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<p class=MsoNormal><span class=SpellE><font size=2 face=Verdana><span
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Verdana'> 2005</span></font></span><font size=2 face=Verdana><span
style='font-size:10.0pt;font-family:Verdana'>;331:128 (16 July), <span
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<h3><b><font size=4 face="Times New Roman"><span style='font-size:13.5pt'><VARDEF id=TEXT>News
roundup<o:p></o:p></span></font></b></h3>
<h2><strong><b><font size=5 color="#cc0000" face="Times New Roman"><span
style='font-size:18.0pt;color:#CC0000;background:white'>Assembly</span></font></b></strong>
meets to tackle <strong><b><font color="#cc0000" face="Times New Roman"><span
style='color:#CC0000;background:white'>health</span></font></b></strong> needs
of the poor<o:p></o:p></h2>
<p><st1:City><st1:place><i><font size=3 face="Times New Roman"><span
style='font-size:12.0pt;font-style:italic'>London</span></font></i></st1:place></st1:City>
Tessa Richards <o:p></o:p></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>More than
a thousand members of the People’s <strong><b><font color="#cc0000"
face="Times New Roman"><span style='color:#CC0000;background:white'>Health</span></font></b></strong>
Movement from about 90 mostly poor countries will meet at the People’s <strong><b><font
color="#cc0000" face="Times New Roman"><span style='color:#CC0000;background:
white'>Health</span></font></b></strong> <strong><b><font color="#cc0000"
face="Times New Roman"><span style='color:#CC0000;background:white'>Assembly</span></font></b></strong>
in </span></font><st1:place><st1:City><span class=SpellE>Cuenca</span></st1:City>,
<st1:country-region>Ecuador</st1:country-region></st1:place>, next week. The
movement (<a href="http://www.phmovement.org%20"><span class=SpellE>www.phmovement.org</span></a>)
is a global advocacy network of people’s <span class=SpellE>organisations</span>,
civil society groups, non-governmental <span class=SpellE>organisations</span>,
women’s groups, social activists, academics, <strong><b><font
color="#cc0000" face="Times New Roman"><span style='color:#CC0000;background:
white'>health</span></font></b></strong> professionals, and policy makers. This
will be the second time that they have come together in a meeting, aimed at
giving a voice to the poor. <o:p></o:p></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>The first
People’s <strong><b><font color="#cc0000" face="Times New Roman"><span
style='color:#CC0000;background:white'>Health</span></font></b></strong> <strong><b><font
color="#cc0000" face="Times New Roman"><span style='color:#CC0000;background:
white'>Assembly</span></font></b></strong>, was held in <span class=SpellE>Savar</span>
in </span></font><st1:country-region><st1:place>Bangladesh</st1:place></st1:country-region>
in 2000, and attracted almost 1500 <strong><b><font color="#cc0000"
face="Times New Roman"><span style='color:#CC0000;background:white'>health</span></font></b></strong>
activists. It was convened by <span class=SpellE>Zafrullah</span> <span
class=SpellE>Chowdhury</span> and his colleagues to discuss the failure to
achieve the goal of <strong><b><font color="#cc0000" face="Times New Roman"><span
style='color:#CC0000;background:white'>health</span></font></b></strong> for
all by the year 2000 (<span class=SpellE>BMJ</span> 2004<span class=GramE>;329:1127</span>).
This was the ambitious target that <strong><b><font color="#cc0000"
face="Times New Roman"><span style='color:#CC0000;background:white'>health</span></font></b></strong>
ministers from 134 countries signed up to at the <st1:City><st1:place>Alma-Ata</st1:place></st1:City>
conference in <st1:country-region><st1:place>Kazakhstan</st1:place></st1:country-region>
in 1978. <o:p></o:p></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>Poverty,
widening economic inequality, <span class=SpellE>globalisation</span>, unfair
trade, and poor <strong><b><font color="#cc0000" face="Times New Roman"><span
style='color:#CC0000;background:white'>health</span></font></b></strong>
governance were held to blame. Governments and the United Nations’
agencies concerned with <strong><b><font color="#cc0000" face="Times New Roman"><span
style='color:#CC0000;background:white'>health</span></font></b></strong> were
charged with failing to enact the principles set out in the </span></font><st1:City><st1:place>Alma-Ata</st1:place></st1:City>
declaration, which called for the development of comprehensive equitable
primary <strong><b><font color="#cc0000" face="Times New Roman"><span
style='color:#CC0000;background:white'>health</span></font></b></strong> care
services (<span class=SpellE>BMJ</span> 2000<span class=GramE>;321:1361</span>-2).
<o:p></o:p></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>During
that meeting, the People’s <strong><b><font color="#cc0000"
face="Times New Roman"><span style='color:#CC0000;background:white'>Health</span></font></b></strong>
Movement came together, and a call to arms was drawn up and endorsed in the
form of the People’s Charter for <strong><b><font color="#cc0000"
face="Times New Roman"><span style='color:#CC0000;background:white'>Health</span></font></b></strong>
(<a href="http://www.healthwrights.org%20"><span class=SpellE>www.<strong><b><font
color="#cc0000" face="Times New Roman"><span style='color:#CC0000;background:
white;text-decoration:none;text-underline:none'>health</span></font></b></strong>wrights.org</span></a>).
The charter, to which signatories continue to be added, demands that <strong><b><font
color="#cc0000" face="Times New Roman"><span style='color:#CC0000;background:
white'>health</span></font></b></strong> and human rights should prevail over
economic and political concerns and that people, especially poor people in less
developed countries, should have a much greater influence on the development of
national and international <strong><b><font color="#cc0000"
face="Times New Roman"><span style='color:#CC0000;background:white'>health</span></font></b></strong>
policy. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>The <strong><b><font
color="#cc0000" face="Times New Roman"><span style='color:#CC0000;background:
white'>assembly</span></font></b></strong> in </span></font><st1:City><st1:place><span
class=SpellE>Cuenca</span></st1:place></st1:City> will continue the debate
within the People’s <strong><b><font color="#cc0000"
face="Times New Roman"><span style='color:#CC0000;background:white'>Health</span></font></b></strong>
Movement on how to narrow the vast and growing <strong><b><font color="#cc0000"
face="Times New Roman"><span style='color:#CC0000;background:white'>health</span></font></b></strong>
and wealth divide between rich and poor countries. It will reinforce the call
to take radical action to counteract the underlying economic, social,
political, and environmental drivers of the divide. It is also set to discuss
the tone and outcome of last week’s G8 summit and the impact of the Make
Poverty History campaign. <o:p></o:p></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>The
meeting will be held at the medical school in </span></font><st1:City><st1:place><span
class=SpellE>Cuenca</span></st1:place></st1:City>, which has pioneered a
community based curriculum, with strong emphasis on looking at the determinants
of ill <strong><b><font color="#cc0000" face="Times New Roman"><span
style='color:#CC0000;background:white'>health</span></font></b></strong> and <strong><b><font
color="#cc0000" face="Times New Roman"><span style='color:#CC0000;background:
white'>health</span></font></b></strong> inequity. Halfway through the <strong><b><font
color="#cc0000" face="Times New Roman"><span style='color:#CC0000;background:
white'>assembly</span></font></b></strong>, on 20 July, a new report (billed as
the alternative world <strong><b><font color="#cc0000" face="Times New Roman"><span
style='color:#CC0000;background:white'>health</span></font></b></strong>
report) will be launched. <o:p></o:p></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>The
Global <strong><b><font color="#cc0000" face="Times New Roman"><span
style='color:#CC0000;background:white'>Health</span></font></b></strong> Watch
2005-6 Report will be released simultaneously in </span></font><st1:City><st1:place>London</st1:place></st1:City>
(at an open public meeting at the Royal Society of Arts) and subsequently in <st1:place><st1:City>Geneva</st1:City>,
<st1:country-region>South Africa</st1:country-region></st1:place>, <st1:State><st1:place>Berlin</st1:place></st1:State>,
and <st1:City><st1:place>Amsterdam</st1:place></st1:City>. The 359 page report,
to which over 120 individuals and 70 <span class=SpellE>organisations</span>
have contributed, has been compiled by members of the People’s <strong><b><font
color="#cc0000" face="Times New Roman"><span style='color:#CC0000;background:
white'>Health</span></font></b></strong> Movement and the Global <strong><b><font
color="#cc0000" face="Times New Roman"><span style='color:#CC0000;background:
white'>Health</span></font></b></strong> Equity Alliance (<a
href="http://www.gega.org.za%20"><span class=SpellE>www.gega.org.za</span></a>)
with support from <span class=SpellE>Medact</span> (<a
href="http://www.medact.org%20"><span class=SpellE>www.medact.org</span></a>). <o:p></o:p></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>“It
is explicit about the social and political causes of ill <strong><b><font
color="#cc0000" face="Times New Roman"><span style='color:#CC0000;background:
white'>health</span></font></b></strong> and poverty,” said David McCoy,
a public <strong><b><font color="#cc0000" face="Times New Roman"><span
style='color:#CC0000;background:white'>health</span></font></b></strong>
specialist and managing editor of the report. “As a civil society report
it has been able to say things that the UN agencies, [the World <strong><b><font
color="#cc0000" face="Times New Roman"><span style='color:#CC0000;background:
white'>Health</span></font></b></strong> Organization], and <span class=SpellE><span
class=GramE>Unicef</span></span> in particular, can’t say. And more to
the point [it can] comment on the capability and effectiveness of these
agencies who are charged with protecting and promoting <strong><b><font
color="#cc0000" face="Times New Roman"><span style='color:#CC0000;background:
white'>health</span></font></b></strong>.” <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>The
report is set to be critical of <span class=GramE>WHO’s</span> past
leadership on <strong><b><font color="#cc0000" face="Times New Roman"><span
style='color:#CC0000;background:white'>health</span></font></b></strong>. David
Sanders, professor of public <strong><b><font color="#cc0000"
face="Times New Roman"><span style='color:#CC0000;background:white'>health</span></font></b></strong>
at the University of the </span></font><st1:State><st1:place>Western Cape</st1:place></st1:State>,
<st1:country-region><st1:place>South Africa</st1:place></st1:country-region>,
and a major contributor to the report, underlines why: “During the 1990s,
WHO relinquished its leading role in determining global heath policy, and the
World Bank has taken over. Over the past two decades macroeconomic policies
pursued by the bank have had a negative impact on <strong><b><font
color="#cc0000" face="Times New Roman"><span style='color:#CC0000;background:
white'>health</span></font></b></strong> equity, and the global crisis in <strong><b><font
color="#cc0000" face="Times New Roman"><span style='color:#CC0000;background:
white'>health</span></font></b></strong>, especially in <st1:place>Africa</st1:place>
has barely been addressed. <o:p></o:p></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>“During
this time WHO has produced sheaves of information on the global burden of
disease and cost effective interventions but said very little about the causes
of ill <strong><b><font color="#cc0000" face="Times New Roman"><span
style='color:#CC0000;background:white'>health</span></font></b></strong>,
foremost among which are poverty, socioeconomic inequity, the adverse effects
of <span class=SpellE>globalisation</span> on the poor, unfair trade, and poor <strong><b><font
color="#cc0000" face="Times New Roman"><span style='color:#CC0000;background:
white'>health</span></font></b></strong> governance.” <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>Professor
Sanders is particularly critical of the market reforms that have been
introduced by the World Bank in poor countries, which have fuelled the
development of private <strong><b><font color="#cc0000" face="Times New Roman"><span
style='color:#CC0000;background:white'>health</span></font></b></strong>
services and further denuded the public sector of staff and resources. User
fees prevent the poorest and most vulnerable getting access to essential
medical care and in some countries even more basic commodities, such as water. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>“In
</span></font><st1:country-region><st1:place>South Africa</st1:place></st1:country-region>,
water supplies are now managed by a public-private partnership. User charges
kick in once per capita consumption exceeds 25 l a day (the average per capita
consumption of water in the <st1:country-region><st1:place>US</st1:place></st1:country-region>
is 250-300 l a day). This has had a hugely negative impact on <strong><b><font
color="#cc0000" face="Times New Roman"><span style='color:#CC0000;background:
white'>health</span></font></b></strong> and wealth. Poor families are now
spending up to 20% of their income on water. When this happened in <st1:country-region><st1:place>Bolivia</st1:place></st1:country-region>,
mass public protest forced the government to retract. <o:p></o:p></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>“We
can’t reverse <span class=SpellE>globalisation</span> but we can do more
to mitigate its adverse effects on the poor, foremost by pushing for fair
trade. More aid is needed too. Intermittent grand charitable gestures by rich
countries are not enough. Promises to deliver aid are frequently broken. The
poorest countries are bankrupt and wholly unable to deliver cost effective
interventions such as <span class=SpellE>immunisation</span> because their <strong><b><font
color="#cc0000" face="Times New Roman"><span style='color:#CC0000;background:
white'>health</span></font></b></strong> systems have collapsed.”
Professor Sanders supports the view that new sources of revenue are needed to
help the poorest countries, such as introducing taxes on global currency
exchange, air travel, and arms. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>Despite
their criticism of WHO, Professor Sanders and Dr McCoy <span class=SpellE>recognise</span>
that the <span class=SpellE>organisation</span> has changed under new
leadership and is more sensitive to the issues raised in the report. The
establishment earlier this year of <span class=GramE>WHO’s</span>
independent Commission on the Social Determinants of <strong><b><font
color="#cc0000" face="Times New Roman"><span style='color:#CC0000;background:
white'>Health</span></font></b></strong> (<a
href="http://www.who.int/social_determinants%20"><span class=SpellE>www.who.int/social_determinants</span></a>)
is, they say, clear evidence of this. The commission, chaired by Michael
Marmot, has a three year remit to compile evidence of community interventions
that improve <strong><b><font color="#cc0000" face="Times New Roman"><span
style='color:#CC0000;background:white'>health</span></font></b></strong>
through action on social determinants from countries with low and medium
incomes. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>“<span
class=SpellE>Intersectoral</span> interventions have much potential to improve <strong><b><font
color="#cc0000" face="Times New Roman"><span style='color:#CC0000;background:
white'>health</span></font></b></strong> and reduce <strong><b><font
color="#cc0000" face="Times New Roman"><span style='color:#CC0000;background:
white'>health</span></font></b></strong> inequalities,” Professor Marmot
told the <span class=SpellE>BMJ</span> last week. “We know that
people’s <strong><b><font color="#cc0000" face="Times New Roman"><span
style='color:#CC0000;background:white'>health</span></font></b></strong> is
hugely influenced by the conditions in which they live and work. We are keen to
work closely with civil society groups to inform and extend our knowledge of
how community interventions improve <strong><b><font color="#cc0000"
face="Times New Roman"><span style='color:#CC0000;background:white'>health</span></font></b></strong>.”
<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>“I am impressed, for example by the positive impact on child <strong><b><font
color="#cc0000" face="Times New Roman"><span style='color:#CC0000;background:
white'>health</span></font></b></strong> of a Latin American initiative that
provides mothers with a small income to spend on sending their children to
school and to nutritional <span class=SpellE>centres</span>. I am looking
forward to going to </span></font><st1:City><st1:place><span class=SpellE>Cuenca</span></st1:place></st1:City>
to explain our work and to get the input of the People’s <strong><b><font
color="#cc0000" face="Times New Roman"><span style='color:#CC0000;background:
white'>Health</span></font></b></strong> Movement into the commission’s
thinking. We need to establish how we can make common cause.”<o:p></o:p></p>
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