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Latin American Conference on Building and Strengthening Universal, Inclusive and Sustainable Health Systems

Declaration of the Latin American Conference on Building and Strengthening Universal, Inclusive and Sustainable Health Systems

The First Latin American Conference on Building and Strengthening Inclusive and Sustainable Universal Health Systems organized by Cebes - Brazilian Center for Health Studies, the Brazilian Ministry of Health and PAHO - Pan American Health Organization, held in Brasilia, Brazil, between June 30 and July 1, 2023, was attended by organizations such as ALAMES, Clacso - Latin American Social Sciences Council and the People's Health Movement PHM, among others, and delegations from Mexico, Dominican Republic, Venezuela, Colombia, Ecuador, Bolivia, Argentina, Uruguay, Paraguay and Brazil.

Agenda for transformation towards the conquest of the universal right to social welfare and health in Latin America

The participants of the Latin American Conference on the Construction and Strengthening of Universal, Inclusive and Sustainable Health Systems approve the following declaration, presenting an agenda of transformations to achieve the universal right to social security and health in Latin America:

Recognizing the persistence of social inequalities that are expressed in Latin America, especially in the field of health.

Recognizing that these health inequalities in the continent have historical, cultural, geographic, political, economic and social roots and intersect with class, race, ethnicity and gender.

Recognizing that the health-disease processes in Latin America have their own social determinations, associated with the historical relations between the global North and South, which must be taken into account and which are expressed in each territory in a particular way.

Considering that a universal public health system requires educational institutions committed to critical, participatory and solidarity-based education.

Aware of the importance of democracy and social participation in the construction of egalitarian and universal health systems, as well as in the collective construction of a critical awareness of the right to health.

Noting the role of the relationship between financialized capitalism and the State in this historical context of consolidation of the private sector in health, since the advent of the transnational medical-industrial complex in the region and especially since the regime of appropriation of knowledge through intellectual property rights and neoliberal hegemony.

Noting that the neoliberal economic policies adopted since the 1980s and 1990s throughout the region deepened social inequalities and consolidated the insertion of the private sector in health systems, not only through the delivery of public resources to private administrators, but also the delivery of management and service provision to private systems.

Considering that the proposal of universal coverage combined with the promotion of the private sector resulted in the segmentation and fragmentation of health systems, produced low quality public services for the disadvantaged social classes and advanced towards the structural privatization of the management of public resources and the provision of services by private agents.

Considering the limitations of social security systems in Latin American countries, which, with high rates of unemployment and informality, need to have their financing guaranteed by a socially based public fund, not dependent on contributions for work.

Reaffirming the Alma-Ata principles, which foresee the central role of Primary Health Care (PHC) to guarantee comprehensive, territorial and intercultural access to health services and the transformation of the living conditions of populations.

Considering that the consecration of the fundamental right to health throughout the region should be understood as a common good, in a social construction of the care of human and non-human life in interdependence, beyond health care and regardless of the purchasing power of individuals.

Considering the different peoples, nations and cultures that inhabit the continent, especially the indigenous population, who demand a health model that takes into account other knowledge and concepts of health beyond the biomedical model; and their cosmovisions around good living, which constitute a message of profound transformation of the relationship between nature and society that should be recognized as an alternative to the hegemonic development model;

Considering the intensification of violent conflicts, drug trafficking and wars resulting from imperialist disputes and extractivist capitalist models.

Considering that the dominant economic development model under the logic of profit, has caused disasters such as climate crisis, health, hunger, food insecurity and migration crisis, which threaten the continuity of life on the planet.

In this context:

1. Calls Latin American States to build a path to transform our social realities based on the collective care of human and non-human life, so that it is possible to advance in the construction of comprehensive systems of social protection that articulate universal and, at the same time, intercultural public policies based on solidarity, dignity and recognition of the diversity of life.

2. Affirms the need to expand the financing of a universal public health system in a sustainable manner based on progressive tax systems integrated with the recovery of social security contributions and public administration of resources, in a democratic, transparent manner and with constitutional guarantees of the necessary resources;

3. It is urgent that Latin American Governments invest in public service infrastructure, with adequate financing integrated with socio-health networks.

4. Stresses that a universal public health system centered on the framework of life care and more broadly integrated with social protection requires well-paid health workers, with decent, stable conditions and continuing education that allow the maintenance of the commitment to guarantee the rights of individuals and communities.

5. Promotes recognition and investment in science and different types of knowledge to ensure the provision of inputs and technologies relevant to health, including the prioritization and strengthening of national public production and regional integration to ensure sovereignty in health and reduce dependence on private industry and the global North.

6. Emphasizes the need for investments aimed at including Latin America in the national health production complex, not only as a supplier of raw materials, but also as a producer of vaccines, biopharmaceuticals, inputs and phytotherapies, with a broad inclusion and valuation of the knowledge and experience, of the community and native peoples, of the scientific and technological potential in a wide cooperation among the countries of the region.

7. It celebrates the cultural and territorial diversity of Latin American peoples and reinforces the need to produce a true interculturality that dialogues and co-constructs transformations based on diverse knowledge systems, in a decolonial perspective.

8. Endorses a proposal for the transformation of health systems that overcomes the hegemonic biomedical model, guarantees the principles of universality, integrality and equality,

prioritizing promotion and prevention in regionalized networks of comprehensive care, ordered by primary care in integral health and that guarantees access to adequate services and technologies at all levels of quality care.

9. Reiterates the need to guarantee health as an inalienable human right, which reduces inequalities and improves responses to different health needs, considering the transformation of the processes that produce and reproduce the matrix of unjust, unequal and neocolonial relations in the world order.

10. Supports the creation of an observatory to monitor the degree of privatization in health and to promote the deprivatization of social security and health systems in Latin America.

11. Calls upon States to guarantee the real and effective participation of communities and populations in decision-making and in the articulation towards effective transformations that combat the processes that deteriorate life and lead to good living and care for the environment.

12. Proposes the creation of a Latin American forum for the universal right to health, integrated by representatives of the peoples and governments of the region, in order to systematically exchange analyses of the national and subnational health situation, as well as to articulate and complement public policies and mechanisms of popular participation in health.

13. Urges not to forget the lessons left by the pandemic, which are of no interest to disaster capitalism, arising from the solidarity, collective and public solutions that saved lives.

14. Calls for the promotion of peace and social justice to overcome wars and violent conflicts.

15. Calls to take advantage of the opportunities of the regional political context to deepen Latin American and Caribbean integration and sovereignty and sovereignty in health.

Therefore, we call the peoples to mobilize at all levels in order to move from resistance to the struggle for real transformations.

Brasilia, July 1st, 2023