Claudio Schuftan, Member of the Steering Council of the People’s Health Movement, Saigon, Vietnam
International Encyclopedia of Public Health, Second Edition, 2, 2017, 438–441
[This article is an updated version of the previous edition article by Ravi Narayan, Claudio Schuftan, volume 5, pp. 41–45, 2008, Elsevier Inc].
The People’s Health Movement (PHM) is both an organization
and a network whose mission is to build a global movement:
the people’s health movement.
Almost 8 years have passed since the publication by Elsevier
in 2008 of the contributions of PHM in the International Encyclopedia
of Public Health (IEPH).
During these years, PHM has grown and developed, has
revamped its governance, has launched programs and projects,
and has made important contributions to the global public
health movement. It is about these that the update here
reports on.
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 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 First People’s Health Assembly 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
program 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 two) 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).
People’s Charter for Health
In Savar, PHM’s Global Peoples Health Charter emerged and was
endorsed by all participants (People’s Health Assembly, 2000).
The Charter has now clearly become:
l- an expression of the Movement’s common concerns;
l- a vision for a better and healthier world;
l- a call for more radical action;
l- a tool for advocacy for people’s health; and
l- 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:
l- it endorses health as a social, economic, and political issue
and as a fundamental Human Right;
l- it identifies inequality, poverty, exploitation, violence, and
injustice as the roots of preventable ill-health;
l- 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;
l- 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
l- 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 PHA 1 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:
l- the violations of people’s right to health;
l- the Economic, social, and political determinants of health;
l- the Environmental determinants of health;
l- war, violence, conflict, and natural disasters as the cause of
preventable mortality and ill-health;
l- the lack of a people-centered health sector reform with the
poor people participating in fostering a healthier world.
In a nutshell, the People’s Health Movement 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:
l- combating the negative impacts of Globalization as
a worldwide economic and political ideology and process;
l- significantly reforming the International Financial Institutions
and the WTO to make them more responsive to
poverty alleviation and the Health for All-Now! Movement;
l- a writing off of the foreign debt of least developed countries
and the use of its equivalent for poverty reduction, health,
and education activities;
l- greater checks on and restraints of the freewheeling powers
of transnational corporations, especially pharmaceutical
houses (and mechanisms to ensure their compliance);
l- greater and more equitable household food security.
l- caps on the runaway international financial transfers;
l- unconditional support of the emancipation of women and
the respect of their full rights;
l- putting health higher in the development agenda of
governments;
l- promoting the health (and other) rights of displaced and
minority people;
l- halting the process of privatization of public health facilities
and working toward greater controls of the already installed
private health sector;
l- more equitable, just and empowered people’s participation
in and greater influence on health and development
matters;
l- a greater focus on poverty alleviation in national and
international development plans;
l- greater and unconditional access of poor people to
health services and treatment regardless of their ability to
pay;
l- strengthening public institutions, political parties, and trade
unions involved, as the Movement is, in the struggle of the
poor;
l- challenging restricted and dogmatic fundamentalist views
of the development process;
l- 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;
l- protecting biodiversity and opposing biopiracy and the
indiscriminate use of genetically modified seeds;
l- holding violators of environmental crimes accountable;
l- systematically applying environmental and health assessments
and people-centered environmental audits of development
projects.
l- opposing war in all its forms and the current USA–led, blind
‘anti-terrorist’ campaigns;
l- categorically opposing the Israeli seizure of Palestinian
territory (having, among other, a sizable negative impact on
the health of the Palestinian people);
l- the democratization of the UN bodies and especially of the
Security Council;
l- getting more actively involved in actions addressing the
silent epidemic of violence against women;
l- more prompt responses and preparedness and rehabilitation
measures in cases of natural disasters; recognizing the
politics of aid;
l- making a renewed call for more democratic Primary Health
Care that is given the resources needed and holding
governments accountable in this task;
l- vehemently opposing the commoditization and privatization
of health care (and the sale of public health facilities);
l- promoting independent national drug policies centered
around essential, generic medicines;
l- 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;
l- assuring WHO stays staunchly independent from corporate
interests;
l- sustaining and promoting the defense of effective patient’s
rights;
l- expanding and incorporating traditional medicine into
people’s health care;
l- 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;
l- defending and fostering public health-oriented (and not
for-profit) health research worldwide;
l- building strong people’s organizations and a global movement
working on health issues;
l- more proactively and effectively countering of the media
that are at the service of the globalization process;
l- empowering people leading to their greater control of the
resources needed for the health services they need and get;
l- 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
l- 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 People’s Health Movement
from as early as the year 2000 on (Schuftan, 2002).
Over 15 years, PHM has repeatedly considered revising
its Charter and has, over and 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 toward more equitable access to
quality health services for all, i.e., for universal access
to decent health care, as well as toward 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 other 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 and 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://www.phm.
phmovement.org/phm-exchange-phmovement.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: (1) 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; (2)
the Coordinating Committee (CoCo) which acts as an executive
secretariat for the GSC; and (3) 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://www.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
Center, Bangladesh (GK http://www.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 1200 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 themis in an article on Perspectives
on Global Development and Technology (Narayan and
Schuftan, 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 People’s Health Movement has been a rather unprecedented
development in the journey toward the ‘Health for
All’ goal. The Movement:
l- now, encompasses an even greater multi-regional,
multi-cultural, and multi-disciplinary mobilization effort;
l- is bringing together the largest ever gathering of activists and
professionals, civil society representatives and the peoples
representatives themselves,
l- as ever, is working on global issues to raise awareness, as
well as the level of concrete actions, and
l- 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 People’s Health Movement
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
Latham, M., 2006. A Global Struggle for Health Rights: The PHA2 Story. SCN News.
No. 31, late 2005 – early 2006.
Narayan, R., Schuftan, C., 2004. The People’s Health Movement: a people’s campaign
for Health For All Now! Perspect. on Global Dev. Technol. Spec. Issue Global Health
3 (1–2), 235–243.
People’s Health Assembly, December 8, 2000. People’s Charter for Health, People’s
Health Assembly. GK Savar – Bangladesh.
Schuftan, Claudio, May 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.
WHO – UNICEF, September 6–12, 1978. Primary Health Care Report of the International
Conference on Primary Health Care. Alma Ata, USSR. World Health
Organization, Geneva, Switzerland.
Relevant Websites
http://www.phmovement.org/en/node/798 – The Cuenca Declaration: People’s Health
Movement (last accessed 22.04.16.).
http://www.phmovement.org/en/pha3/final_cape_town_call_to_action – The Final
Cape Town Call to Action: People’s Health Movement (last accessed 22.04.16.).
http://www.phmovement.org/en/pha1 – People’s Health Assembly – 4 to 8 December
2000 (last accessed 22.04.16.).
http://www.phmovement.org/en/node/28 – The People’s Charter on HIV and AIDS:
People’s Health Movement (last accessed 22.04.16.).
http://www.phmovement.org – People’s Health Movement: Health For All Now! (last
accessed 22.04.16.).
http://www.politicsofhealth.org – Politics of Health (last accessed 22.04.16.).
Peoples Health Movement 441
International Encyclopedia of Public Health, Second Edition, 2, 2017, 438–441
Author’s personal copy