IPHU NY Pre-Course Reading and Viewing
In planning the program for each IPHU we are very keen to leave as much space for interactive sharing as possible. This means seriously limiting the time allocated for formal presentations from our resource people, and not covering some important and complex issues. Limiting formal presentations also means that it’s hard to cover all the introductory material in the first day.
In order to overcome this problem we have identified some critical texts for pre-reading and some videos (that you can listen to while doing the dishes, folding the laundry, etc) and listed them below. They are organized by their importance – mandatory, strongly suggested, and recommended. By doing the mandatory reading and browsing through the remaining materials according to your interest, you will go a long way to making the course a more valuable experience. We will all benefit when you bring to the course the questions, feelings, ideas and arguments that come up for you during the reading and listening.
We recognize that you will not have had much notice of this pre-study before attending the IPHU and will not have time to go through all the material. However, we do expect you to at least do the mandatory reading.
Your suggestions for any additions to this study guide are welcome.
Mandatory Reading and Viewing
The People’s Charter for Health is the foundational document of PHM. It was developed before and during the first People’s Health Assembly and adopted in the final session of the Assembly. It is important to be familiar with the Charter because if reflects the broad commitment which holds PHM together. (A good way of thinking through the PCH is to take the PCH Quiz.)
The Alma Ata Declaration is the international declaration that defined primary health care as the main strategy needed to achieve health for all. (You can find it at the end of this packet.) The term primary health care is used in many different ways: as a type and level of care; a policy model for health systems development; and a strategy for social change, but this declaration is the basis for our understanding of what PHC means. PHC is quite central to PHM’s approach to health care and health systems, including action on the social determinants of health. If you want to go more into depth on PHC and health systems you can explore the health systems section in the IPHU Library.
Many people in rich countries become health activists through non-governmental organizations (NGOs) based in N. America or Europe, but providing services or doing other programmatic work in low and middle income countries or in poor communities domestically. NGO Code of Conduct for Health System Strengthening is a response to the recent growth in the number of international non-governmental organizations associated with increase in aid flows to the health sector. The code serves as a guide to encourage NGO practices that contribute to building public health systems and discourage those that are harmful.
Unnatural Causes: is inequality making us sick? is a documentary series on the social determinants of health that aired on PBS. The series website has a wealth of information, but the required part is to watch the video clips. There are quite a few but they are short. Watch the trailer and the first section, In Sickness and In Wealth, then pick at least 3 clips from 2 other sections.
Strongly Suggested Reading and Viewing
Harvard Law Fellow Alicia Yamin on “Rights-Based Approach to Health” This excellent presentation is a little over an hour. Her remarks start at the 5.25 mark.
Part A: An Alternative Paradigm for Development and Part B: The Health Care Sector are engaging, clear overviews of the complex issues of development and health systems in the context of global political economy.
Stephen Bezruchka’s 9 minute TEDxRainier talk on health inequities.
Recommended Reading and Viewing
About the People’s Health Movement (PHM)
PHM is an organisation, a network of organisations and part of a broader social movement. Some health activists work within the organisation which is PHM. Others work in other organisations which are part of the PHM network. Others work in settings which are not closely linked with PHM
The purpose of IPHU is to strengthen the people’s health movement by providing training opportunities for health activists who are part of the global people’s health movement; either as part of PHM the organisation (for example in national and local PHM circles) or in organisations which are part of the network or in other settings which are part of the broader social movement.
Video about the 1st Peoples Health Assembly:
“The Health Protesters”
A good way to get to know the People’s Health Movement is to browse through the PHM website. In particular, browse through:
- the first and second People’s Health Assemblies;
- the country circles; and
- the news and analysis department department.
PHM is made up of ‘country circles’ and a number of global networks. These global networks include:
- Third World Networkand also the Third World Network in Africa
- Women’s Global Network for Reproductive Rights;
- Consumers International Health Action International
- Asian Community Health Action Network
- International People’s Health Council
- Dag Hammarskjöld Foundation Gonoshasthaya Kendra
Social determinants of health
A good place to start is the WHO Commission on Social Determinants of Health. There is a lot to read including the Final Report and the reports of the various Knowledge Networks and the report of the Civil Society Consultation.
Video: Kumanan Rasanathan “Primary Health Care and the Social Determinants of Health”
Primary health care
A brief overview of the history of community health centers in the USA and what they do.
Kumanan’s talk under Social determinants also applies here
Health as a human right
The Archives of the Right to Health Unit of the University of Essex contain the work done by Paul Hunt during his tenure as the UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. His work is essential reading for anyone interested in the right to health.
Peruse the webpage of the current Special Rapporteur on the Right to Health, Anand Grover.
See Backman and Hunt et al (2008) and the Right to Health series in the Lancet.
For action frameworks that have been used in the PHM Right to Health and Health Care Campaign see:
The current economic crisis and the US as it is
Elizabeth Warren interviewed by Maria Hinojosa on the economy, covering credit cards, unemployment, foreclosures, etc – 24 minutes.
Fixing the Future – NOW visits US communities using innovative approaches to create jobs and build prosperity.
Richard Wolff: “Capitalism Hits the Fan”,
Robert Reich: “The Next Economy and America’s Future”
G. William Domhoff: Wealth, Income and Power. This document on the website Who Rules America? presents details on the wealth and income distributions in the United States, and explains how to use these two distributions as power indicators.
Institute on Assets and Social Policy Research and Policy Brief, The Racial Wealth Gap Increases Fourfold. Assessing the wealth holdings of the same families for 23 years (1984-2007) shows that the wealth gap between whites and African Americans increased more than 4 times, from $20,000 in 1984 to $95,000 in 2003.
Podcast: Chris Hedges and Derrick Jensen on Totalitarianism and Resistance. What is it going to take for concerned and engaged citizens to finally feel as though some crucial threshold has been crossed—that our nation’s political system and the global corporate culture it both serves and feeds into will never represent them or serve their needs?
Information on the US health care reform law and its implementation: Kaiser Health Reform Source
Environment and health
Video: Filmmaker Josh Fox about “Gasland”, his Sundance award-winning documentary on the surprising consequences of natural gas drilling. Fox’s film — inspired when the gas company came to his hometown — alleges chronic illness, animal-killing toxic waste, disastrous explosions, and regulatory missteps.
The UN Environment Program provides a broader picture. See the statement from the Global Intergovernmental and Multi-stakeholder Consultation on the Fifth Global Environment Outlook held in Nairobi from 29-30 March 2010 at https://docs.google.com/viewer?url=http://www.unep.org/PDF/geo5/GEO-5_FinalStatement.pdf
Actually the discussion paper prepared by the Executive Director of the UN Environment Program for the Nairobi Consultation is also very useful. See in particular Annex 4. This annex works through the main areas of ‘the environment’ and identifies the key issues and the relevant international agreements. These main areas of ‘the environment’ are listed as: Air pollution and air quality; Biodiversity; Chemicals and waste; Climate change; Energy; Environmental governance; Forests; Freshwater; Oceans and seas; Soil, land use, land degradation and desertification.
Of course there are other ways of thinking about environmental quality and sustainability. Friends of the Earth International prioritizes the following areas in its environment work:
- Through our program on Climate Justice and Energy, we fight for justice for the communities affected by climate change and promote energy sovereignty, the right of communities to choose their own sustainable energy sources. We also advocate a strong agreement within the framework of the UN negotiations, a just agreement on climate finance and an end to deforestation, one of the biggest causes of climate change.
- Our Food Sovereignty Program aims to halt genetically modified organisms and corporate control of our food. We defend the right of people to determine their own food systems.
- In our Forest and Biodiversity Program, we campaign against illegal logging and deforestation, and work with communities and local people to uphold their rights to manage their forests. We also expose and oppose the negative impacts of monoculture plantations of crops such as, sugar cane, palm oil and soy, to produce agrofuels.
- Our program on Economic Justice – Resisting Neoliberalism challenges the current economic model by exposing and resisting corporate power and the new Global Europe strategy, while identifying and promoting initiatives that generate sustainable livelihoods.
- We defend the right to safe and clean water. We work with local communities to end the tragedies surrounding oil and gas extraction and mining. We inspire creative sustainable lifestyle choices by encouraging people to ‘Live More’. And finally, we stimulate gender equality and celebrate cultural diversity.
Work and Health
For the official perspective visit the International Labour Organisation and scan its coverage of different employment sectors. The international union organisations offer a different perspective again. See for example the International Federation of Chemical, Energy, Mine and General Workers’ Unions health and safety page.
Another approach to environmental activism is to focus on the role of transnational corporations. See the Corporate Watch health page. Or for a more systematic analysis of the role of transnational corporations see the Transnational Institute.
Globalisation and health
There are some useful references on the globalisation page. If you had to read just one reference it might be the report of the globalisation knowledge network of the WHO Commission on SDH.
Globalization101.org is an Internet resource offered by the Levin Institute, a graduate institute of international relations associated with the State University of New York, to promote a greater understanding of globalization.
The WHO website has a section on health systems has both basic information and detailed policies and reports.
How does the US health care system compare to those of 5 other capitalist democracies? Do they all really have single payer systems? (No!) See the webpage of the Frontline Documentary Sick Around the World. You can watch the full program and read/view supplemental materials.
ABSTRACT: This article addresses several issues pertinent to health systems governance for health equity.
Drawing on preliminary findings of a global research project on comprehensive primary health care, it discusses political aspects of progressive health system reform and the implications of equity-focused health system governance on health workers’ roles, noting the importance of health workers claiming their identity as citizens. The article concludes with a commentary on the inherently political nature of health reforms based on equity; the necessary confrontation with power relations politics involves; and the health systems governance challenge of managing competing health discourses of efficiency and results-based financing, on the one hand, and equity and citizen empowerment, on the other.
Health systems policy: global forces
During the worst years of the debt crisis the IMF structural reform packages caused great damage to health systems through reduced funding and supplies, frozen salaries and increasing user fees. In the early 1990s the World Bank entered this field of health policy in support of the IMF. Rather than simply starving health systems the WB model claimed to be ‘reforming’ health systems; hence the rise of the slogan of ‘health sector reform’.
Health sector reform is the focus of one of the political economy pages of the IPHU library. See also the page on health care financing.
Video: Rick Rowden Presents New Book on IMF, Health & AIDS
Development assistance and health
The IPHU Library section on Development Assistance and Health includes some key ideas and useful references.
Wendy Johnson’s 11minuteTEDxRainier talk A New Paradigm for Global Health: Solidarity
Trade and health
See the Trade and Health page of the IPHU Library
See Wikipedia on the Generalised System of Preferences
See Wikipedia on the Lome Conventions and the Cotonou Agreement
See Wikipedia on the Economic Partnership Agreements
Working across difference
See Working across Difference in IPHU Library
Meaning and spirit
See Meaning and Spirit in the IPHU Library
Information and communications technology
See ICT page of the IPHU LIbrary
Research for social change
Research is a key element in the repertoire of the health activist. Among the research skills that can be useful in research are:
- identifying uncertainties which are limiting the development of strategy;
- working out how to resolve those uncertainties (how to undertake the research needed to resolve those uncertainties);
- searching the published literature to find what is known about the problems we are addressing; and
- critically reading the research studies.
Participatory action research is a powerful approach to researching our own practice. Action research is about learning from experience. The key difference is that action research involves documenting the stages of learning: planning, doing, evaluating and reflecting and further planning. Action research is systematic in documenting our plans and what happens so that we can be more systematic in learning from our practice. The participatory aspect of PAR is about working with the people whose health our projects are directed towards. PAR involves a partnership between the researchers and the people whose needs and whose practice are at the centre of the project or campaign.
See the Research page on the IPHU Library.
Declaration of Alma-Ata
International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September
The International Conference on Primary Health Care, meeting in Alma-Ata this twelfth day of September in the year Nineteen hundred and seventy-eight, expressing the need 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, hereby makes the following
The Conference strongly reaffirms that health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.
The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries.
Economic and social development, based on a New International Economic Order, is of basic importance to the fullest attainment of health for all and to the reduction of the gap between the health status of the developing and developed countries. The promotion and protection of the health of the people is essential to sustained economic and social development and contributes to a better quality of life and to world peace.
The people have the right and duty to participate individually and collectively in the planning and implementation of their health care.
Governments have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures. A main social target of governments, international organizations and the whole world community in the coming decades should be the attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. Primary health care is the key to attaining this target as part of development in the spirit of social justice.
Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self reliance and self-determination. It forms an integral part both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.
Primary health care:
1. reflects and evolves from the economic conditions and sociocultural and political characteristics of the country and its communities and is based on the application of the relevant results of social, biomedical and health services research and public health experience;
2. addresses the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly;
3. includes at least: education concerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs;
4. involves, in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communications and other sectors; and demands the coordinated efforts of all those sectors;
5. requires and promotes maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care, making fullest use of local, national and other available resources; and to this end develops through appropriate education the ability of communities to participate;
6. should be sustained by integrated, functional and mutually supportive referral systems, leading to the progressive improvement of comprehensive health care for all, and giving priority to those most in need; 7. relies, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community.
All governments should formulate national policies, strategies and plans of action to launch and sustain primary health care as part of a comprehensive national health system and in coordination with other sectors. To this end, it will be necessary to exercise political will, to mobilize the country’s resources and to use available external resources rationally.
All countries should cooperate in a spirit of partnership and service to ensure primary health care for all people since the attainment of health by people in any one country directly concerns and benefits every other country. In this context the joint WHO/UNICEF report on primary health care constitutes a solid basis for the further development and operation of primary health care throughout the world.
An acceptable level of health for all the people of the world by the year 2000 can be attained through a fuller and better use of the world’s resources, a considerable part of which is now spent on armaments and military conflicts. A genuine policy of independence, peace, détente and disarmament could and should release additional resources that could well be devoted to peaceful aims and in particular to the acceleration of social and economic development of which primary health care, as an essential part, should be allotted its proper share.
The International Conference on Primary Health Care calls for urgent and effective national and international action to develop and implement primary health care throughout the world and particularly in developing countries in a spirit of technical cooperation and in keeping with a New International Economic Order. It urges governments, WHO and UNICEF, and other international organizations, as well as multilateral and bilateral agencies, nongovernmental organizations, funding agencies, all health workers and the whole world community to support national and international commitment to primary health care and to channel increased technical and financial support to it, particularly in developing countries.
The Conference calls on all the aforementioned to collaborate in introducing, developing and maintaining primary health care in accordance with the spirit and content of this Declaration