The Civil society health caucus at the WSSD Global Forum hosted a Commission to discuss the Role of the of the state and water, sanitation and primary health care in the context of globalisation. The discussion included analysis of the situation which raised the following points. • Debt and globalisation impact negatively on the distribution of all resources, including environment and health through their destruction and privatization. • Environmental degradation increases the burden of ill health • Lack of knowledge about environment and health and hygiene are sorely lacking amongst many citizens, especially children. • Environmental services are a basic right which every citizen should enjoy • Privatisation of services, including through public private partnerships, has been a very negative experience for many poor people, especially women and children, in countries as diverse as the UK and Argentina • War and military occupation both severely restrict access to health and basic services, and conflict and psychological stress are also increasingly a result of struggles for access to these services The session tabled the following priority issues: • Globalisation is driving inequity through privatisation of all public services (water, sanitation, health, and other public services) • Public Private Partnerships may reduce government deficits, but are impacting negatively on the health of the poor, and are also affecting the general population through spread of communicable diseases • Local involvement and public-public partnerships for provision and governance of basic services should be prioritised: and positive lessons can be learnt from Brazil in this regard The commission also developed specific recommendations • Scrapping of debt is a prerequisite for health improvement in poor countries • The negative effects of privatisation of public services must be exposed to both communities and governments through research and advocacy • Governments must be rendered accountable through evidence based advocacy and community mobilization and must assume responsibility for provision of basic services through funded partnerships with local communities • Communities need to have control over the provision of health and other social services and play a role in their monitoring • The importance of the relationship between environment and health and hygiene needs to be integrated into learning programmes at all levels. • Learning and advocacy should be promoted at global level through interchange between countries, especially South to South • Powerful governments must be called to account for continuing military occupation and fuelling of conflict which impact mainly on innocent civilians • Unfettered globalisation threatens the planets environment and population health. Urgent steps must be taken to prevent the spread of re-emerging diseases which will affect us all.