The 5th People’s Health Assembly (PHA 5), held in Argentina from April 7 to 11, deepened discussions on the much-needed transformation of health systems. Since the adoption of the Alma Ata Declaration in 1978, health systems have increasingly strayed from the goals of Comprehensive Primary Health Care and Universal Health Care, becoming victims of financialization and corporatization, the activists warned.
“Health goals have been subjugated to shareholder values, market fluctuations, and financial failures,” commented Nicoletta Dentico of the Society for International Development (SID) during the Assembly.
“The forces of financialization are very strong, strategic, well-organized, and proactive,” she added. Over the past five decades, no area of health has been spared the involvement of the private sector, Dentico noted, pointing out that “private first” has become a priority path promoted and chosen by governments and international organizations alike—despite many recognizing in practice that models based on the participation of the private sector, including public-private partnerships (PPP), do not really contribute to achieving universal access to healthcare.
This situation has led to the alienation of people from health, according to Fran Baum, one of the co-authors of the Call to Action announced at the closing of PHA 5. She added that this could lead the world in two directions: towards fascism, as illustrated by the rise to power of Javier Milei’s government in Argentina, or towards new ways of uniting people.
Uniting people and struggles has been recognized as a top priority by many of the activists at the Assembly. Abhay Shukla spoke about the potential held by platforms like the Santap Sabha (Anger Assemblies)—popular spaces organized in India to push back against the neoliberal health trends that have been so harmful to the people. As Shukla highlighted, 200 million more people in India were pushed into poverty due to the COVID-19 pandemic, who are now exploring different ways to ensure justice, including legal evaluation of the high care costs imposed by private health providers during the pandemic.
“Only the larger public, which includes all the non-market systems that saved people during the pandemic, can fight privatization,” he stated.
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Similar forms of seeking health justice have been developed in other parts of the world, to protect and promote health as a right and as a common good. Gianni Tognoni from the Permanent People’s Tribunal linked this to the importance that national health services still hold in the collective perception. These health systems, according to Tognoni, serve as “a memory, indicators, and promoters of democracy in countries.”
The defense of public health systems acts as a catalyst for actions among health workers as well. Struggles of community health workers in India and South Africa point to the importance of changing health systems in a way that promotes and supports the expansion of public health systems and recognizes the key role health workers play in the realization of the right to health.
This is true for the many health workers’ mobilizations that are ongoing in Latin America. In Argentina, confronted with the dedication of Milei’s government to austerity and cuts, as well as the effects of previous World Bank intrusions into the country’s organization of public services, health workers are taking to the streets to ensure a change of course. “We fight towards a national health system that covers not only health care but also the ways that people are treated,” said Jorge Rachid from the movement Primero la Patria.
Health workers in Colombia are engaged in a similar struggle, but in a context where their demands are generally supported by Gustavo Petro’s government. Fabio Melo from the Bogotá District Workers’ Union described how the inauguration of the new administration has allowed workers to forge struggles for the strengthening of public education and healthcare alike, after decades of neoliberal policies that reduced the scope of the public sector and put care out of the reach of too many people. The same policies harmed health workers too, as 85% of them are currently outsourced, which reduces their possibility for organizing. “The commodification of health is a disaster for health workers,” Melo said.
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This recognition has led to the activation of trade unions and professional associations in the struggle for health, as illustrated by the Argentinian Federation of General Medicine (FAMG) and Public Services International (PSI). The pervasive discrimination against certain population groups in the current health systems, including women and Indigenous peoples, means that health workers currently inhabit systems which they cannot defend, according to Pilar Galende from FAMG.
Instead, many of them are turning towards developing alternatives, like the proposal for the social organization of care put forward by PSI. “Care is a public good and a right,” said Susana Barria, PSI Sub-regional Secretary for the Andean Sub-region, speaking about the importance of adopting a new, different way of thinking about public healthcare, especially in the Global South.
The importance of strengthening inputs from the Global South was recognized as a key component in reimagining health systems that are focused on people’s well-being and health, instead of remaining fixated on profit and cost efficiency. “Ideas of transformation will not come from the Global North,” said Oscar Feo from the University of Carabobo and the Bolívar-Marx Institute of Advanced Studies, Venezuela, reaffirming the Assembly’s dedication to the struggle for Health for All.
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