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March 18, 2003
A New Push for 'Health for All'
People's Health Movement targets the neediest
By Yumi Wilson
SAN FRANCISCO, Calif.—Three South Asian health-care advocates began a U.S. tour in Berkeley this month, promoting a new effort to revive the 1978 Alma-Ata Declaration and its hope of achieving "Health for All" by the year 2000.
The declaration was signed by the World Health Organization (WHO), UNICEF and 134 government leaders, but has fallen far short of its ambitious goal.
Dr. Zafrullah Chowdhury of Bangladesh and Drs. Ravi and Thelma Narayan, a husband-and-wife team from Bangalore, India, made their first stop at the North Berkeley Senior Center on March 5, asking about 40 alternative health-care practitioners, peace activists, students, seniors and others to join the People’s Health Movement.
The contingent also visited several universities in the Bay Area, then split up, with Dr. Chowdhury speaking in Seattle, and the Narayans touring in Boston and Washington, D.C.
The People’s Health Movement -- which includes "non-governmental" activist groups, nonprofits and community advocates -- is well known in developing countries like India and Bangladesh, but relatively unheard of in the United States.
Signature drive
Founded by more than 1,450 delegates from nearly 100 countries at a conference in Bangladesh in 2000, the organization is trying to pressure the WHO, UNICEF and world leaders into fulfilling their pledge to come up with strategies that would offer everyone -- rich or poor -- "Health for All."
Members of the People's Health Movement are seeking to get a million signatures on their charter, which re-affirms the goals of Alma-Ata -- with a new deadline for achieving universal access to health care by 2008.
The concept of universal health care is not new. Indeed, some countries -- including Norway, Japan and Britain -- offered basic health to all their citizens long before 1978.
But the conference in Alma-Ata (in what is now Kazakhstan) became historic because so many world agencies and government leaders drafted and ratified a declaration, which stated among other things: "Economic and social development, based on a New International Economic Order, is of basic importance to the fullest attainment of health for all and to the reduction of the gap between the health status of the developing and developed countries."
But 25 years later, the goal of the Alma-Ata declaration remain just that.
Today, access to basic health care remains out of reach for millions of people who cannot afford to see a doctor or pay for the medicine they need to save their lives.
Of the estimated 40 million people worldwide now living with HIV or AIDS, for example, only a fraction have access to antiviral drugs because the costs are prohibitive for the uninsured or people living in poor countries.
Most recently, UNICEF reported that about 1,400 girls and women in developing countries die each day from childbirth complications.
Lack of support
Supporters of the People’s Health Movement blame the rapidly expanding global market economy, along with the privatization of health care, as a big reason for the lack of affordable and equitable health care.
They also blame a lack of financial and political support from government leaders, many of whom who pledged in the 1978 declaration to "channel increased technical and financial support ... particularly in developing countries."
While there seems to be little disagreement over the importance of the People's Health Movement and meeting its goals in a timely manner, some wonder if the new 2008 deadline for universal health access is politically unrealistic.
"I would be very happy if they go about reviving the spirit of Alma-Ata," said Dr. Agostino Paganini, a senior health advisor for UNICEF in New York. "But today, we are not in 1978. We are in 2003. The U.S. is about to go to war with Iraq. We need a road map on how to move ahead in today’s society ... [with the] present approach, we would probably not reach it by 2030. With the present amount of money and commitment, we would go nowhere fast."
Paganini, who credits the Alma-Ata Declaration for helping to improve immunization and lower infant mortality rates among other things, said that the lack of financial support has made it hard for UNICEF and other agencies to help people who need it the most.
But he also suggested that corruption in some countries is preventing international aid from getting into the hands of the people who need it the most.
Angola is a prime example, he said. Corruption is allegedly widespread, and "international aid is basically stolen and not given to build hospitals, schools and other resources for people."
Supporters of the People’s Health Movement agree that political corruption can be one barrier to ensuring universal access to health care. Yet they remain optimistic.
Community efforts
Advocates in Maryland, Texas, Colorado and Washington state are developing initiatives mandating some form of universal health care.
A similar measure failed in Oregon in the 2002 election. In January, Sen. John Breaux (D-La.) introduced a bill to provide group health insurance at low rates to all Americans.
"Many of us don’t agree with the notion that "Health for All’ is a pipe dream," said Sarah Shannon, executive director of the Hesperian Foundation, which is co-sponsoring the People's Health Movement tour along with Doctors for Global Health and numerous other community groups. "There’s never been a grassroots coalition this big. True, we (Americans) are the smallest. But this tour is part of our effort to change that."
The Hesperian Foundation is among an increasing number of groups promoting "community-based" health care, the practice of teaching people health basics so as to make up for their lack of access to services.
The Berkeley-based foundation has published numerous books on self care, including "Women with Disabilities" and "Helping Health Workers Learn."
The foundation’s first book, "Where there is No Doctor," has been translated into more than 80 languages, including Spanish, Vietnamese and Chinese. The book was designed to teach basic health care, prevention, family planning and childbirth issues to villagers and others with no access to a doctor or a hospital.
At the North Berkeley event, Dr. Chowdhury and the Narayans said their movement will succeed because it will involve community-based groups like the Hesperian Foundation.
Their speech, which invoked a number of related social justice themes, asked the audience to take a number of steps to help improve health care by protesting possible war in Iraq, fighting toxic pollution, and lobbying against privatization and the commercialization of medicine.
When asked by an audience member whether the current political climate in the U.S. would hinder their efforts, Ravi Narayan said, "It doesn’t matter if it’s Democrats, Republicans or the Rainbow Coalition (in office). It must be the people of America to make the changes necessary.
"We come here not to despair, but to share in optimism and hope," he said. "We believe our communities can do it."
