People's Health Movement: The Cuenca Declaration PEOPLE'S HEALTH MOVEMENT SECOND PEOPLE'S HEALTH ASSEMBLY CUENCA DECLARATION Coming from 82 countries around the world, 1492 people met at the Second People's Health Assembly in Cuenca, Ecuador from 17th to 22nd July 2005, to analyse global health problems and to de- velop strategies to promote Health for all. Overwhelmingly we reaffirmed the continuing importance of the People's Charter for Health (2000) and saw it as a rallying document for the ongoing struggles of the People's Health Move- ment globally and within countries. The vision endorsed at PHA2 is for a socially and economically just world in which peace prevails; a world in which all people, whatever their social and economic condition, gender, cultural identity and ability, are respected, are able to claim their right to health and celebrate life, nature, and diversity. Solidarity with struggles in Ecuador Here in the heart of the Andes we have learned much from the hospitality, living cultural heritage, and current struggles of our Ecuadoran sisters and brothers. We join them in solidarity to oppose the signing of the Free Trade Agreement imposed by the government of the United States and the international financial institutions. This agreement will increase corporate profits, impoverish the workers, campesinos and indigenous peoples of the Andes, negatively influence their living and working conditions and impede their access to health care and enjoyment of health. We also join our Andean partners in opposing Plan Colombia, the name for the biological warfare carried out against them by the United States, which is poisoning their land and water, and militarizing their border regions. The global health reality We deplore the worsening conditions of health experienced by many of the world's people and we denounce their cause - neo- liberalism. Neo-liberal polices imposed by the G8, transfer wealth from the South to the North, from the poor to the rich, and from the public to the private sector. Corporate profits in- crease while poor people, indigenous peoples and the victims of war and occupation, suffer. Economically and politically generated health inequalities have increased, yet these root causes of avoidable disease and death are not effectively addressed by current policies or programs. The spirit of Alma Ata has been betrayed by most official health systems, though it has been kept alive in the face of adversity by health activists and health workers in community projects all over the world. Comprehensive primary health care is implemented in very few places, and the provision of health services is rarely seen as a collective social responsibility. Under neo- liberalism there is no right to health, racism is nurtured, women's oppression deepens, social exclusion increases, environ- mental degradation becomes the norm, workers' rights are non- existent, and war serves the profit seeking of big corporations. Governments, IFIs, WHO, multilateral and bilateral agencies are strongly influenced by the agendas of these corporations. Establish the Right to health in an era of hegemonic globaliza- tion PHM calls on the peoples of the world to mobilize against the denial of the Right to Health. The global economic framework of neo-liberalism, privatization and "free trade," made operational through the WTO and international financial institutions, has played a determinant role in the transfer to the corporate sec- tor of the control of the determinants of health. This leads to environmental destruction, toxic pollution, denial of rights to water, food, and life itself. The human right to health and health care must take precedence over the profits of corpora- tions, especially the profiteering of pharmaceutical companies. The WTO operates as a de facto world government even though it is unelected, unrepresentative and unaccountable. Responsibility for international trade and development must be returned to the people through reappropriation of relevant UN bodies such as UNCTAD. Unless it is massively reformed to operate democrati- cally, the WTO must be dismantled as it is a major source of massive human rights violations and injustice and a key mecha- nism of corporate control of life on earth. The right to health will be achieved through large scale popular mobilization. PHM will initiate or support struggles related to the right to water, food security and food sovereignty, a healthy environment, dignified work, safe housing, universal education and gender equity, since people's health depends on the fulfillment of these basic rights. PHM will launch a compre- hensive campaign to achieve the "Global Right to Health and Health Care" at the local, national and international levels, to defend health and social security (including health care) sys- tems, and to document and oppose health inequities and denial of the right to health. PHM will defend health workers in their op- position to the privatization of health services by building broad multi-sectoral alliances. PHM will campaign to end TRIPS, remove it from the WTO, and op- pose bilateral Free Trade Agreements and TRIPS+. We call upon governments to use the Doha agreement to provide people with af- fordable generic drugs. We oppose public-private partnerships because the private sector has no place in public health policy making. PHM will continue to monitor and provide inputs for the WHO Commission on the Social Determinants of Health to ensure that it effectively addresses the political and socio-economic causes of poverty, ill health and health inequity and engages in meaningful dialogue with civil society as much as possible. PHM will work with allied movements to coordinate common interna- tional actions against privatization and inequitable trade re- gimes. Promote health in an intercultural context PHM recognises that interculturality is a fundamental element to promote social equity and build a fair health system. Equity in access to health information is a fundamental human right. It is essential in the struggle for indigenous people's health. Peo- ple's knowledge should be incorporated into the development of culturally based equitable health services; culturally sensitive prevention programs; the training of health workers in intercul- tural skills; achieving fair conditions of work; food security; and a healthy ecosystem. PHM will incorporate key issues such as the struggle against trade agreements, land reform and indige- nous people's land restoration, protection against piracy of traditional knowledge as a fundamental defence of social secu- rity, cultural identity and nutritional security. The many use- ful aspects of traditional medicine and culture must be valued and included as part of a people-oriented society and health system. Advance the right to health for all in the context of gender and personal diversity The health of women, men and people of diverse sexual orienta- tion is severely damaged by the dominance of a patriarchal cul- ture with social and gender inequities and discrimination that affects their integrity. The social, health, sexual and repro- ductive rights of women are often denied. PHM commits to main- streaming gender and feminist perspectives in all its work and action plans. Men and women of PHM commit themselves to decon- struct patriarchal relations in private and public life. This Assembly demands the dismantling of neoliberal policies that have increased gender inequality. To do so it will support in- ternational, regional and local campaigns for sexual and repro- ductive rights; strengthen communication and work relations with networks and other movements; and work to ensure safe abortion for all women and girls. PHM firmly denounces all forms of vio- lence including that against women, such as femicide, and de- mands government action to prevent it, to prosecute perpetrators and to provide all necessary support for people affected by vio- lence. People with disabilities and older people should be treated with respect and their right to appropriate health care should be en- sured. PHM supports a new UN convention protecting and promoting the rights of persons with disabilities, promotes rehabilitation services as part of PHC, and urges the Commission on Social De- terminants of Health to develop more focus on people with dis- abilities. PHM argues for the inclusion of people with disabili- ties in all aspects of life, and recommends that disability be addressed in a similar way as gender among donor agencies so that inclusive development is ensured. Protect the right to health in the context of environmental deg- radation PHM calls upon the people of the world to support action to end imperialist control of the earth's natural resources and create and maintain a healthy environment for all. Natural resources essential to health are global commons. We call for a worldwide campaign for a UN Treaty on the Right to Water, ensuring that commodification and privatization of this vital resource - life itself - is both reversed and prevented. Guided by evidence of devastating damage and by the precautionary principle, we demand a moratorium on extractive mining and petroleum explora- tion/extraction, a ban on patenting of life forms and processes, research on nanotechnology, release into the environment of GMOs, and on development and use of all biochemical weapons. Governments are accountable to people not transnational corpora- tions and must guarantee rights relating to health and the envi- ronment through enforceable laws and regulations. Governments, IFIs and the WHO must cease to be accomplices to TNCs and impe- rialism. Dow, Monsanto and other companies must be forced to provide reparations to the thousands of uncompensated victims of disasters such as Bhopal and Agent Orange. Knowledge and science must be reclaimed for the public good and freed from corporate control. Ensure workers' health and safety by defending and extending ex- isting rights PHM calls upon the people of the world to demand the implementa- tion of international treaties that protect workers' health and safety, recognize workers' health as a universal human right and a responsibility of the state, involve workers in the decision and policy-making process on working and health conditions and ban child labour. We support social arrangements to ensure the right to regular, meaningful and adequately remunerated work, with equal pay for equal work for men and women; protection of historical achievements attained by trade unions in the formal sector, renewal and strengthening of trade union, workers' and anti-globalization movements and their links to other movements; protection of the health of informal sector workers and migrants as they are more exposed to occupational health hazards; and universal health coverage through national health systems and insurance.