special issue · 2006-01-20 · 2 contact no.180 - december 2005 editorial opening ceremony lezak...

Publication of the World Council of Churches

contact

No.180December 2005

SPECIAL ISSUE

2 Editorial4 Invoking Health for All6 Markets Cannot Guarantee

the Right to Health8 Neoliberal Onslaught

on Health Reforms10 Community Work, Motor for

Change12 FTAs Threaten Access to

Medicines14 Reclaiming Traditional

Health16 No Health without Peace17 When the Earth Takes Ill18 Battling for Health in Ecuador19 Resources20 Announcements

PEOPLE’S HEALTH ASSEMBLY 2

Ser

vio

Zap

ata

contact No.180 - December 20052

EDITORIAL

Opening ceremony

Leza

k S

halla

t

It is an enormous satisfactionfor the People’s HeathMovement (PHM) to presentthis special issue dedicated tothe second People’s HealthAssembly (PHA2), held in July2005 in Cuenca, Ecuador.

A short summary of thePeople’s Health Movementwill help put this Assembly intocontext for our readers. ThePHM, a network of more than300 base organizations in 80countries worldwide, was bornat the end of the 1990s andheld its f irst internationalAssembly in December 2000in Savar, Bangladesh. That

meeting saw the launch of People’sHealth Charter, the historic documentthat summarizes the ideological positionof our network and has been translatedinto 45 languages. The CuencaDeclaration reiterates and updates theprinciples of this Charter.

The People’s Health Movement has gar-nered many achievements since its in-ception, including:• active participation in the annual World

Health Assembly of the World HealthOrganization• collaboration, as co-author of the Global

Health Watch study, launched inCuenca (see page 19)• key participant in the creation of the

WHO Commission on Social Determi-nants of Health, and consultant to itsupcoming report• the Global Right to Health Campaign

Initiative• the launch, at the PHA2, of the Inter-

national People’s Health University,to prepare future leaders of themovement.

The PHM is organized democraticallyin geographic and thematic circles.

The voices of the PHM are spreadthrough specific interventions by itsmembers in diverse forums aroundthe world and through its website:www.phmovement.org . Discussionand exchange also take place over anelectronic listserve, open to all, at:[email protected]

In Cuenca, the enthusiasm of some 1,500active participants was palpable and con-tagious. The photos in these pages re-flect this energy and the many voicespresented here will transmit to the readersomething of this excitement.

Our thanks to the World Council ofChurches who, in collaboration withFundación EPES (Educación Popularen Salud) in Chile, produced this spe-cial issue of contact. Their efforts bringthe reader an excellent synthetic andpanoramic overview of events at Cuenca—not only its intellectual and politicalachievements, but also the spirit andhopes behind them.

This issue highlights:• health as the outcome of the political

and social determinants that generateit. It also reminds us that Primary HealthCare has been betrayed and that areturn to the vision of “Health for All”laid out at the 1978 Alma-Ata Confer-ence is only possible through popularmobilization at the international level• the right to health is a non-negotiable

demand of all peoples and a key strategy of the PHM regarding the legalobligations of governments and inter-national co-operation. The human rightsstrategy to health transcends the mis-directed “basic needs” approachadopted in recent decades• the disastrous impacts of the

privatization of health services, withdrastic cuts in social spending as dic-tated by neoliberal economic ideol-ogy. The PHM has publicly criticizedthe WHO for not taking a more pro–active position against privatization• community efforts with the potential to

bring structural change by fosteringnew awareness, hope and direct ac-tion by the beneficiaries of health care• the negative impacts on health of free

trade and intellectual property agree-ments, particularly concerning the

contact No. 180 - December 2005 3

EDITORIAL

Leza

k S

halla

t

• This special issue of contact covering the second People’sHealth Assembly (PHA2) was made possible by the WorldCouncil of Churches and Fundación EPES and aims toidentify and disseminate a wide range of alternativeapproaches and experiences that showcase the role ofcommunity participation and organization in health.

• The articles in this issue were written by Lezak Shallat andPaulina Cid, who attended the PHA2 on behalf of EPES.Manoj Kurian of the World Council of Churches and SoniaCovarrubias of Fundación EPES participated in the EditorialCommittee. Jorge Olivares of EPES put together theResources section. A special thanks to editorial writerClaudio Schuftan, Chilean physician living in Vietnam and amember of the People’s Health Movement, and to ServioZapata, the Cuenca artist who contributed the coverdrawing.

• Electronic versions in English and Spanish of this specialissue are posted on the following websites:World Council of Churcheswww.wcc-coe.org/wcc/news/con-s.html

Fundación EPES, www.epes.cl

• A printed version of the Spanish version is available onrequest from Fundación EPES. (See address on backcover.)

— EPES Team

Delegates sponsored by the World Council of Churches

One of the many cultural events

Healthy food workshop in the Cuenca market

Leza

k S

halla

tLe

zak

Sha

llat

For information about the first People’s Health Assembly, seecontact #176 (2002), in: www.wcc-coe.org/wcc/news/con172.pdf

Claudio SchuftanPeople’s Health Movement

need for generic drugs and access tomedicines• the vibrant presence of indigenous

people who understand the value ofan intercultural approach to health.Respect for traditional health care isindispensable in any process of healthreform• the effects of war on non-combatants

and the use of sexual violence as aweapon, as described in testimoniesfrom Iraq, Palestine, Africa, Asia andthe Americas, are unacceptable• the links between the health of the

planet and human health must be seenin the light of the over-exploitation ofnatural resources and new agriculturaltechnologies.

Above all, these pages record how thePeople’s Health Movement creates andextends solidarity to all those who fightfor HEALTH FOR ALL ...NOW.

CREDITS AND ACKNOWLEDGEMENTS


OVERVIEW

Why are we here?“…to learn what’s happening outside our country. We’re surprised to find out that what happens withhealth at home and injustice happens all over.” Marta Salinas, Municipal Health Council, Colina, Chile“…to take back a message of hope that it is possible to fight against a neoliberal system that appears tobe invincible.” Nelsi Arias, indigenous community, Agua Blanca, Colombia

INVOKING HEALTH FOR ALL

Leza

k S

halla

t

Calling upon the spirits

A ceremony of spiritual offerings fromindigenous cultures worldwide, of homageto Mother Earth, the elements, healingsounds and collective energies, launchedthe second People’s Health Assembly(PHA2) in its quest to reclaim health as a

human right and not a marketcommodity.

Some 1,500 people from 82countries traveled to Cuenca,Ecuador from July 17 to 23 togive testimony to the impactsof neo-liberal policies andeconomic globalization andshare their faith in the impor-tance of community re-sponses and resistance.

The central message of theAssembly was simple:economically and politicallygenerated health inequalitieshave increased, but the socialand political determinants thatare the root causes ofavoidable disease and deathare not effectively addressed.Injustice in access to healthcare persists around the globe.

The Assembly sought new ways ofexamining the links between health andpoverty, diminished access to servicesand growing environmental dangers, allsocial determinants generated by theexpansion of neoliberal economic models.

Created by an international alliance ofpublic health activists, medical profes-sionals, academics, health sector work-ers, representatives of faith communitiesand environmental, indigenous, women’s,consumer defense and other social move-

ments, the People’s Health Movement(PHM) began this task in Bangladesh in2000 when it convoked its first Assemblyas a popular alternative to the forums ofmultilateral agencies and governments.

Spirit of Alma-Ata

One of the spirits invoked at Cuenca wasthat of Alma-Ata, birthplace of the “Healthfor All in the Year 2000” declaration signedby 134 nations in 1978. This declarationintroduced Primary Health Care as a UNstrategy. At the PHA2, however, critics ofcurrent UN policies lamented the demiseof the primary health care paradigm andcalled upon governments and the inter-national health community to revitalizecommitment to this approach.

The Cuenca Declaration calls uponpeople everywhere to “mobilize againstthe denial of the Right to Health.” It notesthat governments rarely see provision ofhealth services as a “collective socialresponsibility,” and denouces the globaltrend to place responsibility for personalhealth with the individual.

Diagnosis

“Neoliberalism is bad for people’s health,”the Assembly concurred. Its most visiblesymptom is the impact of privatization onpublic health systems now underway inLatin America and elsewhere (see page8). Economic globalization has subjectedthe future of national health services tothe World Trade Organization and bilat-eral trade negotiations (see page 12).

But voices of dissent exist, many in-spired by the ideals of Latin Americansocial medicine. These reject the“commodification” of health care into a


Ceremony of fire

OVERVIEW

The People’s Health Movement seeks to build upon its strengths. Here aresome thoughts on how to advance:

• “Mobilize masses and multiply voices.”— Joan Jubran, Palestine• “Empower ourselves in the economics of health.” — Zafrullah Chowdhury,

Bangladesh• “Greater participation by workers and peasant organizations, because

they are the prime movers of social change.” — Bert de Belder, Belgium• “Remain decentralized while strengthening regional and local levels.

That’s where the action is. Regional and local actors are the ones whoshould decide where the movement is going, and how.” — Ghassan Issa,Lebanon

• “Believe in the capacity of people to organize themselves. Help mobilizethe sectors that can exert pressure on governments to meet theirdemands.” — Eduardo Espinoza, El Salvador

• “Dare to define clear political strategies for the movement that will de-termine which battles to wage and with what arms.” — Halfdan Mahler,Director General Emeritus, WHO

Nelsi Arias, Colombia

Pau

lina

Cid

THE WAY FORWARD

Excerpted from Pijuano, the PHA2 daily bulletin

product and not a right. Dozens of testi-monies presented at the Assembly madeit clear that resistance is also a form ofhealing.

Many spoke in favor of “interculturality,”an approach to cultural diversity in healthcare that values the traditional medicalknowledge of indigenous peoples andseeks to develop culturally appropriatehealth systems. But sharing traditionalknowledge can also bring the appropria-tion of ancestral knowledge and re-sources by outsiders (see page 14).

The health of the environment and theEarth is essential for native peoples,whose cultures underscore harmoniouscoexistence with nature. As EugenioPoma, a Methodist bishop from Bolivia’sAymará community, said: “If the Earth issick, we cannot be healthy.”

In contrast, the industrial world seesnatural resources such as water,petroleum, wood and minerals as rawproducts to extract and sell with littleconcern for the consequences. Thecontamination of crops and entirecommunities by pesticides resembleslow-intensity biological warfare.Exploitation of oil-producing areas,forests and mineral riches poses a threatto the cultures — and even the survival —of many indigenous peoples.

The “war on terror” has brought death incountries from Iraq to Afghanistan and inEuropean and North American cities. InAfrica, “slow” wars like those of the Sudanand the Congo displace defenselesspopulations and often involve the use ofsexual violence against women.

Women’s right to make decisions abouttheir health was addressed by feministactivists and comadronas (midwives,many from the Cuenca area). But insocieties where fundamentalist religionsare dominant, women are made invis-ible, hampering their struggle for sexualand reproductive rights.

Invisibility also affects the disabled, whoseek policies toward inclusion andrespect. “The world would be different ifwe started to see some people as disabledand others as temporarily able-bodied,”noted Anita Ghai, an Indian activist whoasked participants to “respect humandiversity in all of its dimensions,” includingethnic, physical and generational.

A special plenary session onAfrica showed a continentdebilitated by HIV/AIDS, war-fare and poverty but strong incommunity bonds. But interms of health subsidies,noted South African activistDavid Sanders, “it is better tobe born a cow in Japan than achild in Africa.”

Despite the harsh diagnosis,the Assembly teemed withoptimism. “The People’sHealth Movement has thepower to change the world,”the Cuenca Declarationstates. “A world that includes‘Health for All’ is possible. Wemust all demand and work fora world in which health is aright, and is not subject to theforces of neoliberalism.”

Leza

k S

halla

t


FEATURE

MARKETS CANNOT GUARANTEETHE RIGHT TO HEALTH

Reclaiming a “rights” approach to health is a priority for the People’s Health Movement.

.

EP

ES

The right to health is being violatedsystematically around the world and isincreasingly under threat by trends thatconceptualize health care as a com-modity that can generate profits.

Speakers at the PHA2 denouncedthe World Bank, among other inter-national agencies, for advancing the“commodification” of health care as a“sacred” model for service delivery giveninappropriateness for impoverishedcountries devastated by epidemics andwarfare.

This has been masked by neoliberaldiscourses to persuade public opinioninto believing that shifting responsibilityfor health to the market will provideaccess for all. This weakens the “rights”approach to health care, which is indanger of being supplanted by a “needs-based” focus. The former emphasizesuniversal obigations; the latter facilitatesindividualism and charity hand-outs. Theneeds-based approach ignores key so-cial determinants like inequality, genderand ethnicity, restricting the notion ofhealth to the merely biomedical. It also

welcomes the belief that internationalcooperation can resolve social inequal-ity, thus absolving governments of re-sponsibility for addressing deficits andensuring access to health.

International aid is a form of charity thatdoes not resolve economic justice inaccess to health, stated PHM activistAlison Katz. “The benefits of interna-tional aid are returned one-and-a-halftimes to the North in the form of tradeimbalances,” she stated. “Who are thereal donors and beneficiaries in theseSouth-North transfers?”

Thomas Gebauer (Medico International,Germany) seconded criticism of hand-outs, saying “this type of cooperationonly contributes to maintaining the pre-carious status quo. Donor aid limited toguaranteeing minimum living standardswill not produce transformations. It isworth examining whether donationshave become an end in themselves forthose who offer them.”

Public health consultant ClaudioSchuftan presented a conceptual frame-work to help revitalize the human rights

Protesting for public health


Ser

vio

Zap

ata

FEATURE

Charity can meet needsbut it doesn’t guaranteerights. Rights focus onthe fulfillment ofobligations in a truesocial contract. We mustfight to ensure thatrights are met.Claudio Schuftan

The right to health will have to be achieved through large-scalepopular mobilization. The People’s Health Movement mustinitiate or join in struggles related to the right to water, foodsafety and sovereignty, a healthy environment, dignified work,safe housing, universal education and gender equity — becausepeople’s health depends on them.

focus on health, identifying the follow-ing positive impacts:

• This approach motivates people todemand their rights

• It is based on international humanrights legislation ratified by most coun-tries

• It calls upon people to hold govern-ments responsible for protecting theserights.

According to Schuftan, the differencebetween a “rights” focus and one of“basic needs” is that needs do not implyobligations.

“At most, needs imply a moral duty,” hestated. “In contrast, rights always in-volve a legal obligation that must befulfilled or demanded by citizens.

Needs are not universal, Schuftan noted,but human rights are. Rights areindivisible, whereas needs are easilyprioritized and minimum levelsestablished that do not fulfill the right tohealth care. The rights perspectivelooks less at achieving targets and moreat the processes that lead to results.

Lastly, the human rights approach makescommunity involvement a priority.

Cuenca Declaration


FEATURE

NEOLIBERALONSLAUGHT ONHEALTH REFORMS

Laurita Vicuña health clinic, Santiago, Chile

EP

ES

In the 1980s, Latin American govern-ments launched health system reformswithin a context of widespread neoliberaleconomic restructuring. Structural ad-justment programs were implementedin response to International MonetaryFund demands for cuts in social spend-ing. The World Bank became an influen-tial agency in global health policy, withnegative consequences, particularly forthe poor.

Participants at the PHA2 concurred thatthe decade of the 1990s saw reversalsin the quest for global health. Speakersquestioned the system that, in the wordsof Alison Katz, “maintains inequity be-tween rich and poor and is based on anirrational and unfair economic order.”

Community health — formerly viewedas the “motor” of the public health sys-tem, according to Salvadorean physi-cian Eduardo Espinoza — has beenreplaced by the notion that “the aimofthe health system is to generate in-come.” But the neoliberal model is inca-pable of providing universal access tohealth because universal access con-tradicts the logic of the marketplace.

Arachu Castro (Harvard University, US)referred to the “law of inverse care” bywhich the availability of medical atten-tion is inversely proportional to the de-mand. In other words, those who needthe most receive the least.

Carmen San José Pérez (Network forthe Right to Health, Spain), explainedhow privatization subverts the quest foruniversal access to health care:

• private companies play a key role inestablishing health policies

• the redistributive capacity of the pub-lic health system is lost

• private entities begin to define healthpriorities

• processes are slow and hidden frompublic opinion.

Colombian physican Manuel Vega dis-cussed this tendency in testimony onthe closure of Bogota’s oldest hospital,San Juan de Dios, which offered freemedical services to the poor. “Underthe new model, it was forced into aperverse market logic in which it couldnot compete,” he stated. “And since asa private entity, the government nolonger provided it with an income, it hadto close.”

The People’s Health Movement criti-cizes the World Health Organization forpromoting processes that underminethe primary health care paradigm ofactive community intervention. Thisapproach sees social justice as a pre-requisite for reaching the “Health forAll” goal adopted by the internationalcommunity.


FEATURE

“Genuine commitmentand participation havesustained the importanceof primary health care,and this is what thePeople’s HealthAssembly promotes.”

NEOLIBERAL SOCIAL JUSTICE

• Short-term approach tosymptoms

• “Magic” medicines

• Interventions through healthservices

• Focuses on individuals andmakes individuals responsiblefor their own health

• Sees charity and internationalcooperation as sources offunding

• Maintains the status quo ofextreme concentration ofwealth and power

• Looks at long-term causes

• Attempts to free people frommiserable living conditions

• Satisfaction of basic needs(food, water, housing, etc.)

• Focuses on poverty and struc-tural violence, makes the sys-tem responsible for the healthof the population

• Promotes a fair and rationalinternational economic order

Chart presented by Alison Katz

CONSTRASTING APPROACHESTO HEALTH CARE

This ideal, expressed by the 1978Alma-Ata Declaration, states that “thepeople have the right and duty toparticipate individually and collectivelyin the planning and implementation oftheir health care.”

“There is once again growing support forPrimary Health Care as a valid measurefor promoting and improving humandevelopment,” Hernán Montenegro ofthe Pan American Health Organizationtold the PHA2.

“The WHO says there is no evidencethat comprehensive health care is asolution to confronting inequity,” statedPHM activist David Sanders. But onceprojects that provide comprehensivecare have been widely implemented,“we will be able to show the WHO thatit is wrong.”

PHA2 denounced the “neoliberal fun-damentalism” promoted by the WHOand stated that the organization is look-ing to hide the relationship betweenpoverty, social inequities and healthindicators. Certain “average” indicators(e.g. life expectancy and infant mortal-ity) dominate public discourse and makeinvisible new illnesses and previouslycontrolled diseases, like tuberculosisand cholera, that have reappeared.These indicators obscure the enormousdisparities between regions, socialclasses, gender and ethnicities.

A new report launched at the PHA2provides an alternative vision. TheGlobal Health Watch examines thesocial factors minimized in WHOreports. “This is a wake-up call to theWHO,” said Mike Rowson, editor of thereport (see page 19).

Community and primary health caresurvive in part due to the diverse formsof protest and resistance employedthroughout the world, many of whichwere presented in testimonies to thePHA2.

For example, when the Colombian gov-ernment eventually closed Hospital

Juan de Dios, “workers turned it into aspace for resistance and solidarity,” saidVega. And though there is no hope thatthe hospital will be reopened, “resistancehas spread and efforts are being madeto ensure that this won’t happenelsewhere.”

Miguel Ayllón (Consumer Defense Com-mittee, Bolivia) alerted the PHA2 toprivatization of public hospitals in anation where protests over theprivatization of water and gas reserveshas brought down two governments intwo years.

From Argentina, where economic crisisand bankruptcies have undermined thephysical and mental health of manyworkers, Jorge Kohen described therecovery and self-management of theseindustries by their workers as “healthy ...(since) manifestations of creativity andresistance are also ways of healing.”

Halfdan Mahler


• Guatemala: The prior-ities of ASECSA (Com-munity Health ServicesAssociation), a networkof 63 indigenous organi-zations, include directprimary health care,natural medicine andcommunity developmentwith a social focus. “Forus, health is not an endbut a means,” said HugoIcu, a Maya Kakchiquel

physician. “ASECSA affiliates have nointention of abandoning the healers,bone-setters, midwives, Mayan priestsand traditions they believe in simplybecause the State does not value them.”

FEATURE

COMMUNITY WORK,MOTOR FOR CHANGE

This was a workshop of hope that identified community efforts as the most genuine andtransforming response to the globalizing economy. We highlight seven innovative experiences.

Natural remedies

• The Philippines: For the CommunityHealth Program, 30 years of traininggrassroots monitors has brought homea fundamental principle. “True healthcare is a process by which peoplebecome aware of their own situation,”in the words of María Teresa Guevara.More than 10,000 people nationwide

have been trained in pri-mary care. Results in-clude overall improve-ments in health aware-ness and action.

• Peru and United States: Strengtheningpatient-community bonds by workingwith families and schools is helping tofight TB in Peru. “We have increasedsuccess rates by accompanying pa-tients, visiting families, working withschools and offering group therapy,”reported Esther Montes and GenaroAnco, health monitors from Lima.In Boston, a “direct observation” modeldeveloped by the PACT Project moni-tors HIV patients though daily homevisits.

Leza

k S

halla

t

• El Salvador: Refugees returning thevillage of Guajila have built — with nogovernment support — a health sys-tem with better maternal-infant healthrates than the national average. Thisis due to the organization and disci-pline developed by the community

• India: In Chhattisgarh, the mitanin(“trusted friend”) project is a massivegovernment effort to mobilize womenas health promoters. Launched threeyears ago, it has recruited 60,000volunteers to promote use of healthservices and denounce lapses in care.The greatest challenge — apart from“staying motivated and managing frus-tration” according to one participant —is to maintain critical distance fromother government policies.

Contact:Council for Healthand [email protected]

Contact: [email protected]


Contact:Peru:www.pih.org/wherework/peru/index.html

Boston:www.brighamandwomens.org/socialmedicine/pact.asp

Contact : [email protected]

during years of repression. A docu-mentary presented by EduardoEspinoza showed home medical vis-its, health news broadcasts over RadioSumpul, and data gathering house-to-house.


FEATURE

In Chile, “apechugar” is to stand up to adversity and“pechugas” are breasts. The play on words produced theslogan “¡Mujer: Apechuga con tus pechugas!” for a campaignby grassroots women in Santiago to improve access tomammograms and early detection of breast cancer.

Breast cancer is the primary cause of death from cancer inChile, taking the lives of 2,000 women per year. When agroup of women organized byEPES (Educación Popular enSalud) decided to inform them-selves about the problem, theydiscovered more than a lack ofmedical technology.

The campaign began in the year2000, when interviews revealedthat women with tumors so largethey could be felt had waited upto 10 months for a mammogram.

Visits to primary care clinicsshowed that nurses were notmaking referrals for mammo-grams because of a strict proto-col under which the exam wasallowed only once cancer hadalready been detected.

Research revealed that the nearest hospital, El Pino, did nothave a mammogram machine. At a second hospital, BarrosLuco, exams were only available half-time. Women discov-ered that the municipal health system had “externalized”mammograms to a private company that was not only expen-sive but using such poor quality materials that tests werebeing rejected by the same doctors who had ordered them.

A first campaign — Woman to Woman: Let’s Teach Our-selves about Breast Cancer — was carried out using posters,pamphlets and clothes lines in public markets. Health moni-tors made necklaces with wooden beads representing mam-mary nodes which they distributed at health centers and usedin educational workshops.

• Ghana: Nurses on motorcycles in searchof patients — this is how health arrivesin the subsistence farming communityof Navrongo. The nurse is available24 hours a day and payment is nego-tiable in cash or kind. The experience,

STANDING UP TO BREAST CANCER IN CHILE

Contact: Community Based Health Plan-ning and Serviceswww.ghana-chps.org/


presented by journalist SantuahNiagia, may soon be replicated inEthiopia and Burkina Faso.

The women contacted health authorities, who assured themthat there was no scarcity of mammograms and that appoint-ments that could be easily scheduled. But activists began tofear for the survival of women who were not receivingtreatment in time because of unnecessary unacknowledgeddelays in detection.

The monitors gathered 3,000 signatures for more mam-mogram machines. The womenwere received twice by two Min-isters of Health and presentedstatistics to demonstrate theurgent need to increase the num-ber of exams being given.

As a result, the mammographyservice at Hospital Barros Lucowas extended to full t ime.Collaboration with neighborhoodorganizations and support frommunicipal authorities were key inobtaining a new machine forHospital El Pino, increasingcapacity by 5,000 mammogramsa year.

But getting a machine isn’t thesame as making it work. In thiscase, the apparatus went unused

because no resources were available to make it function.

The women’s campaign took place during a period of newhealth sector reforms in Chile that now guarantee free andtimely care for more than 50 priority conditions, includingbreast cancer. But the plan does not cover early detection.

Authorities have promised to come up with the funds neededto operate the machine. Meanwhile, the health monitors havepainted a five-meter long mural about breast cancer onhospital gates. And they are keeping a close watch on localauthorities, to make sure that they keep their word.

Leza

k S

halla

t

Paulina Cid, EPES, Chile


FEATURE

FREE TRADE AGREEMENTS THREATENACCESS TO MEDICINES

“We are here to protestthe onslaught of the

pharmaceutical industryand its mortal toll.”

Leza

k S

halla

t

Banner reads “ No to FTAs”

One-third of the world population lacks access to medicinesbecause they are too expensive.

New obstacles to accessing essentialmedicines are on the horizon, in theform of Free Trade Agreements (FTAs)that are opening the door to stringentTRIPS (Trade-Related Aspects of Intel-lectual Property Rights) accords.

FTAs have made patents unaffordablefor the majority of people living in thepoorest countries, putting the profits andprivilege of few over the lives of millionswho need affordable medicines.

The PHA2 addressed this topic in asession that examined the importanceof protecting the right to access to medi-cine as an integral component of theright to health care.

Gema Domínguez (Medecins SansFrontieres) reported that one-third ofthe world population lacks access tomedicines, and that lack of AIDS medi-

cation causes some 8,000 deaths eachday. Antiretroviral therapy costs up to12 times its base price, with a price tagof up to US $10,000 per year perperson in poor countries. However,measures adopted in Brazil and SouthAfrica to manufacture generic drugsnow allows these countries to lowerthis price to $300.

“There is nothing ‘free’ about trade inthese agreements,” said Hugo Noboaand Elsie Monge (Ecuador EcumenicalCommission for Human Rights). “Thisis a fiction created and spread in theinterest of the powers that dominate themarket.”

Selling medicine is the world’s mostprofitable business after petroleum,according to Eduardo Espinoza, andpharmaceutical companies welcome

Unnikrshnan,PHA2 coordinator of

communications


Fliers from Peru: “With the FTA, the price of drugs will go sky-high... along with the patients.”

the intellectual property agreements thatprioritize favorable economic treatiesover health.

However, in 2001, the World TradeOrganization adopted the Doha Ac-cord, which established that memberstates cannot be prevented from takingsteps to promote access to medicinesin public health emergencies.

TRIPS agreements “can and shouldbe interpreted and applied in a waythat supports the right of World TradeOrganization member states to…promote access to drugs,” former WHOdirector general Gro Harlem Brundtlandhas said. But economist Martin Khor(Third World Network, Malaysia) toldthe PHA2 that just the opposite ishappening.

Critics of free trade negotiations be-tween the US and Central Americannations claim that these accords ex-ceed TRIPS rules and offer even morebeneficial terms to pharmaceutical com-panies, extending ownership of drugpatents to 25 years and creating ob-stacles to registration of generic drugs.

Gema Domínguez emphasized thatcountries with fewer resources should notbe pressured to accept measures that willonly benefit the pharmaceutical industry.

“Diseases we thought were undercontrol, like diarrhea, measles, TB anddengue fever, are killing thousands ofpeople each year due to a lack ofprevention,” she stated. “Despite theenormous scientific advances that allowfor control of epidemics, vaccinationsand medicines are increasinglyinaccessible.”

Domínguez called upon socialorganizations to demand fairer drugprice policies and the introduction ofgeneric drugs.

Initiatives to denounce the impact ofFTAs on the health of millions are akey element of the People’s HealthMovement platform.

“We are at this Assembly to resolvetwo problems: access and legislation,”said Amitaba Ghud, a physician fromIndia. “We want to solve the problemof HIV/AIDS medication throughgreater flexibility in parallel importsand compulsory licensing.”

Local drug manufactures need to beallowed to provide low-cost medicines.India is already producing low-costmedicines for export, even to the UnitedStates, he noted.

FEATURE


FEATURE

RECLAIMING TRADITIONAL HEALTH CARE

“We call for theconstruction of a betterworld in which people’s

health represents joy,solidarity and harmony.”

Statement of the NativePeoples of the World

Leza

k S

halla

t

Offering

“ ‘Interculturality’ is a fundamental element to promote social equityand build a fair health system”. — Cuenca Declaration

The concept of“interculturality”was not devel-oped in universityclassrooms but innative communi-ties. Its purpose isto preserve an-cient knowledgeand practices.

“It is a question ofrecognizing ethnicdiversity,” saysManuela García

Pú, a Mayan activist. “But it also meansrecognizing the central thing that makesus similar and brings us together: the uni-versal and inalienable right of all peoplesto health.”

While there are differences among cul-tures, native peoples “share a vision ofhealth in harmony with the environmentwithin a healthy ecosystem.” Nativepeoples approach health from that equilib-rium, she explains.

Nelsi Arias, an indigenous Colombianwoman who is the administrative leader ofher district, believes that “the model weseek is to value our cultural heritage first,but not to ignore the world outside. It isimportant to incorporate new things, butwe must do so without exterminating whatis ours.” Protecting our heritage is also aform of resistance to the “voracious andmisguided” models of socio-economicdevelopment imposed from without.

The return of traditional medicine is a goalshared by both indigenous communitiesand many contemporary physicians andhealth seekers.

But attaining this recognition is difficultbecause traditional medicine “continues

to be opposed and repressed, even whereit has become part of the system,” aBolivian healer noted. According this tra-ditional practitioner, “it is not enough tobring ‘cultural adjustment’ plans to clinicsfor doctors to learn a bit about the localculture or language. What’s needed is “fullcultural complementation” to bringWestern medicine closer to ancestral ap-proaches that see human life as linked tothe natural and spirit worlds.

One of the strongest calls to respectancestral knowledge was made by one ofthe youngest PHA2 participants. Laura, aCañari teen in typical dress, began herpresentation by saluting her machicomadres (sisters in healing) and arguingfor the right of comadronas (traditionalbirth attendants) to official recognition fromhealth authorities.

Indigenous women hold similar concernsin the Mexican state of Guerrero, notedMartha Sánchez, an Amuzga communityleader representing the NationalIndigenous Rural Assembly for Autonomy(ANIPA) and the Guerrero IndigenousWomen’s Coordinating Group. This regionsuffers from the highest maternal mortalityrates in Mexico, due to discrimination,lack of culturally appropriate information,and the “lack of harmony” between thehospital system and traditional careprovided by midwives.

“There is a hospital nearby,” Sánchezexplained, “but indigenous women aretreated badly there because of their dirtyfeet, lack of Spanish and appointmentsmissed due to the distances they musttravel.” If they feel they’ve been harassed,they don’t return. Instead, they go tomidwives, who they trust.

Using political savvy, Sánchez and otherscreated the Indigenous Women’s House


Bishop Eugenio Poma:“Healing requires equalityand collective responses”

Leza

k S

halla

t

Leza

k S

halla

t

Martha Sánchez, México

of Health in the regional capital ofOmetepec. “We won’t allow them toexclude us from policy or medicaldiscussions simply because we’re notprofessionals,” she said. “That was a majorbattle.”

The Casa receives members of theAmuzga, Mixteca, Tlapaneca and Nahuacommunities, acting as a go-between andtraining both midwives and doctors. It isself-sustaining and receives no govern-ment support.

“The house is small, but we make gooduse of it,” says Sánchez. When not provid-ing shelter to birthing women, it receiveswomen and children fleeing from domesticviolence.

Another positive model of indigenous carecomes from Australia, where theaboriginal health movement has achieveda significant level of control over theirhealth services. But the process has gonethrough many changes, Stephanie Bell(Australian Aboriginal Congress) told thePHA2.

“At first, we believed that people had totake their demands to governments andmake governments accountable. But I nowthink that governments mostly do nothing,or do the opposite: they divide and conquer.Governments change, power shifts.Government funding brings its owndangers, including competition for the in-frastructure works that are now called‘social determinants.’

“We began this battle, and now we findourselves competing for resources.”

Eugenio Poma, Aymará and Methodist, attended the PHA2with a delegation of Bolivian healers and physicians.

The son of hacienda workers who spoke no Spanish, Pomaworked as a secondary school teacher and a language in-structor for the US Peace Corps before spending a decade inGeneva with the World Council of Churches, where he tookpart in the creation of the UN Permanent Forum on IndigenousPeople. He returned to Bolivia at a time of profound politicalcrisis in which the voice of the indigenous community is beingraised with new force.

“What does health mean to indigenous people? Health, edu-cation, development, participation: the modern world seesthem as separate but indigenous people see them as inte-grated. They think of the health of the cosmos not as humanhealth only, but also as plant, animal and spiritual health.

In Bolivia, indigenous communities will tell you that they areCatholics or evangelical Christians, but there’s always anAndean cosmovision hidden underneath.

Bolivia is a sick society for both its elite and indigenous groups.There is historic discrimination, an apartheid that has left mostof the population without access to quality health care and thathas no respect for its cosmovision.

There has never been justice. The other Bolivia did not makeroom for indigenous Bolivia when it could have. Tupac Katari’swords are coming true: ‘I die today, but I will return and I will bemillions.’ The majority could oppress the minority. There mightbe thirst for revenge. It is the church’s role to seek peace, tostop any vengeance that could surface.

The community knows how to diagnose its own ills. Healinginvolves participating in the life of the nation. The medicine isequality and collective action.”

FEATURE


NO HEALTHWITHOUT PEACE

“Health needs peaceand peace can never be

achieved throughviolence.”

Salam Ismael

“Sorry, friend.” Detail from a drawing by a childfrom Ecuador

Leza

k S

halla

t

Emergency call in Palestine

Pal

estin

ian

Med

ical

Rel

ief S

ocie

ty

FEATURE

It couldn’t havebeen any otherway: the urgenttestimony of anIraqi doctor de-nounced the de-struction of thou-sands of non-

combatant lives and the country’s healthinfrastructure.

“They’ve sent us back to page one,” saidSalam Ismael of the Iraqi Physicians’Association. “The national health systemhas been destroyed. Hospitals have beensacked and left without even the mostbasic supplies. Medical neutrality and theGeneva Convention are violated daily.‘Brain drain’ and escape from violence hasdecimated a generation of medicalprofessionals. Privatization of the little that’sleft has begun under an omnipresent anduncontrollable wave of corruption.”

No one can say how many have died.British doctor Judith Cook presented thelast estimates issued by Medact, an NGOwhose mission is to use health informa-tion to prevent war. (www.medact.org/)“The health system is overwhelmed bythe levels of violence, which are increas-ing. And the impact on mental health isincalculable.”

However, Bert De Belder, coordinator ofMedical Aid for the Third World, did presentan exact number: US $66,650 — the sumof the bill sent to the US Embassy inBrussels for the medical care of HibaKassim, a 15-year-old girl injured by acluster bomb during the invasion ands

transferred to Belgium fortreatment by MATW. “Accordingto international law, the occupyingforces are responsible for the well-being of the civilian populationunder the state of siege,”explained De Belder. “So wecharged them for it. But so far,they haven’t responded.”

In Palestine, in contrast, self-sufficiency has been one of themost important responses to 50years of military occupation. “Youlearn to cope,” said Amal Daoud

(Palestinian Medical Relief Society).“Otherwise you can’t survive.”

Relief teams have built a bulletproofmodel of care — literally. It operatesmobile clinics for a community undersiege, training thousands of young vol-unteers to provide first aid and leader-ship. According to Ghassan Hamdan,physician and member of the PHA2Steering Committee, the model is worthreplicating because it is “progressive onboth a political level and a medical one.”

However, Israel’s construction of a 750 kmwall that isolates more than 40 Palestineprimary care clinics and blocks transit cre-ates “a new geography of segregation”that is even more difficult to overcome.

From Africa, where several “slow wars”progress far from the eyes of the world,Jacques Byucinda, of the Congo, reportedthat the use of sexual violence as a weaponrepresents an insurmountable stigma toits victims.

Another kind of indelible pain was ex-pressed by the Mothers of the Plaza deMayo, whose children “disappeared” dur-ing Argentina’s dirty war in the 1970s and‘80s. This style of war continues in Colom-bia, where the Women’s Pacific Route(Ruta Pacífica de las Mujeres) demands“necessary truths, urgent reparations.”

The legacy of Agent Orange, the herbicidethat continues to take the lives of threegenerations of Vietnamese, was not for-gotten, as testimony reminded the PHA2that reparations for its victims are stillpending.

But communities are also tenacious. Thehealth sector learns to resist, as testimo-nies from Zimbabwe, the Philippines andChiapas (Mexico) made clear. And resis-tance can become resurgence, as reportedfrom Guajila, El Salvador (see page 10).

Colombia’s pacifists offered these wordsto Israel’s Women in Black, on the otherside of the emblematic dividing wall. “Wewant to tell you that neither you nor we arealone. We are women from all continentsand colors fighting to make possible a lifewithout war and injustice.”


Alegremia — a fanciful concept basedon alegria, the Spanish word for hap-piness — is a health indicator thatsymbolizes the level of joy in the blood.The children of Cuenca adopted thisindicator at the Global Children’s Fo-rum, which ran parallel to the PHA2,and made the following diagnosis ofhow to achieve it:

• The AIR is polluted because of com-panies and factories. Filters shouldbe installed in large factories. Wemust be aware of toxic gas emis-sions from vehicles, smokestacksand the use of aerosols.

• The WATER in our rivers, lakes andoceans is polluted. Campaigns areneeded to educate people aboutthe limits of discharging wastes intotheir waters. People living far fromcities must have drinking water be-cause we all have a right to cleanwater.

• We should eat HEALTHY FOOD,not junk food. We shouldn’t eat

“Sure, there’s a recordharvest of GM soya. Butan entire community hastaken ill.”Sofía Gatica

WHEN THE EARTH TAKES ILL

products with dangerous pesticides,genetically modified organisms, ar-tificial colorings or chemical preser-vatives that bring on obesity and lowacademic performance. The hungersuffered by millions must be eradi-cated.

• We must fight to ensure SHELTERfor all children, so that their parentsdon’t have to migrate. This meanscreating more jobs with fair sala-ries. Children have the right to adecent home.

• We must give LOVE to everyone.War affects children first. We mustpromote a “culture of peace andmutual respect” that avoids adultgreed and selfishness.

• ART should be interactive and con-tribute to the preservation of ourcultural identity. We will promotemusic, dance, theater and espe-cially the handicrafts that are basicto the economic sustenance of manyfamilies.

Alegremia

FEATURE

“Veiled genocide” is the term used byresidents of Ituzaingó (near Córdoba,Argentina) to denounce the toll that thefumigation of nearby fields has had ontheir health. Residents suffer from leuke-mia, other cancers and birth defects.Water and soil samples are contami-nated with glysophate, DDT, maliathonand other pesticides. Blood samplesshowed the same results. The situationhas gotten so bad that when residentsasked the Ministry of Health to relocatethe community, the answer was, “Whybother, if you’re contaminated already?”

Meanwhile, genetically modified soyathrives in the fields, creating dependenceon an agricultural model whose impacton environmental and human health hasyet to be determined. What is certain isthat this technology “places extraordi-nary power over food safety andbiodiversity in the hands of translationalcorporations,” according to biologist Eliza-beth Bravo (Network for a GM FreeAmerica).

To the north, the US offensive againstcoca cultivation is best described as “bio-logical warfare,” according to Elsa Nivia(Pesticides Action Network). Plan Co-lombia is responsible for human and ani-mal deaths, as well as the destruction ofpeasant crops (see page 18).

Oil or Blood?

The sad history of natural resource ex-ploitation in Nigeria was succinctly pre-sented by poet/activist Nnimmo Bassey:“We thought it was oil, but it was blood.”

A study of the Ecuador’s oil fieldspresented by Alberto Maldonado(Ecological Action) showed that five yearsafter wells went into operation, arearesidents had a five-fold greater chanceof developing cancer. Today, four-out-of-five people in the region suffer from apollution-related illness.

Water: Vital Liquid

The PHA2 joined the internationalcampaign to promote a new UN Treaty

on the Human Right to Water(www.righttowater.net). The rights tohealth and water are “indivisible,” inthe words of Anil Naidoo (Blue PlanetProject, Canada).

Primary Health Care for Ecosystems

This concept was presented by SandraIsabel Payán (Colombia)and Julio Monsalvo (Argen-tina). It promotes the paral-lels between care for hu-man health and respect forthe environment.

One of its goals is to re-place the current paradigmof exercising “power over”people and natural re-sources with the “power to”heal human beings andecosystems.

Child’s view of Plan Colombia


FEATURE

“The battle has only justbegun and Goliath is not

an ordinary opponent.But neither are the

people of Ecuador.”Amazon Defense Front

(contact No. 157)

BATTLINGFOR HEALTHIN ECUADOR

Population (2005): 13.4 million

Capital: Quito

Area: 272,045 sq. km.

Languages: Spanish, Quechuaand indigeneous languages

Life expectancy: 71 years (m),77 years (f)

Principal Exports: Petroleum,bananas, shrimp, coffee, cacao,cut flowers

GNP per capita: US$ 2,180(World Bank, 2005)

ECUADOR AT A GLANCE

The real size of this geographically smalland ethno-culturally diverse country wasclear throughout the PHA2.

Free health, education and social secu-rity for peasants are universal rightsthat, although not always respected,are enshrined in the Constitution.

The National Front for the Health of theEcuadorian People, national sponsor ofthe PHA2, calls upon all governments“to create health policies outside theimpositions of neoliberalism.” The Frontforms part of the Health Defense Collec-tive Against FTAs and the EcuadorDecides Campaign, alliances that gath-ered 10,000 signatures to protest thetrade negotiations and their potentialimpact on medicines and public utilities(see page 12).

While the PHA2 in Cuenca wasdebating privatization, protestorsin Quito took to the streets todemand the return of socialsecurity funds usurped by thegovernment.

Political instability in Ecuadorhas led to the downfall of threepresidents in eight years. Cur-rent President Alfredo Palaciotook office in April 2005 whenCongress ousted his predeces-sor following violent uprisings.

Palacio has promised to in-crease the taxes paid bytransnational oil companies in

order to bolster government spendingon health and education. Days after theclose of PHA2, Ecuador’s oil exportswere interrupted by protestors callingupon the government to do just that.

In the Amazon, spear-bearing Huaoraniwarriors have declared war on any com-pany that tries to invade their territories.Thousands of native people have al-ready been displaced by oil exploita-tion, which is threatening the culturalsurvival of this and other indigenouscommunities.

From Sucumbios province, along theEcuador/Colombia border, DanielAlarcón (Federation of PeasantOrganizations) blamed Plan Colombia(see page 17) for “causing hunger anddisease, creating ghost towns ofdisplaced populations and generatingterror by armed groups. In the name ofthe 99 communities that make up myregion, I implore the US and Colombia:let us live in peace, poor but unpolluted.”

With Amazonian, Andean, black andmestizo populations, Ecuador’s smallterritory embraces Latin America’s mainethnicities. A training manual presentedat the PHA2 by the New Moon PopularWomen’s Movement (see page 19)acknowledges this heritage of diversityand asks readers to “seek the lifestylesthat cultivate the knowledge,technologies, practices and emotions... from our place in this world.”

Participants from Ecuador

Pau

lina

Cid


RESOURCES

USEFUL PUBLICATIONS

Latin America Health Watch: Alternative Latin America Health ReportBreilh, Jaime/CEAS, ed. July 2005.

Contents: This report presents a critical analysis of growing inequality in health in LatinAmerica and the obstacles to preventing disability and premature death.It aims to identify barriers and promote social mobilization for the Global Right to HealthCampaign.ISBN: 9978-44-257-X284 pp.

Aprendemos haciendo. Renovamos nuestros saberes. Construimos una nueva Era.(We Learn by Doing. Renewing Our Knowledge. We Build a New Era)Calle Pérez, Graciela and Molina Loyola, Cecilia / Fundación Savia Roja

Contents: The 10 modules of this training manual use group dynamics to introduceeconomic, political, social and human rights aspects of Ecuador. It provides tools forleadership development, social organization and participation.75 pp.

Fundación Savia RojaAvenida Los Fresnos 2-71Cuenca, EcuadorTelefax: 288 7735E-mail: [email protected]

América se escribe con sangre(America Is Written in Blood)Maldonado Campos, Adolfo

Contents: The author examines Latin America through the three central ideas: occupation,militarization and health. From the occupation and exploitation of the land and livingbeings, he reflects on militarization and foreign bases in the region and their impact onthe health of people and ecosystems. In demonstrating the inequities of consumption-driven development, Maldonado invites the reader to visualize a healthy America.100 pp.E-mail: [email protected]

Global Health Watch and Global Health Action 2005-2006Global Health Watch is a call to strengthen the global community of health advocatestaking action on ill health, inequity and their underlying political and economic determi-nants. It is divided into five sections and comes with the Global Health Action 2005-2006advocacy document. Produced by the People’s Health Movement, Global Equity GaugeAlliance and Medact, it draws from an evidence-based assessment of political economyof health and health care.This report was released to coincide with the PHA2.

Contents: Building a Fairer World; Extending and Defending the Public Sector;Immigration; Climate Change; Militarism21pp

Global Health Watch and Global Health Action are available at: www.ghwatch.org

Centro de Estudios y Asesorías en Salud (CEAS)Asturias No. 24-02 y G. de Vera, La FlorestaQuito, EcuadorTelefax: (593 2) 2506175, 2566714E-mail: [email protected]


NETWORKING

ANNOUNCEMENTS

contact is a publication of the World Council ofChurches that looks at church and communityinvolvement in health and reports on innovative andcourageous approaches to promotion of health andhealing. .Articles can be reproduced free of charge,citing the source: contact/World Council of Churches.

English and Spanish-language versions (5,000 and1,500 copies, respectively) of this special issue havebeen published by the WCC in collaboration withFundación EPES, Chile.

The Women’s Global Network for Reproductive Rights has participated in thePeople’s Health Movement and its “Health for All” campaign since 1999. Theslogan of the WGNRR’s most recent campaign is “Health for Everyone — Healthfor Women.”

The spirit of Alma-Ata and the ideal of “Health for All” are being attacked by anti-health and anti-poor policies, new diseases, new challenges and the imposition ofprofits over public health.

The “One Million Signatures” Campaign of the People’s Health Movement and theInternational People’s Health Council gathered popular support to strengthen thecore values and strategies of Alma-Ata.

http://phmovement.org/ph2/

Download programs, information on workshops, press releases,documents, presentations, pictures and posters in English,Spanish and other languages.

Find information about PHA2 parallel events, including theInternational People’s Health University, CommunicationForum, Global Children’s Forum, March for the Globalization ofSolidarity and Dignity, Writing Peace, and the Festival of Voicesfrom the Earth.

Design: Luz María Villarroel Ch. Printing: Ariel Corbalán

Women’s Global Network for Reproductive RightsVrolikstraat 453-D, 1092 TJ AmsterdamThe Netherlands(31-20) 620 96 [email protected]

THE MILLION SIGNATURE CAMPAIGN.

WOMEN’S ACCESS TO HEALTH CAMPAIGN

Fundación EPESGeneral Koerner 38, El BosqueSantiago, ChilePhone: (56-2) 548 76 17. Fax: (56-2) 548 60 21E-mail: [email protected] Website: www.epes.cl

contact is posted on the following websites:

World Council of Churcheswww.wcc-coe.org/wcc/news/contact.html

Fundación EPES: www.epes.cl

http://phmovement.org

The Cuenca Declaration can be found at:

http://phmovement.org/pha2/es/papers/cuenca_dec.php.

special issue · 2006-01-20 · 2 contact no.180 - december 2005 editorial opening ceremony lezak...

Documents