Fourth People’s Health Assembly took place 15-19 November 2018 in Dhaka, Bangladesh

Civil society mobilization and policy dialogue for health equity and accountable national and global governance for health.

Concept Note

Let’s come together at the 4th People’s Health Assembly !

Civil society mobilization and policy dialogue for health equity and accountable national and global governance for health.

Background to the Assembly

We are faced today with a global health crisis that is characterized by inequities related to a range of social determinants of health and in access to health services within countries and between countries. In many regions of the world, health systems are poorly designed, under-resourced, and of poor quality, thereby contributing to unacceptable rates of morbidity and mortality. In large measure, the poor and the vulnerable are being pushed further to the margins due to pitifully inadequate measures to address the social determinants of health. They are also denied access to quality health services as a consequence of unfair economic structures and social conditions that lock people into poverty and ill-health. In recent years, austerity measures in both the global South and the North have further compromised access, often as a consequence of the dismantling of public services and the increasing reliance on private provision of healthcare. The achievement of universal and secure access to comprehensive healthcare services can be a reality only through the revitalization of comprehensive primary health care, as envisioned in the Alma-Ata Declaration of 1978. The People’s Charter for Health endorses the Alma Ata declaration, and affirms that health is a social, economic and political issue — but above all, a fundamental and inalienable human right.

Health and healthcare in different regions face additional challenges brought on by the effects of Climate Change and by the deteriorating social and political environment, such as the massive humanitarian crisis brought on by a rise in forced migrations. The promises held out by the Sustainable Development Goals need to be questioned given that these goals, many of them laudable, are proposed to be attained by the same neoliberal model of development and economic growth that has pushed the globe to the brink of multiple crises – social, political, ecological and economic.

Recent decades have witnessed major shifts in the global governance for health, which is currently characterized and shaped by multiple agencies and by multiple interest groups, most of them working independently of national governments or of intergovernmental agencies. An analysis of structures and dynamics of global decision-making reveals the dominance of entrenched power structures – through the agency of more powerful nations, the Bretton Woods institutions, private philanthropies and large transnational corporations –resulting in a democratic deficit in the structures and dynamics of global health. These power structures operate through the UN system, the Bretton Woods system and a plethora of global public private partnerships. They also operate directly through bilateral and regional trade agreements; through the operations of bilateral health-related assistance; and through direct advice and influence. In many respects, the regulatory, financing and policy outcomes of this system reflect an imbalance between the interests of a limited number of country governments and global institutions, many of them private, and the needs and priorities of a majority of the world’s population. Local and national policies are often captive to policies and decisions that are negotiated at global and regional levels. New actors, especially non-state actors such as private foundations, public-private partnerships, consultancy organizations play an increasingly important role in shaping polices at the global, as well as local and national levels, thereby making the task of holding institutions of health governance accountable, much more challenging.