ࡱ> G Ebjbjَ _iA]44448ǃ" $ ^ 44, 484444  -~(lp4m?vw &p  Global Health Watch Mobilising the global health and social justice movement around an alternative Wworld Health Report Introduction Global civil society does not participate strongly and consistently in international health advocacy. Whilst there have been some high-profile successes due to pressure from civil society, (for example with campaigns to improve access to medicines and to regulate the promotion of infant formula), there is a striking lack of involvement and pressure from civil society on broad health and health systems issues. With the failure of the global community to achieve Health for All by the Year 2000, new targets - such as the Millennium Development Goals have come to the fore. However, whilst overseas development assistance declines, and the trade and investment environment become even more unfriendly to poor countries, there is a great danger that these objectives too will not be met, increasing cynicism and discontent in the world. A fragmented, disease- and issue-specific approach to health dominates advocacy as well as research and governance agendas, under-emphasising the underlying causes of ill-health. Meanwhile, disparities in health care consumption between the rich and the poor are growing alarmingly within and between countries, leaving society with a major political, social and moral challenge. The values that underpin the goal of health equity and the PHC Approach are often undermined by development policies emphasising efficiency at the expense of fairness; market forces at the expense of planning based on population needs; and selective approaches to disease-eradication at the expense of more comprehensive strategies for achieving health. In addition, the diminished capacity and role of national governments, particularly of poor countries, has further undermined the notion of social solidarity and inclusive health systems. Although there has been a recent and welcome shift by the World Health Organisation to highlight global inequity and reassert the principles of the Primary Health Care Approach, constant pressure from civil society is needed to hold national policy-makers and international organizations accountable to declared values and to address the fundamental causes of ill-health and failing health systems. To be effective, civil society voices must be well informed, evidence-based, and united on fundamental issues. In response to this, the Peoples Health Movement, with the support of the Global Equity Gauge Alliance and Medact, propose to mobilise a fragmented global health community around values which stress the need to tackle more effectively the fundamental causes of ill-health and health inequity in our societies. The vehicle for this is the Global Health Watch, an initiative that will combine outstanding research and policy analysis, a commitment to bringing the views of poor and vulnerable groups to the attention of international and national policy makers and a more effective civil society advocacy movement. We want the Watch to be an initiative that: Amplifies the calls for a broad, multi-sectoral approach to health by explicitly and concretely linking health concerns to the environment, international finance, agriculture and food security, war, housing, land rights, conflict and education. Strengthens the capacity and accountability of the worlds global health institutions to provide technical and value-based leadership in the struggle to attain adequate health for all. Creates a more vibrant global civil society in health by strengthening the links between socially conscious non-government and civil society organisations across all regions of the world, based on shared values. Provides a forum for magnifying the voice of the poor and vulnerable and those who advocate for them; Shifts the health policy agenda away from technocratic approaches, to one that also recognises the political, social and economic barriers to better and more equitable health; and Promotes human rights as the basis for health policy, as a corrective to the market-led policy agenda which tends to fragment and exclude. Institutional framework of the Watch The Peoples Health Movement (PHM) is an organised network of civil society and grassroots organisations that developed out of the international gathering of the first  HYPERLINK "http://phmovement.org/pha2000/index.html" People's Health Assembly in Bangladesh in December 2000. At that meeting, delegates from all over the world reaffirmed their commitment to the strengthening of health care systems that are equitable, sustainable and locally appropriate, as well as to the view that health is a human right. This has since been encapsulated in a Peoples Health Charter, which has been translated into several different languages. As a global network, with its base firmly rooted in developing countries, the PHM is a vehicle that can act as a unifying umbrella for a wide range of individuals, organisations and community-based organisations engaged in struggles and efforts to improve health and social justice globally. Medact is a UK-based charity with a health professional membership that has been active in highlighting the harmful effects of globalisation, poverty, environmental degradation and war on health and equity. GEGA, a network of projects mainly in the South that primarily addresses in-country health inequities, has committed itself to tackling the global determinants of health disparities within and between countries. Together with PHM, they have helped to provide the impetus around the development of the Global Health Watch. In keeping with the organisational philosophy of the Peoples Health Movement, the aim is now to promote the involvement of as many NGOs and individuals as possible in the development and use of the Watch as an advocacy tool. The efforts to ensure this widespread involvement and the shared ownership of all those who participate in the development of the Watch and / or endorse its contents will strengthen global civil societys engagement with global health policy, and are as important as the actual production of the report. A central feature of the workplan to produce the Watch is therefore the process of forging and strengthening linkages between CBOs, NGOs and academics; between constituencies in the South and the North; and between the progressive health sector and other progressive social and environmental movements and organisations. Aims of the Watch The regular production of an alternative world health report The Global Health Watch will regularly be produced as an alternative world health report that is coherent, rigorous and written to support civil societys capacity to promote a more socially conscious and equitable health agenda. To be effective, the reports credibility as a reliable source of sound evidence is crucial. At the same time, the report will serve as a forum for civil society perspectives, testimonies from the ground and the voices of people who are traditionally unheard. The report will consist of a compilation of chapters on various health issues. Generally, the Watch will not commission new research but will rely on research and analysis already done by NGOs and academics, providing a platform for the further dissemination and popularisation of this work. Chapters will be written by different authors from various regions of the world. Each chapter would also have designated reviewers, thus expanding the network of contributors to the text. An editorial committee will oversee the report production, ensuring the overall quality of the material, the coherence of the report as a whole, and that it reflects the voices of the unheard from different parts of the world. There will be a set of recommendations at the end of each chapter and the opening chapter will draw out the main themes of the report and put forward over-arching recommendations. A dedicated editor will be hired to support individual contributors in producing material of adequate quality, and finalising and copy editing the report. The approximate size of the report will be 100,000 words and the suggested structure and chapter headings of the report are shown below. It is envisaged that the scope and size of the report will change somewhat each time to accommodate emerging issues while preserving a critical core that remains consistent over time 2) Advocacy In addition to the production of a report, the Watch incorporates an advocacy strategy that aims to: Increase the responsiveness of global health institutions to the opinions and ideas of global civil society; Legitimise and strengthen our core message: that equity, the centrality of effective and inclusive public health systems and broad public health issues need greater recognition in both global and national health and development policy agendas; and Encourage greater involvement of civil society organisations in the determination of international health policy, with a particular emphasis on strengthening representation of the poor and their advocates. The activities planned to realise these goals combine a mixture of activities at national and global level. The process of producing the Watch. By involving a diverse range of NGOs, CSOs and individuals from both developed and developing worlds in the writing the report, the core messages of the Watch will be filtered and communicated through a wide range of formal and informal networks and information channels. Pre-launching the report. In order to raise the level of expectation and demand for the Watch, it will be pre-launched. The Watch was presented and discussed at the World Social Forum in Mumbai in January 2004, and will be presented to a broad group of health, development NGOs, CSOs and trade unions as well as the press at a meeting in London in March 2004. In addition various notices about the report have already been disseminated through different list-serves, websites and e-lists. Simultaneous launch of the Watch. We plan to launch the published report at the time of the World Health Assembly in May 2005. We will also be asking local NGOs, CSOs, academics and others to help organise a simultaneous launch of the report in as many countries as possible. Both GEGA and the Peoples Health Movement are already networks of country-based individuals and organizations that are capable of covering a large number of countries. Campaign around central recommendations. Apart from encouraging advocacy around the recommendations made in specific chapters of the Watch, a campaign around a number of the cross-cutting recommendations will aim to exert influence on global and national health institutions through national governments and a broad coalition of NGOs/CSOs. Organisations at the national level will be encouraged to take the report to representatives of their national governments and to use it to strengthen their own positions in advocating for equity in the areas of health and development that they work in. A key global health institution that the Watch will engage with is the World Health Organisation, and participating organisations will be encouraged to raise the main and chapter recommendations from the Watch with WHO. Dissemination. In addition to hard copy distribution of the report, the Watch will also be available without charge on the World Wide Web. The report as a whole and individual chapters will be available in easily downloadable format to facilitate advocacy . Reaching different language groups. We will develop shortened versions of the report initially in Portuguese and Spanish for dissemination to grassroots organisations and other civil society groupings. We will explore avenues for the translation of the document into other languages. Proposed structure and lay-out of the Watch Foreword Introduction Executive Summary and Overview A summary of the report, linking the chapters, drawing out the main themes and ending with major recommendations.Section A: Politics and Economics of HealthA1: Politics and economics of poverty - a global public health priority Describes the mechanics of the global political economy that keeps people and countries poor; covers trade, global financial systems, debt and their linkages to health.A2: Approaches to health care An overview of the relevance of the PHC approach today, and how health policies are influencing the shape of health care in ways that diverge from the principles of Alma Ata. This includes some commentary on the role and effects of GPPPs.A3: Health Policy: the privatisation agenda Describes the processes of commercialisation and privatisation of health care, the resulting problems and the appropriate government and non-government responses. Describes the weaknesses and shortcomings of the marketisation and commercialisation of health care.A4: The global brain drain of health personnel Describes the effect of migration of health personnel, the underlying forces of economic and political globalisation and suggests ways to address the problem. Critiques the lack of effective action to tackle this urgent health priority.A5: Big Pharma and the funding of R&D for medicines Describes the multi-billion dollar pharmaceutical industry in relation to global health and world poverty and the influences of this industry on health policy. Sets out an argument about the need for more fundamental reform of R&D and the need for excessive profit-making from medical care to be regulated. A6. Responding to treatment access and beyond A critique of 3x5, the Global Fund and the World Banks treatment programmes, in the context of the overall progress towards combating the HIV/AIDS epidemic.A7: Genomes and health The unravelling and exploitation of the human genome leads to important questions in the health sector from an ethical and equity perspective. This chapter further explores the unclear inter-face between commercial health care and public health, and for accountable governance of the future development of this industry at the international and national level.Section B: Beyond the Health SectorB1. Nutrition and the right to food Focus of this chapter is still to be definedB2: Water and Sanitation Covers the commodification of water and control of water rights by private companies, looks at case studies from around the globe, discusses responses from UN and recommendations from water NGOs. B3: War, the new militarism and public health Focus of this chapter is still to be definedB4: Environment Focus of this chapter will be on making the connections between health and global warming; and thereby between politics, economics, development paradigms and environmental justice with health.B5: Education Focus of this chapter is still to be definedSpecial chapter: Indigenous people, land and healthDescribes the relationship of indigenous people to land and discusses the underlying health effects of displacement of these communities.Special chapter: Disabled peoples rights and healthFocus of this chapter is still to be definedSection C: Monitoring Section This section will highlight a few key advocacy targets and institutional case studies, so that the Watch evolves over time into a tool that monitors the performance of key actors, institutions and policy processes. Debt cancellation / HIPC processODA quantity and quality include an in-depth case study of one bilateral donorWorld Bank monitor what are the strengths and weaknesses of the World Bank and the key recommendations for change.IMF monitor what are the strengths and weaknesses of the IMF and the key recommendations for change.WTO monitor what are the strengths and weaknesses of the IMF and the key recommendations for change.WHO monitor what are the strengths and weaknesses of the WHO and the key recommendations for change.UNICEF monitor what are the strengths and weaknesses of UNICEF and the key recommendations for change.FAO monitor what are the strengths and weaknesses of FAO and the key recommendations for change.Foundation monitor private philanthropic foundations have been playing a greater role in the development of health policies and programmes in recent years. In order to develop some assessment of their role and effects, it is proposed that an in-depth case study of one Foundation be developed.Cross-cutting themes It is expected that the voices of the unheard will be incorporated throughout the report in the form of short case studies and testimonies. It is expected that the issue of gender will be mainstreamed throughout the report. 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