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Cape Town Call to Action




We reaffirm our commitment to the People’s Charter for Health and to the Cuenca Declaration, which are the
foundational documents to this Call to Action.

        This Call to Action will guide our work until the Fourth People’s Health Assembly.

          Our health has been devastated by neoliberal policies that are the hallmark of present day capitalism.
The global health crisis is a consequence of the failure to address the social, political and environmental
determination of health. The current capitalist crisis has several inter-related dimensions, among them:
political, food, economic, financial and ecological. Its roots lie in the
neoliberal model of globalisation.

          The response of national and international institutions, to the current financial crisis, has been
merely to ‘restore the confidence’ of the same institutions and financial markets that caused the crisis in the
first place. Governments have enacted an ‘austerity agenda’ – cutting health and social spending - effectively
deepening and reinforcing the very neoliberal economic model the crisis had so discredited, and handing
even more power to finance capital.

         There is a need to redesign our political culture and our institutions, both nationally and globally; to
create relations based on solidarity; and to put in place the mechanisms of accountability needed to run the
global political, economic and social structures in a manner that is just, equitable and sustainable.

Our Alternate Vision:

    •   A reformed economic system that values every individual, not every dollar;
    •   Just, fair and democratic political and economic processes and institutions;
    •   Better and transformed global heath governance that is free from corporate influence and the
        influence of unaccountable private actors;



                                                                                                              1
•   Equitable Public Health Systems that are universal, integrated and comprehensive, as well as provide
        a platform for appropriate action on social determination of health.

What is to be Done:

No change will happen without the mobilization of the people through the building of social and political
power amongst people and communities. We commit ourselves to building alliances with others who seek
progressive and transformative change.

We leave Cape Town determined to:
    • set up new PHM circles
    • energise, broaden and deepen the work of existing PHM country circles
    • strengthen and develop the thematic circles of the PHM.

We leave Cape Town committed to:

    •   creating and communicating alternative visions, analyses, discourses and evidence;
    •   actively support and facilitate a range of campaigns.

We will continue and expand our global work around existing global programmes – suitably redesigned
wherever necessary, namely:
   • the Right to health campaign;
   • the International Peoples Health University;
   • the Global Health Watch;
   • the Democratising Global Health; WHO Watch and Supporting the Restitution of the WHO.

We further commit ourselves to expand our global Right to Health campaign, a campaign that will be globally
co-ordinated, but locally owned and driven.




                                                                                                         2
A. Preamble


After two years of participatory engagement and planning we, the People’s Health Movement, have gathered
800 strong from 90 countries representing the voices of tens of thousands more in our movement across
every continent in the world.

In Cape Town we have:

    •   strengthened and deepened our resolve and solidarity;
    •   expressed our outrage at the continuing global health crises embedded in myriad structural and
        socio-political inequities;
    •   developed principles for alternative economic, political and social order; and
    •   re-committed ourselves to work towards the world we have envisioned.


We reaffirm our commitment to the People’s Charter for Health and to the Cuenca Declaration, which are the
foundational documents to this Call to Action.

This Call to Action will guide our work until the Fourth People’s Health Assembly.




                                                                                                       3
B. The Global Health Crisis


Our health has been devastated by neoliberal policies that are the hallmark of present day capitalism, and
increasingly so by the global crisis of capitalism. The current crisis underpins the growing global health
inequities within and between countries.

Health crisis: Growing health inequities

The global health crisis is a consequence of the failure to address the social, political and environmental
determination of health, resulting in an erosion of food sovereignty, in higher levels of poverty, as well as in a
lack of fair and equitable access to water, housing, sanitation, education, employment and universal and
comprehensive health services.

Ill-health and disability are being perpetuated by the aggressive marketing of unhealthy products such as
tobacco, alcohol, junk food and beverages; by the pollution of our air, our land and water sources; by the
colonization of lands and other natural resources; and by the forced eviction of vast numbers of people,
including indigenous peoples, from their lands and homes.

We have heard how:

    •   small farmers are losing their livelihoods as a result of the dumping of subsidised foodstuffs from
        industrialised agriculture in the North;
    •   indigenous people are being herded off their land by the extractive mining industry and the struggles
        by communities that are affected are being criminalized;
    •   the health of workers is jeopardised by the absence of safety and regulations at the workplace, as
        well as by environmental degradation and pollution;
    •   poor people in dense urban settings are being driven to depend on junk food, available more cheaply
        than nutritious natural food;
    •   the relegation of women's health to only encompass maternity and family planning, on the one hand,
        and the concerted attack on women's reproductive and sexual rights, on the other, violates women's
        autonomy, personhood, dignity and human rights;
    •   women and young people are being denied the right to sexual and reproductive health services;
    •   migrants and displaced people suffer from xenophobia and from a lack of access to healthcare; and
    •   racism - social, institutional and structural - coupled with religious intolerance, disrupts the lives of
        people and prevents them from living a dignified life free of fear;
    •   children’s rights are being undermined by denying them the conditions in which they can thrive and
        flourish.

Millions of families, particularly in low- and middle-income countries, are being denied access to
comprehensive primary health care and universal health services by way of their poverty and the other many
institutional barriers they face. In high income countries, there has been a continuing campaign to reduce
funding and support for the public sector and to replace public services with those provided by the market.
Moving health care out of the public domain makes it easier for large capitalist enterprises (big pharma, big
insurance and biotechnology corporations) to increase sales and profits, working in close partnership with
those who profit from the delivery of health services. The commodification of health has been intensified by
the promotion of a reductionist, industrial, biomedical model.




                                                                                                               4
The current global trade and investment regime (driven by multilateral, plurilateral and bilateral trade and
investments agreements) is seriously undermining universal social entitlements and rights, as well as the
power of states to regulate the activities’ of corporations and of private financial institutions.

Access to affordable medicines has been compromised worldwide as a result of the WTO-TRIPS Agreement
and the continuing pressure on developing countries to adopt TRIPS-plus standards through trade agreements
and bogus anti-counterfeiting initiatives.

While we welcome the recent surge in interest in the concept of universal health coverage, we oppose the
idea that this be achieved through the promotion of a minimalistic insurance model that would offer 'basic
packages of care' and would operate within a market-based system of healthcare. We oppose attempts to use
this approach to dismantle or undermine the public health system to promote corporate interests in health
care delivery. Universal health coverage must be achieved through organized and accountable systems of high
quality public provision of comprehensive primary health care and of a fully functional referral system
governed by need of care.

The global health crisis also reflects a crisis in effective and accountable global health governance. The
dimensions of this crisis include:

    •   The undermining of the World Health Organisation;
    •   The power exerted by a fragmented and uncoordinated health aid industry;
    •   The undue influence of unaccountable private corporations and foundations over health policy and
        programming;
    •   An approach that seeks to remedy the problems of structural inequality through a ‘charity’ model
        rather than through systemic and structural transformations.

The crises of capitalism

Genesis of the current crisis
The current capitalist crisis has several inter-related dimensions, among them: political, food, economic,
financial and ecological. Its roots lie in the neoliberal model of globalisation that emerged in the 1970s as a
response to declining rates of profit and wealth accumulation in developed capitalist economies. It also
included privatisation and commercialisation of public services, such as in health, education, water and
energy supply and public transport. The model, in its endeavour to create a global market for goods and
services, promotes the integration of global economies and the expansion and liberalization of global trade.

This model was forced upon developing countries through structural adjustment programmes, trade
agreements and investment treaties, effectively legally locking many developing countries into the neoliberal
paradigm which is highly inequitable and, at best, extremely inefficient in reducing poverty and meeting
people’s needs.

Meanwhile, the current development and aid industry merely sustains and reproduces existing social and
political inequities.

Neoliberal globalisation has resulted in an immense concentration of power among a wealthy and corporate
elite, who actively undermine democracy and social justice through their influence and through the
corruption of national governments and international institutions. The present political crisis is rooted in the
lack of accountable, transparent and democratic decision-making. Even in countries with progressive
governments, spaces for democratic participation are being eroded and protest is being criminalized.




                                                                                                             5
The war industry, having blighted lives in many parts of the world, is deeply embedded within the capitalist
economic system. Imperialism has increased the use of its military might to maintain and expand its control
over the political architecture, as well as the resources of the planet.

There is a need to redesign our political culture and our institutions, both nationally and globally; to create
relations based on solidarity; and to put in place the mechanisms of accountability needed to run the global
political, economic and social structures in a manner that is just, equitable and sustainable.

The crisis today and its manifestations
The current financial crisis is rooted in the de-regulation of banks that were allowed to become ‘too big to
fail', to increase their ratio of loans (debts) to assets, and to speculate heavily on currencies, on derivatives
and on mortgages.

The response of national and international institutions has been merely to ‘restore the confidence’ of the
same institutions and financial markets that caused the crisis in the first place. Governments have moved
quickly to bail out the failing banks and have enacted an ‘austerity agenda’ – cutting health and social
spending - effectively deepening and reinforcing the very neoliberal economic model the crisis had so
discredited, and handing even more power to finance capital.

The ecological crisis is also a part of the capitalist crisis and mirrors the rise in global inequalities as
characterized by the obscene over-consumption of a small minority that is overstretching the capacity of the
planet, while a large majority are denied even their basic needs. The resources of this planet are being
privatized and plundered in ways that are damaging and lethal for future generations. Public stewardship of
our scarce resources is the only solution to the equitable protection of the planet.

Rich nations are passing on the burden of the ecological crisis onto poor nations through various mechanisms,
including through the shifting of the impacts of the ecological crisis onto poor peoples. Coercive population
control policies enacted in the name of climate protection are now violating women’s rights. Many of the
effects of overproduction and over-consumption and of climate change are felt by the world's indigenous
communities, small-scale peasant farmers, poor people and the working classes. Although the planet is
capable of providing for the needs of all its people, the current system of production and consumption only
undermines the natural basis of life through a need for constant growth, leaving billions of people in poverty.

The annual Conference of the Parties (COP) meeting under the UN Convention on Climate Change has failed
miserably to ensure the rapid reduction in the emissions of greenhouse gases. Under the domination of
predatory transnational corporations the negotiations have sought to impose false solutions such as carbon
trading, Reducing Emissions from Deforestation and Forest Degradation (REDD) and other market/financial
incentives to safeguard continued profit margins and the continuity of economic growth.

The food crisis as evidenced by the existence of a billion hungry people and two billion overweight or obese
people is a manifestation of a much larger and more pervasive malaise, caused by the loss of food sovereignty
and of control by communities and poor nations over the use of their own resources. The food system is
dominated by transnational corporations (big agribusiness and big food and beverage corporations). This has
resulted in, among other things, mono-cropping and the replacement of food crops with crops for bio-fuels; a
huge increase in the speculative trading of food grains; unfair trade agreements; and oligopolies in the food
retail sector. The food crisis is now worsening as a consequence of ‘land grabs’, a new form of colonialism in
which transnational corporations and sovereign wealth funds are acquiring large tracts of arable land in poor
and often poorly governed countries – displacing domestic food production systems, as well as rural peoples
from their lands. Meanwhile, hunger and malnutrition is being converted into a new market for processed
ready-to-use foods (RUTF) and nutriceuticals, often assisted by the aid industry and multilateral organisations.



                                                                                                              6
C. Our Alternative Vision


PHM seeks a better world and offers a critical alternative. We believe that transformative and radical change
is needed and can indeed be achieved. Our vision consists of a number of inter-related dimensions:

    •   A reformed economic system;
    •   Just, fair and democratic political and economic processes and institutions;
    •   Better and transformed global heath governance;
    •   Equitable Public Health Systems.

Reformed economic system
We need an economic system that values every individual, not every dollar. The primary objective must be to
maximise benefits to people – their health, their wellbeing, and their quality of life – not total output or
income. It should be based on collaboration within and between communities and nations, not on
competition, and should seek to minimise the use of environmental resources while fostering sustainable
livelihoods for all. It will be socially directed rather than market driven.

Such an economic system will:

    •   encourage adequate, appropriate, equitable and sustainable consumption, with the least ecological
        and human impact, reflecting a commitment to future generations and harmony with the planet;
    •   replace existing global and regional trade and financial agreements with those that will eradicate
        food insecurity and malnutrition and will foster food sovereignty;
    •   be rooted in and have obligations towards local communities while being globally responsible;
    •   establish and develop worker controlled enterprises;
    •   create sustainable, dignified work opportunities that meet the basic needs of all;
    •   build solidarity between people;
    •   reverse the land grabs that have occurred; and
    •   be rooted in the effective measurement of societal progress on the basis of health, social and
        environmental indicators.

Just, fair and democratic political and economic processes and institutions
We need a new system of global governance, including in the different international trade and financial
systems, that :
• places health, well-being, human rights and environmental sustainability at the centre of all policies;
• ensures genuine equality of influence at the heart of all decision-making;
• promotes democracy, accountability and transparency at all levels.

We need news systems of national governance:
• in which electoral democracy is not captured by capital or undue private influence;
• where forms of participatory democracy are integral to structures of governance;
• where people have adequate constitutional rights and protections, including the right to protest against
   conditions or practices that create social exclusion and oppression.

We seek a world in which governments will:

    •   work multi-laterally to reach peaceful resolutions to international conflicts




                                                                                                          7
•   refrain from imposition of their own policies and interests on other sovereign nations, whether
        through force or by economic pressures;
    •   be held accountable for the full implementation of the Universal Declaration of Human Rights and
        the Covenants on Political, Civll and Economic, Social and Cultural Rights.

A new system of global and national governance will include regulatory structures that, among other, ensure:

    •   fair and progressive taxation regimes within and between countries that will enable a transformative
        and equitable redistribution of resources and power;
    •   closure of tax havens and democratic reform and regulation of the international banking system;
    •   fair trade arrangements and agreements;
    •   a new regime for research and development that does not seek to monopolise knowledge in a few
        hands, prioritises the genuine needs of the largest numbers of people and sees local communities as
        equal partners in the research cycle;
    •   a new regime for the production, management and dissemination of knowledge and technology that
        prevents their private appropriation and promotes an open system of knowledge sharing.

A better global heath governance
We seek a more coherent and accountable system of global health governance that is free from corporate
influence and the influence of unaccountable private actors. We seek a radical rationalization and
transformation of the multiple Global Health Partnerships and funds. We seek new and more accountable
mechanisms for the management and allocation of global public finance, working with and through UN
institutions.

The World Health Organisation must:
    • follow its constitutional mandate to act as the directing and coordinating authority for international
       and global health;
    • be fully and adequately funded by assessed and untied contributions from member States;
    • be accountable to member states and the people of the world.

Equitable and Public Health Systems
Health systems should be:
    • Universal, integrated and comprehensive, as well as provide a platform for appropriate action as
        regards the social determination of health;
    • supported by a guarantee of the right to health in the national constitution;
    • based on accessible, effective, gender-sensitive, youth-friendly and free comprehensive primary
        health care, accountable and appropriate to people’s health needs, supported by fully functional
        referral systems governed by need of care;
    • accessible to all, with no discrimination on the basis of gender, age, race, ethnicity, religion, economic
        status, sexual identity, disability, cultural knowledge, language or any other basis;
    • welcoming of alternate cultural understandings of health and systems of healing, and not based
        solely on biomedical concepts of health and illness;
    • properly and adequately publicly financed with public expenditure representing the major share of
        total health expenditures, as well as capable of protecting the population against the rising costs of
        health care;
    • be able to retain local health workers within the national health system rather than losing them to
        international migration;
    • built around an integrated network of public facilities responsible for providing comprehensive care,
        based on the principles of universality and equity;



                                                                                                             8
•   empowered to strictly regulate commercial health care providers (where present) within an ethical
        framework;
    •   participatory and responsive to peoples’ needs through social participation in the formulation,
        implementation, monitoring and evaluation of policies;
    •   compatible with sound ecological principles and practices.

PHM will also work towards developing frameworks of analysis using its global community of public health
practitioners, academicians and activists who can work on innovative and creative design solutions that will
ensure more effective, efficient and equitable public health systems.




                                                                                                         9
D. What is to be Done?


This Call to Action was developed at and is directed to all delegates of the Third Peoples Health Assembly
(Cape Town July 2012) and their fellow health and social activists from across the world.

D.1. Power to the People: Building the Movement

No change will happen without the mobilization of the people. Power will not be given to the people unless
we force it out from the political, corporate and financial elites; and hold our public institutions accountable
and make them work in ways that are transparent and truly representative and that serve the public interest
and social justice. All this requires the building of social and political power amongst people and
communities.

The Third PHA celebrated the successes of the growing People’s Health Movement, especially the
development of new country circles in Africa. While we are a movement focused on health and are built
mainly around health activism, we share many goals with other social movements that also seek a more just
and sustainable world. In order to diminish the power of financial capital, democratize governance and defeat
neoliberal economic policies, we need to build a more effective and broad-based social movement.

To this end, we commit ourselves to building alliances with others who seek progressive and transformative
change. PHM is in a unique position to build alliances across existing movements, including those of informal
and formal sector workers, the landless, indigenous peoples, women and youth.

We will build solidarity with those struggling against big dams, nuclear power plants, illegal mining, hazardous
working conditions and others. We will work with the environmental justice movement. We will seek greater
trans-disciplinary engagement with, among others, progressive economists, environmental scientists, lawyers,
urban planners and political-social scientists.

We leave Cape Town determined to:
    • set up new PHM circles
    • energise, broaden and deepen the work of existing PHM country circles
    • strengthen and develop the thematic circles of the PHM.

We leave Cape Town with a new and reinvigorated Global Steering Council that, among other, will improve
communications within the movement, facilitate effective coordination across the movement and ensure
organic linkages with regional and country circles. This will include facilitating the recruitment and support of
PHM outreach workers to assist the development of PHM in countries and regions.

We will strive to foster and develop community-based struggles, campaigns and advocacy initiatives from
local to national and global levels on multiple fronts, as well as develop the health movement in the coming
phase.

D.2. Creating and communicating alternative visions, analyses, discourses and evidence

We recognise that the neoliberal orthodoxy and the vested interests of the rich and powerful are heavily
represented in the mainstream media. We recognise the power of the mainstream media and of corporate
propaganda in shaping prevailing views and attitudes, and sustaining the belief that there is no alternative to
the current political and economic system.




                                                                                                              10
We recognize that many scientific journals and institutions of education and knowledge generation act to
legitimize and sustain the current system and paradigm. We recognise the lack of investment in research, in
monitoring and surveillance that can serve the interests of the poor and promote the global social justice and
equity agenda that PHM stands for.

To this end we commit to:

    •   communicating alternative visions, analyses and discourses to the people, using a wide variety of
        media and communication techniques, especially those that engage people creatively;
    •   using the Global Health Watch as an instrument to communicate our alternative progressive analysis
        of the state of global health and our critiques of the current institutional framework for global health.
        We will work to improve the dissemination of the periodic GHWs both in English and in other
        languages using alternative media so as to reach a greater diversity of audiences. We will establish
        and maintain local and national health watches;
    •   expanding and extending the reach of the International Peoples Health University (IPHU) as a means
        of education, empowerment and mobilisation of young PHM cadres;
    •   expanding processes such as community-based monitoring to ensure health system accountability
        and community oriented action research.

D.3. Organising and planning to make change happen

To make change happen, movement building and alternative analyses must be translated into concrete
campaigns and programmes of action. Actions will need to be planned and organised at the local and national
levels. As a global movement, we will seek to actively support and facilitate a range of campaigns, by:

    •   providing information and facilitating the sharing of information on the international context and
        country experiences;
    •   providing campaigning materials on issues of international priority;
    •   liaising and coordinating with organisations in different countries working on related issues;
    •   providing multiple fora for the sharing of experiences;
    •   supporting campaigns at the international level giving them wide publicity;
    •   actively mobilizing to oppose health damaging policies and actions of international organizations and
        of Northern governments.

To enable us to fulfil this role effectively, we will intensify our fundraising efforts, in order to strengthen the
movement through:
    • Increasing the capacity of young PHM activists through supporting more IPHUs;
    • strengthening regions and countries through the recruitment of regional outreach coordinators;
    • Increasing regional support to build the movement at the local and country level;
    • Strengthening the global secretariat;
    • Increasing the resources available for information, media and advocacy activities at the international
        and local levels.

We will continue and expand our global work around existing global programmes – suitably redesigned
wherever necessary, namely:
   • the Right to health campaign;
   • the International Peoples Health University;
   • the Global Health Watch;
   • the Democratising Global Health; WHO Watch and Supporting the Restitution of the WHO.



                                                                                                                11
Developing a Global Campaign
We further commit ourselves to expand our global Right to Health campaign. The campaign will be globally
co-ordinated, but locally owned and driven. The campaign will integrate a number of specific elements, each
addressing key concerns of PHM circles as well a the global movement. PHM circles will be encouraged to be
part of the global campaign and to determine their level of engagement with specific issues based on their
local priorities and local capacity. We propose the basic framework and proposed elements for the expanded
global campaign in Annexure 1.




                                                                                                        12

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Cape Town Call to Action

  • 1. Cape Town Call to Action We reaffirm our commitment to the People’s Charter for Health and to the Cuenca Declaration, which are the foundational documents to this Call to Action. This Call to Action will guide our work until the Fourth People’s Health Assembly. Our health has been devastated by neoliberal policies that are the hallmark of present day capitalism. The global health crisis is a consequence of the failure to address the social, political and environmental determination of health. The current capitalist crisis has several inter-related dimensions, among them: political, food, economic, financial and ecological. Its roots lie in the neoliberal model of globalisation. The response of national and international institutions, to the current financial crisis, has been merely to ‘restore the confidence’ of the same institutions and financial markets that caused the crisis in the first place. Governments have enacted an ‘austerity agenda’ – cutting health and social spending - effectively deepening and reinforcing the very neoliberal economic model the crisis had so discredited, and handing even more power to finance capital. There is a need to redesign our political culture and our institutions, both nationally and globally; to create relations based on solidarity; and to put in place the mechanisms of accountability needed to run the global political, economic and social structures in a manner that is just, equitable and sustainable. Our Alternate Vision: • A reformed economic system that values every individual, not every dollar; • Just, fair and democratic political and economic processes and institutions; • Better and transformed global heath governance that is free from corporate influence and the influence of unaccountable private actors; 1
  • 2. Equitable Public Health Systems that are universal, integrated and comprehensive, as well as provide a platform for appropriate action on social determination of health. What is to be Done: No change will happen without the mobilization of the people through the building of social and political power amongst people and communities. We commit ourselves to building alliances with others who seek progressive and transformative change. We leave Cape Town determined to: • set up new PHM circles • energise, broaden and deepen the work of existing PHM country circles • strengthen and develop the thematic circles of the PHM. We leave Cape Town committed to: • creating and communicating alternative visions, analyses, discourses and evidence; • actively support and facilitate a range of campaigns. We will continue and expand our global work around existing global programmes – suitably redesigned wherever necessary, namely: • the Right to health campaign; • the International Peoples Health University; • the Global Health Watch; • the Democratising Global Health; WHO Watch and Supporting the Restitution of the WHO. We further commit ourselves to expand our global Right to Health campaign, a campaign that will be globally co-ordinated, but locally owned and driven. 2
  • 3. A. Preamble After two years of participatory engagement and planning we, the People’s Health Movement, have gathered 800 strong from 90 countries representing the voices of tens of thousands more in our movement across every continent in the world. In Cape Town we have: • strengthened and deepened our resolve and solidarity; • expressed our outrage at the continuing global health crises embedded in myriad structural and socio-political inequities; • developed principles for alternative economic, political and social order; and • re-committed ourselves to work towards the world we have envisioned. We reaffirm our commitment to the People’s Charter for Health and to the Cuenca Declaration, which are the foundational documents to this Call to Action. This Call to Action will guide our work until the Fourth People’s Health Assembly. 3
  • 4. B. The Global Health Crisis Our health has been devastated by neoliberal policies that are the hallmark of present day capitalism, and increasingly so by the global crisis of capitalism. The current crisis underpins the growing global health inequities within and between countries. Health crisis: Growing health inequities The global health crisis is a consequence of the failure to address the social, political and environmental determination of health, resulting in an erosion of food sovereignty, in higher levels of poverty, as well as in a lack of fair and equitable access to water, housing, sanitation, education, employment and universal and comprehensive health services. Ill-health and disability are being perpetuated by the aggressive marketing of unhealthy products such as tobacco, alcohol, junk food and beverages; by the pollution of our air, our land and water sources; by the colonization of lands and other natural resources; and by the forced eviction of vast numbers of people, including indigenous peoples, from their lands and homes. We have heard how: • small farmers are losing their livelihoods as a result of the dumping of subsidised foodstuffs from industrialised agriculture in the North; • indigenous people are being herded off their land by the extractive mining industry and the struggles by communities that are affected are being criminalized; • the health of workers is jeopardised by the absence of safety and regulations at the workplace, as well as by environmental degradation and pollution; • poor people in dense urban settings are being driven to depend on junk food, available more cheaply than nutritious natural food; • the relegation of women's health to only encompass maternity and family planning, on the one hand, and the concerted attack on women's reproductive and sexual rights, on the other, violates women's autonomy, personhood, dignity and human rights; • women and young people are being denied the right to sexual and reproductive health services; • migrants and displaced people suffer from xenophobia and from a lack of access to healthcare; and • racism - social, institutional and structural - coupled with religious intolerance, disrupts the lives of people and prevents them from living a dignified life free of fear; • children’s rights are being undermined by denying them the conditions in which they can thrive and flourish. Millions of families, particularly in low- and middle-income countries, are being denied access to comprehensive primary health care and universal health services by way of their poverty and the other many institutional barriers they face. In high income countries, there has been a continuing campaign to reduce funding and support for the public sector and to replace public services with those provided by the market. Moving health care out of the public domain makes it easier for large capitalist enterprises (big pharma, big insurance and biotechnology corporations) to increase sales and profits, working in close partnership with those who profit from the delivery of health services. The commodification of health has been intensified by the promotion of a reductionist, industrial, biomedical model. 4
  • 5. The current global trade and investment regime (driven by multilateral, plurilateral and bilateral trade and investments agreements) is seriously undermining universal social entitlements and rights, as well as the power of states to regulate the activities’ of corporations and of private financial institutions. Access to affordable medicines has been compromised worldwide as a result of the WTO-TRIPS Agreement and the continuing pressure on developing countries to adopt TRIPS-plus standards through trade agreements and bogus anti-counterfeiting initiatives. While we welcome the recent surge in interest in the concept of universal health coverage, we oppose the idea that this be achieved through the promotion of a minimalistic insurance model that would offer 'basic packages of care' and would operate within a market-based system of healthcare. We oppose attempts to use this approach to dismantle or undermine the public health system to promote corporate interests in health care delivery. Universal health coverage must be achieved through organized and accountable systems of high quality public provision of comprehensive primary health care and of a fully functional referral system governed by need of care. The global health crisis also reflects a crisis in effective and accountable global health governance. The dimensions of this crisis include: • The undermining of the World Health Organisation; • The power exerted by a fragmented and uncoordinated health aid industry; • The undue influence of unaccountable private corporations and foundations over health policy and programming; • An approach that seeks to remedy the problems of structural inequality through a ‘charity’ model rather than through systemic and structural transformations. The crises of capitalism Genesis of the current crisis The current capitalist crisis has several inter-related dimensions, among them: political, food, economic, financial and ecological. Its roots lie in the neoliberal model of globalisation that emerged in the 1970s as a response to declining rates of profit and wealth accumulation in developed capitalist economies. It also included privatisation and commercialisation of public services, such as in health, education, water and energy supply and public transport. The model, in its endeavour to create a global market for goods and services, promotes the integration of global economies and the expansion and liberalization of global trade. This model was forced upon developing countries through structural adjustment programmes, trade agreements and investment treaties, effectively legally locking many developing countries into the neoliberal paradigm which is highly inequitable and, at best, extremely inefficient in reducing poverty and meeting people’s needs. Meanwhile, the current development and aid industry merely sustains and reproduces existing social and political inequities. Neoliberal globalisation has resulted in an immense concentration of power among a wealthy and corporate elite, who actively undermine democracy and social justice through their influence and through the corruption of national governments and international institutions. The present political crisis is rooted in the lack of accountable, transparent and democratic decision-making. Even in countries with progressive governments, spaces for democratic participation are being eroded and protest is being criminalized. 5
  • 6. The war industry, having blighted lives in many parts of the world, is deeply embedded within the capitalist economic system. Imperialism has increased the use of its military might to maintain and expand its control over the political architecture, as well as the resources of the planet. There is a need to redesign our political culture and our institutions, both nationally and globally; to create relations based on solidarity; and to put in place the mechanisms of accountability needed to run the global political, economic and social structures in a manner that is just, equitable and sustainable. The crisis today and its manifestations The current financial crisis is rooted in the de-regulation of banks that were allowed to become ‘too big to fail', to increase their ratio of loans (debts) to assets, and to speculate heavily on currencies, on derivatives and on mortgages. The response of national and international institutions has been merely to ‘restore the confidence’ of the same institutions and financial markets that caused the crisis in the first place. Governments have moved quickly to bail out the failing banks and have enacted an ‘austerity agenda’ – cutting health and social spending - effectively deepening and reinforcing the very neoliberal economic model the crisis had so discredited, and handing even more power to finance capital. The ecological crisis is also a part of the capitalist crisis and mirrors the rise in global inequalities as characterized by the obscene over-consumption of a small minority that is overstretching the capacity of the planet, while a large majority are denied even their basic needs. The resources of this planet are being privatized and plundered in ways that are damaging and lethal for future generations. Public stewardship of our scarce resources is the only solution to the equitable protection of the planet. Rich nations are passing on the burden of the ecological crisis onto poor nations through various mechanisms, including through the shifting of the impacts of the ecological crisis onto poor peoples. Coercive population control policies enacted in the name of climate protection are now violating women’s rights. Many of the effects of overproduction and over-consumption and of climate change are felt by the world's indigenous communities, small-scale peasant farmers, poor people and the working classes. Although the planet is capable of providing for the needs of all its people, the current system of production and consumption only undermines the natural basis of life through a need for constant growth, leaving billions of people in poverty. The annual Conference of the Parties (COP) meeting under the UN Convention on Climate Change has failed miserably to ensure the rapid reduction in the emissions of greenhouse gases. Under the domination of predatory transnational corporations the negotiations have sought to impose false solutions such as carbon trading, Reducing Emissions from Deforestation and Forest Degradation (REDD) and other market/financial incentives to safeguard continued profit margins and the continuity of economic growth. The food crisis as evidenced by the existence of a billion hungry people and two billion overweight or obese people is a manifestation of a much larger and more pervasive malaise, caused by the loss of food sovereignty and of control by communities and poor nations over the use of their own resources. The food system is dominated by transnational corporations (big agribusiness and big food and beverage corporations). This has resulted in, among other things, mono-cropping and the replacement of food crops with crops for bio-fuels; a huge increase in the speculative trading of food grains; unfair trade agreements; and oligopolies in the food retail sector. The food crisis is now worsening as a consequence of ‘land grabs’, a new form of colonialism in which transnational corporations and sovereign wealth funds are acquiring large tracts of arable land in poor and often poorly governed countries – displacing domestic food production systems, as well as rural peoples from their lands. Meanwhile, hunger and malnutrition is being converted into a new market for processed ready-to-use foods (RUTF) and nutriceuticals, often assisted by the aid industry and multilateral organisations. 6
  • 7. C. Our Alternative Vision PHM seeks a better world and offers a critical alternative. We believe that transformative and radical change is needed and can indeed be achieved. Our vision consists of a number of inter-related dimensions: • A reformed economic system; • Just, fair and democratic political and economic processes and institutions; • Better and transformed global heath governance; • Equitable Public Health Systems. Reformed economic system We need an economic system that values every individual, not every dollar. The primary objective must be to maximise benefits to people – their health, their wellbeing, and their quality of life – not total output or income. It should be based on collaboration within and between communities and nations, not on competition, and should seek to minimise the use of environmental resources while fostering sustainable livelihoods for all. It will be socially directed rather than market driven. Such an economic system will: • encourage adequate, appropriate, equitable and sustainable consumption, with the least ecological and human impact, reflecting a commitment to future generations and harmony with the planet; • replace existing global and regional trade and financial agreements with those that will eradicate food insecurity and malnutrition and will foster food sovereignty; • be rooted in and have obligations towards local communities while being globally responsible; • establish and develop worker controlled enterprises; • create sustainable, dignified work opportunities that meet the basic needs of all; • build solidarity between people; • reverse the land grabs that have occurred; and • be rooted in the effective measurement of societal progress on the basis of health, social and environmental indicators. Just, fair and democratic political and economic processes and institutions We need a new system of global governance, including in the different international trade and financial systems, that : • places health, well-being, human rights and environmental sustainability at the centre of all policies; • ensures genuine equality of influence at the heart of all decision-making; • promotes democracy, accountability and transparency at all levels. We need news systems of national governance: • in which electoral democracy is not captured by capital or undue private influence; • where forms of participatory democracy are integral to structures of governance; • where people have adequate constitutional rights and protections, including the right to protest against conditions or practices that create social exclusion and oppression. We seek a world in which governments will: • work multi-laterally to reach peaceful resolutions to international conflicts 7
  • 8. refrain from imposition of their own policies and interests on other sovereign nations, whether through force or by economic pressures; • be held accountable for the full implementation of the Universal Declaration of Human Rights and the Covenants on Political, Civll and Economic, Social and Cultural Rights. A new system of global and national governance will include regulatory structures that, among other, ensure: • fair and progressive taxation regimes within and between countries that will enable a transformative and equitable redistribution of resources and power; • closure of tax havens and democratic reform and regulation of the international banking system; • fair trade arrangements and agreements; • a new regime for research and development that does not seek to monopolise knowledge in a few hands, prioritises the genuine needs of the largest numbers of people and sees local communities as equal partners in the research cycle; • a new regime for the production, management and dissemination of knowledge and technology that prevents their private appropriation and promotes an open system of knowledge sharing. A better global heath governance We seek a more coherent and accountable system of global health governance that is free from corporate influence and the influence of unaccountable private actors. We seek a radical rationalization and transformation of the multiple Global Health Partnerships and funds. We seek new and more accountable mechanisms for the management and allocation of global public finance, working with and through UN institutions. The World Health Organisation must: • follow its constitutional mandate to act as the directing and coordinating authority for international and global health; • be fully and adequately funded by assessed and untied contributions from member States; • be accountable to member states and the people of the world. Equitable and Public Health Systems Health systems should be: • Universal, integrated and comprehensive, as well as provide a platform for appropriate action as regards the social determination of health; • supported by a guarantee of the right to health in the national constitution; • based on accessible, effective, gender-sensitive, youth-friendly and free comprehensive primary health care, accountable and appropriate to people’s health needs, supported by fully functional referral systems governed by need of care; • accessible to all, with no discrimination on the basis of gender, age, race, ethnicity, religion, economic status, sexual identity, disability, cultural knowledge, language or any other basis; • welcoming of alternate cultural understandings of health and systems of healing, and not based solely on biomedical concepts of health and illness; • properly and adequately publicly financed with public expenditure representing the major share of total health expenditures, as well as capable of protecting the population against the rising costs of health care; • be able to retain local health workers within the national health system rather than losing them to international migration; • built around an integrated network of public facilities responsible for providing comprehensive care, based on the principles of universality and equity; 8
  • 9. empowered to strictly regulate commercial health care providers (where present) within an ethical framework; • participatory and responsive to peoples’ needs through social participation in the formulation, implementation, monitoring and evaluation of policies; • compatible with sound ecological principles and practices. PHM will also work towards developing frameworks of analysis using its global community of public health practitioners, academicians and activists who can work on innovative and creative design solutions that will ensure more effective, efficient and equitable public health systems. 9
  • 10. D. What is to be Done? This Call to Action was developed at and is directed to all delegates of the Third Peoples Health Assembly (Cape Town July 2012) and their fellow health and social activists from across the world. D.1. Power to the People: Building the Movement No change will happen without the mobilization of the people. Power will not be given to the people unless we force it out from the political, corporate and financial elites; and hold our public institutions accountable and make them work in ways that are transparent and truly representative and that serve the public interest and social justice. All this requires the building of social and political power amongst people and communities. The Third PHA celebrated the successes of the growing People’s Health Movement, especially the development of new country circles in Africa. While we are a movement focused on health and are built mainly around health activism, we share many goals with other social movements that also seek a more just and sustainable world. In order to diminish the power of financial capital, democratize governance and defeat neoliberal economic policies, we need to build a more effective and broad-based social movement. To this end, we commit ourselves to building alliances with others who seek progressive and transformative change. PHM is in a unique position to build alliances across existing movements, including those of informal and formal sector workers, the landless, indigenous peoples, women and youth. We will build solidarity with those struggling against big dams, nuclear power plants, illegal mining, hazardous working conditions and others. We will work with the environmental justice movement. We will seek greater trans-disciplinary engagement with, among others, progressive economists, environmental scientists, lawyers, urban planners and political-social scientists. We leave Cape Town determined to: • set up new PHM circles • energise, broaden and deepen the work of existing PHM country circles • strengthen and develop the thematic circles of the PHM. We leave Cape Town with a new and reinvigorated Global Steering Council that, among other, will improve communications within the movement, facilitate effective coordination across the movement and ensure organic linkages with regional and country circles. This will include facilitating the recruitment and support of PHM outreach workers to assist the development of PHM in countries and regions. We will strive to foster and develop community-based struggles, campaigns and advocacy initiatives from local to national and global levels on multiple fronts, as well as develop the health movement in the coming phase. D.2. Creating and communicating alternative visions, analyses, discourses and evidence We recognise that the neoliberal orthodoxy and the vested interests of the rich and powerful are heavily represented in the mainstream media. We recognise the power of the mainstream media and of corporate propaganda in shaping prevailing views and attitudes, and sustaining the belief that there is no alternative to the current political and economic system. 10
  • 11. We recognize that many scientific journals and institutions of education and knowledge generation act to legitimize and sustain the current system and paradigm. We recognise the lack of investment in research, in monitoring and surveillance that can serve the interests of the poor and promote the global social justice and equity agenda that PHM stands for. To this end we commit to: • communicating alternative visions, analyses and discourses to the people, using a wide variety of media and communication techniques, especially those that engage people creatively; • using the Global Health Watch as an instrument to communicate our alternative progressive analysis of the state of global health and our critiques of the current institutional framework for global health. We will work to improve the dissemination of the periodic GHWs both in English and in other languages using alternative media so as to reach a greater diversity of audiences. We will establish and maintain local and national health watches; • expanding and extending the reach of the International Peoples Health University (IPHU) as a means of education, empowerment and mobilisation of young PHM cadres; • expanding processes such as community-based monitoring to ensure health system accountability and community oriented action research. D.3. Organising and planning to make change happen To make change happen, movement building and alternative analyses must be translated into concrete campaigns and programmes of action. Actions will need to be planned and organised at the local and national levels. As a global movement, we will seek to actively support and facilitate a range of campaigns, by: • providing information and facilitating the sharing of information on the international context and country experiences; • providing campaigning materials on issues of international priority; • liaising and coordinating with organisations in different countries working on related issues; • providing multiple fora for the sharing of experiences; • supporting campaigns at the international level giving them wide publicity; • actively mobilizing to oppose health damaging policies and actions of international organizations and of Northern governments. To enable us to fulfil this role effectively, we will intensify our fundraising efforts, in order to strengthen the movement through: • Increasing the capacity of young PHM activists through supporting more IPHUs; • strengthening regions and countries through the recruitment of regional outreach coordinators; • Increasing regional support to build the movement at the local and country level; • Strengthening the global secretariat; • Increasing the resources available for information, media and advocacy activities at the international and local levels. We will continue and expand our global work around existing global programmes – suitably redesigned wherever necessary, namely: • the Right to health campaign; • the International Peoples Health University; • the Global Health Watch; • the Democratising Global Health; WHO Watch and Supporting the Restitution of the WHO. 11
  • 12. Developing a Global Campaign We further commit ourselves to expand our global Right to Health campaign. The campaign will be globally co-ordinated, but locally owned and driven. The campaign will integrate a number of specific elements, each addressing key concerns of PHM circles as well a the global movement. PHM circles will be encouraged to be part of the global campaign and to determine their level of engagement with specific issues based on their local priorities and local capacity. We propose the basic framework and proposed elements for the expanded global campaign in Annexure 1. 12