New book "Perspective on Global Development and Technology"
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Here are the extracts from a recent book on Globalization which
comments on the significance of the People's Health Movement
(PHM) and should inspire us all to doing more to strengthen
globalization from below.
PHM Secretariat team
People's Health Movement: An independent assessment
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Some extracts from a recently published book:
"Perspective on Global Development and Technology".
Edited by Richard L. Harris and Melinda J. Seid
Globalization and Health in the New Millennium
"Since 1980s, the shift in global health strategy that has ac-
companied the promotion of neo-liberal policies by the IMF and
the World Bank has replaced the goal of providing comprehensive
primary health care, reducing government budgets for health and
other social services, downsizing the public health sector, pri-
vatizing hospitals and clinics, charging fees for health and
other public services, eliminating or greatly reducing food sub-
sidies; and freeing the prices of drugs and health services to
that they are no longer within the reach of large sectors of the
population. Many critical observes and activists have criticized
the World Bank for this shift in strategy and for the adverse
health effects of the neo-liberal policies this shift in global
health strategy has caused. They argue that the Bank's promotion
of neo-liberal policies has placed the burden of health care
costs on the shoulders of the poor, drastically reduced public
health services, turned over to private doctors and businesses
most of the health services that used to be provided free or on
a subsidized basis, and priced many medical interventions beyond
the capability to pay of those who have the greatest need for
these interventions...
The World Bank's market-oriented health policies have come under
sever criticism from health activists in new People's Health
Movement, who accuse the Bank of having contributed to the dete-
rioration of health conditions around the world. They also
charge that the World Bank has 'hijacked health' from the WHO,
since the Bank now provides more funds for health-related pro-
grams than the WHO. The PHM is an international movement that
has affiliates in five continents. It represents a primary exam-
ple of what has been called "globalization from below', that is,
the kind of global solidarity and collaboration that occurs when
groups of people at the grassroots level around the world link
up to protect their interests against the forces of globaliza-
tion from above.
The PHM emerged out of the People's Health Assembly (PHA) that
brought health activists from some 92 countries together in
Savar, Bangaldesh, in December 2000. This international assembly
produced a People's Charter for Health (PHA 2000), which has
since been translated into 35 languages. The Charter is aimed at
combating the negative effects of globalization and at making
health a fundamental human right that is respected by all na-
tional governments and intergovernmental organizations..
The PHM advocates comprehensive primary health care for all (as
envisioned in the Alma Ata Declaration); calls for the radical
transformation of the World Bank, the IMF, WTO, and the WHO to
make them more responsive to poverty alleviation and promoting
health for all; demands that the foreign debts of the developing
countries be cancelled; calls on national governments to protect
the health rights of their citizens; demands that transnational
corporations (particularly those involved in health) be effec-
tively regulated so that they do not exploit or harm people's
health; opposes the privatization and commodification of health
care; and calls for the establishment of people's organizations
and movements top work at the global, national and community
world order. Representatives of the PHM met with the WHO Direct-
General at the May 2001 World Health Assembly in Geneva and the
PHM sent the largest civil society delegation to the May 2002
World Health Assembly. It is engaged in organizing regional and
country 'circles' to build awareness about and mobilize support
for the movement around the world. The PHA Charter concludes
that although governments are responsible for promoting health
equality, people's organizations are required to force them to
meet this responsibility..."
Trade Liberalization and the Privatization of Health Care:
"In the present context of increasing privatization and the pro-
motion of neo-liberal policies at both global and the national
levels by the IMF, World Bank and the WTO, national government
responsibility for providing basic health care for all members
of the population has been replaced by so-called selective pri-
mary health care, public-private partnerships, and the privati-
zation of health services and health care facilities. As the es-
say by Narayan and Schuftan indicates, this shift in responsi-
bility for providing health care is considered by many critics
of globalization and the current trends in health to be a be-
trayal of the international commitment made in the late seven-
ties to provide primary health care for all by the year 2000.
This was the official commitment made by the most of the govern-
ments represented at the 1978 International Health Assembly held
at Alma - Ata in the Central Asian republic of what was then the
Union of Soviet Socialist Republics..."
The Health Effects of the Inequities Promoted by Globalization
"The PHM sees a direct relationship between existing health ine-
qualities and globalization. The members of this global movement
consider inequality, poverty, exploitation, violence and injus-
tice as the root causes of ill health in the world today. As Na-
rayan and Schuftan make clear in their discussion of the Peo-
ple's Charter for Health, achievement of the PHM's goal of
"Health for All - Now!" requires 'challenging, the powerful eco-
nomic interests that dominant the existing global order, oppos-
ing globalization in its existing iniquitous form, and drasti-
cally changing the political and economic priorities at all lev-
els of the global system..."
Community Health Care, Grassroots Action, and Globalization from
below
The essay on the People's Health Movement (PHM) reveals the em-
phasis this new movement gives to community control of health
care, grassroots action, and global action based on the use of
international health advocacy networks. These are important ele-
ments in the movement's global campaign to combat the health
inequalities associated with globalization and to make sure that
universal access to comprehensive primary health care is pro-
vided everywhere in the world. This movement is engaged in what
amounts to "globalization from below" as it builds support for
its global Health for All - Now strategy, lobbies at the global
level, and mobilizes a grassroots - based campaign to realize
the vision and achieve the goals of the People's Charter for
Health...
The Charter, which is the PHM's visionary statement of goals and
its main tool for advocacy, calls for "a people-centered health
sector that is democratic and accountable". The Charter calls on
the people of the world to: (1) build and strengthen people's
organizations as a basis for analysis and action; (2) promote,
support and engage in actions that encourage people's involve-
ment in decision-making in public services at all levels; (3)
demand that people's organizations be represented in local, na-
tional and international for a that are relevant to health; and
(4) support local initiatives towards participatory democracy
through the establishment of people-centered solidarity networks
across the world. One of the primary principles of the Charter
is the proposition that 'the participation of people and peo-
ple's organizations is essential to the formulation, implementa-
tion and evaluation of all health and social policies and pro-
grams"..
McIntyre concludes in his essay that "the growth in number, size
and power of civil society organizations combined with the in-
creased networking of these organizations across national
boundaries" is having a 'countervailing effect' on the negative
health impacts of globalization. They give the example of how
civil society organizations in South Africa gained the support
of civil society groups in the United States to pressure the US
government into dropping its efforts to convince the South Afri-
can government to change its policy relating to the importation
of medicines so that it would not contravene the TRIPS agree-
ment. They show how these groups in South Africa also teamed up
with International groups such as Medecins Sans Frontieres and
Health Action International to oppose the efforts of the trans-
national pharmaceutical corporations (with the support of their
host governments) to pressure the South Africa government and
governments of other developing countries (such as!
Thailand) into restricting their use of certain provisions in
the TRIPS agreement that permit governments to obtain urgently
needed patented medicines at reduced price..
The adverse effects of existing international trade agreements
on health, human rights, and the environment have been subjected
to increasing public criticism in recent years. As Labonte notes
in his essay, these agreements have "become the focus for pro-
gressive social movements". The global networking and collabora-
tion that have developed among these social movements, such as
the PHM, represent a form of 'globalization from below" that is
rising up to challenge the "globalization from above", imposed
by the transnational corporations and their allies in the IMF,
World Bank, WTO, the Group 8 governments (led by the US govern-
ment), and certain large international non-governmental organi-
zations that are closely associated with these forces..."
Alternatives to the Globalization of Health from above
"The PHM is clear evidence that the existing linkages between
globalization and health are contestable. In fact, most of the
essays in this collection indicate that the adverse health ef-
fects of globalization are being challenged at the global, na-
tional, and local levels. The People's Health Movement and the
People's Charter for Health provide a significant expression of
alternatives "from below" to the present globalization, privati-
zation and commercialization of health coming "from above". This
People's Charter for Health provides a vision of a better and
healthier world, a call for radical action, a tool for advocacy
for people's health, and a rallying point for building a global
health movement based on international networks and coalition
building...
The People's Charter for Health lays out a blue print for the
transformation of the existing global order through democratiza-
tion at all levels of the existing system and through what some
people in the global social justice movement call "globalization
from below". It is based on the fundamental, but radical, as-
sumption that "to ensure health, people's basic needs for food,
water, sanitation, housing, health services, education, employ-
ment and security must be met" in the present time frame. In ad-
dition, it is based on the assumptions that global decision must
be democratized and that people's organizations and organized
grass roots action can bring about an "alternative vision of de-
velopment - one that promotes human and environmental well-
being". To achieve this vision, the PHM is pursuing the democra-
tization of health decision and outcome at all levels...
The Charter for People's Health calls upon national governments
and global institutions to recognize health as a fundamental hu-
man right and as a social, economic and political exploitation,
violence and injustice as the roots of ill-health and it makes
clear that the achievement of universal access to primary health
care requires challenging powerful economic interests; opposing
privatization and globalization (in its present inequitable
form); and drastically changing the prevailing political and
economic priorities at all levels in the global order...
The Charter also makes it clear that the PHM wants the poor and
marginalized (rarely heard) people's throughout the world to
participate in health decision-making and develop their own lo-
cal solutions to their health problems. The movement encourages
people to hold local authorities, national governments and in-
ternational organizations and corporations accountable for en-
suring that the goal of Health for All is achieved now, not at
some distant point in the future. However, even though the PHM
firmly believes national governments have the primary responsi-
bility for promoting an equitable approach to health and human
rights, the movement knows that it will take pressure from peo-
ple's organizations to force their governments to meet this re-
sponsibility. This statement reflects one of the most important
strategic assumptions held by the PHM: that it will take organ-
ized grassroots action as well as concerted action at the global
level to bring about the profound social changes that are needed
to achieve the sweeping vision and radical goals of the move-
ment..."
--
Source: Perspectives on Global Development and Technology, Vol.
3, No. 1-2, 2004.
The Subscription price of Vol. 3 (2004) is EUR 84.- (US$ 97.50)
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