The Struggle for Health is the Struggle for a More Equitable, Just and Caring World

After months of mobilisation through national and regional assemblies we, over 1400 health activists from 73 countries across all regions, met in Savar, Bangladesh, six years after the assembly in Cape Town, to reaffirm our commitment to the struggle for health, which – in the words of Amit Sengupta – we see as the struggle for a more equitable, just and caring world. The vision provided in the People’s Charter for Health (2000)1 and the Cuenca Declaration (2005) is more relevant than ever before, as unfortunately the root causes of ill health and inequality persist and are yet to be reversed. These root causes are deeply embedded in patriarchy, caste-ism, racism, religious fundamentalism, able-ism, transphobia and hetero-normativity and reinforced by the current paradigm of development, which is characterised by individualism, anthropocentrism and neoliberal capitalism. Communities the world over are increasingly losing their access to land, water and livelihoods on the one hand, while facing heightened militarisation, violence and repression on the other. This paradigm has significantly boosted the clout of the transnational corporations, leading to an enormous inflation in private profit and creation of a class of transnational executives and shareholders whose wealth and power are direct threats to equity, justice and the health of the planet. The controlling interests of corporate capitalism are systematically eroding the sovereignty of our governments thereby conceding the rights and privileges of the people to interests of profit. Corporations are indulging in rampant destruction of ecosystems and biodiversity, generating enormous volumes of toxic waste, while endangering cultural identities, diversity and ways of living. The complexities of emerging and chronic conflicts, migration, climate change, threat to privacy – to name a few – are presenting new challenges every day. All of this, aided by unjust global and national economic and trade policies, is promoting an unsustainable and inequitable development paradigm and creating a complex canvas of determinants that is seriously impeding the realisation of health for all.

It is against this disturbing backdrop that we place our struggle for the right to health; for a new model of society, with more solidarity, empathy, equity and humanity, which safeguards human lives and ecosystems.

The Crisis of Health is a Crisis of the Capitalist Model
High income countries, working closely with transnational corporations, are promoting neo-liberal policies to manage the contemporary crisis of globalised capitalism in the interests of the transnational capitalist class. With help from a network of one-sided 'trade and investment' agreements, these policies are either being accepted by or being forced on the governments of low and middle income countries. The resulting national policies are having far reaching consequences for the social conditions that shape people's health, and also for the approach and funding of comprehensive health care. Such policies are worsening the fundamental determinants of health, and progressively crippling healthcare infrastructure and delivery of services. Such policies are encouraging national governments to abdicate their responsibilities to public health, while ushering in privatisation and insurance regimes.

PHM's Alternative Vision: Equity, Ecological Sustainability and Health for All
Our vision is of a world in which equity between and within countries is achieved and health for all is a reality. We reaffirm that health results from social, economic and environmental justice. We visualise a world where empathy, solidarity and respect for people and the environment are at the core of global, national and local communities; a world free of discrimination and oppression based on gender, race, caste, ethnicity, disability, sexuality, religion, occupation, citizenship; a world where human rights and the empowerment and health of all communities, together with the dignity and rights of all natural beings, are respected and promoted.
We demand that governments, international financial institutions and the United Nations agencies including the World Health Organisation (WHO) be accountable to people, not to transnational corporations and their agents. We demand that they guarantee rights relating to health and the environment through enforceable laws and regulations. We demand that they protect those who struggle to defend their rights and end the impunity with which corporations threaten, harm and kill people and nature.
We want equitable public health systems that are universal, context-appropriate, integrated and comprehensive -not discriminatory, disempowering, private and for profit. Systems that provide a platform for appropriate action on the social determinants of health including a radical shift in existing power structures.

Our Commitment
As we affirmed in the Cape Town Call to Action (2012), no change is possible without the mobilisation of people through the building of social and political power amongst people and communities. PHM activists commit to creating bridges to connect all movements fighting for the right to health with other social movements defending people's lands, water, livelihoods, rights of indigenous communities and rights against the aggression of transnational corporations and governments that represent corporate interests.
We commit to strengthening the PHM by ensuring that our governance is transparent, democratic and gender just. We commit to building new country circles and strengthening the existing ones, through broadening linkages and solidarity with other likeminded organisations, networks and people's movements and by engaging new and especially young people at the country, regional and global levels. This will mean that the diversity of our movement is more represented.
Our work in the short term will be organised around six different thematic and action areas with specific objectives, but we remain open to new themes in the medium to long term. For instance, the importance of people's traditional knowledge on ecosystems and health, as forms of sustainable and empowering resistance to the dominant hegemonic biomedical approach to health.

GENDER JUSTICE AND HEALTH
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.

ENVIRONMENT AND ECOSYSTEM HEALTH
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 unorganisedlabourers and for a safe workplace.

FOOD AND FOOD SOVEREIGNTY
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.

TRADE AND HEALTH
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 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.

EQUITABLE HEALTH SYSTEMS
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.

FORCED MIGRATION
The insatiable thirst for profit, together with the imperialist aspirations of many countries including Europe and the US, are causing war and insecurity on a global scale but also poverty and environmental degradation. They are destabilising whole countries through economic policies, political intervention, arms trade, drug traffic and unbridled resource extraction. All of these are creating the conditions that are provoking massive movements of people across the world. Forced migration due to armed conflicts, ethnic cleansing, development projects, land grabbing or climate change are realities of the day, the seeds of which often lie in inequities and policies of neoliberalism. Indeed, the globalised neoliberal economy undermines local economic initiatives and systems and this is probably an important root cause of expulsion and social dislocation.
Large populations lose their basic rights of citizenship when they are forced to migrate to an alien country. Even displacement within the country causes severe stress and uncertainty. Although displacement affects populations as a whole, experiences of affected peoples are multifaceted and often gendered with consequences for sexual and reproductive as well as mental health.
PHM denounces the direct and indirect impact on health of war, occupation and militarisation, and highlights the implications for health of migration and migration policies that are not respectful of human rights. PHM also denounces the military and security industry as a public health threat, as a continuous cause of conflict and therefore human suffering and also one of the world's worst environmental polluters and carbon emitters.
PHM proposes to: • Pressure international organisations to advocate for equitable policies, conflict resolution, peace building, disarmament, end of occupation, safe and free movement of people.
• Mobilise local and international civil society organisations, humanitarian groups, and health volunteers to provide immediate relief and medical attention to displaced people.
• Pressure the local governments involved to provide emergency nutrition, shelter, clothing and healthcare to such displaced people.
• In case of cross-border migration, mobilise world bodies like the UN and relevant organisations and networks to put multi-lateral pressure on the respective countries and recognise displaced people as refugees and fulfil all rights and privileges that they are entitled to.
• Ensure that migrants' and refugees' health rights are upheld.
• Campaign to stop military research and development with taxpayer's money.

Building our People's Health Movement
Towards achieving the goals set for ourselves through thematic areas, we must further build our People's Health Movement through our collective efforts to develop and apply a broad global vision and a strategy that is based on a correct assessment of our strategic partners at all levels -global, national and local. It is urgent that we build our capacity, for research, analysis and action through more training that will lead to social mobilisation; for campaigns and for strategising for action. We need to build alliances with trade unions, organisations, social movements, representing women, peasants, frontline workers, indigenous communities and youth. Finally, if we are to build an alternative culture and alternative institutions, each of us needs to actively support our comrades in their struggles. Only this carries hope for the future of humanity and for mother earth. This further entails the defence of the members of our movement who are working in dangerous settings and who are too often the first to be targeted by the repressive organs of the state.
We, as PHM, commit ourselves to this Declaration.