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Final Declaration of the 1 st World Social Forum for Health

The 800 participants from 27 countries gathered at the latest World Social Forum for Health in Porto Alegre, Brazil, from the 23 rd to the 25 th of June 2005 declare:

  • Neoliberalism, the expression of economic policies founded on the accumulation of capital in the world and its concentration in the hands of large corporations is the main generator of suffering, disease and death on a worldwide scale. We hereby state that neoliberal policies are incompatible with the human right to health, as trade agreements and the initiatives of the WTO, the World Bank and international financial institutions, including some UN agencies, treat health as a commodity, conditioning access to health to people's economic power .
  • Besides the economic attacks on the right to health, we denounce the devastating effects of the wars of imperialist aggression in Afghanistan and Iraq, the conflict in the Middle East and the civil wars in several regions of the world as consequences of the world’s current economic and political order, which denies and violates human and social rights and perpetuates injustice on a global scale.
  • The tragic episode of the Tsunami has shown a disregard for life and a vision of international aid that does not aim to promote the living conditions of the affected populations, but instead, limits its initiatives to providing crisis relief. This form of aid effort is not concerned with addressing the structural problems that are crucial in the fight against misery and poverty in the affected regions or with contributing to sustained human and social efforts aimed at the construction of public systems capable of responding to the needs of an extremely vulnerable population.
  • Neoliberal reforms of states are destroying social security systems and leaving socially vulnerable populations, like rural populations, informal workers, children, women and old people, unprotected as they are denied the right to housing, health, social security, social assistance, education and work. We alert that the lack of a social security system centered on quality of life means that it is impossible to positively affect health determinants, thus perpetuating the conditions that generate poverty and disease.
  • The mercantilization of health and its submission to international commercial and financial interests systematically and massively violates the right to health, as it alienates the majority of the world’s population from the conditions that generate health, and prevents those populations from accessing fundamental public services.
  • For those people who do not have the economic means to participate in the market processes proposed by neoliberalism, the World Bank and other international financial institutions impose a partial insurance system - based on the financial contributions of workers in the formal labour market, thereby institutionalising focus and naturalising exclusion, and eliminating the debate about rights to replace it with a pragmatism concerned merely with what is feasible to do in poor countries.
  • Added to these restrictions on the right to health, there are also the limitations imposed by the intervention of different kinds of religious fundamentalism, which restrict full sexual and reproductive rights and sexual orientation rights; and the persistence of institutionalised racism, which excludes and discriminates black and native populations.
  • The privatising and definancing attacks on public health systems directly affect and deteriorate living conditions and working relations, leading to longer working hours, subcontracting services, ignoring labour union rights and to adverse effects on health workers’ health.
  • We reiterate that the accomplishment of the Human Right to Health is closely linked to the ruling economic and social model and to the construction of national and global public policy systems that can guarantee compliance with the principles of universality, integrality and equity, with active social participation. In order to achieve this goal we must break the dependence on health policies determined by the hegemonic guidelines established by market principles.
  • We understand Health as the result of the conditions of social determinants such as access to land, water, food, shelter, public transport, electricity... Thus, we emphasise the need to understand health globally, and not just as the absence of disease, covering different human and social aspects connected to life quality, and understanding and intervening on its determinants.
  • The universality-integrality-equity triad, combined with the fundamental principle of social participation and society’s control over the state constitute an interdependent whole and cannot be treated in a fragmented way, because if any one of those aspects is not contemplated, the Human Right to Health cannot be accomplished.
  • The evaluation of the Equity factor must include aspects such as social class and territory, age, gender, sexual orientation, race and ethnicity. The formulation of public policies and the organisation of health and social security systems should address the diverse needs of different social groups, generating enough qualified responses to mitigate iniquity and promote the general improvement of the living conditions of the population.
  • Efforts to achieve integrality as a constitutive principle of a new form of health care should strive to incorporate integral care in areas that have traditionally been ignored, in spite of epidemiological indicators pointing to their social relevance, such as oral health, qualified and non-institutionalised mental health care, intensive care and access to essential medication and high-cost medication. These efforts also entail eliminating the idea that integrality concerns only less complex care, and guaranteeing an integral response to the needs of populations - from adequate nutrition to transplants, while at the same time emphasising quality of life. Integrality also includes access, through the public health system, to the traditional practices of each country, respecting their ethnicity within an intercultural and diverse framework .
  • Universality, therefore, is constituted and qualified through integrality and equity, as what we wish to guarantee as universal is an integral and equitable response - producing the services needed in a timely fashion according to each person’s need.
  • We understand health as a human, economic, social and cultural right directly linked to the fundamental right to life and, therefore, requiring immediate attention. We are thus opposed to progressivity in the accomplishment of the right to health. A commitment to this position, demanding the immediate fulfilment of the right to health, must be obtained from national, regional and local governments, as well as from international and intergovernmental organisations, particularly international credit institutions .
  • The human right to health includes sexual and reproductive rights, taking into account the specific needs of races/ethnicities, life cycle, sexual orientation and people with special needs. Nevertheless, the United Nations’ International Conferences on Population and Development ( Cairo ‘93) and the World Conference on Women’s Rights ( Beijing /94) have been systematically violated by its signatory nations, with loss of rights and retrocess in the implementation of public policies.
  • We understand that it is the State’s Duty to guarantee the Right to Health, since it is responsible for guaranteeing citizens’ rights. Therefore, the State must be held responsible if it does not guarantee or if it violates the rights that it should be protecting. The Duty of the State does not exempt civil society from the responsibility to promote and protect the quality of life and health of the population.
  • We need to increase visibility and understanding of the feasibility of establishing universal health systems, arguing for their effectiveness in the economic sphere, in the social sphere and in the constitution of social security systems.
  • We propose to build a universal right to social security, through agendas that define the right to health as a target of regional systems and a constitutive element of a shared social security in regionally and internationally.
  • The decentralisation of health services and systems must not compromise the universality of the citizenship contracts of each country. Decentralisation should be a constitutional guideline for the unicity of rights and each nation’s responses, and it should be guided by an effort to encourage local participation in decision making processes, addressing the specificities of each territory/population.
  • In order to claim the Human Right to Health each person has to undergo a social, cultural and political transformation in order to become a full citizen, capable of demanding the fulfilment of this right, which requires a sustained social efforts in popular education to empower social actors to generate change in their social realities.
  • With regards to the international debate on intellectual property and the population’s access to knowledge, we state that all knowledge produced is a heritage of humanity. The production of scientific knowledge and its application on the production of drugs, gene therapies, etc., must be at the service of solving humanity’s problems, so this knowledge constitutes social property and not a market commodity.
  • The Brazilian Sistema Único de Saúde - SUS (Unified Health System), a result of the mobilisation and struggle of the Brazilian people, represents great progress in the construction of a health system that subscribes to the principles of universality, integrality, equity and social participation. Its conception and organisation should be a reference in international debates, as it affirms the possibility of universality, integrality´and equity with social participation and social control over the state, with decision making power.
  • However, several structural factors hinder the effective implementation of SUS’ constitutional principles, as this social experience is being developed within the context of the neoliberal economic policies under way in Brazil and the rest of the world, increasing the concentration of wealth, with the logic of the private sector dominating services, academic curricula and professional training, while it does not meeting the demands of public health, nor provides sufficient resources to respond to the general needs of the population in the spheres of universality, integrality and equity.

We also wish to emphasise that :

  • The recognition of the Human Right to Health implies its disassociation from the logic of the market, taking it out of the sphere of the WTO and regional and bilateral trade agreements .
  • It is incoherent to propose global social objectives, such as the so-called Millennium Development Goals or to propose a global fight against poverty, while maintaining in place the present neoliberal policies that treat health as a commodity. The Millennium Goals deny rights and occupy spaces in international and national agendas, obstructing possibilities of setting up universal health and social security systems.
  • Therefore, we endorse the statements of special rapporteur Paul Hunt, denouncing the absence of human rights in the Millennium Goals’ document (they are present in the Declaration but not in the Goals and Indicators adopted) and the fact that these Goals can distract from the real needs of the populations and the imperative of its responses, as they repeat elements previously referred to in other declarations, such as the Alma-Ata and other declarations of rights and international commitments.
  • The 1st World Social Forum for Health must be included in all initiatives involved in the struggle for a new world order, opposed to wars and in favour of a multipolar world, which, by resisting the imperialist unipolar hegemony, can be a guarantor of World Peace. We must support all world initiatives that struggle for Peace. We support the CEBRAPAZ initiative, through a petition that will be sent to the UN.
  • We also stand in favour of a review of all Legislation on Intellectual Property imposed to developing countries because it is contrary to national interests and to the construction of national projects - developmentalist and sovereign -, as they disrespect our stage of scientific and technological development.
  • We propose the integration between different types of knowledge, in a dialectic relationship between traditional and academic knowledge and expertise, eliminating the false antagonism between different knowledges, which are the property of humanity. We emphasise the need to recover traditional health practices, taking into consideration the races and ethnicities that have contributed to the economic, political, social and cultural formation of peoples.
  • We defend the effective implementation of a mental health policy, focused on developing care services to replace institutionalised mental health care, guaranteeing full human rights to patients.
  • We demand effective social control in the economic, financial and fiscal areas in every sphere of the State’s structure, as they determine and condition the implementation of social policies. This must also be required from international organisations and regional integration processes.
  • We are committed to the effort to secure investments in education at every level, as a way of enhancing the participation of individuals in collective matters and especially in social control.
  • We stress the importance of participating in efforts to reduce maternal mortality and to combat the effects on women’s health caused by unsafe abortions, which affects mainly young, poor, black and indigenous women. We point to the need to build strategies to address the specific needs of adolescents and young people in the area of sexual and reproductive health.
  • We support an alliance of all workers to ensure the application of ILO conventions numbers 155 and 161, which regulate health, safety and environmental issues and guarantee workers’ health rights. We aim to develop a broad health policy for workers, aimed at eliminating all forms of violence in labour relations - moral and sexual harassment, child labour, slave labour - adapting working hours according to the requirements of the type of activity - as in the case of health workers.
  • In order to overcome health inequalities we demand urgent and specific measures to be taken in public policies, involving promotion strategies that include prevention, protection, education, healing and rehabilitation services, as well as the management and organisation of services and systems, aimed at expanding mobilisation strategies and the organised participation of different social stakeholders, with society’s effective control over the state.
  • Finally, we reiterate the character of this World Social Forum for Health as a thematic branch of the World Social Forum Movement and we plan for its future editions to accompany the decentralised model of the World Social Forum in 2006 and then its edition in Africa in 2007. The decision making process and organisation of mobilisations in the next two years - including the World Health Week in 2005 and interventions in meetings of heads of state and the WTO-, will take place at an International Managing Council set up at this Forum. The list of organisations interested in collaborating with our efforts will remain open.
  • Contacts with the World Social Forum for Health - FSMS can be made primarily through the web on HYPERLINK "http://www.fsms.org.br" www.fsms.org.br and through the Executive Secretariat’s HYPERLINK mailto: fsms@berthier.com.br .

Porto Alegre , 25 th January 2005