PHA-Exchange> People's Health Movement update

[Claudio]

People's Health Movement: One year after the Cuenca Declaration.

 

[PHM plans to make yearly updates after each of its people's health assemblies every five years. PHA II was held in Ecuador a year ago where the Cuenca Declaration was approved unanimously by 1,400 participants. The latter reiterated PHM's adherence to its People's Charter for Health (Bangladesh, 2000) and set the course for our movement for the next five years, 

see www.phmovement.org ].

 

Considering that:

 

1.     Health still stands high on the international development agenda and calls for a major push ahead -now!

2.     The roots of most health inequities are unchanged: they are social and political.

3.     Socially-conditioned health inequalities continue to be an important political issue.

4.     The social determinants of health are still not being incorporated into planning in too many countries in the world.

5.     The choice of vocabulary these days more and more calls for the use of 'social justice' and 'right to health' as opposed to 'efficiency' and cost-effectiveness'.

6.     Health care interventions targeted at disadvantaged groups still only seek to repair the damage inflicted by social inequity.

7.     Health and ill-health continue to be the result of the prevailing social production process --and that the same social production process still is delivering an unfair health care system.

8.     The prevailing health sector reform approaches have only attempted to target those worst off in relation to health care thus helping only a really small part of the population; this has resulted in strategies that focus primarily on targeted interventions which simply manage the consequences of poverty. These targeted interventions of 'health for the poor' continue to legitimize poverty.

9.     A veritable social gradient in the access to health is the norm in most countries in the world.

10. The ongoing social exclusion agenda of the rich is intimately linked to health inequities.

11. Universal health care coverage programs are still seen as too costly by the Establishment and the provision of health services is not yet seen as a collective social responsibility.

12. The distribution of health resources continues to be highly inequitable. 

13. Countries with highly authoritarian regimes still have unresponsive governance structures that frustrate efforts to engage in a true policy dialogue on health issues and to come up with viable recommendations.

14. The existing barriers to a true health dialogue with authorities are mostly in the political arena and are related to power (a dialogue among unequals).

15. It is not primarily a lack of knowledge that has hampered action on the root causes of ill-health.

16. Policy failure in health is not primarily a symptom of ignorance, but the logical consequence of existing unequal power relations.  

17. Certain influential constituencies derive benefit from the status quo we observe on global health matters.

18. Physicians continue to maintain a monopoly over the authoritative discourse and are reluctant to see this control slip away from them.

19. Various other health providers deriving profit from patient care are also resisting change. But resistance also comes from corporate and commercial interests.

20. Corporations continue to fight government regulations and controls over labor practices, workplace safety and environmental impact of their activities..and do anything they can to minimize their taxes.

21. PRSPs have not resulted in changes in the neoliberal model and have had only negligible effect on Health For All  --with asymetric power relations remaining pretty much as they were before.

22. In 2006, as before, IFIs, multilateral and bilateral health and other development agencies are strongly influenced by corporate agendas.

23. Governments still justify their policies in terms of economic gains rather than in terms of ethical arguments (For them, what best makes them listen is the argument of Money).

24. Public health scientists continue to believe that they can influence policy simply by providing government officials with solid scientific evidence when sound evidence does not possess an inherent power to spur real change.

 

PHM thus re-commits itself to:

 

1.     To put all its energies in furthering the Global Right to Health Care Campaign being launched since Cuenca (July 2005). 

2.     To continue to aim at the root causes of preventable ill-health, malnutrition and health inequalities in all its advocacy work.

3.     To forcefully advance a pro-equity agenda oriented towards practical action.

4.     To ensure that the social determinants of ill-health are sustainably anchored in the policies of countries worldwide.

5.     To work to reduce gradients of wealth and power by working with its constituent grassroots organizations for them to demand redistribution processes are introduced.

6.     In the same line, to work to reduce inequities in power; to decrease the population's exposure to health-damaging factors; to lessen the vulnerability of disadvantaged people; and to reduce the unequal consequences of ill-health.

7.     To promote universal as opposed to targeted health and nutrition programs.

8.     To contribute to fill the gaps in the scientific evidence base related to social and political determinants of ill-health and malnutrition and on effective, people-centered policies and interventions to address them.

9.     To become a protagonist in exerting political pressure in the competition for more resources for primary health care.

10. To demand full political accountability of duty-bearers in the health sector.

11. To actively lobby for a specific WHO-internal action agenda that incorporates PHM's key recommendations into policy.

12. To engage additional civil society groups as active partners whenever they fully endorse PHM's People's Charter for Health. 

13. To open channels of strategic dialogue with key players including the needed organized confrontation with G8 policies detrimental to PHM's principles.

14. To work on programmatic proposals for interventions in each country that reduce health inequalities through action on social and political factors affecting the fulfillment of the right to health.

15. To tirelessly work as anti-war activists, staying engaged in current world conflicts, specifically condemning aggressor and occupying forces, and the health atrocities being committed. (PHM considers the recent Israeli aggression in Lebanon inhuman and strongly condemns it; PHM regrets the global silence in speaking up with one voice against it. It affirms its solidarity with the Lebanese people).

 

Therefore: 

Cognizant that if its political strategy is not well developed, it may fail to generate the concrete changes it seeks, PHM has developed a comprehensive policy to cover the aspects above.

Because of that, government leaders and decision-makers will often be opposed to many aspects of the PHM strategy on ideological grounds and will resist PHM members' advocacy. This does not deter PHM and its members.

Success will ultimately depend on widening PHM's network of alliances. PHM will buy-in on the ongoing support from major global institutions; this is seen as essential.

PHM will align its policy recommendations with the MDGs only as a tactical step in an effort to redirect the MDG Movement from within. MDG proponents will thus be PHM's tactical, but not strategic allies. Without strong political action on the processes that are to lead to the attainment of the MDGs, PHM is clear the MDGs will not be attained. 

In 2006, PHM aims at generating results and not just words. For that, PHM aims at capturing the attention of political decision-makers to encourage them and their colleagues to adopt the PHM agenda.

PHM will, therefore, define the opportunities and constraints for action in each country where it is active and will identify which constituencies may align themselves with the PHM agenda and which may offer resistance. For this, it will: a) develop a typology of countries with respect to their capacities for action along the People's Charter for Health,  and b) classify countries by level of national resources allocated to health.

 

In conclusion, PHM will play its historical role, and that is above all political --and mostly in the health sector. It will broker policy dialogue with both its allies and opponents; in that effort, PHM will use all appropriate modes of engagement.

 

Global Secretariat

August, 2006

 

We encourage you to share this document and the address of PHM's website www.phmovement.org , as well as its list-server at pha-exchange at lists.kabissa.org with all the fellow travelers on the (uphill) road for a better world.
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