Cuenca, Ecuador, 21 July 2005

Submission from the People’s Health Movement on The Fifth Draft, 24 June
2005, of the Bangkok Charter for Health Promotion

Thank you for the opportunity to comment on the draft Bangkok Charter. This
submission comes from the People's Health Movement (PHM) and is based on
email discussions between PHM members and supporters worldwide and
discussions held at the People´s Health Assembly 2 in Cuenca, Ecuador. The
People´s Health Movement is a worldwide coalition of people's
organisations, civil society organisations, NGOs, social activists, health
professionals, academics and researchers that endorse the People´s Charter
for Health (http://www.phmovement.org/charter/pch-index.html).

The PHM is strongly focused on the interests of the poor and the
marginalized and their struggle for health. The People´s Charter for Health
summarises our basic ethos about the struggle to achieve ¨health for all¨
as envisioned by the Declaration at Alma Ata. Our comments overall reflect
the discrepancies in focus and intent between the draft Bangkok Charter and
the People´s Charter for Health

We appreciate the work and expertise that has gone into developing the
draft Charter. We are supportive of the intent to address global issues
that have arisen since the Ottawa Charter was drafted in 1986. However, we
have concerns about many aspects of the draft and hope that our comments
will be taken constructively to inform the final draft to represent the
interests of those currently marginalised by the global obstacles to
¨health for all¨. We would thus like to make the following points:

1. We agree that health is a human right but would like to see this firmly
grounded by reference to Article 12 of the International Covenant on
Economic, Social and Cultural Rights, and more clearly articulated
throughout the document.

2. We see the reduction of inequalities between and within countries as a
fundamental aspect of health promotion and would like to see this
re-instated explicitly as a principle in the draft (in addition to
referring to social justice and health equity).

3. We believe that the increase in poverty and health inequalities since
the Ottawa Charter was drafted should be clearly identified.

4. We believe that the Ottawa Charter has been very important in the
development of health promotion and that it remains relevant today. We
would like to see a stronger endorsement of the Ottawa Charter and more
explicit identification that the Bangkok Charter will operate alongside it,
as opposed to replacing the Ottawa Charter.

5. We believe that the draft should explicitly identify the serious
negative forms and impacts of the processes that may be collectively termed
¨globalisation¨. Key elements of current globalisation such as
transnational property and land tenure concentration; large-scale social
exclusion, privatisation of public resources; and the loss of human rights
resulting from commodification should be identified due to the challenges
they pose to health.

6. We believe the draft should also identify that the current processes of
globalisation have reduced social and economic development prospects,
particularly for marginalised and impoverished peoples, and that they have
exacerbated health inequalities. Whilst some members of developing
countries have benefited from globalisation, it is important that the
overall negative effect of current modes of globalisation on health is
noted.

7. We argue that any potential positive health effects of a ¨globalising
world¨ lie in adherence by all nations to internationalised rights and
obligations. The draft should therefore clearly endorse and align with
existing international human rights and environmental treaties, and
agreements such as the Framework Convention on Tobacco Control and the
Millennium Development Goals (MDGs). These treaties offer health promotion
potentially powerful frameworks which have the backing of international
law.

8. We are concerned that the draft charter is weaker than aforementioned
existing international human rights and environmental treaties, the MDGs
and other international agreements that promote health. If the draft is not
clearly aligned as above, there is the risk that it could be cynically used
by corporations, states and international finance institutions to claim
that their actions were “health promoting in accordance with the Bangkok
Charter” and thus avoid complying with stronger health promoting standards
set by the international treaties, agreements and MDGs. If this happened,
the Charter would facilitate the equivalent of “greenwash” and have a
negative effect.

9. We argue that the potential negative impacts on health of international
trade agreements should be identified and that rights which improve health
should be asserted as superordinate to the provisions of any such
agreements and incorporated as such within all bilateral, regional and
multilateral trade agreements.

10. We would like to see the endorsement of equity-focused health impact
assessment of trade agreements during their negotiation and the endorsement
of assistance from global bodies for poorer countries to undertake this.

11. We reject that the importance of health is for poverty reduction.
Rather, the relationship is in the opposite direction whereby the
importance of poverty reduction is for health.

12. We suggest several other strategies to make globalisation less negative
for health:
 · Trade agreements should be reformed to discriminate positively in favour
of economic development of low- and middle-income countries.
 · Debt owed by developing countries should be cancelled due to the
negative impact this transfer of wealth has on the health of the poor.
 · Economic conditionalities should be removed from debt cancellation,
development assistance or loans/grants from the international financial
institutions and other development banks.
 · Financial markets and international taxation systems should be
reorganised to ensure equitable cost-sharing of public programs and
infrastructures amongst all citizens and corporations.
 · All nations should immediately ratify, and agree on enforcement measures
for, the United Nations Convention on Corruption to reduce the negative
health effects of bribery and other forms of illegal or unethical practices
involving multinational corporations and governments.

13. We strongly advocate the re-instatement of the need to support
governments to work for peace in areas of conflict and minimise the health
impacts of war on peoples, given the enormous effect that war continues to
have on health.

14. We reject the encouragement given to public-private partnerships
throughout the draft. Such partnerships do not improve health, particularly
for the poor and marginalised peoples that are our focus. Instead they
contribute to the commodification of health. We do not believe that
advocacy of such partnerships is therefore consistent with health
promotion. All references to facilitation of such partnerships should be
removed.

15. We would add that a core responsibility of all governments is to
develop appropriate legal and regulatory frameworks to protect health from
commercial activity and promote appropriate, sustainable and health
promoting intersectoral collaborations

16. We strongly advocate the consideration of the health of indigenous
peoples in the draft. Currently, this is a serious omission. The Bangkok
Charter should aim to be of particular benefit to indigenous peoples given
the specific and grave health problems they face.

17. We believe that the draft could achieve this by aligning itself with
the 1999 World Health Organisation Declaration on the Health and Survival
of Indigenous Peoples, which called for action on the following:
 · Respect for all the rights of indigenous peoples as described in
international instruments and other treaties and agreements between
governments and indigenous peoples.
 · Recognition for indigenous peoples' concept of health andsurvival and
expressions of culture and knowledge.
 · Policies and programmes in capacity building, research, education,
rectifying the inequities and imbalances in globalisation; increased
resources; co-ordination between United Nations bodies; the participation
of indigenous peoples at all stages of policy development and
implementation; and constitutional, legislative and monitoring mechanisms.
 · Action on the broad determinants of the health and wellbeing of
indigenous peoples which include the effects of the loss of identity due to
removal from family and community, displacement and dispossession of lands,
resources and waters, and the destruction of languages and cultures; the
impact of environmental degradation; the need for sustainable development;
the need for participatory community development; and the effects of war
and conflict.

18. We believe that there should be consideration of labour rights in the
draft, and support for the need for governments and corporations to respect
such rights globally and nationally, including the ratification of
International Labour Organisation conventions.

Once more, thank you for the opportunity to make this submission and
contribute to the drafting process for the Bangkok Charter. We look forward
to the discussions at the 6th Global Conference on Health Promotion and the
final document.

The People´s Health Movement


People's Health Movement Secretariat (Global)
C/o Community Health Cell
# 367, "Srinivasa Nilaya", Jakkasandra I Main
I Block, Koramangala,
Bangalore- 560 034
India
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Telephone:   + 91-80 - 51280009 (Direct) or + 91-8