PHM-Exch> [PHM] a bit of history (4)

[Claudio Schuftan]

*PEOPLE’S HEALTH MOVEMENT*

*SECOND PEOPLE’S HEALTH ASSEMBLY*





*CUENCA DECLARATION*

Part 1

Coming from 82 countries around the world, 1492 people met at the Second
People’s Health Assembly in Cuenca, Ecuador from 17th to 22nd July 2005, to
analyse global health problems and to develop strategies to promote Health
for all.



Overwhelmingly we reaffirmed the continuing importance of the *People’s
Charter for Health* (2000) and saw it as a rallying document for the
ongoing struggles of the People’s Health Movement globally and within
countries.



*The vision* endorsed at PHA2 is for a socially and economically just world
in which peace prevails; a world in which all people, whatever their social
and economic condition, gender, cultural identity and ability, are
respected, are able to claim their right to health and celebrate life,
nature, and diversity.



*Solidarity with struggles in Ecuador *

Here in the heart of the Andes we have learned much from the hospitality,
living cultural heritage, and current struggles of our Ecuadoran sisters
and brothers. We join them in solidarity to oppose the signing of the Free
Trade Agreement imposed by the government of the United States and the
international financial institutions. This agreement will increase
corporate profits, impoverish the workers, campesinos and indigenous
peoples of the Andes, negatively influence their living and working
conditions and impede their access to health care and enjoyment of health.
We also join our Andean partners in opposing Plan Colombia, the name for
the biological warfare carried out against them by the United States, which
is poisoning their land and water, and militarizing their border regions.



*The global health reality*

We deplore the worsening conditions of health experienced by many of the
world’s people and we denounce their cause – neo-liberalism. Neo-liberal
polices imposed by the G8, transfer wealth from the South to the North,
from the poor to the rich, and from the public to the private sector.
Corporate profits increase while poor people, indigenous peoples and the
victims of war and occupation, suffer.

Economically and politically generated health inequalities have increased,
yet these root causes of avoidable disease and death are not effectively
addressed by current policies or programs.  The spirit of Alma Ata has been
betrayed by most official health systems, though it has been kept alive in
the face of adversity by health activists and health workers in community
projects all over the world. Comprehensive primary health care is
implemented in very few places, and the provision of health services is
rarely seen as a collective social responsibility. Under neo-liberalism
there is no right to health, racism is nurtured, women’s oppression
deepens, social exclusion increases, environmental degradation becomes the
norm, workers' rights are non-existent, and war serves the profit seeking
of big corporations. Governments, IFIs, WHO, multilateral and bilateral
agencies are strongly influenced by the agendas of these corporations.



*Establish the Right to health in an era of hegemonic globalization*

PHM calls on the peoples of the world to mobilize against the denial of the
Right to Health. The global economic framework of neo-liberalism,
privatization and “free trade,” made operational through the WTO and
international financial institutions, has played a determinant role in the
transfer to the corporate sector of the control of the determinants of
health. This leads to environmental destruction, toxic pollution, denial of
rights to water, food, and life itself. The human right to health and
health care must take precedence over the profits of corporations,
especially the profiteering of pharmaceutical companies. The WTO operates
as a *de facto* world government even though it is unelected,
unrepresentative and unaccountable. Responsibility for international trade
and development must be returned to the people through reappropriation of
relevant UN bodies such as UNCTAD. Unless it is massively reformed to
operate democratically, the WTO must be dismantled as it is a major source
of massive human rights violations and injustice and a key mechanism of
corporate control of life on earth.

The right to health will be achieved through large scale popular
mobilization. PHM will initiate or support struggles related to the right
to water, food security and food sovereignty, a healthy environment,
dignified work, safe housing, universal education and gender equity, since
people’s health depends on the fulfillment of these basic rights. PHM will
launch a comprehensive campaign to achieve the “Global Right to Health and
Health Care” at the local, national and international levels, to defend
health and social security (including health care) systems, and to document
and oppose health inequities and denial of the right to health.  PHM will
defend health workers in their opposition to the privatization of health
services by building broad multi-sectoral alliances.

PHM will campaign to end TRIPS, remove it from the WTO, and oppose
bilateral Free Trade Agreements and TRIPS+. We call upon governments to use
the Doha agreement to provide people with affordable generic drugs. We
oppose public-private partnerships because the private sector has no place
in public health policy making. PHM will continue to monitor and provide
inputs for the WHO Commission on the Social Determinants of Health to
ensure that it effectively addresses the political and socio-economic
causes of poverty, ill health and health inequity and engages in meaningful
dialogue with civil society as much as possible.  PHM will work with allied
movements to coordinate common international actions against privatization
and inequitable trade regimes.



*Promote health in an intercultural context*

PHM recognises that interculturality is a fundamental element to promote
social equity and build a fair health system. Equity in access to health
information is a fundamental human right. It is essential in the struggle
for indigenous people's health.  People’s knowledge should be incorporated
into the development of culturally based equitable health services;
culturally sensitive prevention programs; the training of health workers in
intercultural skills; achieving fair conditions of work; food security; and
a healthy ecosystem. PHM will incorporate key issues such as the struggle
against trade agreements, land reform and indigenous people’s land
restoration, protection against piracy of traditional knowledge as a
fundamental defence of social security, cultural identity and nutritional
security. The many useful aspects of traditional medicine and culture must
be valued and included as part of a people-oriented society and health
system.



*Advance the right to health for all in the context of gender and personal
diversity*

The health of women, men and people of diverse sexual orientation is
severely damaged by the dominance of a patriarchal culture with social and
gender inequities and discrimination that affects their integrity. The
social, health, sexual and reproductive rights of women are often denied. PHM
commits to mainstreaming gender and feminist perspectives in all its work
and action plans. Men and women of PHM commit themselves to deconstruct
patriarchal relations in private and public life. This Assembly demands the
dismantling of neoliberal policies that have increased gender inequality.  To
do so it will support international, regional and local campaigns for
sexual and reproductive rights; strengthen communication and work relations
with networks and other movements; and work to ensure safe abortion for all
women and girls. PHM firmly denounces all forms of violence including that
against women, such as femicide, and demands government action to prevent
it, to prosecute perpetrators and to provide all necessary support for
people affected by violence.

People with disabilities and older people should be treated with respect
and their right to appropriate health care should be ensured. PHM supports
a new UN convention protecting and promoting the rights of persons with
disabilities, promotes rehabilitation services as part of PHC, and urges
the Commission on Social Determinants of Health to develop more focus on
people with disabilities. PHM argues for the inclusion of people with
disabilities in all aspects of life, and recommends that disability be
addressed in a similar way as gender among donor agencies so that inclusive
development is ensured.



*Protect the right to health in the context of environmental degradation*

PHM calls upon the people of the world to support action to end imperialist
control of the earth’s natural resources and create and maintain a healthy
environment for all. Natural resources essential to health are global
commons. We call for a worldwide campaign for a UN Treaty on the Right to
Water, ensuring that commodification and privatization of this vital
resource – life itself – is both reversed and prevented. Guided by evidence
of devastating damage and by the precautionary principle, we demand a
moratorium on extractive mining and petroleum exploration/extraction, a ban
on patenting of life forms and processes, research on nanotechnology,
release into the environment of GMOs, and on development and use of all
biochemical weapons. Governments are accountable to people not
transnational corporations and must guarantee rights relating to health and
the environment through enforceable laws and regulations. Governments, IFIs
and the WHO must cease to be accomplices to TNCs and imperialism. Dow,
Monsanto and other companies must be forced to provide reparations to the
thousands of uncompensated victims of disasters such as Bhopal and Agent
Orange. Knowledge and science must be reclaimed for the public good and
freed from corporate control.



*Ensure workers’ health and safety by defending and extending existing
rights*

PHM calls upon the people of the world to demand the implementation of
international treaties that protect workers’ health and safety, recognize
workers' health as a universal human right and a responsibility of the
state, involve workers in the decision and policy-making process on working
and health conditions and ban child labour. We support social arrangements
to ensure the right to regular, meaningful and adequately remunerated work,
with equal pay for equal work for men and women; protection of historical
achievements attained by trade unions in the formal sector, renewal and
strengthening of trade union, workers’ and anti-globalization movements and
their links to other movements; protection of the health of informal sector
workers and migrants as they are more exposed to occupational health
hazards; and universal health coverage through national health systems and
insurance.



*CUENCA DECLARATION*

Part 2

*Defend the right to health in the face of war, militarization and violence*

PHM calls on the people of the world to oppose war and militarization as
the most blatant attacks on people’s health, especially the health of women
and the poor. While the terror attacks in New York, Madrid and London
caused unjustifiable damage, the US-led “war on terror” has generated an
even more terrible, unjustifiable and endless war on defenseless
populations in order to control their natural resources. At the same time,
wars that have claimed millions of lives are unacknowledged as the UN
system and our governments allow them to continue unabated.

PHM will continue to participate in the global movement to end the US
occupation of Iraq and Afghanistan. Foreign troops should be removed
immediately and reparations paid for damage caused by the US-led war. PHM
calls for an investigation into the use of torture by US soldiers and
medical personnel at Guantanamo Bay, in Iraq and Afghanistan, and an
immediate end to the detention of foreign nationals held without trial at
Guantanamo Bay. We demand that medical personnel refuse to participate in
illegal detention and torture. The US and its allies must be charged with
violations of the Geneva Conventions for their attacks on civilian
populations, particularly medical personnel and institutions in Iraq.

PHM calls upon the United Nations and humanitarian agencies to intervene
effectively in the “hidden wars” in the Congo, Sudan, Chechnya and many
other places to foster lasting peace through political reconciliation and
economic and social development programs that transform the social and
economic conditions that give rise to these wars.

PHM opposes the Israeli occupation of Palestine and the efforts to isolate
and ghettoize the Palestinian people behind the illegal separation wall.
Denial of Palestinian health rights on the West Bank and Gaza has reached
emergency proportions.

PHM supports the steps toward democracy and self-determination made by the
indigenous people of southern Mexico, and calls for an end to the
low-intensity conflict waged against them by the Mexican government.

PHM denounces the biological warfare called Plan Colombia currently being
waged against the peoples of Colombia, Ecuador and Peru under the guise of
drug control. These actions contravene international conventions, and
irreversibly damage environmental and human health in the region.

PHM calls upon the United States to take responsibility for and compensate
victims of Agent Orange in Vietnam, and the toxic contamination left by US
military bases in the Philippines and elsewhere.



Struggle for comprehensive primary health care and sustainable, quality,
local and national health systems

PHM recognises that neo-liberal policies have resulted in disinvestments in
public sector health services; the promotion of a limited number of mostly
curative technical interventions selected solely on the basis of a very
narrow and often inappropriate application of cost effectiveness analysis,

the corresponding neglect of broader environmental actions; the accelerated
migration of health workers from public to private sectors and thence to
wealthy countries; and the continuing spread of HIV/AIDS especially in
Africa, with the collapse of public health services in many countries.



PHM calls upon governments to:



   - Implement comprehensive community-based Primary Health Care
   initiatives that enroll or involve relevant sectors and are supported by
   legislation.
   - Provide healthy living and working environments in order to respect
   and guarantee the health

rights of all.

   - Establish and fully implement universal health care financing
   mechanisms at national level in all countries (public health expenditure
   being at least 15% of the overall budget, especially in African countries)
   in order to provide protection for the whole population.
   - Address the crisis of human resources for health (HRH) by: improving
   working conditions, training, support and supervision for health workers;
   implementing an International code of practice on ethical recruitment,
   financial compensation to exporting countries, return and reorientation of
   health workers in the diaspora through incentives, and establishing a
   global fund for HRH.
   - Ensure widespread knowledge on HIV status; access to opportunities for
   voluntary testing; equitable, and sustainable access to ARVs with emphasis
   on prevention; comprehensive home-based care including health and social
   services.



PHM calls upon the WHO to support and promote the above as national
government responsibilities and to advocate for the removal of economic and
political obstacles at global, regional and national levels, that adversely
affect national governments' social policies.



PHM will continue to raise awareness among communities on policies,
policy-making processes and financial issues to enable them to monitor
government performance, increase accountability and address health equity
issues. PHM commits to gathering from within its movement, positive
experiences of comprehensive PHC to build up the evidence base that
supports such an approach, and to undertake concerted advocacy for its
revitalization.



Finally, PHM salutes and supports the strong social justice approach to
health in Venezuela and Cuba which inspires and encourages us towards
Health for All.



*Support the growth of PHM*

The People’s Health Movement is both a network and a movement that takes as
its mission the strengthening of the much wider movement of individuals and
organisations around the world fighting for the Right to Health. PHM is
bound by a commitment to the People’s Charter for Health and includes
country circles, issue circles and affiliates which are actively involved
in advancing the work of the PHM.  Beyond this core of PHM activists are
the friends of PHM and organisational partners at all levels.



*Another world is possible – these are our strategies to achieve it!*

This declaration urges health activists around the world to organise,
influence, advocate, analyse and educate to advance global people’s health.



The People’s Health Movement -

- will pursue work on the human right to health that includes both
individual and community rights.

- will continue to struggle for improved ways of working by strengthening
its regional as well as its global coordination.  It will continue to
develop participatory and transparent decision making so that activists at
all levels know that their views are valued.

- celebrates the inauguration of the International People’s Health
University, a university for health activists with courses presented in
association with local PHMs and selected universities around the world.

- will engage with formal training institutions and challenge the dominance
of the biomedical paradigm of health care.  It will incorporate diverse
strategies for reorienting health worker education to comprehensive PHC,
keeping people in communities at the centre.

- will become a forum within which intellectuals can support local
activists in their action and struggle.

- will challenge the media to disseminate its perspectives and publicize
its activities.

- will strengthen its communications strategy to reach communities at the
grassroots.

- will translate as many of its communications as possible into two or more
languages; will establish a mix of central and regional/national websites;
the PHM newsletter will continue quarterly publication and will be
translated into other languages.



As a summary of PHM´s strategy for the next three years:

-PHM will be linking the local, the national and the global by passing on
and giving guidance to its geographical circles on the issues on which to
concentrate tactically.

-PHM will document, analyze and disseminate research findings on key issues
pertaining to the principles in its Charter, including gathering, analyzing
and disseminating key evidence for its constituency of the efficacy and
sustainability of initiatives in comprehensive primary health care.

-PHM will create awareness about the burning health issues of the day and
will delegitimize and demystify false claims, prescriptions and slogans
used by the Establishment.

-PHM will work with grassroots organizations and communities trying to
understand their issues, building partnerships and supporting their
activists in their struggle.

-PHM will adopt an approach of strengthening rights, and will support
initiatives to achieve the Right to Health and Health Care at the local,
national and international levels

-PHM will work tirelessly to build international solidarity with the
oppressed and with those affected by natural disasters and civil strife,

- PHM will confront powerful forces of oppression in the struggle for
economic justice, in particular  through support for cancellation of debt,
the end of economic conditionalities and the establishment of a fair
international tax regime.

-PHM will incorporate cultural and spiritual practices in all aspects of
its work.

-PHM will advocate with national governments, UN and other national and
international agencies to influence their decision-making.



*The power of the People’s Health Movement can change the world. Another
World, which includes Health for All, is possible. We must all demand and
struggle towards a world in which health is a right, and is not subject to
the forces of neo-liberalism. *



*SUPPORT* and sign on to the People’s Health Charter and the Million
Signature Campaign which is demanding Health for All Now, *JOIN *your local
PHM group and support the new campaigns and activities being initiated.
www.phmovement.org




Cuenca, Ecuador


22 July 2005
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