Global experience

At the tricontinental dialogue on "Experiences on globalisation and subversion of public health", (from left) Edelina de la Paz (the Philippines), David Sanders (South Africa), Armando de Negri (Brazil) and Maria Hamlin Zunega (Nicaragua).-A.M. FARUQUI At the tricontinental dialogue on "Experiences on globalisation and subversion of public health", (from left) Edelina de la Paz (the Philippines), David Sanders (South Africa), Armando de Negri (Brazil) and Maria Hamlin Zunega (Nicaragua).

The People's Health Movement tries to influence global health policies and also makes country-level interventions.

THE People's Health Movement (PHM) originated in the Third World. It first began with the People's Health Assembly (PHA) in Savar, Bangladesh, where some 1,500 people from 75 nations met in December 2000 to endorse a People's Health Charter and subsequently set the agenda for the PHM.

The PHM took off from several struggles for equity in the 1970s and the 1980s. It imbibed what the 19th century German pathologist Rudolf Virchow said: "Medicine is a social science and politics is nothing more than medicine practiced on a larger stage." It is also the understanding of the PHM that it is a certain kind of politics that determines the health outcomes in various parts of the world, including in India, where the State of Kerala has stood apart in terms of certain positive health indicators. The PHM underscored the primary health care approach and the need for inter-sectorality in health. It has often coincided, thematically, with other important global movements such as the World Social Forum, but has retained its own identity where health and equity for all have been the driving slogans.

A.F.M. Imam Uddin was the coordinator of the first PHA. He told Frontline that the PHM emerged in a context of political chaos after the disintegration of the Soviet Union. The massive corporatisation of public services following the collapse of the Socialist bloc provided the much-needed impetus for several like-minded people to come together. It was also realised that the right to health flowed from economic rights. Health was not a bio-medical issue alone.

At present the PHM was trying to influence global health policies and also make country-level interventions, taking stock of national realities. Imam Uddin said the conditions in India, Bangladesh and Pakistan were similar as far as the impact of neoliberal policies was concerned. The role of international funding agencies was dubious, he said. Recently, a Bill guaranteeing immunity to the World Bank and absolving it for any of its activities undertaken, had been mooted in Bangladesh. But timely mobilisation of support for its stand by the PHM prevented the Bill from being legislated. He said Bangladesh, despite having good rural health infrastructure, lacked trained medical personnel. Although there was no concept of private-public partnership as in India, there was organised propaganda to privatise everything, he said.

One of the founders of the global PHM and a known expert on public health, David Sanders, director of the School of Public Health, University of the Western Cape, outlined the African health situation. Speaking at the tri-continental dialogue on "Experiences of Globalisation and Subversion of Public Health from Asia, Africa and Latin America", he said that despite substantive progress in life expectancy and infant mortality, global health iniquities had widened. From a comprehensive primary healthcare approach, a shift had been made to a more "selective health care" approach, he said.

The health iniquities were sharp, he said. A woman in a high-income OECD (Organisation for Economic Cooperation and Development) country had a nine-in-ten chance of reaching the age of 65, but in Malawi she had a four-in-ten chance. Similarly, in Tanzania, every sixth child born alive was certain to die before turning five years; in OECD countries, every 167th child died before the age of five. The 1990s, he said, was a period of reversal of progress in health in Africa and this had to do with debt servicing and structural adjustment.

Quoting United Nations Conference on Trade and Development figures, Sanders said that between 1970 and 2002, African countries borrowed $540 billion from foreign sources; they paid back $550 billion in principal and interest and still owed $295 billion. A World Health Organisation report said the majority of studies, whether theoretical or empirical, were negative towards structural adjustment and its effects on health outcomes. The population living under the poverty line in southern Africa between 1996 and 2001 had increased dramatically. Public health, he said, was more about micronutrients rather than food security.

Interestingly, there has been a massive influx of nurse registration in the United Kingdom from African countries like Zimbabwe, Ghana and Malawi. Commenting on how AIDS and aid had the potential of disrupting health systems, Sanders said that in 2000 Tanzania prepared 2,400 quarterly reports on separate aid-funded projects and hosted 1,000 donor-visit meetings a year.

The most damning indictment of the international order came from Jihad Mishal from PHM, Palestine, and from Salaam Obaidi of the Doctors for Iraq Society. Mishal said health was politics and health in Palestine was under siege. He showed the birth certificate of a baby, where in the slot for inscribing the place of birth, the name of a prominent checkpoint was mentioned. Unemployment in the West Bank and Gaza was as high as 67 per cent and the population under the poverty line was around 65 per cent, Mishal said. Malnutrition in Palestine, he said, was comparable with the levels in sub-Saharan Africa.

In the last six years, he said, 200 children had been shot in the head and 140 Palestinians, of whom 67 per cent were children, had died because they were prevented from receiving medical treatment. As nearly 46 per cent of the Palestinian population was under 15 years, the bulk of the casualties were children. The 750-kilometre wall that was being built had already cut off 26 primary health care centres. Access to health care had decreased severely after the beginning of the second Intifada in 2000. "Our problem is not humanitarian, it is political," he said.

Salaam Obaidi narrated how for Iraqis their passports determined their destinies. Referring ironically to the "civil war" in Iraq, he said if there should be one, it should have been in his home as he was of mixed Shia-Sunni parentage. He said four years of "liberation" had meant several things to the health sector. Nearly 40 per cent of medicines in the markets were being sold without proper scrutiny. Of the 18 big hospitals in Baghdad, most had been raided and looted. The water purification and sanitation station had been bombed; prices of antibiotic drugs had doubled. The cost of one litre of liquid oxygen had increased from 150 dinars to 1,500 dinars in the post-occupation period. There had also been an exodus of doctors; nearly 230 senior physicians had left the country. More than 7 per cent of the Iraqi population was suffering from malnutrition, he said.

Similarly, Ghassan Issa from PHM, Lebanon, narrated how children accounted for 30 per cent of all deaths in the Israeli bombings of 2006. Nearly 60 to 70 per cent of the infrastructure, including health infrastructure, was destroyed.

The global PHM has come a long way. By highlighting the concerns of imperialist globalisation and by rallying people around, it has succeeded in emphasising the truth that the determinants of health lie outside health.