PHA4: report, key issues and demands

The People’s Health Assembly (PHA), is organised approximately every 5 to 7 years by the People’s Health Movement (PHM), a global network of grassroots health activists, civil society organisations and academic institutions. The 4th PHA was hosted by PHM-Bangladesh from November 15 to 19, 2018 at the campus of BRAC-CDM, Savar, Dhaka.

PHA4 was a gathering of around 1400 delegates, representing 74 countries of the world. Please find below an approximate breakdown per region showing the vast majority of participants to come from the global South. Participants in the Assembly, among whom were a large number of young activists, included representatives of various organisations and institutions working in the field of public health, including popular science movements, trade unions, women’s organisations, other civil society organisations, governments, inter-governmental bodies, and academic institutions. The majority of participants were from the global South, with over half coming from Bangladesh. The table below reflects the approximate breakdown per region:

Africa 7%
Australia 1%
Europe 4%
India 18%
Latin America 3%
Middle East 2%
North America 1%
Nepal and Sri Lanka 9%
South East Asia 4%
Bangladesh 52%


People’s Health Assembly at Dhaka will be remembered for its indomitable spirit. The organizers were told by Bangladesh government officials, at the very last minute, that the event might have to be cancelled. After delicate negotiations, the event was allowed to go ahead at a new venue and as a four rather than five day event. Despite the shortened timeframe, the national and international organising groups managed to arrange a new venue (thanks to BRAC), rework the 5 day programme into 4 days, and print the programme, and avoid any rancour from delegates. Unfortunately, during the period of uncertainty as to whether the Assembly would be allowed to continue, some participants cancelled or broke their journeys. As most participants had arrived or were already en route, this was relatively few participants.

The 15th November, which would have been the first day of the Assembly was used as an opportunity for regional meetings and mobilisation. As the People’s Health Assembly opened on 16 November, the mood in the plenary hall was very upbeat. This optimism prevailed despite the fact that many delegates had spent hours in immigration before being allowed into the country and a few were even deported/not allowed to enter. The difficulties some faced entering Bangladesh seemed to feed into the strong sense of solidarity at the Assembly.

The Assembly discussed key processes and policies that affect health and healthcare all over the world. A wide range of health workers and activists attending the assembly shared experiences and pledged to take actions to secure universal and equitable access to health and health care.

Returning to the venue of the first Assembly

The People’s Health Assembly returned, after 18 years, to Savar, where the very first Assembly was held in December 2000. The People’s Health Movement was founded at the Assembly, which adopted the People’s Charter for Health, the founding document of the Movement.

The first PHA and the People’s Health Charter it adopted emerged as a response to the failure of the countries of the world to achieve the goal of “Health for All by the Year 2000” that they had set for themselves as part of the Alma-Ata Declaration of 1978 and the weak implementation of its key strategies. The second Assembly was held in Cuenca, Ecuador in July 2005, and the third Assembly was held in Cape Town, South Africa in July 2012.

Key themes discussed in the assembly

The assembly had nine plenary sessions and eighteen sub-plenary sessions and a series of thematic strategy discussions, workshops and cultural activities spread over four days. The discussions at the Assembly revolved around four “thematic axes” – (1) the political and economic landscape of development and health, (2) social and physical environments that destroy or promote health, (3) strengthening health systems to make them just, accountable, comprehensive, integrated and networked, and (4) organizing and mobilizing for Health for All. The opening ceremony was a curtain raiser to the different thematic axes, interspersed with cultural expressions by participating countries. Plenary sessions focused on the major themes of the Assembly. An additional special plenary session on the last day was on 40years of Alma Ata Declaration. Sub-plenaries elaborated each of the four themes. Parallel discussions which took place on different key issues that together make up PHM’s Health for All campaign developed strategies to align and co-ordinate activities and struggles across continents. There was space for civil society organizations/networks and other participating groups to organize workshops on topics related to their own priorities within the framework of the Assembly themes. There were more than 10 concurrent self-organized workshops every day, with a total of 43 workshops being held.

Highlights of the sessions

Eduardo Espinoza, the Deputy Health Minister of El Salvador, delivered the opening Plenary Session of the Assembly. Eduardo hailed the importance of PHM as the broadest global health movement and as a voice of resistance in current era where neoliberal policies dominate and governments fail in providing health for all. Eduardo explained how neoliberal policies and the dominance of MNCs are resulting in the uncontrolled exploitation of natural and human resources in the Latin American countries. He highlighted the crises of displacement, armed conflicts and the frustration manifested by lack of development in large parts of the developing world, which are contributing to the current situation of violence and counter violence. Climate change, manifested in the form of global warming, rising sea levels, emission of poisonous gases, rapid loss of bio-diversity, extinction of exotic species are, according to Eduardo, not a result of a natural development process but a reflection of mindless greed. Prof Fran Baum, past chair of the Global Steering Council of the People’s Health Movement, while delivering her address, expressed solidarity with indigenous people from the world over and expressed her anguish about the atrocities by national governments. She recollected how Dr Halfdan Mahler hailed PHM as the only movement upholding the true spirit of PHC.

David Sanders, one of the founding members of PHA and one of the PHM global steering council co-chairs, showed how developing countries have higher burden of deaths of children whereas unprecedented accumulation of wealth is taking place in a small percentage of the population, mainly in developed countries, as a result of neoliberal globalization.

The plenary on “Political and economic landscape of development and health” raised issues ranging from the examination of the dominant economic model of development, power relations between and within countries, trade agreements, and the role of powerful actors such as the Bretton Wood Institutions, multinational corporations, private foundations and global partnerships and religious fundamentalist forces. It also addressed the underlying factors, global and regional, which are driving forced migrations and precipitating a humanitarian crisis in many regions of the world. Prof Jane Kelsey raised concerns about the rise of populist authoritarianism globally and the fact that genuinely progressive governments are finding it difficult to survive the onslaught. She also emphasized the enormous power of lobbying TNCs have over global policy making processes like the trans-pacific partnership. She drew attention to the fact that foreign investors are suing governments over supposed infringements of their right to reap uncontrolled future profit.

Amit Sengupta, one of the global coordinators, a leading voice in PHM and a key force behind the success of PHA 4, while delivering his speech at the opening plenary pointed out that the world had to bear the ill effects of austerity measures in developed countries in their efforts to bail out the corporates, which has affected the working population disproportionately. He also highlighted that though there are improvements in medical technology and medicines the benefits are reaching only the rich, and mainly in the developed nations.

A few days after the Assembly, Amit died in a tragic accident, leaving us in utter shock and grief.

The plenary on “Social and physical environments that destroy or promote health” focussed on how the existing layering of society through differences in power dynamics related to class, gender, ethnicity, caste, etc. are contributing to a global trend of rising xenophobia, war-mongering and intolerance. These, perhaps more than ever before, contribute to inequity in access to healthcare services and to a worsening of many social determinants such as food security and sovereignty, secure employment and decent housing. Speaking in the plenary Shireen Huq talked about the plight of displaced people and how women are particularly vulnerable in such situations as that of Rohingya Refugees from Myanmar. Bangladesh hosts one of the largest refugee camps in the world- for Rohingya refugees belonging to both Muslim and Hindu communities. The Rohingyas had faced years of hardship with discrimination, hatred, no health and family planning services; no schooling apart from religious schooling. They arrived in Bangladesh at a time when it was making considerable social progress in education and health and it was feared that the inclusion of Rohingyas would pull the country down. Despite this, civil society in Bangladesh along with the government and international agencies, attempted to provide aid. However, due to intensified crises in many other countries, international aid has started to dry up. Myanmar was also supported by big countries in the region including China, Russia and India and Bangladesh was isolated internationally.

The plenary on “Strengthening health systems to make them just, accountable, comprehensive, integrated and networked” discussed the various alternative models of healthcare delivery that are better suited to promote equity in access, that are fair, and that promote accountable systems built around popular participation, particularly women and others who are socio-economically and politically marginalised. Rapeepong narrated the Thailand experience with UHC, namely how the country invested heavily in building public health infrastructure, increased production of doctors and nurses; introduced measures like compulsory rural posting decades before it formally introduced UHC. There are several schemes catering to various sections of the society, including government employees and civil servants; armed personnel and the majority of common people. One key feature of UHC is the involvement of local bodies and decentralization of decisions and planning processes. Mauricio Torres highlighted continuing violation of the right to health in Columbia and the limited contribution of the health system in addressing the health needs of ordinary people. In the absence of formal public and private systems and as opposed to the hegemonic international order, communities are working to develop their own health system. Kedar Baral narrated how reforms were continued even amidst political turmoil and immense conflict in Nepal, and how the health system was strengthened and expansion of health services continued. Women were central to these developments; mothers’ groups and cooperatives were handed over many aspects of society including forestry and health services. He opined that the recent elections in local bodies which took place after nineteen years would strengthen the decentralization process further and are expected to have far reaching implications on health system.

The plenary on “Organizing and mobilizing for Health for All” brought out the various struggles for health and actions by groups, peoples, movements, NGOs, community based organizations as sources of inspiration, mutual learning and strategizing for future action. Alexis Benos highlighted the role of the Solidarity Movement in Greece against the gold extraction industry being set up in northern Greece, which is leading to irreversible climatic disruptions as huge number of trees are being cut. He pointed out that the refugee crisis and closure of border in European countries is being resisted by people. People are protesting for the rights of the refugees. As a collective response to fascists, grassroots movements are being strengthened and people to people bonds are being built. Sulakshana shared the role of Mitanins (community health volunteers) in protecting forests against mining projects and preventing deforestation in Chhattisgarh state in India. Through the struggle Mitanins, with the support of PHM, the mining project was stalled for four years. The other crucial issue raised by PHM in Chhattisgarh state is the right to family planning services by the particularly ulnerable Tribal Communities.

The plenary on 40 Years of Alma Ata Declaration started with tribute to Dr. Halfden Mahler, the three times WHO DG, who was instrumental in organizing the Alma Ata declaration and has been a great source of support for the PHM and termed it as the true upholder of the spirit of PHC as envisioned in Alma Ata Declaration. Maria Zuniga highlighted how the history of PHM is associated with people’s struggles for a social world – the struggles in Nicaragua in the early 1990s, for independence in apartheid South Africa or the fight of Palestinian people against Zionist onslaughts. The International Peoples’ Health Council was a predecessor of PHM and led to the formation of PHM in 2000 at Savar. Paul Rutter, UNICEF pointed out the key differences between the Alma Ata declaration and that of the Astana Conference. While Alma Ata argued for Health as a human right and health for all, the emphasis in Astana is on ‘equity’, though both talk about PHC as a key approach to improve health. The Astana declaration emphasises UHC and characterises PHC as the foundation for UHC. David Sanders pointed out that Alma Ata Declaration called for a New International Economic Order (NIEO) based on equity, sovereign equality, interdependence, common interest and cooperation among all States, irrespective of their economic and social systems. The concept of PHC had strong sociopolitical implications. These aspects have been lost in the Astana process.

The PHA4 ended in a spirit of incredible energy, enthusiasm, and passion. Delegates from each region of the world took turns to sing a rousing call to arms. The inspiration that comes from such passion is vital to progressive health civil society movements.

Key issues, calls and demands emerging from the PHA

The PHA drew in civil society organizations and networks, social movements, academia and other stakeholders from around the globe. The PHA provided a unique space for sharing experiences, mutual learning and joint strategizing for future actions.

The Assembly called attention to the “global health crisis that is characterised by inequities related to a range of social determinants of health and in access to health services within countries and between countries”. The key theme that emerged out of four days of deliberation was that the current global and political regime, with its protection of the rights of TNCs and its creation of mind numbing economic inequalities, is the greatest threat to the health of people and planet. Several speakers articulated that everyday living conditions (such as housing, employment, opportunity to access health services, educational opportunities) drive people’s health status and these are, in turn, driven by underlying political and economic factors and the corporate determinants discussed above. The assembly also heard positive stories, ranging from innovative models of healthcare to challenges to corporate power. These models represent the few voices who protest the fact that many governments are failing to invest in the public infrastructure needed to promote health or to question growing corporate control over our lives and health.

The action plans on the issues derived from the main themes of the conference— health systems; food and nutrition; trade, health, and access to medicines; gender; environment and development; and occupation, militarisation, and war—were presented and will soon be available at