People's Health in People's Hands:
What Works and Who Decides?
By Denise Zwahlen and Karen Leiter
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"Friends, we come in the spirit of solidarity and sharing." These were the opening words of Drs. Thelma and Ravi Narayan at a Community Forum in Boston on March 12, 2003, entitled Globalization and Health: Health For All or Health For All Who Can Pay? DGH volunteers organized this event to bring together health care practitioners and advocates, labor and environmental activists, educators, and others working and organizing in local communities. The Narayans, leaders of the People's Health Movement (PHM) from Bangalore, India, also spoke to medical and public health students and faculty, and to South Asian activists at two other events in the Boston area. This was one stop on their March 2003 speaking tour in the US. The tour was co-sponsored by DGH and the Hesperian Foundation to invite participation in the North American Circle of the PHM and included presentations in Berkeley, Seattle, New York City, Boston and Washington, DC.
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“The People's Health Movement is formed by individuals and community groups letting their voices be heard and taking an active role in shaping alternatives to the current situation. ” |
When we volunteered to coordinate the Narayans' visit to Boston, we thought it would be a great opportunity to get to know organizations working locally to promote social justice in the same spirit with which DGH advocates for health and human rights abroad and at home.
We were ourselves unfamiliar with the PHM. We knew little about the speakers beyond the fact that they were academic researchers, activists and founders of the Community Health Cell, a Society for Community Health Awareness, Research and Action that had played a key role in the formation of the People's Health Movement in India. We were curious to see how they would approach the topic of the ill effects of globalization on health.
Our experience was an extremely positive one. The process of contacting and working with local organizations (such as the Association for India's Development and the South Asian Center, and Jobs With Justice, a coalition of labor and community organizations) paved the way for future collaborations. And the eloquence, dedication, solidarity and curiosity of the Narayans left us with several messages and principles to inspire and challenge our volunteer health and human rights work. We would like to share just a few of these here:
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| Left to Right: Drs. Linnea Capps, Thelma Narayan, Diana Ramirez, Ravi Narayan and Lanny Smith, speaking on a Social Medicine panel in NYC. |
- There is already a people's health movement happening in the US.
In three weeks of visiting, Ravi and Thelma were surprised to meet so many individuals and organizations working on environmental, labor, poverty and other justice issues at the grassroots level. They identified these groups as "fellow travelers" and remarked that the groundswell of peace activism in the States against the war in Iraq can be the seed of a national PHM mobilization.
- The People's Health Movement is formed by individuals and community groups letting their voices be heard and taking an active role in shaping alternatives to the current situation.
Testimonies, like that of Barbara Walsh, a disabled Medicaid recipient who spoke at the Community Forum, have been and should continue to be part of building the PHM. Empowering individuals to take action for change is essential-just as Barbara does by joining Health Care for All, an organization fighting for universal health care access in Massachusetts. Ravi's description of the trains that brought people from all over India to an organizing meeting in Hydrabad for the People's Health Assembly in 2000, complete with rolling workshops and popular theater at each stop, struck us as a wonderful example of this principle.
- Community empowerment projects must be accompanied by national and international policy change efforts.
Ravi described the need to work in both arenas. Empowerment without policy change risks co-optation and the creation of parallel institutions absolving governments of their responsibilities for health and health care. On the other hand, when international organizations move away from people-centered agendas for change and public health specialists become jet-setting consultants, greatly influenced by transnational corporations, all the resources poured into initiatives have little effect on the basic determinants of health (such as hunger, poverty, draught and environmental contamination). This was clearly demonstrated by the failure of a twenty-year World Bank project in India.
- Look to the local level, where politics are more open to change.
Many of us are frustrated by state budget cuts eliminating services and programs, not to mention the politics of national policies. A successful alternative strategy that Thelma modeled was her description of women's empowerment at the district level and the achievements of 18 networks of community-based organizations collaborating to produce educational materials and mobilizing the PHM in India.
Where do we go from here? Thelma and Ravi closed each presentation in Boston by telling us not to despair. Indeed, we recognized many common and resonant themes in their analysis and experiences. Overall, the Narayans' visit left us with a renewed eagerness to forge alliances and to continue to learn and share locally towards the goal of having an active US presence at the next People's Health Assembly in Brazil in 2004.
One immediate and concrete way to participate in the People's Health Movement is to add your name to The Million Signature Campaign (www.TheMillionSignatureCampaign.org), which endorses the People's Charter for Health, reaffirming the principles of the Alma-Ata Declaration and joining thousands around the world demanding "Health for All, Now."
- For more information or to subscribe to the PHM-USA listserve, visit the DGH-PHM page.
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