I dont think we can blame the increasing dominance of lifestyle approaches
on the Ottawa Charter.  To my mind, the Ottawa Charter served to hold back
the lifestyle surge.  I see the lifestyle surge as a by-product of the
growth of neo-liberal discourse -- reflecting the increasing power and
influence of international corporations and transnational capital -- with
its emphasis on the shrinking of the state, individualized approaches to
risk, and the unleashing of "market forces."

And I agree that the Bangkok Charter represents the completion of the
neo-liberal vision.

see below...

Dear all,

 Some additional points about the Bangkok charter for consideration by
Alison in NZ.  I am not mentioning the points others have made with which I
agree.

 1) Ottawa charter already introduced the idea of health as a resource
above (and instead of) Health as a Human Right.  This utilitarian concept
has been reinforced over past decades, esp. Sachs school in which health is
an input for capitalist production. Invest in health for growth. Health as
"capital". PHM would surely reject both. Health as a Human Right is an
absolute value needing no justification in terms of its contribution to
productivity/growth. (There is a certain amount of humbug in the "health as
a resource for society" plea. Keeping slaves or workers in appalling
conditions did not and does not always hinder profits. They were and are
extremely cheap. Early deaths and untreated disease matter little, there
are plenty more to exploit. And keeping whole communities on their knees
allows the rich and powerful to plunder in relative peace).

 2) Reinforce Ronald's point about neutral use of term globalization and
assumption that it is inevitable. The globalization that is being referred
to is a neoliberal, capitalist, corporate driven, neocolonial project.
There are powerful interests behind it. These are resisted because by and
large they harm the interests of popular majorities. This impossibly
dishonest "neutral" language (langue de bois) serves to disguise root
causes, major actors and interests - and conflicts between these. Perhaps
PHM would like to have the term internationalism in the charter: the
internationalization of rights and social justice. Nothing imposed from
above (the glob)! But support and solidarity between peoples, communities
and regions. The draft charter talks about an "increasingly interdependent
world". Again, glib and dishonest. Through corporate globalization", fatal
dependencies are deepened through the age-old patriarchal game of dominance
and submission.

 3) "Weakened government control over a growing number of health
determinants" 3rd section of charter. The myth of the weak state is
perpetuated. It is only weak today in terms of its responsibilities to the
people. The state is still extremely powerful and used to the full by TNCs.
If it were not, we would never have seen the aggression on Iraq and the
subsequent colonial takeover of the entire economy of a nation at the speed
of lightening.

 4) "Central importance of health for poverty reduction" (3rd section). The
reversal of public health history and logic. Health is not central for
poverty reduction. It plays a serious exacerbating role in existing
conditions of poverty which are determined by macroeconomic factors way
beyond the control of communities and even nations.

 5) On our partners for health. Let us once and for all talk about people
and not stakeholders. This language of financial investment again
reinforces the idea that life on earth exists to serve capitalist
production. As for active participation (2nd section), it is almost a
heresy but I'll say it anyway " Why the private sector". Why not the public
sector?  Why not people's movements and people's representatives?  Trade
unions should be there up front. Social justice political parties and
movements. Let us deconstruct these terms: the private sector means 3000
Chief Executive Officers of the world's most powerful economic entities
(TNCs). The public sector means not only all public sector workers
providing services but all recipients - millions and billions of really
existing people!

 6) The private sector is not a partner for global or national public
health policy. Partners share goals. We need various interactions with the
private sector who like any other actors in society are called on to
provide services for the general public good. Example: Companies
manufacturing plumbing equipment are not partners in formulating policy to
achieve the right to water! TNC influence in public policy making is
illegitimate.  Individual people employed in the private sector (or those
owning vast parts of it) have the same right of influence in health matters
- NO more No less - than any other citizen employed anywhere
else.  Furthermore, if they have a financial material interest in a health
matter, they should be excluded from discussions and policy formulation for
reasons of conflict of interest. (So I agree with others about removing
entirely paragraph on corporate practices and the need for partnerships).

 7) Political leadership etc (4th section).  These are emphatically NOT the
key ingredients of success. Many strong leaders do all the wrong things
with great force and with disastrous effects on people's health.  It is the
people's political power which is the key ingredient (and absent from this
document).

 8) "One world" myth behind this charter and much "new public health" talk
today.  "There is no us and them?"  This is empty, facile and misleading.
It is just like the "AIDS knows no boundaries" song. Africa and Asia have
epidemics which are incomparable to those affecting the rich countries (25%
and 0.1%). "Us and them" has never been more stark as inequalities
accelerate. (Ratio of richest to poorest 3:1 in 1900, 10:1 1960 and more
than 82 :1 in 1990s) This is not to deny that an ever larger group of
people (North and South) join the ranks of the excluded in both rich and
poor countries every day and that very soon (now?) the excluded will
revolt.

 Frankly, PHM might wish to start again and not bother tinkering with this
deeply flawed document. Certainly I cannot see PHM being able to endorse
many sections of it. But comment we must, I agree.

 Look forward to discussions, best to all, Alison Katz

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