PHM-Exch> [PHM] a bit of history (1)

[Claudio Schuftan]

In preparation of PHA4, phm-exchange will over the coming weeks feature
some of the important documents of the past for our new members to get a
better feeling where we have been as a movement. For those of you
old-timers, it will be a trip in memory lane.

*A Brief Introduction*

*People’s Health Movement in Brief*
The People’s Health Movement (PHM) is a global network bringing together
grassroots health activists, civil society
organizations and academic institutions from around the world, particularly
from low and middle income countries.
PHM currently has presence in around 70 countries that include both
individuals and well-established circles with their
own governance structures.
PHM works towards the revitalisation of Primary Health Care (PHC), as
described in the Alma-Ata Declaration of
1978 as well as to address the social determinants of health, in
particular, the growing inequity within and between
nations mostly due to the unfair economic structures which lock so many
people into poverty and poor health.
The PHM governance structure includes a Secretariat, an executive body
known as the Co-ordinating Commission and
the Steering Council that is the principal decision making body. The PHM
Secretariat rotates every three years. Dhaka
(Bangladesh, 2001-2002), Bangalore (India, 2003-2006) and Cairo (Egypt,
2006-2009) have hosted the Secretariat
earlier and at present it is based in Cape Town (South Africa). The present
Cape Town Secretariat is assisted by two
additional Secretariat offices in Cairo (Egypt) and New Delhi (India).
PHM organises a People’s Health Assembly (PHA) every five years that draws
people from across the globe. The First
PHA was organised in Dhaka (Bangladesh, 2000) and the Second in Cuenca
(Ecuador, 2005). The Third Assembly is
to be organised in Cape Town in 2011 (South Africa).


*Background*
In 1978, at the PHC Conference in Alma-Ata, 134 countries in
association with the World Health Organization (WHO) and UNICEF called for
“Health
for All by the Year 2000” and selected PHC as the best tool to achieve it.
Unfortunately, that dream never came true. The health status of third world
 populations has not improved, and in many caseshas deteriorated further.

We are facing a global health crisis characterized by growing inequalities
within
and between countries. New threats to health are continually emerging. This
is
compounded by negative forces of globalization which prevent the equitable
distribution of resources necessary for people's health, particularly the
poor’s.

Within the health sector, failure to implement the principles of PHC has
significantly aggravated the global health crisis.
Governments and the international community are fully responsible for this
failure. By the end of the year 2000, in
response to the intentional denial of “Health for All”, several
international organizations, civil society movements, NGOs
and women's groups decided to work together towards the denied yet possible
dream of “Health for All”. Along with
others committed to the principles of PHC and people's needs, they
organized the PHA from the 4th to the 8th of
December, 2000 in the People's Health Centre at Gonoshasthaya Kendra (GK),
in Savar, Bangladesh.
1453 participants from 92 countries came to the Assembly after a
culmination of 18 months of preparatory action
around the globe, which included thousands of village meetings, district
level workshops and national gatherings. At
the Assembly, they reviewed their problems and difficulties, shared their
experiences and plans, formulated and
endorsed the People's Charter for Health. In their Charter, people
considered equity, ecologically-sustainable
development and peace the heart of their vision of a better world – a world
in which a healthy life for all is a reality; a
world that respects, appreciates and celebrates all life and diversity; a
world that enables the flowering of people's
talents and abilities to enrich each other; a world in which people's
voices guide the decisions that shape our lives. We
believe that there are more than enough resources to achieve this vision.

The People’s Charter for Health defines health as a social, economic,
political issue, and above
all, a fundamental human right. It considers inequality, poverty,
exploitation, violence and injustice
the root of ill-health and deaths of poor and marginalized people.
Accordingly, “Health for All”
means that powerful interests have to be challenged, that globalization has
to be opposed, and
that political and economic priorities have to be drastically changed.

The Charter is now the common tool of a worldwide citizens movement
committed to making the
Alma-Ata dream a reality. It has been translated and published in more than
36 languages till
present. The Charter and its two updates, the Mumbai Declaration of January
2004 and the
Cuenca Declaration of July 2005 articulate PHM’s vision.

*Strategic objectives*
Key objectives of the PHM, as elaborated in its key documents, include:
Challenge powerful interests and political and economic priorities of
globalisation.
Encourage people to develop their own solutions.
Hold accountable local authorities, national governments, international
organizations and corporations.
Demand that governments and international organizations reformulate,
implement and enforce policies and
practices which respect the right to health.
Build broad-based popular movements to pressure governments to incorporate
health and human rights
into national constitutions and legislation.
Demand transformation of the World Trade Organisation and the global
trading system so that it ceases to
violate social, environmental, economic and health rights of people and
begins to discriminate positively in
favour of countries of the South.
Pressure governments to introduce and enforce legislation to protect and
promote the physical, mental and
spiritual health and human rights of marginalized groups.
Demand that education and health are placed at the top of the political
agenda. This calls for free and
compulsory quality education for all children and adults, particularly girl
children and women, and for quality
early childhood education and care.
Hold transnational and national corporations, public institutions and the
military accountable for their
destructive and hazardous activities that impact on the environment and
people’s health.
Develop people-centred, community-based indicators of environmental and
social progress, and to press for
the development and adoption of regular audits that measure environmental
degradation and the health status
of the population.
Support actions and campaigns for the prevention of natural disasters and
the reduction of subsequent
human suffering.
Oppose international and national politics that privatize health care and
turn it into a commodity.
Demand that governments promote, finance and provide comprehensive Primary
Health Care as the most
effective way of addressing health problems and organizing public health
services so as to ensure free and
universal access.
Demand a radical transformation of the World Health Organization (WHO) so
that it responds to health
challenges in a manner which benefits the poor, avoids vertical approaches,
ensures intersectoral work,
involves people’s organizations in the World Health Assembly, and ensures
independence from corporate
interests.
Promote, support and engage in actions that encourage people’s power and
control in decision-making in
health at all levels, including patient and consumer rights.
Demand that research in health, including genetic research and the
development of medicines and
reproductive technologies, is carried out in a participatory, needs-based
manner by accountable
institutions.
Build and strengthen people’s organizations to create a basis for analysis
and action. Promote, support and
engage in actions that encourage people’s involvement in decision-making in
public services at all levels.
Demand that people’s organizations be represented in local, national and
international fora that are
relevant to health.
Support local initiatives towards participatory democracy through the
establishment of people-centred
solidarity networks across the world”.

*Key Programs*
 PHM has three globally co-ordinated programs and numerous other activities
across the globe. The globally coordinated
activities include:
1. Global Health Watch: An Alternative World Health Report (www.ghwatch.org)
At the WHA in May 2003, the PHM, together with Global Equity Gauge Alliance
(GEGA)
and Medact discussed the need for civil society to produce its own
alternative World
Health Report. It was felt that the WHO reports including the annual ‘World
Health
Report’ were inadequate; that there was no report monitoring the
performance of global
health institutions; and that the dominant neo-liberal discourse in public
health policy
needed to be challenged by a more people-centred approach that highlights
social
justice. The idea of an alternative report soon developed into an
initiative called the
'Global Health Watch' (GHW) with the first report launched in July 2005,
during the PHA-
2 in Ecuador. The second edition, GHW2, was launched in October 2008. Each
edition
of the Watch had approximately 150 contributors, representing people’s
organizations, civil society organizations,
academic institutions, and each was launched in over 20 countries around
the globe. The development of GHW3 is
coordinated by Delhi office of the PHM global secretariat.

2. International People's Health University (IPHU) www.phmovement.org/iphu
The IPHU aims to contribute to 'health for all' by strengthening people's
health
movements around the globe, by organising and resourcing learning, sharing
and
planning opportunities for people's health activists, particularly from
Third World
countries. The IPHU’s principal activities are:
To organise regular short course opportunities for health activists from
around the world but particularly from Third
World countries;
Present a range of learning opportunities; a growing collection of resource
materials; and a wider network of
resource people to progressively enhance its programs;
Sponsors research into the barriers to Health for All and strategies to
support the people's struggle for health.
The IPHU has conducted its first short course on “Political Economy of
Health and Primary Health Care” in July 2005 in
Cuenca, Ecuador – July 2005 just prior to the 2nd PHA, which was attended
by 61 health activists from more than 20
countries. Since when, a total of 10 IPHU courses were organized, each of
approximately 2 weeks duration, in Bhopal
(India), March 2007; Vancouver (Canada), June 2007; Atlanta (USA), June
2007; Savar (Bangladesh), November
2007; Jaipur (India), March 2008; Cairo (Egypt), March 2008; London (UK),
April 2009; Thessaloniki (Greece), May
2009; Bangalore (India), September 2009; Havana (Cuba), November 2009.

3. Global Right to Health and Health Care Campaign (RTHHC) This campaign
has now been replaced by the Health For All Campaign. More in subsequent
postings.
PHM has embarked on a global RTHHC campaign which involves coordinated
national and international level action. The overall idea of the campaign
is to
change the international approach to health and development, and, via a
‘Global Action Plan on the Right to Health Care,’ convincingly show how
quality
essential health care services (based upon the Alma Ata PHC model) could be
made available NOW to every human being on earth, provided certain key
reallocation of priorities and resources. PHM uses a consultative process in
about 40 countries to involve thousands of people in making this demand.
The campaign involves the production of rights-based evaluations of
national health policies in countries with PHM
circles. The global coordinating group has developed The Assessment of the
Right to Health at the Country Level: A
People's Health Movement Guide for national PHM circles to use to produce
consistent reports using human rights law.
The process generates lobbying/activist strategies to use on the national
and international level. Key strategic allies
within international organizations are also enlisted.

*Other Activities of the PHM include*:
1. Evolving an advocacy strategy to bring WHO back to Health for All
perspective and goals and to focus action
on health determinants.
In 2003: a campaign to influence the resolution on PHC. The campaign
succeeded to put a pressure on some
member states to change the direction of the resolution from ‘celebrating
the anniversary of Alma Ata declaration’
to ‘revitalize the PHC approach’
In 2006: a campaign to influence the elections of the WHO’s Director
General (DG). The campaign strategy
included publishing articles about the role of the WHO and PHM expectations
from the coming DG. One of these
articles was published in the Lancet just before the elections. In
addition, PHM developed a list of key questions
that was sent to the potential candidates for the DG position and responses
were widely published (PHM list of
questions and the responses of the candidates including the current WHO DG;
Dr. Margaret Chan are published
on the PHM website).
One of the biggest achievements of this circle was pushing the WHO to
launch a Commission on Social, Economic
and Political Dimensions of Health which is resulted in the creation of the
Commission on Social Determinants of
Health (CSDH). PHM pushed to be formally represented in the CSDH and we
believe that PHM was influential to
the final report of the Commission. In addition, the PHM has used the
opportunity of the CSDH for an intensive
mobilization process in different regions. This process resulted in an
independent civil society report on the social
determinants of health. The full report was published by the PHM while its
summary was published by the WHO.
In 2009: a campaign to influence the resolutions on PHC and SDH. PHM
jointly with several civil society partners
has organized a civil society workshop (Equity, Justice and Health) in
Geneva prior to the 62nd WHA. The
workshop came out with a single civil society voice (statement) that was
read during the assembly.

2. Building country circles around community and national needs, challenges
and opportunities.
Strong country circles exist today in over 30 countries, including
Bangladesh, India, Sri Lanka, Philippines, South
Africa, Zimbabwe, USA, Australia and many countries of Central and South
America such as Ecuador, Brazil,
Guatemala, Argentina, Mexico, El Salvador etc. Over 40 countries are in the
process of developing country circles.

3. Facilitating PHM representation and building global solidarity;
participation in local, national, regional an
international fora and meetings. This has ensured the PHM’s regular
involvement and participation in the World
Social Forum, Global Forum for Health Research, and WHO’s World Health
Assembly.

4. Disaster and Humanitarian Responses The PHM’s War, Disaster and
Humanitarian Circle has been active
raising issues and promoting collective initiatives during the build up to
the Iraq war, and during the Tsunami
(South Asia), earthquake (Iran) and some Latin America disasters.

*Get involved*
· Read and discuss the Alma Ata Declaration, the People's Charter for
Health, the Mumbai Declaration, the
People's Charter of HIV/AIDS and the Cuenca Declaration.
· Endorse the People's Charter for Health.
· Organise a convention of Primary Health Care workers and community level
PHC volunteers. Listen to their
experiences. Endorse their work.
· Organise street theatre or folk culture events that express solidarity
with the themes of the People's Health
Movement through skits, songs and other forms of cultural expression.
· Organise a small exhibition of Alma Ata Declaration principles and the
action points of the People's Charter for
Health.
· Write a letter from your PHM Regional Circle to the Government (to the
President, Prime Minister, Health
Ministry and other related ministries such as Rural Development, Urban
Development, Social Justice and
Empowerment, Labour and Employment, Environment and Forests) and share your
concerns about Primary
Health Care and the concerns of the People's Charter for Health.
· Write articles in the newspaper or in magazines, journals or your local
newsletter on the need for Primary
Health Care, the Health for All Now Movement and other PHM themes.
· Translate the People's Charter for Health and other PHM documents into
your local language and distribute
them freely to the community and local health officials.
· Launch a PHM circle in your institution/ local area/ district/ state.
· Register to the PHM website to contribute to its content and health
library.

More at http://www.phmovement.org

*Contacts*
Website: www.phmovement.org
Email: globalsecretariat at phmovement.org
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