PHA-Exchange> FW: Bangkok Charter - Action Needed!
David Werner
healthwrights at igc.org
Fri Jul 15 08:26:56 PDT 2005
from David Werner:
Hi Jim and Jason of HealthWrights,
Have you been keeping up with the important exchange of concerns about the
Bangkok Charter. It has been a good round of discussion, with some very
valuable critique -- and yet some unfortunate compromises: even from
"committees" coming from a progressive perspective (as seen in this last
watered-down statement by Alison B's New Zealand group). I hope the PHA can
muster the courage and focus to come out with an uncompromising statement
that is both analytically accurate and sufficiently forceful to be
strategically useful. The issues in question, which urgently need to be
confronted here, are surely on the front edge of the "Politics of Health"
and would be good grist for the forum we invasions on
www.politicsofhealth.org. The debate itself has been a good learning
experience.
David W
-----Original Message-----
From: Alison Blaiklock [mailto:alisonb at hpforum.org.nz]
Sent: Friday, July 15, 2005 12:26 AM
To: 'Kumanan Rasanathan'; 'Ronald Labonte'; healthwrights at igc.org; 'Mira
Shiva'; 'Claudio'; 'Jason Weston'; 'Jim Hunter';
sandersdav at yahoo.com.au; d.mccoy at ucl.ac.uk; secretariat at phmovement.org;
jbreilh at ceas.med.ec; 'Katz, Alison'; 'Kumanan Rasanathan'; 'Ronald
Labonte'; healthwrights at igc.org; pha-exchange at lists.kabissa.org;
sandersdav at yahoo.com.au; 'Jason Weston'; 'Jim Hunter'; 'María Hamlin
Zúniga'
Subject: RE: PHA-Exchange> Bangkok Charter - Action Needed!
Dear friends and colleagues
Thank you very much for the very helpful comments on PHA list - They have
certainly influenced what is in the submission we made - I haven’t been able
to be as strong as some of your comments because I am writing on behalf of a
particular organization. I decided to try to use references that may be of
particular interest to WHO and leave making specific text suggestions until
the next stage. I hope that you can see your influence in the submission
which I've copied below.
And I'm sure that the submission from the PHM will be superb and look
forward to it.
Alison
Alison J Blaiklock
MB ChB D Com H FAFPHM
Executive Director
Health Promotion Forum of New Zealand
Runanga Whakapiki ake i te Hauora o Aotearoa
Phone 09 520 3711; Fax 09 520 4152; Mobile 021 382 209
27 Gillies Ave, Newmarket, Auckland
P O Box 99 064, Newmarket, Auckland
Email: alisonb at hpforum.org.nz
http://www.hpforum.org.nz
I. Introduction
1. Thank you very much for the opportunity to comment on the draft
Bangkok Charter.
2. This submission comes from the Health Promotion Forum of New Zealand
which is our national umbrella organisation for health promotion and has
almost 200 organisations as members. The submission is based on email
consultation with members and supporters, discussions at three meetings
attended by over 60 people, and informal discussions within New Zealand and
internationally.
3. We are most appreciative of the enormous amount of dedicated work,
care and expertise that has gone into developing the Charter. We are very
supportive of the intent to build on the Ottawa Charter and tackle difficult
and complex issues. Our comments focus on areas where we hope there will be
further development of the Charter’s text and are intended as constructive
suggestions.
II. The Ottawa Charter
4. The Ottawa Charter has been central to the development of health
promotion in this country. It is used alongside Te Tiriti o Waitangi (the
1840 treaty which set out the relationship between the indigenous people and
the British Crown in New Zealand).
5. It has been found to be a short, inspiring, inclusive and eloquent
guiding statement and a practical framework to use to promote health.
6. We hope that the new Charter will strongly affirm the value of the
Ottawa Charter.
III. The health of indigenous peoples
7. About one in twenty-five people in the world are indigenous (1). We
are seriously concerned about the health of Indigenous Peoples in this
country and throughout the world, and want the Bangkok Charter to be of
particular benefit to Indigenous Peoples.
8. In 1999 WHO consulted with representatives of indigenous
communities, nations, peoples and organisations. This led to the Geneva
Declaration on the Health and Survival of Indigenous Peoples which states
“the health of Indigenous Peoples in every region of the world is
acknowledged to be in a poor state due to the negation of our way of life
and world vision, the destruction of our habitat, the decrease of
biodiversity, the imposition of sub-standard living and working conditions,
the dispossession of traditional lands and the relocation and transfer of
populations” (WHO, Committee on Indigenous Health, Geneva,WHO/HSD/00.1.) (2)
9. The Geneva Declaration calls for action in four areas:
• Respect for all the rights of Indigenous Peoples as described in
international instruments and other treaties and agreements between
governments and Indigenous Peoples.
• Recognition for Indigenous Peoples' concept of health and survival
and expressions of culture and knowledge.
• Policies and programmes in capacity building, research, education,
rectifying the inequities and imbalances in globalisation, increased
resources; co-ordination between United Nations bodies; ensuring the
participation of Indigenous Peoples at all stages of policy development and
implementation; and constitutional, legislative and monitoring mechanisms.
• Action on the broad determinants of the health and wellbeing of
Indigenous Peoples which include the effects of the loss of identity due to
removal from family and community, displacement and dispossession of lands,
resources and waters, and the destruction of languages and cultures; the
impact of environmental degradation; the need for sustainable development;
the need for participatory community development; and the effects of war and
conflict.
10. The draft Charter goes part way towards including these actions with
some references to health as a human right, environmental change, health
inequalities, culture as an asset, community participation, traditional
approaches to health, and building capacity. It is, however, much weaker
than the Geneva Declaration.
11. The new Charter needs to be much stronger in its references to human
rights including recognition of the rights of Indigenous Peoples. It needs
to clearly recognize indigenous understandings of health, wellbeing, culture
and knowledge. It needs stronger statements which match those in the Geneva
Declaration around policies and programmes. It needs to include the sort of
broad view of the determinants of health taken by the Geneva Declaration.
For example, we understand that the previous draft had references to war and
peace, but this has been removed from the current draft.
IV. International human rights and environmental treaties and
agreements, the Millenium Development Goals, globalisation, and corporate
interests
12. The draft Charter begins with a statement about human rights. Health
and human rights are both powerful approaches to improving the wellbeing of
people (3).
13. Health promotion is based on respect for the dignity of each person
and human rights. Human rights include respect for equity, social justice,
diversity and participation. The right to enjoy the highest attainable
standard of health includes access to public health and health care, and
access to shelter, food and clean water, education, peace and all the other
determinants of health. A rights-based approach to health means paying
particular attention to the wellbeing of those who are most marginalised and
disadvantaged. It means that governments have an obligation to international
assistance and co-operation towards the right to health – for example in
ensuring that international trade agreements do not adversely impact on the
rights to health and in humanitarian assistance (4,5).
14. The new Charter should clearly support existing international human
rights and environmental treaties and the Millennium Development Goals
(MDGs). These treaties offer health promotion potentially powerful
frameworks which have the backing of international law. The treaties and the
MDGs also offer the advantages of being developed outside the health sector,
applying across sectors, cultures and national borders, and having
established accountability mechanisms.
15. There are other international agreements which have important
benefits for health – including the Framework Convention on Tobacco Control,
various multi-lateral environmental agreements, the ILO Conventions and some
trade agreements.
16. The United Nations Convention on the Rights of the Child has
underpinned the growing movement for and with children throughout the world
and thus had considerable impact on improving the health of children. The
work of the United Nations Committee on the Rights of the Child in
monitoring countries’ progress in complying with the Convention on the
Rights of the Child demonstrates how civil society and marginalised groups
can participate and influence the treaty monitoring accountability
mechanisms, and how the opportunity to take part in the accountability
mechanisms can mobilise people and contribute to the development of social
movements.
17. The Charter will be strengthened greatly by ensuring that throughout
there is clear recognition of the importance of the human rights approach,
democratic mechanisms, and using and strengthening international law and
agreements to promote health. It should offer inspiration to reach beyond
the standards already established in these treaties and agreements and the
MDGs.
18. The draft Charter takes a neutral view of globalisation – as seen in
the proposal to “make globalisation health friendly”. The effects of
globalisation may bring both benefit and harm to health, but health
promotion must recognise that “globalisation is already affecting in a
negative way the health expectation of millions of inhabitants in the poorer
countries of the world” (6). The draft also takes a neutral view towards
powerful corporate interests although there is considerable evidence that
these have often acted in ways that are very harmful to the health of
people, especially those who are poorest and have least power. The use of
neutral language disguises the underlying causes, powerful interests, and
conflicts.
19. We are seriously concerned that the draft Charter is much weaker
than existing international human rights and environmental treaties, the
MDGs and other international agreements that promote health. If the Charter
is not clearly and strongly aligned with these, then it could be cynically
used by powerful interests - including some corporates, states and
international finance institutions - to claim that their actions were
“health promoting in line with the Bangkok Charter” and thus avoid
complying with the much stronger standards set by the international
treaties, agreements and MDGs. If this happened, the Charter would become
used as an equivalent of “greenwash” and have a negative effect.
20. It is essential that the new Charter is strongly and clearly aligned
with the international human rights and environmental treaties, the MDGs and
other international agreements that promote health, in order to use these
mechanisms to promote health - and in order to avoid doing harm.
Our appreciation
21. Thank you very much for the opportunity to make this submission. We
look forward to the discussions at the 6th Global Conference on Health
Promotion and we very much appreciate being able to contribute to this
important process.
References
(1) Durie, M. The health of indigenous peoples. BMJ 2003;326:510-511.
(2) The Geneva Declaration can be found at
http://www.healthsite.co.nz/hauora_maori/resources/feature/0001/002.htm
(3) Mann, J. M., Gostin, L., Gruskin, S., Brennan, T., Lazzarini, Z., &
Fineburg, H. (1999). Health and human rights. In J. M. Mann, S. Gruskin, M.
A. Grodin & G. J. Annas (Eds.), Health and human rights: a reader. New York:
Routledge.
(4) United Nations Committee on Economic, S. a. C. R. (2000). The right to
the highest attainable standard of health : 11/08/2000. E/C.12/2000/4.
(General Comment No. 14).
(5) United Nations Special Rapporteur on the Right to Health. (2003). Report
of the Special Rapporteur to the Commission on Human Rights. E/CN.4/2003/58.
13 February 2003.: Economic and Social Council
(6) Hernandez-Aguado I, Alvarez-Dardet C. Globalisation and health: action
now! J Epidemiol Community Health 2001;55:609
-----Original Message-----
From: Kumanan Rasanathan [mailto:kumananr at yahoo.com]
Sent: Friday, 8 July 2005 1:35 p.m.
To: 'Ronald Labonte'; healthwrights at igc.org; pha-exchange at lists.kabissa.org
Cc: 'Claudio'; 'Mira Shiva'; 'Jason Weston'; 'Jim Hunter';
sandersdav at yahoo.com.au; alisonb at hpforum.org.nz
Subject: RE: PHA-Exchange> 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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