1. PUBLIC HEALTH IN THE 21st CENTURY: towards a people's health paradigm THE FIRST DR. N. H. ANTIA MEMORIAL LECTURE (Indian Health Front and PHM Tamilnadu) Dr. Ravi Narayan Community Health Adviser Society for Community Health Awareness, Research and Action Bangalore 28 th February 2008

5. Alma Ata, 1978 The International Conference on Primary Health Care calls for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world by the year 2000.

9. “ From Alma Ata to the Millennium Declaration”

10. “ From Alma Ata to the Millennium Declaration” Source: Community Health Cell, Bangalore (www.sochara.org) Accessibility ? Affordability

13. What are the people saying? Less Food No Jobs No water

14. Increasing Poverty and inequality ….. The greatest obstacle to Health for All and the Millennium Development Goals Poverty / Inequality

18. Researching levels of analysis and solutions Levels of analysis of tuberculosis Casual understanding of tuberculosis Solutions / Control strategies for tuberculosis Surface phenomenon (medical and public health problem) Infectious disease / germ theory BCG, case finding and domiciliary chemotherapy Immediate cause Under nutrition/ low resistance, poor housing, low income / poor purchasing capacity Development and welfare – income generation / housing Underlying cause (symptom of inequitable relations) Poverty / deprivation, unequal access to resources Land reforms, social movements towards a more egalitarian society Basic cause (international problem) Contraindications and inequalities in socio-economic and political systems at international, national and local levels More just international relations, trade relations etc.

20. ARBO VIRUSES AGRICULTURAL DEVELOPMENT ANIMAL HUSBANDRY DEVELOPMENT PROJECTS FORE-STRY LABOUR MIGRATION URBANIZATION (including larger villages) INTERNATIONAL TRAVEL/ ECO TOURISM WILD LIFE SPORTS (Hunting, Hiking) CHANDIPURA WEST NILE CHIKUN GUNYA ALPHA VIRUSES ? KFD DENGUE JE New challenges of Globalization…. INEQUALITY MARGINALISATION NEW ECONOMIC POLICIES (Liberalization, Privatization, Globalization ) DISASTERS :NATURAL & MAN-MADE COMMERCIALIZATION OF HEALTH CARE DECREASED INVESTMENT IN SOCIAL SECTOR PRIVATIZATION OF HEALTH CARE AND SOCIAL SECURITY MORE TRAVELLERS/ MORE DESTINATIONS UNSUSTAINABLE DEVELOPMENT AND DISPLACEMENT

21. An Agenda for Change -1998 “ A need for strong countervailing movement initiated by health and development professionals and activists, consumer and people’s organizations to bring health care and medical education and their right orientation high on the political agenda of the country and to ensure that the health policy choices are led by people’s health needs, not market factors”

22. 2000- Preparing Campaign Materials for Health Mobilization

24. Indian People’s Health Charter … We reaffirm our inalienable right to and demand for comprehensive health care that includes food security; sustainable livelihood options including secure employment opportunities; access to housing, drinking water and sanitation; and appropriate medical care for all; in sum - the right to Health For All, Now! … … We declare health as a justiciable right and demand the provision of comprehensive health care as a fundamental constitutional right of every one of us. We assert our right to take control of our health in our own hands… … Ethical guidelines for research involving human subjects be drawn up and implemented after an open public debate… December 2000 Kolkota, India

25. The First Global People’s Health Assembly In 2000 December 1454 health activists from 75 countries met in Savar, Bangladesh to discuss the challenge of attaining Health for All, Now! Over 250 Indian delegates attended

26. The People’s Charter for Health “ Health is a social, economic and political issue and above all a fundamental human right.”

27. The People’s Charter for Health “ Health for all means that powerful interests have to be challenged, that globalisation has to be opposed, and that political and economic priorities have to be drastically changed.”

30. Publications

32. Globalizing solidarity from over 80 countries at the Second People’s Health Assembly, Cuenca Ecuador

33. Peoples voices at national level People’s health tribunals in India

37. Right to Health Movement

40. Medical Pluralism Challenge. (AYUSH in Public Health) “ Respect communities and its diversities…. Support, recognize and promote traditional and holistic healing systems and practioners and their integration into Primary Health Care “ Source: PCH- Dec 2000.

47. Developing a research and advocacy agenda for Health Translating research into policy, advocacy and action to strengthen accountability

48. In Conclusion. THE NEED FOR A PARADIGM SHIFT ARE WE READY FOR THIS CHALLENGE ? Approach Biomedical Model Social Community Model Focus Individual Community Dimensions Physical / pathological Psycho- social, cultural, economic, political, ecological Technology Drugs / vaccines Education and social processes Type of service Providing/ Dependence creating / Social marketing Enabling / Empowering Autonomy Building Link with people Patient as passive beneficiary Community as active Participant Programmes and Campaigns Social Movements

49. “ From Alma Ata to the Millennium Declaration” Recognizing the People’s Paradigm Why Renew PHC? For many in the region there is a feeling that, “health is a social, economic and political issue and, above all, a fundamental right, and inequality, poverty, exploitation, violence, and injustice are at the root ill-health and the death of poor and marginalized people” pp: (Quoting People’s Charter for Health in PAHO PHC document 2007, )

51. Recognizing the People’s Paradigm The Peoples Health Movement is an international network of organization and individuals that came together in 2000 to reignite the call for the Health for All, Now. The goal of PHM is to reestablish the health and equitable development as top priorities at local, national and international policy making, with comprehensive primary health care as the strategy to achieve this priorities……. It is transnational network …… and a good example of an emerging player in global civil society… On a day today basis the secretariat in Bangalore …… puts forward strategic campaigning priorities…. Source: Public Health Text Book - UK

52. Recognizing the People’s Paradigm “ A strong voice in the global health debate for free primary health care is the people’s health movement which in 2000, presented the Peoples Health Charter. The charter argues strongly for a publicly financed health services and for development policies that favors health…. This network presently led from Bangalore in India is a leading representative for NGO’s in the Global health debate. This global network is itself a new aspect of globalization” Source: Public Health Text Book- Sweden .

55. Shimoga - 2006

56. Thank you www.phmovement.org

57. Health for All, Now ! JOIN US THANK YOU

58. For further information visit www.sochara.org www.phm-india.org www.phmovement.org www.ghwatch.org www.iphcglobal.org