The
Mumbai Declaration
The
Mumbai Declaration is the consensus document of the Third International Forum for the Defense
of the People’s Health
held in Mumbai,
India on 14th and 15th January 2004 and organized by the People's Health
Movement.
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Preamble
We,
the 700 persons from 44 countries, gathered at the III International Forum
for the Defense of the People’s Health at Mumbai on 14th and 15th
of January 2004, reaffirm the validity and relevance of the People’s
Charter for Health, the foundational document of the People’s Health
Movement, which describes increasing and serious threats to health in the
early 21st century.
Since
the Charter’s adoption in December 2000 at the first People’s Health
Assembly, at GK Savar, Bangladesh, the health of the world’s poor has
worsened and more threats to people’s health have emerged.
Social,
political, economic and environmental threats to health identified as the
basic causes of ill health and the inequitable distribution of health
within and between countries have increased.
The
III International Forum for the Defense of the People’s Health provided
opportunities to hear inspiring testimonies, from the world’s poor and
health activists:
-
Denouncing
the denial of health to their communities and their efforts to overcome
this injustice.
-
Threats
to health from the unfair system of global trade and the imperialist
policies of developed countries including unjust wars and efforts to
counter them
-
The
Demands for acknowledgement of health as a universal human right and the
implementation of Comprehensive Primary Health Care as a strategy to
achieve Health for All.
The
Forum recognized the particular discrimination suffered by many groups
which makes achieving Health for All even more difficult. These included
women, people with disabilities, sex workers, children living in difficult
circumstances (including street children), migrant workers, Dalit people,
Indigenous peoples in rich and poor countries, and all those affected by
wars, disasters and conflicts.
The
Forum demanded Health for All, Now! and reiterated that Another World in
which health is a reality for All is necessary and possible.
The Forum brought together all the concerns and
experiences shared into a Declaration for action, entitled "The
Mumbai Declaration". This Declaration is an update on the state of
people's health across the globe at the beginning of 2004 and calls on the
People's Health Movement, Civil Society and Governments to evolve action
in six key areas to achieve the goal of "Health for All Now!"
dream.
-
End corporate-led
globalization
-
End War and Occupation
-
Implement Comprehensive and
Sustainable Primary Health Care
-
Confront the HIV/AIDS epidemic with Primary Health Care
and Health Systems approach
-
Reverse environmental damage caused by unsustainable
development strategies
-
End Discrimination in the Right to Health
End
corporate-led globalization
Corporate-led globalization continues to be a major threat to health.
Since the People’s Charter for Health was adopted in 2000, the
International Monetary Fund, the World Bank and the World Trade Organization have continued to advance the economic health of corporations
at the expense of global health.
The
protection of intellectual property (through trade agreements such as the
Trade Related aspects of Intellectual Property Rights, TRIPS) and unfair
trading practices (through the General Agreement on Trade in Services,
GATS) have caused enormous damage to people’s health.
The
tobacco industry offers a clear example: Tobacco
kills, yet transnational companies continue to target youth and
marginalized communities with their tobacco marketing strategies.
The
epidemic of privatizations of water, electricity, education and health
care, imposed by Structural Adjustment Packages (SAPs), has limited access
to or removed the foundation upon which public health is built.
Public-private
partnerships, as promoted by World Bank, Global Funds and
International health agencies including WHO, have removed responsibility
for health from the public sector, essentially privatizing health and
treating it as a commodity rather than a human right. User
fees have further decreased people’s access to health care services.
This
Declaration:
Calls
for Action by People’s Health Movement and Civil Society
-
Pressure the World Bank and
the International Monetary Fund to acknowledge their culpability in the
current health care crisis, especially the damage caused by Structural
Adjustment Programs.
-
Build
the Campaign “No To Intellectual Property Rights” in our
traditional systems of medicine and our seeds to resist the efforts of the
WTO and transnational corporations to patent, own and trade in them.
-
Demand
the representation and active participation of people’s organizations,
health workers, and farmers in policy-making processes related to Access
to Health.
-
Expose,
shame and stop government officials, academic institutions, and civil
society organisations from accepting money from the tobacco industry and
other industries which undermine public interest initiatives
internationally and nationally.;
Calls
for Action by Governments
-
Regulate
the entry and behavior of the corporate sector in the social services such
as health, education, transportation, etc., and ensure that public health
concerns always take precedence over trade agreements and corporate
profit.
-
Resist
“TRIPS-plus” through bilateral or regional trade agreements driven by
the United States government
and the institutions it controls.
-
Ensure
negotiations on “Free Trade” treaties and the like are transparent and
democratic and not conducted behind closed doors.
-
Resist
pressure to privatize health essential industries (health care,
electricity, water and education) and renationalize these industries.
-
Sign,
ratify and implement the Framework Convention on Tobacco Control (FCTC).
End
War and Occupation
Since 2000, war, occupation
and militarism have become ever more devastating threats to people’s
health. The violent imposition of imperial will has led to death, injury,
and social and environmental destruction for untold numbers of people.
Actions in support of
international law and are pro-health and against the war in Iraq, the
occupation of Iraq and Palestine, the construction of the Wall in
Palestine are urgently needed.
This Declaration:
Calls
for Action by People’s Health Movement and Civil Society
Strengthen
the international anti-war movement through:
-
Building
the global campaign: “No to War, No to WTO, Fight for People’s
Health”.
-
Monitoring
the impact of war, occupation, and militarisation through a global
“Occupation Watch”.
-
Targeting
corporations which benefit from the war in Iraq, invasions
and military occupations and those that enrich themselves (e.g.
pharmaceutical and food companies) by fostering ill-health through a
“Boycott Bush” campaign.
-
Establish
peace initiatives at various levels based on justice and equality.
Calls
for Action by Governments
Implement
Comprehensive and Sustainable Primary Health Care
Since
2000, the Global Fund and other international health programmes of WHO,
UNICEF and World Bank have continued to promote selective and vertical
health programs which corrupt and weaken Comprehensive Primary Health Care
as defined in the WHO Alma Ata Declaration.
Health
professionals educated in the developing world and migrating to the
developed world represent a transfer of billions of dollars from South to
North. This unrequited training investment further burdens health systems
already suffering from a precarious lack of human resources.
The
“brain drain”
flows not only from developing to developed countries, but also from the
public to the private sector.
Traditional
and alternative systems of medicine are vibrant parts of Comprehensive
Primary Health Care. Traditional Birth Attendants provide the first and
often the only access to reproductive health in many areas of the world.
These knowledge and traditions should be validated and their skills
reinforced through continuing education, and support to the revitalisation
of local health traditions.
New
areas, relevant to Primary Health Care, not adequately addressed in the
Alma Ata Declaration need to be promoted in an integrated way. These
include gender, environment, disability, mental Health and traditional
systems of health.
This
Declaration:
Calls for Action by
People’s Health Movement and Civil Society
-
Demand that universities
and other training institutions incorporate Comprehensive Primary Health
Care into the curriculum for all health professionals updated to address
gender, environment, disability, mental health, traditional systems and
other issues.
-
Lobby for widespread
adoption of Community Health Workers and Traditional Birth Attendants as
integral members of multi-disciplinary Primary Health Care teams.
Calls for Action by
Governments
-
Develop
national policies on traditional and alternative medical systems and
include them in national health programmes.
-
Involve
marginalised sectors in decision-making regarding policies that affect
them.
-
Strengthen
health systems in the context of access, quality and equity;
-
Establish
Comprehensive Primary Health Care services based on the principles and
strategies of Alma Ata outlined in this declaration and related to local
needs and updated to address gender, environment, disability, mental
health, traditional systems and other issues.
Calls for Action by WHO
Confront
the HIV/AIDS epidemic
The
HIV/AIDS epidemic has continued to worsen since 2000, especially in
Africa and increasingly in Asia
and elsewhere. Spreading along migration routes and linked to the
influx of capital related to globalisation, HIV/AIDS is now associated
with the resurgence of other communicable diseases of poverty, such as
tuberculosis.
Access
to ARV treatment has increased the life expectancy and quality of life of
those who can afford it. The majority of AIDS patients being impoverished
are denied access to treatment in violation of the principles of the
international covenant on social, economic and cultural rights. Children
orphaned by HIV/AIDS and women who are more vulnerable take a heavy toll.
WHO
has recently become stronger in its technical support to HIV/AIDS and has
made an official commitment to pursue its 3 X 5 goal (3 million persons
with AIDS receiving ARV treatment by 2005) through strengthened health
systems. Yet addressing the HIV/AIDS
epidemic requires contextual solutions. We
are however, particularly concerned
that:
-
The
3 x 5 initiative focuses on treatment alone, ignoring the complexity of
the epidemic.
-
The
high drug costs that can lead to long-term dependency on donors.
-
There
is inadequate involvement of people living with and affected by HIV/AIDS
and civil society in planning and implementation and evaluation.
-
There
is inadequate budgetary and related commitments on improving health
systems, particularly Primary Health Care to provide drugs, general health
services and information in the long term.
This
Declaration:
Calls for Action by
People’s Health Movement and Civil Society
-
Continue campaigns for the
rights of people in poor countries to receive ARV treatment delivered
through comprehensive PHC services.
-
Facilitate Public Interest
Litigations to oppose changes in Patent Laws that are expected to escalate
ART prices.
-
Make the links between the
spread of HIV/AIDS and the underlying societal determinants such as
poverty, war, displacement and participate in efforts to redress these
injustices.
Calls for Action by
Governments
Develop
a comprehensive Primary Health Care oriented and health systems’
strengthening approach to address the HIV/AIDS epidemic through
interventions, including:
-
Peer
education that includes sexual and reproductive health and rights
information.
-
Oppose
stigma and promote respect of and care for people living with
HIV/AIDS.
-
Increased
access to basic services by people living with HIV/AIDS.
-
Immediate
availability of ARV drugs.
-
Support
those affected by the epidemic through empowerment.
Calls to WHO
-
To evolve a comprehensive
approach emphasising Primary Health care and health systems’
strengthening approaches including preventive information and services and
ARV treatment.
-
Work towards reduction of
high drug costs.
-
Enhance involvement of
people and communities affected and civil society in its planning and
initiatives through proactive dialogue.
Reverse
Environmental Destruction
The
People’s Charter for
Health recognised environment,
livelihood, and people’s health are interconnected and environmental
degradation is a major threat to global health. Since 2000, continuing
environmental destruction has had a highly negative impact on health.
Rivers
around the world, like the Abra in the Philippines and
the Narmada in
India, are in danger of being
destroyed, as are the lives and health of the people and communities who
depend on these rivers.
Toxins
in pesticides, fertilizers, defoliants (such as Agent Orange and those of
the “War on Drugs” of Plan Colombia), waste from US Military Bases
(such as those in the Philippines), dust from exploded depleted uranium
ordinance (such as that used in Iraq and Puerto Rico) and medical and
nuclear waste as well as from mining run-off and exploration for petroleum
are poisoning our environment and represent a critical hazard to health.
This Declaration:
Calls for Action by
People’s Health Movement and Civil Society
-
Monitor environmental
damage caused by unsustainable development strategies with specific focus
on pesticides, industrial and military toxic wastes, etc.
-
Link PHM
with other organisations working for environmental justice at the
grassroots, national and international levels. Join them in their
struggles and invite them to join in our struggle for the People’s
Health.
Calls for Action by
Governments
End
Discrimination in the Right to Health
The
People’s Health Charter asserted the right to health for all people. We
reaffirm this by noting that the marginalised groups listed below suffer
particular and on-going health problems requiring urgent attention.
-
Around
the world, many women lack access to basic health care, endangering
them and their families. Women’s
right to health, including sexual and reproductive health, is violated not
only by current socio-economic and political structures but also by
religious and cultural fundamentalism. Population
control policies have violated human rights, including the use of
disincentives and such reprehensible practices as forced sterilisation of
women. Newer contraceptives and reproductive technologies often ignore
hazards to women’s health and other ethical and moral issues.
-
Trafficking
of women and girls is
a major public health problem, little addressed by governments where the
trafficking is most rampant.
-
Sex-
selective abortion is a misuse of technology that discriminates
against the girl child.
-
The
rights of sexual minorities
and sex workers, including access to health care, must be respected.
-
The
health and human rights of persons with mental disorders are currently
ignored or inadequately addressed throughout the world. There is an urgent
need to provide effective community based programmes for people with
mental illnesses.
-
The
unjust social systems like caste in India
and
ethnic discrimination in other parts of the world have created a health
apartheid and human rights reality for the socially
marginalised.
-
Indigenous
people in developed
and developing countries suffer health problems at a higher rate than the
general population of the country in which they reside. As they are forced
to follow the hegemonic cultural and development paradigms, they are being
deprived of traditional knowledge and traditional systems of medicine and
access to basic resources.
-
The
health and other human rights of persons
with disabilities are currently ignored or inadequately addressed
throughout the world.
-
Migrant
workers living and
working in the developed and developing world suffer poorer health than
the general population surrounding them. Their basic human rights are
denied through lack of access to health, education, housing, etc.
-
Children
living in difficult circumstances,
such as street children, AIDS orphans, children of war, etc. face
increasing discrimination. Corporate-led globalisation only increases the poverty
in which they live and robs them of a dignified future.
This Declaration:
Calls for Action by
People’s Health Movement and Civil Society
-
Make
concerted efforts to incorporate all the above marginalised populations,
the “unheard and unseen”, into their networks and facilitate their
access to and influence in mainstream discourse.
-
Ensure
gender equity within the movement and within their own networks and
communities
Calls for Action by
Governments
-
Make concerted efforts to
incorporate the needs of marginalised populations, the “unheard
and unseen”, in health and development strategies and social policies in
a Right’s context.
-
Ensure
availability of disaggregated data on health status and access to health
services for different groups (age, sex, region, ethnicity etc.) in the
community to make discrimination to the right to health more transparent
and enable actions to be taken.
In
Conclusion
We,
the members of the People’s Health Movement and the participants of the
III International Health Forum for the Defense of People’s Health commit
ourselves to promoting the People’s Charter for Health 2000 and the
concerns and calls for action of the Mumbai Declaration 2004.
-
We
believe that an Another World is Possible.
-
A
Healthy World is Possible.
-
Health
for All Now! is Possible.
