Archive for the 'People's Health Movement' Category
1 Comment December 9th, 2009 by bronxdoc
This week’s edition of the Lancet (12/5/2009) features a letter to the editor about US health care reform written on behalf of the US People’s Health Movement. We were very pleased that the Lancet chose to feature a quote from the letter on their cover:
“The health-care reform process exposes how corporate influence renders the US government incapable of making policy on the basis of evidence and the public interest.”
The text of the letter can be read at this link.
American exceptionalism?
One of the many curious things about the current health care reform debate in Washington is the extent to which the US is considered to be outside of the community of nations. We are judged by our own standards and can learn only from our own experiences. This phrase is neatly captured in the desire for a “uniquely American solution” to health care. (See our prior posting about “misleading messaging” and the failure of health care reform).
But what are we to say about a health care “solution” that will deny women abortions, deny care to undocumented workers and their families, not provide universal health care, and not recognize a right to health? What are we to say about a health care system delivered up to the insurance companies and big Pharma? Isn’t this really just a “uniquely corporate solution” to health care?
In the letter we suggest something different:
There is no excuse for the USA not to adopt a system like any of those in many other countries that cover everyone and control costs—systems that better integrate public health and individual medical care. Without such a system, comprehensive primary health care will not be implemented, nor will the social determinants of health be effectively addressed.
The belief in US exceptionalism must be laid to rest. People living in the USA are as entitled to the right to health as others, and the USA should be accountable to the same standards as any other country.
The People’s Health Movement (PHM) was established in December of 2000 in Bangalore to keep alive the goal of “Health Care for All.” It is an organization of activists, academics, and grass roots organizations from around the world. The website of the US circle of the PHM is at http://www.phm-usa.org/
posted by Matt Anderson, MD (a co-signator)
7 Comments August 24th, 2009 by Laura
Over the past several years, in almost every meeting I’ve attended about health care reform, someone has suggested using “messaging” strategies to communicate more effectively. They often mention the Herndon Alliance as a resource. Herndon has been described as “the most influential group in the health arena that the public has never heard of … the messaging arm of a vast center-left infrastructure pushing health care reform.” But I’ve concluded that over reliance upon messaging strategies in general, and on message recommendations from the Herndon Alliance in particular, is a main reason real health care reform will fail this year.
“Messaging” uses techniques from public relations and cognitive science that tap into people’s values and beliefs in order to create an emotional reaction that leads to opinion or behavior change. Sophisticated messaging relies upon in-depth research through surveys, focus groups and other methods to discover clusters of values and beliefs that groups of people share. Any individual tends to fall into one of these clusters. Communications can then be tailored to reach particular groups. There is no doubt that these techniques can be effective in changing minds because they are the same techniques that sell us new cars and shoes every year. They can be used to promote anything without regard for the truth or evidence. For people working for social justice this kind of strategy can never be effective.
One of the tenets of the messaging strategy is that most people don’t reach opinions based on evidence or facts. Herndon’s specific messaging strategies discourage any mention of facts. Since it is always easier to sow doubt than confidence about any change, messages with no connection to fact or reality give an advantage to the status quo. People’s beliefs are often not based upon learning but on misperceptions acquired through individual experience, the grapevine and the media. Catering to these beliefs and values means reinforcing them, even if they are untrue or against the general welfare.
Progressives are angry about the tales of “death panels” spread by the right wing. However, the messages Herndon promotes are also misleading. Not in the outrageous way that right wing messaging is, but untrue just the same. A current statement recommended by Herndon is, “Reform will give us the freedom of secure choices—to keep our plan and doctors, to choose another private plan, or the choice of a robust public health insurance option.” As it looks now, this statement is false. It is likely that only people without insurance from their employer will have the option of choosing the public plan – if there even is a public plan. If you get insurance through your employer, your employer chooses your plan options, and can switch them at any time.
Trudy Lieberman, in Columbia Journalism Review, noted another misleading Herndon frame.
(Herndon) advises: “Don’t just say ‘bring costs down,’ … It is better to say ‘health care reform will make health care AFFORDABLE—it will cost less and you will get more.” Hey guys, that’s not likely to happen if the current nostrums for reducing medical costs remain the only ones on the table. As for getting more? The current trend in health insurance—shifting costs from insurers and employers to policyholders—means thousands are getting fewer benefits, not more.
The Herndon messaging suggestions are worded this way because their goal is to get people to accept whatever ends up emerging from the legislative meat grinder as “health care reform”. Rather than messaging about specific demands, they use words with highly positive associations to state what health care WILL do: “You will have the choice of a QUALITY affordable public health insurance plan.” This phrase doesn’t explain what characteristics a QUALITY public plan should have so that people can demand those characteristics from the congress.
There is no guarantee that the health care system we get after the legislation passes will be anything like the Herndon Alliance says. Even if people agree with the messages, they also hear the claims made by Republicans. They (rightfully) don’t trust the congress to deliver what is best for ordinary people. The health care reform debate becomes a competition between which set of misrepresentations you want to believe in. And with a third of Americans illiterate or barely literate, and most getting their news from television, they don’t have any rational basis on which to decide.
Messaging works most effectively on an uninformed disempowered population and serves only to further disempower them. The Herndon Alliance disconnects people from real potential solutions to the US health crisis with messages like, ‘Health care reform will be a uniquely American solution.” This reinforces the already deeply ingrained and harmful belief in American exceptionalism, preventing people from learning from the experiences of other countries where there are better health systems.
Even health care reform activists seem to get confused by these messages. They begin to think of messaging recommendations as true statements about the actual legislation or as policy recommendations. Because of the language about “keeping your plan if you like it” some activists, are losing sight of the fact that what people really want is to be able to keep or choose their medical providers. Beyond that, “progressive” activists shouldn’t be promoting the idea of keeping your private insurance as characteristic of good reform when the private insurance system is the problem in the first place.
I am not arguing that opinion and values research isn’t useful to help activists understand what the general population or subgroups are thinking. But activists shouldn’t be so naïve as to accept the analysis and recommendations of one group without considering that group’s political goals. All opinion research is biased by the questions that are asked and the way they are asked. (I won’t critique Herndon’s research because it has been done elsewhere: HERE and HERE). Although it claims to be non-partisan, Herndon has very close ties to the Democratic Party. Democrats are the recipients of huge amount of money from the insurance, health care and pharmaceutical industries. Most analysts agree that failing to pass some kind of health care reform legislation will be a huge blow to the party. They have to pass something and Herndon has its own ideas about what it wants. What they specifically don’t want is national health insurance (single payer) and all of their messages are designed to keep people from considering that idea on its merits and convince activists that Americans don’t support it.
Like the founding and board organizations of Herndon Alliance, Families USA, Health Care for America Now (HCAN), AARP, and SEIU, most of the approximately 200 Herndon Alliance partners are groups that either have never supported a social insurance or single payer model, or are so convinced it is not politically feasible (some sincerely and some not) they will support almost any other reform when faced with a choice. Many have actively undermined campaigns for single payer that would have had a chance for success – if all “progressives” stuck together. The same scenario we are going through nationally has happened repeatedly on the state level with the same groups. Although their goal is “high-quality, affordable health care for all Americans,” the specific policies they push are those that increase access by increasing the flow of money from individuals and the government to the private insurance and pharmaceutical companies. Families USA, SEIU, and AARP are part of the PR front groups Healthy Economy Now and Americans for Stable Quality Care that also include Pharmaceutical Research and Manufacturers of America (PhRMA), the American Medical Association, the Business Roundtable, and the Federation of American Hospitals. These coalitions have presented millions of dollars of TV commercials promoting health care reform using the same warm and fuzzy misleading language as Herndon.
The climate for health reform this year is different for one reason: the rate of profit that insurance and pharmaceutical companies are making has reached its limit in the US. They need more customers to keep growing. The current health care reform increases profits by 1) requiring people to buy insurance products 2) providing government subsidies so they can actually afford the products. Even the so-called public option, since it is completely undefined (and has functioned as a marketing slogan, a bargaining chip, and a red herring for opposition), can easily be structured to channel public funds into private profits. For example, it could be modeled after some state employees’ health plans, where the government subsidizes private health plan coverage, while assuming the financial risks involved
The question remains why so many self-identified progressives are buying the Herndon Alliance strategy and message. Some just haven’t taken off the glasses and are themselves manipulated by Herndon rhetoric. Some are looking for a way to change opinion without doing the hard work of political education and consciousness raising. For the rest, Helen Redmond had a good explanation in Counterpunch.
For the Democrats, with the exception of John Conyers and a few others, they simply don’t want to abolish the private insurance industry. They are capitalists and believe in the capitalist system that makes health care a commodity to be bought and sold. For them, health care is not a human right. And importantly, they don’t want to take on President Obama who is opposed to single-payer. Like the true cowards they are, they will not oppose Obama on health care reform even though they disagree with him.
HCAN thinks it’s impossible to get rid of the insurance companies, they’re too powerful, and they have too much money and influence. They don’t believe a large social movement can be built to take on and win against the insurers and the government. The leadership of HCAN are the ones who would have said under slavery, “We can’t win abolition, so let’s settle for a few reforms that make the lives of slaves more bearable.”
Public relations strategies are the antithesis of a human rights based or social justice approach. Social justice requires meaningful participation by people affected by a problem. Meaningful participation means that people must have the capacity to engage in advocacy for themselves. They need to participate in identifying the problem and its causes, and be supported with the tools and resources to understand it. Then they must be engaged in making demands on their representatives, government or other duty bearers. These citizens will be resistant to PR manipulation by any party. With our government seemingly incapable of making policy based upon evidence and the general, rather than corporate, welfare, there are no shortcuts to social justice.
8 Comments July 11th, 2009 by bronxdoc
From our Friends at the People’s Health Movement: USA Circle
PHM and IPHU are pleased to announce the upcoming IPHU courses in India (September 21-30, 2009), Morocco (September 21-30, 2009) and Cuba (November 4-14, 2009). For details and registration, go to http://phmovement.org/iphu/. US health activists are encouraged to attend.
The International People’s Health University (IPHU) is one of the major programs of the People’s Health Movement. IPHU is a global university providing short courses and other resources for health activists. Courses are of a high academic standard and are documented for academic credit from established universities. IPHU short courses enable younger health activists, in particular, to make new connections, share experiences and study together. IPHU short courses strengthen the global network of people’s health activists.
Morocco – http://phmovement.org/iphu/en/morocco, in French and Arabic, Fes, Morocco
India – http://phmovement.org/iphu/en/bangalore/announcement, in English, Bangalore. This course is focused on Health and Equity.
Cuba – http://www.phmovement.org/iphu/en/CubaAnnounce, in Spanish and English, Havana
Add a comment March 3rd, 2009 by bronxdoc
We have just published the 12th edition of Social Medicine/Medicina Social, our bilingual, online journal. It is available in both English and Spanish. Our 12th issue captures the stories and struggles of diverse health activists, among them Dr. Walter Lear (shown below):
US Health Activism Collection
Last summer we had an opportunity to interview Dr. Lear (now 85 years old), founder of the US Health Activism Collection. In a wide-ranging interview in his home Dr. Lear discussed his personal background, the origins and purpose of the collection, the impact of the McCarthy period on the US health left, as well as his vision for the future (available at this link). Dr. Lear later added copious footnotes to his interview creating a virtual “Who’s Who” of the mid-20th century US health left.
Dr. Lear also allowed us to make PDF copies of two of the pamphlets in his collection. These are Autopsy on the AMA: An Analysis of Healthcare Delivery Systems in America [1970] published by the Student Research Facility and Your Health Care in Crisis: A HEALTH/PAC Special Report [1972] [Both documents are a bit long and may take some time to download.] Although HEALTH/PAC no longer exists as an organization, there is a HEALTH/PAC website.
Seize the Hospital to Serve the People
We are also publishing a video of Cleo Silvers, a remarkable Bronx health activist who was involved in the takeover of Lincoln Hospital. (For more on this take over see our spring 2007 journal) The video of Ms. Silvers can be seen at our Audio/Visual tab.
Should India Use Commercial Ready To Use Therapeutic Foods (RUTF) For Severe Acute Malnutrition (SAM) ?
Indian Activists associated with Jan Swasthya Abhiyan (People’s Health Movement – India) and the Right to Food Campaign question the value of Plumpy Nut, an Ready to Use Therapeutic Food (RUTF). They argue that locally produced alternatives are cheaper, more acceptable, and serve to strengthen communities. At the very least Plumpy Nut should have been compared to local supplements before being adopted by the government. Available at this link.
Combatting Organ Tafficking
Activists Debra A. Budiani and Kabir Karim of the Coalition for Organ-Failure Solutions discuss the social roots of organ trafficking and consider the implications of a 2008 WHO resolution and the Istanbul Declaration. Available at this link.
posted by Matt Anderson, MD
Add a comment January 29th, 2009 by bronxdoc
The USA circle of the People’s Health Movement is participating in two events in Washington in early February. In collaboration with Oxfam these two forums will address the role of the private sector in promoting access to universal health care. Here are the flyers for the two events:
The USA circle has recently set up a section on the PHM website which is worth a visit. You can now sign up for a PHM/USA listserve.
Posted by Matt Anderson
2 Comments October 19th, 2008 by bronxdoc
Last week saw the release of the second Global Health Watch report, created as an alternative to the WHO’s World Health Report. It is an initiative coordinated by the People’s Health Movement, the Global Equity Gauge Alliance and Medact with input from 80 organisations and more than 130 individuals. It presents a progressive agenda for global health. A sixteen page overview of the report can be downloaded here.
The Global Health Watch is important for several reasons. First, it provides a radical critique of the existing model of “global health” which is dominated by neoliberalism and a subservience to corporate interests. Secondly, it is a truly international critique which draws on the resources and experiences of academics, activists, and social movements throughout the world. This is a report born with a democratic spirit. Finally, in this international call to realize the vision of Alma Ata, we are reminded that another world is possible. Indeed, the very creation of the report shows us that there is a broad movement to create that other world. This is good news.
From the Press Release:
Alternative world health report calls for radical change
Civil society organizations and scientists from around the world are calling for ‘a new development paradigm’ to address the toxic combination of climate change, growing poverty and inequality and poor health.
The new report, Global Health Watch 2, says that unfair social and economic policies combined with bad politics are to blame for the poor state of the health of millions of people in the world. The report makes stinging criticisms of key global actors, including the World Health Organization, the World Bank and the Gates Foundation. The report calls on governments to stop the Bank from meddling in health politics.
Global Health Watch 2 provides examples of civil society mobilization across the world for more equitable health care and more health promotion, although more is needed to bring about significant improvements in health.
The report reveals widespread unease about the immense but unaccountable power and influence of the Gates Foundation. It says that although the Gates Foundation has injected vast sums of money into global health, it operates in an undemocratic way and reinforces a medical-technical approach.
Among other issues it highlights is the pressure exerted on the World Health Organization by powerful and vested interests that would prefer WHO’s activities and programme to have a more biomedical and less political focus.
The first edition of Global Health Watch, published in 2005, was hailed for its ground-breaking analysis and mobilising call to action.
Marion Birch, director of the London-based charity, Medact:
“Priorities set by the rich world damage the health of people thousands of miles away. Funding for water and sanitation is falling while slum-dwellers in Lagos pay up to 40 times as much for water as residents in downtown New York. Oil extraction in the Niger Delta generates billions of dollars of revenue but local communities lack basic health care.”
Amit Sengupta of the People’s Health Movement in India:
“The World Bank’s job is to help transfer resources from richer to poor countries and it should act accordingly. Its impact on the health systems of poor countries has been largely negative. Internationally, it has also contributed to the uncoordinated circus of health sector policy-making that makes it difficult for Ministries of Health to function”.
Martin Drewry, director of the charity Health Unlimited:
“The majority world does not want charity – it wants a fairer political and economic system. It needs fewer billionaires; not more. While it is great that Bill Gates is willing to donate his money towards improving health in Africa, he would do far better campaigning for more effective tax systems both nationally and internationally”.
Posted by Matt Anderson
Add a comment June 30th, 2008 by bronxdoc
Our friends at the People’s Health Movement have just announced the next short course for health activists, being offered in Porto Alegre, Brazil, September 7-20, 2008. This course will be offered in Portuguese, Spanish and English.
The curriculum is an interesting one, and can be viewed at the International People’s Health University (IPHU) website. Of particular interest is the Resource Library at the IPHU website which includes a very rich selection of readings, Powerpoints and other materials (including videos) on the course content.
The curriculum includes:
- the struggle for health: achievements, strategies and new directions
- working with communities and with grass roots health organizations
- comprehensive primary health care: achievements, lessons and new
directions
- the political economy of health: globalization, the WTO, the IMF and
the WB; local issues and global pressures
- the right to health: principles, achievements and new directions
- people’s health and the environmental struggle
- research: part of the problem and part of the solution
- social determinants of health (poverty, oppression and hierarchy)
- alienation and exclusion
- racism and sexism
The 11 day course is presented by the International People’s Health University (IPHU) and the People’s Health Movement (PHM) in association with the School of Public Health of Rio Grande do Sul. The teaching faculty is drawn from Latin America and beyond. Priority is given to students from the Southern Cone. For more information about IPHU and the Porto Alegre Short Course go to www.phmovement.org/iphu. Further inquiries should be directed to the Course Coordinators (porto@phmovement.org).
The short course is offered periodically in various venues and languages. It was, for instance, offered at the US Social Forum in June of 2007.
Matt Anderson
[This entry was updated on 7/13/2008]
1 Comment May 12th, 2008 by bronxdoc
[This post, by Naveen Thomas, was originally published in June of 2005]
In January 1984, a group of doctors and other professionals who left their jobs in mainstream medical colleges started a community health study-reflection and action group in Bangalore, South India. Community Health Cell (CHC) which grew out of this group, was supported by the Centre for Non-Formal and Continuing Education, Bangalore, till 1990. In June 1990, the project was reviewed and the Society for Community Health Awareness, Research and Action (SOCHARA) was established and registered. Community Health Cell became its functional unit.
As the name suggests, the main aim of SOCHARA was to promote community health awareness, action and research. SOCHARA’s mandate also included evolving educational strategies in Community Health and Development. SOCHARA recognised the need to dialogue and participate with policy makers and implementers to enable the formulation and implementation of community oriented health policies. As a part of efforts to promote community health, SOCHARA also established a library, documentation and interactive information center in Community Health.
SOCHARA consists of 32 members who are distinguished in their own areas of work. CHC, the functional unit of SOCHARA consists of a small core team of 20-25 people, including health and social science professionals, office and library team, research and training assistants, supported by a large informal network of professional associates and friends. The strength of SOCHARA has been its wide network leading to a rich and diverse web of interaction among persons and groups involved in Community Health in India and across the globe.
SOCHARA/CHC have been involved in participatory community health training at middle and grassroots level, primarily with voluntary agencies in South India. On the medical education front, CHC collaborated with the Rajiv Gandhi University of Health Sciences, Karnataka to reorient the vision and mission of medical colleges, to improve their management and to introduce medical ethics, rational drug education and other socially relevant topics in the medical curriculum. In addition, SOCHARA/ CHC were also involved in research on strategies for social relevance and community orientation of Medical Education and follow up initiatives with colleges and universities.
Promotion and awareness building concerning rational drug prescribing, rational drug policy, patents and alternative systems of medicine is another area of SOCHARA/ CHC’s functioning. SOCHARA/ CHC also took an active part in the recent Global Campaign against Indian Patents Amendment (GCAIPA).
SOCHARA/CHC has been providing active support to research and awareness building on environmental health issues including mining, Bhopal gas disaster, etc. The other disasters that SOCHARA/ CHC has been actively involved in facilitating relief and rehabilitation efforts include the Bangladesh cyclone disaster, Uttarkashi, Marathwada and Kutch earthquakes and Tsunami in Southern India.
Over the past two decades, SOCHARA/CHC have been motivating and guiding young professionals who were in the process of reflecting about their personal interest or commitment to community health. They spent 3 – 12 months in CHC where they went through a learning process that was person-centred, with peer support, short assignments, self-study, presentations, writing of reports, etc. Today, over 95% of the professionals continue to work in the area of community health.
A review of SOCHARA/CHC in 1998 and subsequent reviews suggested that CHC expand its training and mentoring role. As a result, a Community Health Fellowship Scheme commenced in April 2003, providing an opportunity for young professionals to learn about community health and its various options by involving themselves in a person-centred, semi-structured training programme. This role of SOCHARA/ CHC is being further consolidated, and CHC is evolving into a research and educational centre in community health, public health and health policy.
The other area in which SOCHARA/CHC has been greatly involved is in building a people’s movement in health. The SOCHARA/ CHC review had also suggested that CHC utilize its network and relationships built over the years to contribute to a mass movement in health. This came true in 2000 A.D., with the Indian Health Assembly held in Calcutta, India and the first People’s Health Assembly (PHA-1) being held in Savar, Bangladesh in December 2000. CHC contributed in mobilizing people and organisations, and in conducting both these assemblies. CHC was also deeply involved in the formation of the People’s Health Movement (PHM) and in drafting of the People’s Charter for Health.
In 2002 two years after the first PHA, PHM secretariat was shifted from GK, Savar to the PHM India region, and CHC was asked to host it on behalf of region. Ravi Narayan is currently the co-ordinator of the PHM Secretariat (Global) based at CHC, Bangalore. The People’s Health Movement has come a long way, and five years after its formation, is getting ready to host the second People’s Health Assembly (PHA-2) at Cuenca, Ecuador in July 2005.
To know more about SOCHARA/CHC, get in touch with us, or email Thelma Narayan, the co-ordinator of CHC.
Naveen I. Thomas, Health Policy Fellow, CHC (June 2005)
