agree with others about removing entirely paragraph on corporate practices and the need for partnerships). 

7) Political leadership etc (4th section).  These are emphatically NOT the key ingredients of success. Many strong leaders do all the wrong things with great force and with disastrous effects on people's health.  It is the people's political power which is the key ingredient (and absent from this document).

8) "One world" myth behind this charter and much "new public health" talk today.  "There is no us and them?"  This is empty, facile and misleading. It is just like the "AIDS knows no boundaries" song. Africa and Asia have epidemics which are incomparable to those affecting the rich countries (25% and 0.1%). "Us and them" has never been more stark as inequalities accelerate. (Ratio of richest to poorest 3:1 in 1900, 10:1 1960 and more than 82 :1 in 1990s) This is not to deny that an ever larger group of people (North and South) join the ranks of the excluded in both rich and poor countries every day and that very soon (now?) the excluded will revolt. 

Frankly, PHM might wish to start again and not bother tinkering with this deeply flawed document. Certainly I cannot see PHM being able to endorse many sections of it. But comment we must, I agree. 

Look forward to discussions, best to all, Alison

-----Original Message-----
From: pha-exchange-bounces at lists.kabissa.org [mailto:pha-exchange-bounces at lists.kabissa.org] On Behalf Of Kumanan Rasanathan
Sent: 08 July 2005 03:35
To: 'Ronald Labonte'; healthwrights at igc.org; pha-exchange at lists.kabissa.org
Cc: sandersdav at yahoo.com.au; 'Jason Weston'; 'Jim Hunter'
Subject: Possible SPAM detected::PHA-Exchange> Re: Bangkok Charter - Action Needed!

Dear Ronald and everyone

Thanks for all your responses to our initial email about the Charter,

and the suggestions for changes. I too am interested in what people

think as to whether changing the Charter is an important enterprise. Of

course, documents such as these can be fairly ineffectual.

However, we are particularly concerned about how this Charter could be

used as a roll-back position by cynical multinationals claiming they are

"health promoting in line with the Bangkok Charter" despite ignoring

other international covenants. 

Alison will co-ordinate the response from New Zealand. However, we are

particularly concerned about the apparent lack of representation from

the developing world in this document. As such, we thought the PHM could

be a strong vehicle to partially remedy this. 

I am leaving for Cuenca today and will be there on Sunday. I will be

attending the IPHU and am happy to help co-ordinate a response from

there. However, I am sure (in fact I know!) there are far more able and

experienced people in the PHM ranks. I would welcome comment on the best

way to do this keeping in mind the July 14 deadline.

I look forward to further discussions and moreover action in Cuenca.

Suerte

Kumanan

-----Original Message-----

From: Ronald Labonte [mailto:rlabonte at uottawa.ca] 

Sent: Thursday, 7 July 2005 12:48 a.m.

To: healthwrights at igc.org; pha-exchange at lists.kabissa.org; 'Kumanan

Rasanathan'

Cc: 'Claudio'; 'Mira Shiva'; 'Jason Weston'; 'Jim Hunter';

sandersdav at yahoo.com.au

Subject: RE: PHA-Exchange> Bangkok Charter - Action Needed!

Importance: High

Hello all.  David forwarded this exchange to me.  

I'm a little less incensed about the Bangkok Charter than others might

be.

Perhaps that's because I have grown cynical of such Charters and do not

believe they accomplish much. Human rights covenants could offer much

more,

and even there they require mobilization and civil society agitation to

be

useful tools for social change.  So I would first question whether

word-smithing the Bangkok Charter is an important political activity.

I'm also not sanguine about actually changing the tone of the document

very

much at this late time, which factors into my comments above.

However, that does not preclude the PHM from going on record with a

statement about what the Charter should actually contain.  

For me, the issue is less about whether or not globalization is good/bad

or

should be made healthier/unhealthier.  Treating the concept neutrally is

not

a bad strategy if one then wants to critique certain elements of it more

harshly.

So, for the critique:

Under the section, 'Health promotion in a globalizing world' I would add

something like:  'This commitment is evidenced in human rights treaties

and

covenants, multilateral environmental agreements and specific health

agreements such as the Framework Convention on Tobacco Control.'  I'm

not

sure of how to word what would follow, but it would need to emphasize

the

importance of governments to honour these commitments.  

Under the section, 'Make globalization health friendly,' I think

specific

reference to the right to health (Article 12, ICESCR) would be useful,

and

something that re-committed governments to this right (and to such

related

rights as the right to food, to water, etc.) and the fact that such

rights

are superordinate to all other multilateral agreements, including trade

agreements.  Best to draft this with a human rights expert?  We might

also

want to support Paul Hunt's call for creation of a 'right to health

impact

assessment methodology' for trade agreements.  This section is also

where a

strong statement on the need to affirm the rights of indigenous peoples

to

food security, land, traditional knowledge, etc. could be made.

(Current

language on 'cultural diversity' seems a bit weak.)

Other well-known policy options for making globalization health

friendlier

include:

Reform of trade agreements to discriminate positively in favour of

economic

development of low- and middle-income countries (the principle of

non-reciprocity eliminated by the WTO but not regaining some policy

favour).

Removal of economic conditionalities from development assistance or

loans/grants from the international financial institutions and other

development banks.

Reform financial markets and international taxation systems to ensure

equitable cost-sharing of public programs and infrastructures amongst

all

citizens and corporations.

I'm sure there are many others...

Remove from the next two sections any reference to public-private

partnerships.  If there is to be any reference, it should be to

developing

legal frameworks to regulate them, not to promote them!  

Under the 'core responsibility of all governments' section, there should

be

some reference to the need to support labour rights, nationally and

globally, by ensuring that ILO conventions are ratified and honoured.

It's

amazing that corporations are discussed throughout, but not labour!

Under the 'good corporate practices section,' also delete reference to

collaboration with the public health care providers.  This collaboration

is

a matter of public policy, not private sector initiative!  This is a

good

place, too, to reiterate the need for corporations to support reforms to

create more equitable international (as well as national) taxation

systems,

and to support binding rules on multinational corporate practices to

ensure

a 'level playing field' for all in the increasingly integrated global

market.

That's about all the time I have for a preliminary comment.  I'd be

interested to hear from others whether they think this is an important

intervention point.  I'd also be willing to review a statement that

(perhaps

Kumanan? Or some other?) might be willing/able to prepare for a quick

PHA

e-mail review, that could be sent to WHO prior to the July 14 deadline.

Cheers.

_____________

Ronald Labonte

Canada Research Chair, Globalization/Health Equity

Institute of Population Health

Professor, Department of Epidemiology and Community Medicine,

Faculty of Medicine, University of Ottawa

Address:

Institute of Population Health

1 Stewart Street, Ottawa, Ontario, Canada

K1N 6N5

ph:  (613) 562-5800 ext.2288

fax:  (613) 562-5659

cell: (613) 796-1668

e-mail:  rlabonte at uottawa.ca

web:  www.iph.uottawa.ca

-----Original Message-----

From: David Werner [mailto:healthwrights at igc.org] 

Sent: Friday, July 01, 2005 12:45 PM

To: pha-exchange at lists.kabissa.org; Kumanan Rasanathan

Cc: Claudio; Mira Shiva; Jason Weston; Jim Hunter;

sandersdav at yahoo.com.au

Subject: RE: PHA-Exchange> Bangkok Charter - Action Needed!

from David Werner

Ref the Bangkok Charter:

http://www.who.int/healthpromotion/conferences/6gchp/hpr_050624_bangkok_

char

ter_hp.pdf

Dear friends in the PHA forum,

I agree very much with the view of Nandri, Kumanan, and the New Zealand

group that this new Bangkok Charter has glaring and in some ways

dangerous

weaknesses. Not only does it take a "neutral" view on globalization, but

it

takes an uncritical view of private-public partnerships, many of which

advance corporate interests at the expense of people's health. Worst of

all,

the new charter takes the corporate line that the interests of the

powerful

corporations are basically (or at least potentially) pro-people, and

that

their commitment to equity, public health, and sustainable environment

should be voluntary rather than through strong regulation and democratic

process. In essence, it lets the crook off the hook! The Bangkok charter

is

typical of corporate and World Bank double-speak: all the progressive

rhetoric with faulty analysis and unworkable solutions.

Such deadly proposals need to be exposed and strongly opposed (not just

amended). I think this should be a concern for PHA2.

Best wishes,

David Werner

-----Original Message-----

From: pha-exchange-bounces at lists.kabissa.org

[mailto:pha-exchange-bounces at lists.kabissa.org]On Behalf Of Kumanan

Rasanathan

Sent: Thursday, June 30, 2005 7:21 PM

To: pha-exchange at lists.kabissa.org

Cc: alisonb at hpforum.org.nz

Subject: PHA-Exchange> Bangkok Charter - Action Needed!

Vannakkam and Kia Ora Koutou

Please find enclosed the latest draft of the Bangkok Charter from the

WHO website. As you may be aware, the Bangkok Charter is to be launched

at the Bangkok conference on health promotion in August, as a

significant update of the Ottawa Charter. The Bangkok Charter is an

attempt to address the significant global developments that have

occurred in the last twenty years. Significant work has been undertaken

to produce a document with the aim of meaningfully influencing the

practice of health promotion to engage with these issues to improve

health. As such, the rationale behind this document should be supported

by all those who advocate "health for all".

However, many of us in New Zealand are concerned about the latest draft

of the document. In particular we are concerned about its neutral

treatment of globalisation (as shown by the proposed commitment to

ensure that "globalisation becomes more health friendly"!), its lack of

consideration of indigenous health, and its failure to clearly endorse

the MDGs and recent international human rights and environmental

treaties. We are concerned that this document will thus be cynically

used as a roll-back position, which is possible given the international

endorsement it will receive. Comparing the draft Charter to the

People's Health Charter, there are obvious problems. Furthermore, the

latest draft is more tepid than previous versions, removing references

to the need for equity and the consideration of the impact of war on

health.

We have not seen anything on the PHM list about this document. We

believe that the PHM could make a material difference to improve this

document. The consultation process for the document has been unclear up

to now, but essentially it is being driven by WHO. WHO is now seeking

comment by the 14th of July at:

http://www.who.int/healthpromotion/conferences/6gchp/bangkok_charter_com

ment

s/en/

We understand that the PHM is fully occupied at the moment preparing

for the PHA-2. However, the Ottawa Charter is widely used in New

Zealand and elsewhere, and we believe that a well framed Bangkok

Charter could be a valuable tool in the fight for "health for all".

Moreover, as currently framed, we are concerned it could have a

negative effect. As such, we would appreciate your suggestions on how

the PHM can advocate to improve this document. One of us (Kumanan) will

be at the IPHU and PHA-2 in Cuenca, and it would great if we could make

time there to discuss this. However, it may be important to submit

something by the deadline of July 14. We are hoping that among the PHM

ranks, some of you may have a better idea about the best way to proceed

with this.

We look forward to hearing from you.

Nandri

Kumanan Rasanathan and Alison Blaiklock

---

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