PHM-Exch> [PHM NEWS] draft PHA4 Declaration

[Claudio Schuftan]

The Struggle for Health is the Struggle for a More Equitable, Just and
Caring World

*Declaration of the Fourth People’s Health Assembly - PHA4*

*Savar, Bangladesh, 15-19 November 2018*



This Declaration was written inspired by the memory and spirit of Amit
Sengupta, whose dedication to struggling for a fairer, healthier and more
caring world was absolute and will continue to inspire future PHM activists.
Our Struggles

After months of mobilisation through national and regional assemblies we,
over 1400 health activists from 73 countries across all regions, met in
Savar, Bangladesh, six years after the assembly in Cape Town, to reaffirm
our commitment to the struggle for health, which - in the words of Amit
Sengupta - we see as the struggle for a more equitable, just and caring
world.

The vision provided in the People's Charter for Health
<https://phmovement.org/the-peoples-charter-for-health/> (2000) and the
Cuenca Declaration (2005) is more relevant than ever before, as
unfortunately the root causes of ill health and inequality persist and are
yet to be reversed. These root causes are deeply embedded in the current
paradigm of development, which is characterised by individualism,
anthropocentrism, neoliberal capitalism, patriarchy, caste-ism, racism,
religious fundamentalism, able-ism and homophobia.

This model has significantly boosted the clout of the transnational
corporations, leading to an enormous inflation in private profit and
creation of a class of transnational executives and shareholders whose
wealth and power are direct threats to equity, justice and the health of
the planet.

The controlling interests of corporate capitalism are systematically
eroding the sovereignty of our governments thereby conceding the rights and
privileges of the people to interests of profit. Communities the world over
are increasingly losing their access to land, water and livelihoods on the
one hand, while facing heightened militarisation, violence and repression
on the other. Corporations are indulging in rampant destruction of
ecosystems and biodiversity, generating enormous volumes of toxic waste,
while endangering cultural identities, diversity and ways of living. Newer
complexities of terrorism, climate change, threat to privacy – to name a
few – are presenting new challenges every day. All of this, aided by unjust
global and national economic and trade policies, is promoting an
unsustainable
                               and inequitable development paradigm and
creating a complex canvas of determinants that is seriously impeding the
realisation of health for all.

It is against this disturbing backdrop that we place our struggle for the
right to health; for a new model of society, with more solidarity, empathy,
equity and humanity, which safeguards human lives and ecosystems.


The Crisis of Health is a Crisis of the Capitalist Model

The high income countries, working closely with transnational corporations,
are promoting neo-liberal policies to manage the contemporary crisis of
globalised capitalism in the interests of the transnational capitalist
class. With help from a network of one-sided ‘trade and investment’
agreements, these policies are either being accepted by or being forced on
the governments of low and middle income countries. The resulting national
policies are having far reaching consequences for the social conditions
which shape people’s health, and also for the approach and funding of
comprehensive health care. Such policies are worsening the larger
determinants of health, and slowly but surely crippling healthcare
infrastructure and delivery of services. Such policies are encouraging
national governments to abdicate their responsibilities to public health,
while ushering in privatisation and insurance regimes.
PHM’s Alternative Vision: Equity, Ecological Sustainability and Health for
All

Our vision is of a world in which equity between and within countries is
achieved and health for all is a reality not just a dream. We reaffirm that
health results from social, economic and environmental justice. We
visualise a world where empathy, solidarity and respect for people and the
environment are at the core of global, national and local communities; a
world free of discrimination and oppression based on gender, race, caste,
ethnicity, disability, sexuality, religion, occupation, citizenship, and
one that upholds human rights, empowerment and health of all communities.

We demand that governments, international financial institutions and the
World Health Organisation (WHO) be accountable to people, not to
transnational corporations and their agents. We demand that they guarantee
rights relating to health and the environment through enforceable laws and
regulations. We demand that they protect those who struggle to defend their
rights and end the impunity with which corporations threaten, harm and kill
people.

We want equitable public health systems that are universal, integrated and
comprehensive – not discriminatory, not private, not for profit – that
provide a platform for appropriate action on the social determinants of
health including a radical shift in existing power structures.
Our Commitment

As we affirmed in the Cape Town Call to Action
<https://phmovement.org/wp-content/uploads/2018/06/CPT-Call-To-Action.docx>
(2012), no change is possible without the mobilisation of people through
the building of social and political power amongst people and communities.
PHM activists commit to creating bridges to connect all movements fighting
for the right to health with other social movements defending people’s
lands, water, livelihoods, rights of indigenous communities and rights
against the aggression of transnational corporations and governments that
represent corporate interests.

We commit to strengthening the PHM by ensuring that our governance is
transparent, democratic and gender just; we commit to building new country
circles and strengthening the existing ones, through broadening linkages
and solidarity with other likeminded organisations, networks and people's
movements and by engaging new and especially young people at the country,
regional and global levels. This will mean that the diversity of our
movement is more represented.

Our work in the short term will be organised around six different thematic
and action areas with specific objectives, but we remain open to new themes
in the medium to long term.
Gender Justice and Health

PHM believes that gender oppression is intricately linked to other systems
of oppression and that interactions between these forms of oppressions
further compromise wellbeing and access to health care. Although they
manifest differently and to varying levels in diverse contexts, experience
of gender inequity, discrimination and violence is universal. Gender
justice and health are mutually reinforcing and are imperative to the
realisation of the goal of health for all. PHM critically examines the
gendered implications of macroeconomic and policies and the current
developmental paradigm, that together with domestic policies and laws are
discriminatory and unjust and continue to impede the realisation of health
for all.

To advance towards gender justice, PHM commits to:

·       Enable understanding and analysis of gender as a cross-cutting
issue that informs all the thematic circles within PHM; integrate gendered
analysis and understanding in all PHM discussions, events and assemblies.

·       Promote and sustain action against gender unequal and gender unjust
social, economic and political systems that impact health and human rights
at the local, regional as well as global levels.

·       Consolidate evidence through research, testimonies, case studies
and experiences from different regions for global advocacy and action on
gender - just health policies and accountability.

·       Forge and strengthen linkages and solidarity with women’s groups,
health groups, coalitions, networks, people’s movements, campaigns and
interest groups, on identified gender justice and health challenges and
concerns.

·       Monitor and resist global agendas that diminish sexual and
reproductive health rights, for example the global gag rule.

·       Mobilise and build understanding and capacities, especially of the
youth, on gender justice and health through the International People’s
Health University (IPHU) and other processes.
Environment and ecosystem health

The overarching focus of neoliberal policies on maximising profit with
minimum accountability is encouraging over-consuming, unsustainable
lifestyles and polluting technologies and industries. These are
irreversibly affecting soil quality, ground water reserves, bio-diversity
by over-extracting forest and fishery resources, proliferating mining
operations, and expanding modern agriculture for the global market, just to
name a few. Such a developmental vision is evidently responsible for
widespread environmental destruction and generation of immense quantities
of waste – both nuclear as well as from toxic chemicals and pesticides –
causing severe soil and water pollution, air pollution, depletion of the
ozone layer and climate change, all of which have far reaching effects on
people’s health.

In order to promote ecosystem health, in the vision that our health is the
health of nature as a whole, PHM commits to:

·       Develop a global campaign against the impact of extractivist
industries on health.

·       Support organisations that oppose the global extractivist project
and strengthen links between land rights, environmental rights, and human
rights movements that are people's movements.

·       Condemn the criminalisation, repression and extra-judicial killing
of activists in the struggle for environmental justice.

·       Create healthcare systems that are not harmful to the environment
and that support healthy ecosystems.

·       Support models of work that promote safe, healthy work and systems
of production.
Food and Food Sovereignty

PHM believes that our unsustainable and inequitable food system is a
determinant of poor health, particularly manifesting in what is called the
triple burden of malnutrition, as well as the pandemic of non-communicable
diseases. The common roots underlying both under and over-nutrition in our
globalised world pertain to the impact of current practices related to food
production, processing, manufacture, distribution, trade and commerce on
food systems, as well as to the power differentials between those who are
most affected by and those who benefit most from the current food system.
The unregulated penetration of food and beverage companies and the
aggressive marketing of processed and ultra-processed foods have severely
compounded the problem of malnutrition and the underlying food insecurity.

PHM proposes to:

·       Create a food system that, ‘from seed to fork’, is equitable, fair,
and based on the inalienable right to food and adequate nutrition.

·       Appropriately politicise food and nutrition issues, i.e., increase
understanding of the political economy of food and nutrition.

·       Build awareness about the negative links between food and financial
systems including about undue corporate influence, as well as about the
flaws of current multi-stakeholder ‘solutions’, as for example the Scaling
Up Nutrition (SUN) initiative adopted by UN agencies and selected NGOs.

·       Resist the growing power of the transnational food industry.

·       Resist the technical and individualised vision of nutrition by
correcting misinformation fed to the public on how to make the food system
more equitable. Create bridges between PHM and the agroecologist movement
to gain food sovereignty.
Trade and Health

Almost all countries represented at this Assembly have concluded or are
negotiating regional or bilateral trade and investment agreements,
generally driven by the US or the EU, and directed to advancing the
interests of the transnational corporations. These are in effect economic
integration agreements, going well beyond the liberalisation of trade in
goods, to include the liberalisation of trade in services, extreme
protection for intellectual property, regulatory harmonisation, and new
provisions to protect transnational corporations from regulation by host
governments. The regime thus put in place has far reaching consequences for
access to comprehensive health care and to the social conditions which
shape people’s health.

In order to put health before profit, PHM commits to:

·       Stop the negotiation of trade and investment agreements designed to
further extend and strengthen the neoliberal regime and terminate (withdraw
from) existing agreements which shore up this regime.

·       Work towards a New International Economic Order which incorporates
positive discrimination in favour of low and middle-income countries and
which is oriented around an ecologically sustainable civilisation, based on
living well rather than corporate profit.

·       Reform medicines regulation ensuring that it is based on national
sovereignty and directed towards ensuring quality, safety, affordability
and efficacious rational use.
Equitable Health Systems

PHM reiterates its commitment to primary health care (PHC) in the pursuit
of health and well-being for all, aiming to achieve equity in health
outcomes. This is critical as we are faced with a global health crisis that
is characterised by inequities related to a range of social, economic and
political determinants of health and in access to health services within
and between countries. In many regions of the world, poorly designed,
under-resourced, poor quality health systems are causing unacceptable rates
of morbidity and mortality. PHM also recognises that health systems are
deeply gendered, caste-ist / racist institutions that reinforce
inequalities, with discriminatory policies and practices being huge
barriers to access to health information and care globally. Gender also
plays a critical role in the health workforce and determines the location
and experiences of women and men as health workers.

PHM also deplores the global trend towards privatisation of health care,
the implementation of insurance schemes (especially in Asia and Africa) in
the name of achieving universal health coverage, which reinforce
privatisation and commercialisation of health. Public private partnerships
and outsourcing of public services, including in health, are being promoted
despite overwhelming evidence of failures and their adverse impact on
health equity and conditions of health workers. These have evoked sharp
resistance from people’s movements.

PHM proposes to:

·       Institute action to promote publicly funded, universal health
systems based on primary health care as defined in the Alma Ata Declaration.

·       Provide evidence on the failure of health insurance, privatisation,
public private partnerships in attaining better health for the people that
will strengthen the campaign in exposing the neoliberal framework being
used to justify the privatisation of health systems.

·       Document struggles and resistance to health privatisation and build
on positive experiences in organisation of health care services and primary
health care.

·       Establish a corporate watch initiative on healthcare across global
regions, in partnership with other networks doing similar work.

·       Build awareness about the importance of frontline workers as both
agents of social change and extension workers for the health system and
work towards strengthening their role in ensuring health for all, through
better designed programmes, fair and decent work and adequate remuneration.

·       Highlight the key role of health workers in the functioning of
health systems, and build awareness about the effects of neoliberal
policies on their working conditions.

·       Promote decent work in health systems and for all health workers,
including adequate remuneration, social protection and employment
conditions. Highlight the linkages between informal and irregular forms of
work and quality of health services.

·       Support the right to organise and bargain collectively for health
workers, and create linkages with progressive trade unions that struggle
for the rights of health workers.
War and conflict, occupation and forced migration

The insatiable thirst for profit, together with the imperialist aspirations
of Europe and the US, are causing war and insecurity on a global scale but
also poverty and environmental degradation. They are destabilising whole
countries through economic policies, political intervention, arms trade,
drug traffic and unbridled resource extraction. All of these are creating
the conditions that are provoking massive movements of people across the
world.

Forced migration due to armed conflicts, ethnic cleansing, development
projects or climate change are realities of the day, the seeds of which
often lie in inequities and policies of neoliberalism. Such situations may
cause mass civilian displacement forcing people to leave their homes and
move to locations that are unfamiliar, inhospitable and unsafe. Large
populations lose their basic rights of citizenship when they are forced to
migrate to an alien country. Even displacement within the country causes
severe stress and uncertainty.

PHM denounces the direct and indirect impact on health of war, occupation
and militarisation, and highlights the implications for health of migration
and migration policies that are not respectful of human rights. PHM also
denounces the military and security industry as a public health threat, as
a continuous cause of conflict and therefore human suffering and also one
of the world’s worst environmental polluters and carbon emitters.

PHM proposes to:

·      Pressure international organisations to advocate for equitable
policies, conflict resolution, peace building, disarmament, end of
occupation, safe and free movement of people.

·      Mobilise local and international civil society organisations,
humanitarian groups, and health volunteers to provide immediate relief and
medical attention to displaced people.

·      Pressure the local governments involved to provide emergency
nutrition, shelter, clothing and healthcare to such displaced people.

·      In case of cross-border migration, mobilise world bodies like the UN
and relevant organisations and networks to put multi-lateral pressure on
the respective countries and recognise displaced people as refugees and
fulfil all rights and privileges that they are entitled to.

·      Ensure that migrants’ and refugees’ health rights are upheld.

·      Campaign to stop military research and development with taxpayer’s
money.
Building our People’s Health Movement

Towards achieving the goals set for ourselves through thematic areas, we
must further build our People’s Health Movement through our collective
efforts to develop and apply a broad global vision and a strategy that is
based on a correct assessment of our strategic partners at all levels –
global, national and local. It is urgent that we build our capacity, for
research, analysis and action through more training that will lead to
social mobilisation; for campaigns and for strategising for action. We need
to build alliances with trade unions, organisations, social movements,
representing women, peasants, frontline workers, indigenous communities and
youth.

Finally, if we are to build an alternative culture and alternative
institutions, each of us needs to actively support our comrades in their
struggles. Only this carries hope for the future of humanity and for mother
earth. This further entails the defence of the members of our movement who
are working in dangerous settings and who are too often the first to be
targeted by the repressive organs of the state.

We, as PHM, commit ourselves to this Declaration.
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