Elsevier Reference Module in Biomedical Sciences, (2015) http://dx.doi.org/10.1016/B978-0-12-801238-3.92828-9 1
Claudio Schuftan, Steering Council PHM
cschuftan@phmovement.org
Background
In 1978, in Alma–Ata, the universal slogan Health for All by the year 2000 was coined. At the same time, the famous Alma Ata
Declaration was overwhelmingly approved, putting people and communities at the center of health planning and health care
strategies, as well as emphasizing the role of community participation, appropriate technology and inter-sectoral coordination.
The Declaration was endorsed by most of the governments of the world and symbolized a significant paradigm shift in the
global understanding of Health and Health Care. (WHO–UNICEF, 1978; http://www.who.int/publications/almaata_declaration_
en.pdf).
Thirty-five years later, after much policy rhetoric, some concerted but mostly ad-hoc action, quite a bit of misplaced euphoria,
and distortions brought about by the growing role of the market economy as it has affected health care, this Declaration remains
unfulfilled and mostly forgotten, as the world comes to terms with the new economic forces of globalization, liberalization and
privatization which have made ‘Health for All’ a receding dream.
The People’s Health Assembly in Savar, Bangladesh, in December 2000, and the People’s Health Movement (PHM) that evolved
from it are both a civil society effort to counter this global laissez faire and to challenge health policy makers around the world with a
Peoples Health Campaign for Health for All-Now!
The First People’s Health Assembly
The People’s Health Assembly 1 brought together 1450 people from 92 countries, and resulted in an unusual 5-day event in which
grassroots people shared their concerns about the unfulfilled ‘Health for All’ challenge. The Assembly’s programme included a
variety of interactive dialogue opportunities for all health professionals and activists who gathered for this significant event (http://
www.phmovement.org/en/pha1).
This People’s Health Assembly was preceded by a long series of pre-assembly events all over the world. The most exceptional of
these was the mobilization in India. For nearly 9 months preceding the Assembly, there were grassroots, local and regional
initiatives of people’s health enquiries and audits; sensitization and policy dialogues; sub-districts and district level seminars; as
well as campaigns to challenge medical professionals and the prevailing health system. Finally, over 2000 delegates traveled to
Kolkata (Calcutta), for 2 days of conferences, parallel workshops, exhibitions, two public rallies for health and a myriad of cultural
programs. The Assembly endorsed the Indian People’s Health Charter. About 300 delegates from this Assembly then traveled to
Bangladesh to attend the Global Assembly. Similar preparatory initiatives, though less intense, took place in Bangladesh, Nepal, Sri
Lanka, Cambodia, Philippines, Japan and other parts of the world, including Latin America, Europe, Africa, and Australia.
The Second and Third People’s Health Assemblies
The second People’s Health Assembly (PHA 2) followed in July 2005, in Cuenca, Ecuador with 1492 participants from 80 countries
(Latham, 2006).
Again, it was an unusual international health meeting expressing and symbolizing an alternative health and development
culture of dialogue and celebration. PHA2 was preceded by holding of the first session of the International Peoples Health
University (IPHU) in which 52 young people were trained as PHM activists. This is an effort to bring young people into the
leadership of the Movement. Since then over 20 IPHUs have been held in all continents training over 1000 activists.
The third People’s Health Assembly was held in Cape Town in South Africa in July 2012 with a similar attendance. It produced
the Cape Town Call for Action which focused on the tasks PHM members have to engage in on the road to Health For All (http://
www.phmovement.org/en/pha3/final_cape_town_call_to_action).
The People’s Charter for Health
In Savar, PHM’s Global Peoples Health Charter emerged and was endorsed by all participants (People’s Health Assembly, 2000a). The
Charter has now clearly become:
• an expression of the Movement’s common concerns;
• a vision for a better and healthier world;
• a call for more radical action;
• a tool for advocacy for people’s health; and
• a worldwide rallying manifesto for global health movements, as well as for networking and coalition building.
The significance of the People’s Charter for Health is multiple:
• it endorses health as a social, economic, and political issue and as a fundamental Human Right;
• it identifies inequality, poverty, exploitation, violence and injustice as the roots of preventable ill-health;
• it underlines the imperative that ‘Health for All’ means challenging powerful economic interests, opposing globalization as the
current iniquitous development model; it thus drastically changes our political and economic priorities;
• it brings in a new perspective and the voices from the poor and the marginalized (the rarely heard) encouraging people to
develop their own local solutions; and
• it encourages people to hold accountable their own local authorities, national governments, international organizations and
national and transnational corporations.
The vision and the principles of the Charter, more than any other document preceding it, extricates health from the myopic
biomedical-techno-managerialist approach it has seen in the last two decades and centers it squarely in the more comprehensive
context of today’s global socioeconomic-political-cultural-environmental realities. However, the most significant gain of PHA1
and the Charter is that, for the first time since Alma Ata, a ‘Health For All’ action-plan unambiguously endorses a call for action
that tackles the broader determinants of health, which include:
• The violations of people’s right to health
• The Economic, social and political determinants of health;
• The Environmental determinants of health;
• War, violence, conflict and natural disasters as the cause of preventable mortality and ill-health;
• The lack of a people-centered health sector reform with the poor people participating in fostering a healthier world.
In a nutshell, the PHM started promoting a wide range of approaches and initiatives which combated the ill effects of the triple
assault by the forces of globalization, liberalization and privatization on health, on health systems and on health care. In more
detail, the PHM initiatives still today call for:
• Combating the negative impacts of Globalization as a worldwide economic and political ideology and process;
• Significantly reforming the International Financial Institutions and the WTO to make them more responsive to poverty
alleviation and the Health for All-Now! Movement;
• A writing off of the foreign debt of least developed countries and the use of its equivalent for poverty reduction, health and
education activities;
• Greater checks on and restraints of the freewheeling powers of transnational corporations, especially pharmaceutical houses
(and mechanisms to ensure their compliance);
• Greater and more equitable household food security.
• Caps on the runaway international financial transfers;
• Unconditional support of the emancipation of women and the respect of their full rights;
• Putting health higher in the development agenda of governments;
• Promoting the health (and other) rights of displaced and minority people;
• Halting the process of privatization of public health facilities and working towards greater controls of the already installed
private health sector;
• More equitable, just and empowered people’s participation in and greater influence on health and development matters;
• A greater focus on poverty alleviation in national and international development plans;
• Greater and unconditional access of poor people to health services and treatment regardless of their ability to pay;
• Strengthening public institutions, political parties and trade unions involved, as the Movement is, in the struggle of the poor;
• Challenging restricted and dogmatic fundamentalist views of the development process;
2 Peoples Health Movement
• Exerting greater vigilance and activism in matters of water and air pollution, the dumping of toxics, the disposal of water,
climate changes and CO2 emissions, soil erosion and other attacks on the environment;
• Protecting biodiversity and opposing biopiracy and the indiscriminate use of genetically modified seeds;
• Holding violators of environmental crimes accountable;
• Systematically applying environmental and health assessments and people-centered environmental audits of development
projects.
• Opposing war in all its forms and the current USA–led, blind ‘anti-terrorist’ campaigns;
• Categorically opposing the Israeli seizure of Palestinian territory (having, among other, a sizeable negative impact on the health
of the Palestinian people);
• The democratization of the UN bodies and especially of the Security Council;
• Getting more actively involved in actions addressing the silent epidemic of violence against women;
• More prompt responses and preparedness and rehabilitation measures in cases of natural disasters; recognizing the politics
of aid;
• Making a renewed call for more democratic Primary Health Care that is given the resources needed and holding governments
accountable in this task;
• Vehemently opposing the commoditization and privatization of health care (and the sale of public health facilities);
• Promoting independent national drug policies centered around essential, generic medicines;
• Calling for the transformation of WHO actively reminding it of the obligations it has after the Report of the Commission on the
Social Determinants of Health and making sure WHO remains accountable to public interest civil society and social
movements;
• Assuring WHO stays staunchly independent from corporate interests;
• Sustaining and promoting the defense of effective patient’s rights;
• Expanding and incorporating traditional medicine into people’s health care;
• Working for changes in the training and retaining of health personnel to assure they cover the great issues of our time as
depicted in the People’s Charter for Health;
• Defending and fostering public health-oriented (and not for-profit) health research worldwide;
• Building strong people’s organizations and a global movement working on health issues;
• More proactively and effectively countering of the media that are at the service of the globalization process;
• Empowering people leading to their greater control of the resources needed for the health services they need and get;
• Creating the bases for a better analysis and better concerted actions by its members through greater involvement of them in the
PHM’s website (www.phmovement.org) and list-server (phm-exchange); and
• Fostering a global solidarity network that can actively support fellow members when facing disasters, emergencies or acute
repressive situations.
This comprehensive view of actions for health is probably the most significant contribution of the PHM from as early as the year
2000 on (Schuftan, 2002). Over 15 years, PHM has repeatedly considered revising its Charter and has, over an again, decided it is
not necessary: After 15 years, it is still as relevant as it was when first written – and that tells the reader Why PHM? Yes,
new developments have arisen which may not have been current in 2000. So PHM complemented its charter with several
Declarations over the years. (http://www.phmovement.org/en/node/798; http://www.phmovement.org/en/node/28; http://
www.phmovement.org/en/pha3/final_cape_town_call_to_action).
Significant Gains Made By the People’s Health Movement Since 2008
PHM worked closely with the WHO Commission on the Social Determinants of Health till 2008 and continues to be committed to
working towards more equitable access to quality health services for all, that is, for universal access to decent health care, as well as
towards a more effective action on global warming and other forms of environmental degradation.
Working across languages, PHM has continued to emphasize capacity building and supports movement building worldwide, as
well as facilitating the sharing and learning from diverse country experiences especially in its IPHUs. It also actively builds relations
with affiliated networks and organizations fostering regional coordination and making the most possible of its own and others
resources and people.
Among other, because of their current relevance, the issues that PHM is now concerned with are:
The privatization of health services, the structuring of people-friendly health systems, the negative health impacts of free trade
agreements (FTAs) and of climate change, the worrisome developments in the ‘casino economy’ and in foreign debt, the effects on
health of austerity policies and resulting unemployment, the neglected aspects of the access to health of migrants and of people
during social strife and war, the special and neglected needs of women and children, as well as of LGTB; health problems created by
transnational extractive industries, the health an nutrition consequences of growing land grabbing, the role of TNCs in setting up
and influencing decisions through PPPs, the growing pandemic of non-communicable diseases (NCDs) and the future of WHO as
a body independent of private sector influence.
Another significant gain has been the translation of the People’s Charter for Health into five more languages (now over
45 languages worldwide). An audiotape in English with Braille titles is also available. PHA2 produced a new document called The
Cuenca Declaration, which reiterated and updated the principle enshrined in the Charter. This Declaration was translated into five
languages. The Movement itself has since put in place a communications strategy which importantly includes its website (www.
phmovement.org) and the e-list server group for exchange and discussion (http://phm.phmovement.org/phm-exchangephmovement.
org).
Today, PHM is the largest global network of networks of grassroots organizations working on health and on the right to health.
Its presence formally or informally stretches over 70 countries. It brings together grassroots health activists, civil society organizations
and academics from around the world, particularly from low and middle income countries (L&MIC).
PHM has modernized its governance as follows:
The governance structure of PHM includes: (i) the Global Steering Council (GSC) as the principal decision-making body of
PHM between our holding of People’s Health Assemblies. It has representatives of regional PHM circles, PHM thematic programs
and PHM affiliated networks; (ii) the Coordinating Committee (CoCo) which acts as an executive secretariat for the GSC; and
(iii) the Global Secretariat which is the main executive and representative body of the movement and currently function with a very
small staff through three offices in Cape Town, New Delhi and Cairo; it is lead by Bridget Lloyd (South Africa) as a global
coordinator. The Secretariat is heavily dependent on modern communications technology. (http://www.phmovement.org/en/
about).
PHM’s funding partners are a critical component of the overall movement. They are generally based in the North. These funding
partners are a very real expression of North–South solidarity.
PHM-affiliated networks include:
Medecine pour le Tiers Monde/Third World Health Aid (M3M/TWHA http://m3m.be/), Medicus Mundi International (MMI
http://www.medicusmundi.org/en), Health Poverty Action (HPA http://www.healthpovertyaction.org/), the Latin American Association
of Social Medicine (ALAMES http://www.alames.org/), Gonoshasthaya Kendra – People’s Health Centre, Bangladesh
(GK http://healthmarketinnovations.org/program/gonoshasthaya-kendra-gk), Health Action International (HAI http://www.
haiweb.org/), the Third World Network (TWN http://www.twn.my/), HAI Asia Pacific (HAI-AP http://www.haiasiapacific.org/),
and the International Baby Food Action Network (IBFAN http://www.ibfan.org/).
Consequent with its political economy focus, these days, PHM has the greatest visibility through the following core global
activities:
1. The International People’s Health University (IPHU http://www.iphu.org/) as its main research and training arm; PHM has
organized over 25 short courses on the political economy of health attended by over 1,200 health activists across the globe;
2. The Global Health Watch (GHW http://www.ghwatch.org/) as a civil society alternative world health report; together with
several other organizations, PHM has, so far, produced and published four volumes of the book version (GHW4 in
November 2014);
3. The Democratizing Global Health Governance initiative (DGHG http://www.ghwatch.org/democratising) focusing on
WHO-watch (http://www.ghwatch.org/who-watch/about); In this activity, PHM interacts with the agendas of the meetings of
WHO’s governing bodies providing analytical commentaries; and
4. The Health for All Campaign Platform (HFACP http://www.phmovement.org/en/campaigns/145/page), PHM’s umbrella for
health activism at different levels.
As needs arise, PHM also issues sporadic position statements on current events clearly stating its view and opinion on developments
in health and its social determination: PHM is always on top of cutting issues and makes its presence noted. (e.g., about the ebola
crisis http://www.phmovement.org/en/node/9587; about Universal Health Coverage http://www.phmovement.org/en/node/
9160).
The PHM multilingual website (www.phmovement.org) keeps current on where the Movement is going and is an endless source
of important information for health activists the world over. With its worldwide members, PHM keeps in touch on a daily basis
with a very active list-server, the PHM-exchange.
In many countries of the world, emerging country level PHM circles are organizing public meetings and campaigns which
include taking health to the streets as a rights issue. All over the world, there are increasing examples at local and national level
where PHM related networks are empowering people, communities and campaign groups to demand for policy, action, advocacy
and research strategies that strengthen the Health for All Movement. PHM is fast becoming recognized as an alternative to the
Globalization of Health from above and many academics, researchers and policy makers are beginning to recognize its role. One of
them is in a book on Perspectives on Global Development and Technology (Harris and Seid, eds., Brill, 2004).
What Next?
PHM sees itself firmly as staying critically engaged with local, national and global health and nutrition issues, building capacity for
health activism, developing resources for activists, issuing position statements as needed, organizing and mobilizing local
communities and global partners, lobbying UN agencies, the post 2015 development agenda preparation process and its
follow-up, lobbying other regional and national agencies, advocating for Health for All and comprehensive primary health care, as
well as critically engaging with health initiatives at different levels.
Conclusion
The PHM has been a rather unprecedented development in the journey towards the ‘Health for All’ goal. The Movement:
• Now, encompasses an even greater multi-regional, multi-cultural, and multi-disciplinary mobilization effort;
• is bringing together the largest ever gathering of activists and professionals, civil society representatives and the
peoples representatives themselves,
• as ever, is working on global issues to raise awareness, as well as the level of concrete actions, and
• is actively involved in solidarity with the health struggles of people, especially poor and marginalized people affected by
the current global economic order.
In short, every day the list of follow-up actions at various levels increases. But the increasing recognition by the non-PHM world of
the PHM world is a challenge to us as well as a great responsibility.
Recognizing that we need to carry out a continuous, sustained, and collective effort, the PHM process, through the People’s
Health Charter, the Cuenca Declaration and the Cape Town Call to Action, reminds us that a long road lies ahead in the campaign
for Health for All-Now!
References
Harris RL and Seid MJ (2004) Perspectives on global development and technology. Brill.
Latham, M. (2006). A global struggle for Health Rights: The PHA2 Story. SCN News. No. 31, late 2005 – early 2006.
People’s Health Assembly. (2000). People’s Charter for Health, People’s Health Assembly, 8 December 2000, GK Savar: Bangladesh.
Schuftan, C. (2002). The People’s Health Movement (PHM) in 2002: Still at the Fore Front of the Struggle for “Health for All Now”; issue paper-2 for World Health Assembly, May 2002.
WHO–UNICEF. (1978). Primary Health Care report of the International Conference on Primary Health Care. 6–12 September 1978, Alma Ata, USSR. Geneva, Switzerland: World Health Organization.
Relevant Websites
http://www.phmovement.org.
http://www.phmovement.org/en/pha1.
http://www.phmovement.org/en/pha3/final_cape_town_call_to_action.
http://www.phmovement.org/en/node/798.
http://www.phmovement.org/en/node/28.
http://www.politicsofhealth.org.