Declaration of the 4th People’s Health Assembly (PHA4)

PHM promotes an understanding and analysis of gender as a cross-cutting issue that informs all the thematic circles within PHM. PHM moves beyond male/female binary and includes LGBQI (Lesbian, Gay, Bisexual, Queer and Intersex) and transgender communities by integrating a non-binary gendered analysis and understanding in all PHM discussions, events and assemblies.
PHM believes that gender oppression is intricately linked to other systems of oppression and that interactions between these further compromise wellbeing and access to health care. Although they manifest differently and to varying levels in diverse contexts, experience of gender inequity, discrimination and violence is universal. PHM recognizes that that besides women – other victims of gender based violence include children, persons with non-normative sexual orientations or gender identities, and that vulnerability to violence is exacerbated by disabilities, marital status, race, caste, religion, ethnicity, occupation, conflict situations, and social and economic status.
Gender justice and health are mutually reinforcing and are both central to the realisation of the goal of health for all. PHM critically examines the gendered implications of macroeconomic policies and the current developmental paradigm, that together with domestic policies and laws are discriminatory and unjust and continue to impede the realisation of health for all.

To advance towards gender justice, PHM commits to:

• Promote health services and reproductive and sexual health care with special emphasis for women, girls and LGBTQI and transgender communities, those belonging to racial and caste minorities and people with disability.
• Promote and sustain action against gender unequal and gender unjust social, economic and political systems that impact health and human rights at the local, regional as well as global levels.
• Consolidate evidence through research, testimonies, case studies and experiences from different regions for global advocacy and action on gender-just health policies and accountability.
• Forge and strengthen linkages and solidarity with women’s groups, health groups, coalitions, networks, people’s movements, campaigns and interest groups, on identified gender justice and health challenges and concerns.
• Monitor and resist global agendas that diminish sexual and reproductive health rights, for example the global gag rule.
• Mobilise and build understanding and capacities, especially of the youth, on gender justice and health through the International People’s Health University (IPHU) and other processes.

The overarching focus of neoliberal policies on maximising profit with minimum accountability is encouraging over-consuming, unsustainable lifestyles and polluting technologies and industries. These are irreversibly affecting soil quality, ground water reserves, bio-diversity by over-extracting forest and fishery resources, proliferating mining operations, and expanding modern agriculture for the global market, just to name a few. Such a developmental vision is evidently responsible for widespread environmental destruction and generation of immense quantities of waste – both nuclear as well as from toxic chemicals and pesticides – causing severe soil and water pollution, air pollution, depletion of the ozone layer and climate change, all of which have far reaching effects on people’s health. In addition, the labour force working in these polluting industries often comes from the most under-privileged section of society. Laws and policies have been continuously flouted by industries in context of these vulnerable workers’ health, exposing them to a highly hazardous workplace.

In order to promote ecosystem health, in the vision that our health is the health of nature as a whole, PHM commits to:

• Develop a global campaign against the impact of extractivist industries on health.
• Support organisations that oppose the global extractivist project and strengthen links between land rights, environmental rights, and human rights movements that are people’s movements.
• Condemn the criminalisation, repression and extra-judicial killing of activists in the struggle for environmental justice.
• Promote healthcare systems that are not harmful to the environment and that support healthy ecosystems.
• Support models of work that promote safe, healthy work and systems of production.

• Support workers’ rights groups who struggle for the health rights of organised and unorganised labourers and for a safe workplace.

PHM believes that our unsustainable and inequitable food systems is a determinant of poor health, particularly manifesting in what is called the triple burden of malnutrition, as well as the pandemic of non-communicable diseases. The common roots underlying both under and over-nutrition in our globalised world pertain to the impact of current practices related to food production, processing, manufacture, distribution, trade and commerce on food systems, as well as to the power differentials between those who are most affected by and those who benefit most from the current food system. The unregulated penetration of food and beverage companies and the aggressive marketing of processed and ultra-processed foods have severely compounded the problem of malnutrition and the underlying food insecurity.

PHM proposes to:

• Create a food system that, ‘from seed to plate’, is equitable, fair, and based on the inalienable right to food and adequate nutrition.

• Appropriately politicise food and nutrition issues, i.e., increase understanding of the political economy of food and nutrition.
• Build awareness about the negative links between food and financial systems including about undue corporate influence, as well as about the flaws of current multi-stakeholder ‘solutions’, as for example the Scaling Up Nutrition (SUN) initiative adopted by UN agencies and selected NGOs.
• Resist the growing power of the transnational food industry.
• Resist the technical and individualised vision of nutrition by correcting misinformation fed to the public on how to make the food system more equitable. Create bridges between PHM and the agroecologist movement to gain food sovereignty.
• Raise awareness on and prevent the massive use of agrotoxic products and pesticides in food, water and land, opposing the hegemonic discourse on agribusiness.

Almost all countries represented at this Assembly have concluded or are negotiating regional or bilateral trade and investment agreements, generally driven by the US or the EU, and directed to advancing the interests of the transnational corporations. These are in effect economic integration agreements, going well beyond the liberalisation of trade in goods, to include the liberalisation of trade in services, extreme protection for intellectual property, regulatory harmonisation, and new provisions to protect transnational corporations from regulation by host governments. The regime thus put in place has far reaching consequences for access to comprehensive health care and to the social conditions which shape people’s health.

In order to put health before profit, PHM commits to:

• Stop the negotiation of trade and investment agreements designed to further extend and strengthen the neoliberal regime and terminate (withdraw from) existing agreements which shore up this regime.
• Work towards a New International Economic Order which incorporates positive discrimination in favour of low and middle-income countries and which is oriented around an ecologically sustainable civilisation, based on living well rather than corporate profit.
• Reform medicines regulation ensuring that it is based on national sovereignty and directed towards ensuring quality, safety, affordability and efficacious rational use.

PHM reiterates its commitment to primary health care (PHC) in the pursuit of health and well-being for all, aiming to achieve equity in health outcomes. This is critical as we are facing a global health crisis that is characterised by inequities related to a range of social, economic, commercial,environmental and political determinants of health, and in access to and quality of health services within and between countries. In many regions of the world, poorly designed, under-resourced, and poor quality health systems are causing unacceptable rates of morbidity and mortality. PHM also recognises that health systems are deeply gendered, caste-ist and racist institutions that reinforce inequalities, with discriminatory policies and practices being huge barriers to access to health information and care globally. Gender also plays a critical role in the health workforce and determines the location and experiences of health workers.

PHM also deplores the global trend towards privatisation of health care, the implementation of insurance schemes (especially in Asia and Africa) in the name of achieving universal health coverage, which reinforce privatisation and commercialisation of health. Public private partnerships and outsourcing of public services, including in health, are being promoted despite overwhelming evidence of failures and their adverse impact on health equity and conditions of health workers. These have evoked sharp resistance from people’s movements.

PHM proposes to:

• Institute action to promote universal health systems that are publicly funded and publicly provided, equitable and of good quality, based on primary health care as defined in the Alma Ata Declaration. Universal public health systems, free at the point of use and financed through taxation, centred on primary health care, are the most effective and efficient path towards the promotion of equity and the realisation of the universal right to health.

• Provide evidence on the failure of publicly funded health insurance in low and middle-income countries, privatisation, public private partnerships in attaining better health for the people that will strengthen the campaign in exposing the neoliberal framework being used to justify the privatisation of health systems.
• Document struggles and resistance to health privatisation and build on positive experiences in organisation of health care services and primary health care.
• Establish a corporate watch initiative on healthcare across global regions, in partnership with other networks doing similar work.
• Build awareness about the importance of frontline workers as both agents of social change and extension workers for the health system and work towards strengthening their role in ensuring health for all, through better designed programmes, fair and decent work and adequate remuneration.
• Highlight the key role of health workers in the functioning of health systems, and build awareness about the effects of neoliberal policies on their working conditions.
• Promote decent work in health systems and for all health workers, including adequate remuneration, social protection and employment conditions. Highlight the linkages between informal and irregular forms of work and quality of health services.
• Support the right to organise and bargain collectively for health workers, and create linkages with progressive trade unions that struggle for the rights of health workers.