PHM-Exch> [PHM NEWS] A People's Charter for Health refresher

[Claudio Schuftan]

Dear all,
Believe it or not, our Charter is 22+ years old.
Most of us have probably not reread it for a long time and newer members
may have never read it in detail.
It is only 8 pages long and can be read in 15-20 minutes.
More than for memories' sake we invite you to re-read it to reinvigorate
our commitments and to show how seminal a document it is since it still
applies today. Take the time to read it!
Note that the Charter is available in 33 languages. You can go to
https://phmovement.org/the-peoples-charter-for-health/ and read it in your
own language. (Also, as you have it in your own language, disseminate it to
like-minded people and groups and invite them to endorse it on our PHM
website ).

People’s Charter for Health



INTRODUCTION

In 1978, at the Alma‐Ata Conference, ministers from 134

member countries in association with WHO and UNICEF

declared “Health for All by the Year 2000” selecting Primary

Health Care as the best tool to achieve it.

Unfortunately, that dream never came true. The health status

of third world populations has not improved. In many cases it

has deteriorated further. Currently 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 with regard to

the health of people and especially that of the poor.

Within the health sector, failure to implement the principles of

primary health care, as originally conceived in Alma‐Ata has

significantly aggravated the global health crisis.

Governments and the international bodies are fully responsible

for this failure.

It has now become essential to build up a concerted

international effort to put the goals of health for all to its

rightful place on the development agenda. Genuine, people-centered

initiatives must therefore be strengthened in order to

increase pressure on decision‐ makers, governments and the

private sector to ensure that the vision of Alma‐ Ata becomes a

reality.

Several international organizations and civil society

movements, NGOs and women’s groups decided to work

together towards this objective. This group together with

others committed to the principles of primary health care and

people’s perspectives organized the “People’s Health Assembly”

which took place form 4‐8 December 2000 in Bangladesh, at

Savar, on the campus of the Gonoshasthasthaya Kendra or GK

(People’s Health Centre).

1453 participants form 92 countries came to the Assembly

which was the culmination of eighteen months of preparatory

action around the globe. The preparatory process elicited

unprecedented enthusiasm and participation of a broad cross

section of people who have been involved in thousands of

village meetings, district level workshops and national

gatherings.

1

The plenary sessions at the Assembly covered five main

themes: Health, Life and Well‐Being; Inequality, Poverty and

Health; Health Care and Health Services; Environment and

Survival; and The Ways Forward. People from all over the world

presented testimonies of deprivation and service failure as well

as those of successful people’s initiatives and organization. Over

a hundred concurrent sessions made it possible for participants

to share and discuss in greater detail different aspects of the

major themes and give voice to their specific experiences and

concerns. The five days event gave participants the space to

express themselves in their own idiom. They put forward the

failures of their respective governments and international

organizations and decided to fight together so that health and

equitable development become top priorities in the policy

makers agendas at the local, national and international levels.

Having reviewed their problems and difficulties and shared their

experiences, they have formulated and finally endorsed the

People’s Charter for Health. The charter from now on will be the

common tool of a worldwide citizens’ movement committed to

make the Alma‐ Ata dream reality.

We encourage and invite everyone who shares our concerns and

aims to join us by endorsing the charter.



PREAMBLE

Health is a social, economic and political issue and above all a

fundamental human right. Inequality, poverty, exploitation,

violence and injustice are at the root of ill‐health and the deaths

of poor and marginalised people. Health for all means that

powerful interests have to be challenged, that globalisation has

to be opposed, and that political and economic priorities have

to be drastically changed. This Charter builds on perspectives of

people whose voices have rarely been heard before, if at all. It

encourages people to develop their own solutions and to hold

accountable local authorities, national governments,

international organisations and corporations.



VISION

Equity, ecologically‐sustainable development and peace are at

the heart of our 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 2º

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. There are more than enough resources to achieve this

vision.


THE HEALTH CRISIS

“Illness and death every day anger us. Not because there are

people who get sick or because there are people who die. We are

angry because many illnesses and deaths have their roots in the

economic and social policies that are imposed on us”

(A voice from Central America)

In recent decades, economic changes world‐wide have

profoundly affected people’s health and their access to health

care and other social services.

Despite unprecedented levels of wealth in the world, poverty

and hunger are increasing. The gap between rich and poor

nations has widened, as have inequalities within countries,

between social classes, between men and women and between

young and old.

A large proportion of the world’s population still lacks access to

food, education, safe drinking water, sanitation, shelter, land

and its resources, employment and health care services.

Discrimination continues to prevail. It affects both the

occurrence of disease and access to health care.

The planet’s natural resources are being depleted at an

alarming rate. The resulting degradation of the environment

threatens everyone’s health, especially the health of the poor.

There has been an upsurge of new conflicts while weapons of

mass destruction still pose a grave threat.

The world’s resources are increasingly concentrated in the

hands of a few who strive to maximise their private profit.

Neoliberal political and economic policies are made by a small

group of powerful governments, and by international

institutions such as the World Bank, the International Monetary

Fund and the World Trade Organisation. These policies,

together with the unregulated activities of transnational

corporations, have had severe effects on the lives and

livelihoods, health and well‐being of people in both North and

South.

Public services are not fulfilling people's needs, not least

because they have deteriorated as a result of cuts in

governments’ social budgets. Health services have become less

accessible, more unevenly distributed and more inappropriate.

Privatisation threatens to undermine access to health care still

further and to compromise the essential principle of equity. The

persistence of preventable ill health, the resurgence of diseases

such as tuberculosis and malaria, and the emergence and

spread of new diseases such as HIV/AIDS are a stark reminder of

our world's lack of commitment to principles of equity and

justice.



PRINCIPLES OF THE PEOPLE'S CHARTER FOR

HEALTH

• The attainment of the highest possible level of health and

well‐being is a fundamental human right, regardless of a

person's colour, ethnic background, religion, gender, age,

abilities, sexual orientation or class.

• The principles of universal, comprehensive Primary Health

Care (PHC), envisioned in the 1978 Alma Ata Declaration,

should be the basis for formulating policies related to

health. Now more than ever an equitable, participatory

and intersectoral approach to health and health care is

needed.

• Governments have a fundamental responsibility to ensure

universal access to quality health care, education and

other social services according to people’s needs, not

according to their ability to pay.

• The participation of people and people's organisations is

essential to the formulation, implementation and

evaluation of all health and social policies and

programmes.

• Health is primarily determined by the political, economic,

social and physical environment and should, along with

equity and sustainable development, be a top priority in

local, national and international policy‐making.


A CALL FOR ACTION

To combat the global health crisis, we need to take action at all

levels ‐ individual, community, national, regional and global ‐

and in all sectors. The demands presented below provide a basis

for action.


HEALTH AS A HUMAN RIGHT

Health is a reflection of a society’s commitment to

equity and justice. Health and human rights should prevail over

economic and political concerns.

This Charter calls on people of the world to:

• Support all attempts to implement the right to health.

• Demand that governments and international

organisations 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.

• Fight the exploitation of people’s health needs for

purposes of profit.



TACKLING THE BROADER DETERMINANTS OF

HEALTH

Economic challenges:

The economy has a profound influence on people’s health.

Economic policies that prioritise equity, health and social

well‐being can improve the health of the people as well as the

economy.

Political, financial, agricultural and industrial policies which

respond primarily to capitalist needs, imposed by national

governments and international organisations, alienate people

from their lives and livelihoods. The processes of economic

globalisation and liberalisation have increased inequalities

between and within nations. Many countries of the world and

especially the most powerful ones are using their resources,

including economic sanctions and military interventions, to

consolidate and expand their positions, with devastating effects

on people’s lives.

٢

This Charter calls on people of the world to:

• 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. In order to protect public health,

such transformation must include intellectual property

regimes such as patents and the Trade Related aspects of

Intellectual Property Rights (TRIPS) agreement.

• Demand the cancellation of Third World debt.

• Demand radical transformation of the World Bank and

International Monetary Fund so that these institutions

reflect and actively promote the rights and interests of

developing countries.

• Demand effective regulation to ensure that TNCs do not

have negative effects on people's health, exploit their

workforce, degrade the environment or impinge on

national sovereignty.

• Ensure that governments implement agricultural policies

attuned to people's needs and not to the demands of the

market, thereby guaranteeing food security and equitable

access to food.

• Demand that national governments act to protect public

health rights in intellectual property laws.

• Demand the control and taxation of speculative

international capital flows.

• Insist that all economic policies be subject to health,

equity, gender and environmental impact assessments

and include enforceable regulatory measures to ensure

compliance.

• Challenge growth‐centred economic theories and replace

them with alternatives that create humane and

sustainable societies. Economic theories should recognise

environmental constraints, the fundamental importance

of equity and health, and the contribution of unpaid

labour, especially the unrecognised work of women.

Social and political challenges

Comprehensive social policies have positive effects on people’s

lives and livelihoods. Economic globalisation and privatisation

have profoundly disrupted communities, families and cultures.

Women are essential to sustaining the social fabric of societies

everywhere, yet their basic needs are often ignored or denied,

and their rights and persons violated.

Public institutions have been undermined and weakened. Many

of their responsibilities have been transferred to the private

sector, particularly corporations, or to other national and

international institutions, which are rarely accountable to the

people. Furthermore, the power of political parties and trade

unions has been severely curtailed, while conservative and

fundamentalist forces are on the rise. Participatory democracy

in political organisations and civic structures should thrive.

There is an urgent need to foster and ensure transparency and

accountability.

This Charter calls on people of the world to:

• Demand and support the development and

implementation of comprehensive social policies with full

participation of people.

• Ensure that all women and all men have equal rights to

work, livelihoods, to freedom of expression, to political

participation, to exercise religious choice, to education

and to freedom from violence.

• Pressure governments to introduce and enforce legislation

to protect and promote the physical, mental and spiritual

health and human rights of marginalised 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.

• Demand that the activities of public institutions, such as

child care services, food distribution systems, and housing

provisions, benefit the health of individuals and

communities.

• Condemn and seek the reversal of any policies, which

result in the forced displacement of people from their

lands, homes or jobs.

• Oppose fundamentalist forces that threaten the rights and

liberties of individuals, particularly the lives of women,

children and minorities.

• Oppose sex tourism and the global traffic of women and

children. 7º

٢

Environmental challenges:

Water and air pollution, rapid climate change, ozone layer

depletion, nuclear energy and waste, toxic chemicals and

pesticides, loss of biodiversity, deforestation and soil erosion

have far‐reaching effects on people’s health. The root causes of

this destruction includes the unsustainable exploitation of

natural resources, the absence of a long‐term holistic vision, the

spread of individualistic and profit‐maximising behaviours, and

over‐consumption by the rich. This destruction must be

confronted and reversed immediately and effectively.

This Charter calls on people of the world to:

• 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.

• Demand that all development projects be evaluated

against health and environmental criteria and that caution

and restraint be applied whenever technologies or policies

pose potential threats to health and the environment (the

precautionary principle).

• Demand that governments rapidly commit themselves to

reductions of greenhouse gases from their own territories

far stricter than those set out in the international climate

change agreement, without resorting to hazardous or

inappropriate technologies and practices.

• Oppose the shifting of hazardous industries and toxic and

radioactive waste to poorer countries and marginalised

communities and encourage solutions that minimise

waste production.

• Reduce over‐consumption and non‐sustainable lifestyles ‐

both in the North and the South. Pressure wealthy

industrialised countries to reduce their consumption and

pollution by 90 per cent.

• Demand measures to ensure occupational health and

safety, including worker‐centred monitoring of working

conditions.

• Demand measures to prevent accidents and injuries in the

workplace, the community and in homes.

• Reject patents on life and oppose bio‐piracy of traditional

and indigenous knowledge and resources.8º

• 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.

War, violence, conflict and natural disasters:

War, violence, conflict and natural disasters devastate

communities and destroy human dignity. They have a severe

impact on the physical and mental health of their members,

especially women and children. Increased arms procurement

and an aggressive and corrupt international arms trade

undermine social, political and economic stability and the

allocation of resources to the social sector.

This Charter calls on people of the world to:

• Support campaigns and movements for peace and

disarmament.

• Support campaigns against aggression, and the research,

production, testing and use of weapons of mass

destruction and other arms, including all types of

landmines.

• Support people's initiatives to achieve a just and lasting

peace, especially in countries with experiences of civil war

and genocide.

• Condemn the use of child soldiers, and the abuse and

rape, torture and killing of women and children.

• Demand the end of occupation as one of the most

destructive tools to human dignity.

• Oppose the militarisation of humanitarian relief

interventions.

• Demand the radical transformation of the UN Security

Council so that it functions democratically.

• Demand that the United Nations and individual states end

all kinds of sanctions used as an instrument of aggression

which can damage the health of civilian populations.

• Encourage independent, people‐based initiatives to

declare neighbourhoods, communities and cities areas of

peace and zones free of weapons.

• Support actions and campaigns for the prevention and

reduction of aggressive and violent behaviour, especially

in men, and the fostering of peaceful coexistence.

• Support actions and campaigns for the prevention of

natural disasters and the reduction of subsequent human

suffering.



A PEOPLE‐CENTERED HEALTH SECTOR

This Charter calls for the provision of universal and

comprehensive primary health care, irrespective of people’s

ability to pay. Health services must be democratic and

accountable with sufficient resources to achieve this.

This Charter calls on people of the world to:

• Oppose international and national policies that privatise

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 organising public

health services so as to ensure free and universal access.

• Pressure governments to adopt, implement and enforce

national health and drugs policies.

• Demand that governments oppose the privatisation of

public health services and ensure effective regulation of

the private medical sector, including charitable and NGO

medical services.

• 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 organisations 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.

• Support, recognise and promote traditional and holistic

healing systems and practitioners and their integration

into Primary Health Care.

• Demand changes in the training of health personnel so

that they become more problem‐oriented and practice10º

based, understand better the impact of global issues in

their communities, and are encouraged to work with and

respect the community and its diversities.

• Demystify medical and health technologies (including

medicines) and demand that they be subordinated to the

health needs of the people.

• 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. It should

be people‐ and public health‐oriented, respecting

universal ethical principles.

• Support people’s rights to reproductive and sexual self-determination

and oppose all coercive measures in

population and family planning policies. This support

includes the right to the full range of safe and effective

methods of fertility regulation.



PEOPLE'S PARTICIPATION FOR A HEALTHY WORLD

Strong people’s organisations and movements are fundamental

to more democratic, transparent and accountable decision-making

processes. It is essential that people’s civil, political,

economic, social and cultural rights are ensured. While

governments have the primary responsibility for promoting a

more equitable approach to health and human rights, a wide

range of civil society groups and movements, and the media

have an important role to play in ensuring people's power and

control in policy development and in the monitoring of its

implementation.

This Charter calls on people of the world to:

• Build and strengthen people’s organisations 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 organisations 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.



AMENDMENT

After the endorsement of the PCH on December 8, 2000, it was

called to the attention of the drafting group that action points

number 1 and 2 under Economic Challenges could be

interpreted as supporting the social clause proposed by the

WTO, which actually serves to strengthen the WTO and its

neoliberal agenda. Given that this countervails the PHA

demands for change of the WTO and the global trading system,

the two paragraphs were merged and amended.

The section of War, Violence and Conflict has been amended to

include natural disasters. A new action point, number 5 in this

version, was added to demand the end of occupation.

Furthermore, action point number 7, now number 8, was

amended to read to end all kinds of sanctions. An additional

action point number 11 was added concerning natural disasters.
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