III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru1

People’s Health in People’s Hands

Hani Serag

Global Secretariat Coordinator

People’s Health Movement

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru2

Contents

• Why did 1453 Persons from 92 countries meet in Savar, Bangladesh in late 2000?

• What did these people achieve?

• What happened after this gather in Savar?

• Then, what?

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru3

First People’s Health Assembly• Several international organizations, civil society

movements, NGOs and women's groups decided to work together towards “Health for All”.

• With others committed to the principles of PHC and people's perspectives, they organized the People's Health Assembly, 4-8 December 2000 in People's Health Centre of GK, Savar, Bangladesh.

• 1453 participants from 92 countries came to the Assembly, a culmination of 18 months of preparatory action around the globe, including thousands of village meetings, district level workshops and national gatherings.

• At the Assembly, they reviewed their problems and difficulties, shared their experiences and plans, and formulated and endorsed the People's Charter for Health.

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru4

Why was the huge gather?

• Intentional Denial for “Health for All”.

• Growing inequalities within and in-between countries.

• Profit is dominant and very well-protected.

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru5

“Health for All”. . Global Intentional Denial!

• In 1978, at the Alma-Ata Conference, 134 countries in association with WHO and UNICEF called for 'Health for All by the Year 2000' and selected PHC as the best tool to achieve it.

• Unfortunately, that dream never came true.

– Health status of Third World populations has not improved. In many cases it has deteriorated further.

– We are facing a global health crisis, characterized by growing inequalities within and between countries.

– New threats to health are continually emerging. This is compounded by negative forces of globalization which prevent the equitable distribution of resources necessary for people's health, particularly the poor.

– Within the health sector, failure to implement the principles of PHC has significantly aggravated the global health crisis. Governments and the international community are fully responsible for this failure.

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru6

Disparities Among Regions

Western Pacific

Eastern Mediterranean

Europe

South-East Asia

Americas

Africa

0

20

40

60

80

100

120

140

160

180

Regions

Dea

ths

/ 100

0 liv

e b

irth

s

WHO records 2002

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru7

Disparities within a RegionChild Mortality Rate In Eastern Mediterranean Region (WHO records 2002)

0

50

100

150

200

250

300

Afgh

anes

tan

Som

alia

Yem

en Iraq

Pakis

tan

Suda

n

Egyp

t

Iran

Mor

roco

Leba

non

Jord

an

Saud

iaAr

abia

Syria

Kuwa

it

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru8

WTO RegimeExample of the TRIPs & TRIPs-Plus

• Imposition of stricter legislation related to pharmaceutical production and supply, being driven and reinforced by the parallel adoption and/or expansion of IPR laws as required by the WTO TRIPs, and now being made even stricter through bilateral treaties (TRIPs-Plus).

– Previously, the production and commercialization of drugs were driven by state legislation, defining what could be sold and under what conditions, for the prime purposes of setting national priorities and ensuring quality assurance.

– With this wave of new laws and increased scope of IPR regimes, conditions are being created for the private industry to control world markets and set requirements for what producers can and cannot do, and what consumers can access.

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru9

Top 10 Pharmaceutical Companies by Sales, 2004

Company Pharma Sales 2004(US$ millions)

Company Profit /Rank 2004 (US$ millions)

Rank by Profit(2004)

1. Pfizer 46,133 11,361 1

2. GlaxoSmithKline 32,853 8,095 4

3. Sanofi-Aventis 32,208 10,122 2

4. Johnson & Johnson 22,128 8,509 3

5. Merck & Co. 21,494 5,813 5

6. AstraZeneca 21,426 3,813 8

7. F. Hoffman-La Roche 19,115 5,344 7

8. Novartis 18,497 5,767 6

9. Bristol-Meyers Squibb 15,482 2,381 9

10. Wyeth 13,964 1,234 10

Total 243,300 62,439

Source: Scrip’s Pharmaceutical League Tables 2005 provided by PJB Publications; company profit data (not necessarily limited to pharma sales) from 2005 Fortune Global 500.

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru10

• Globally, the 1990s witnessed a dramatic increase in concentration in the pharmaceutical and other industries, with a sharp rise in further mergers and acquisitions amongst companies in these vital field continuing over the last several years in particular.

• Recent analyses indicate that what looks like buying and selling between countries is, in fact mostly the redistribution of capital among subsidiaries of the same parent multinational corporations.

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru11

Results of the sub regional price negotiations in Latin America and the Caribbean

• Some of the advantages of the subegional negotiations are: – success in obtaining uniform regional prices, a significant discount over those

obtained by the countries individually; – support for countries with less negotiating capacity; – closer cooperation among countries; and the optimization of technical

cooperation.

• The principal achievements were:– In the Caribbean: a reduction in the price of the first-line triple therapy regimen to

the price offered to Sub-Saharan Africa, around US$ 1,100.– In Central America: a 55% reduction, on average, in the price of the first-line

triple therapy regimen.– In the 10 Latin American countries: a 30-92% reduction in the price of the first-

line therapy, considering brand-name and generic drugs.– The companies that manufacture antiretrovirals and reagents in several

countries participated in the negotiations, which were conducted by the countries’ ministries of health and the subregional cooperation agencies (CARICOM, SICA, and ORAS), with technical support from the Pan American Health Organization (PAHO) and other institutions.

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru12

World Health Assembly Adopts Resolution Tying Public Health To Trade Policy

• India suggested adding a new paragraph urging member states, “to reflect all the flexibilities permitted under international trade agreements in national laws to address public health concerns.” It also suggested adding “multi-stakeholder” in to make the resolution read: “to promote multi-stakeholder dialogue” on trade and health.

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru13

• The United States said the issue of flexibilities in the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) was already “more than adequately covered” in other resolutions, including the research and development resolution that also was adopted today. It proposed deleting the Indian paragraph.

• Australia also said that India’s proposal was already dealt with other places in the resolution. Moreover, it said that the TRIPS Agreement offered the member countries the opportunity “to take up flexibilities but does not require them to do so.”

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru14

• As a compromise, India proposed adding its point, in a somewhat watered-down version, to another paragraph referring to trade agreements, then reading: “using the flexibilities inherent in them.” The US suggested adding, “considering where appropriate” to be added before this.

• This was agreed and the resolution was adopted.

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru15

What does Health System do? (An Example from Egypt)

Foreign donors

3%

Households

51%Ministry of Finance

35%

Social Insurance

6%

Firms5%

Where does money come from?

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru16

What does Health System do? (An Example from Egypt)

Where does money go?

HIO services

8%

Other Private

5%

Other Public

3%

MOH Services

19%

Private Providers

18%

University and

teaching hospitals

10%

Pharmacies

36%

NGOs1%

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru17

What does Health System do? (An Example from Egypt)

People's pockets & Public

Private & donations

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Here where it goes

Non-for Profit

For Profit

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Here where it comes from

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru18

Occupation, War, Sanctions, Conflicts, . .

Palestine!

Sept 29th 2000 – April 29th, 2005

855 children were killed• 411 with live ammunition / 200 shot in the head

Around 10,000 children were injured• 516 of those became permanently disabled

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru19

• 25 Palestinians have died due to prevention of medical treatment– 22 of those were

children– 3 were newborns

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru20

66 Palestinian women gave birth at the check point or before reaching the Hospital

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru21

People who are living on less than $US 2 per day

50% of West Bank population

75% of Gaza population

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru22

People’s Health MovementStruggle for “Health for All”through Evidence-Based Action

• Equity, ecologically-sustainable development and peace are at the heart of our vision of a better world – – a world in which a healthy life for all is a reality; – a world that respects, appreciates and celebrates all life and

diversity; – a world that enables the flowering of people's talents and

abilities to enrich each other; – a world in which people's voices guide the decisions that

shape our lives.

• There are more than enough resources to achieve this vision.

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru23

People’s Charter for Health

Health is a social, economic and political issue and above all a fundamental human right.

Inequality, poverty, exploitation, violence and injustice are at the root of ill-health and the deaths of poor and marginalized people.

Health for all means that powerful interests have to be challenged, that globalization has to be opposed, and that political and economic priorities have to be drastically changed.

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru24

People’s Charter for Health

• The Charter is now the common tool of a worldwide citizen's movement committed to making the Alma-Ata dream a reality.

• The charter published now in 33 languages (Arabic, Bangla, Chinese, Danish, Dutch, English, Farsi, Filipino, Finnish, French, German, Greek, Guarani, Hausa, Hindi, Indonesian, Italian, Japanese, Kannada, Malayalam, Nepalese, Ndebele, Portuguese, Quichua, Russian, Serbian, Sinhala, Spanish,

Swahili, Swedish, Turkish, Vietnamese, Urdu).

• We encourage and invite everyone who shares our concerns and aims to join us by endorsing the Charter.

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru25

Second People’s Health AssemblyJuly 2005 – Cuenca, Ecuador

• More than 1500 people from over 80 countries gathered in Cuenca, Ecuador from July 17-22, 2005.

• Cuenca Declaration.

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru26

Global Health WatchAlternative World Health Report

Part A: Health for All in the 'borderless world'?

Part B: Health care services and systems B1: Health care systems and approaches to healthB2: Medicines B3: The global health worker crisis B4: Sexual and reproductive health B5: Gene technology

Part C: Health of Vulnerable Communities C1: Indigenous peoples C2: Disabled people

Part D: The wider health context D1: Climate change D2: Water D3: Food D4: Education D5: War

Part E Holding to account: global institutions, transnational corporations, rich countries E1: World Health Organization E2: UNICEF E3: World Bank and International Monetary Fund E4: Big business E5: Aid E6: Debt relief E7: Essential health research

Part F Conclusions

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru27

International People´s Health University (IPHU)

• Conducting short courses for health activists – First course “Political Economy of Health

and PHC / 61 participants) prior to the second Assembly in Cuenca)

• Enables researchers

• Generate evidence

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru28

What Now?

• Right-to-Health Campaign– Be a part of it . . – Organize the right to health campaign in

your village, district, country or region around specific wedge identified issues

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru29

• Global Health Watch

– Use the first GHW: Distribute / Translate / Use as an advocacy document

– Get involved in the process of production of second GHW: Participate in writing / Send testimonies / Organize public consultation around draft materials

– Produce Country / Regional Health Watches

What Now?

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru30

• WHO’s “Commission on Social Determinants of Health”: Engaging with, monitor and influence the process.

What Now?

III National Conference on Health “Voices and Proposals for the Right to Health”“Voices and Proposals for the Right to Health” 10-12 July 2006 – Lima, Peru31

BE A PART OF THE PHM• Endorse the People’s Charter for Health

• Subscribe in the PHA exchange

www.phmovement.org