Editorial by David Reggio, Santa Catarina, Brazil
April 2012 marked the International Forum on Universal Health Coverage in Mexico, May marked the Sixty-fifth World Health Assembly in Geneva, June bore witness to the G20 Summit chaired by the Mexican Presidency, and in that same month, the Rio+20 opened in Rio de Janeiro, a city which has been steeped in the narratives of social movements, collectives and the politics of health reform since the mid 1970s against what was then termed by the voices of CEBES (Centro Brasileiro de Estudos em Saúde), “the mercantilism of industry.” Rio de Janeiro, as other Brazilian states, is rooted in the struggle (luta) for social justice and human rights, and as a logical consequence to a (at times) thorny history, the Cúpula dos Povos (People’s Summit) opened on Flamengo beach, as a comparative measure to the Rio+20, boasting an attendance of 80,000. The Cúpula dos Povos, composed of 33 national networks ranging from the APIB (Articulation for the Indigenous Peoples of Brazil) to the AMB (Brazilian Women’s Organization), and from FNR (National Forum for Urban Reform) to CBJP (Brazilian Commission for Justice and Peace – CNBB), has an attendance rate difficult to imagine in other countries, and one that is difficult to ignore.
I remember Paulo Amarante, the prominent figure of the school of public health at the Oswaldo Cruz Foundation, emphasizing to me on several occasions that “it is not about integration but participation, because the collective voices of diverse areas of society […] form part of the social fabric which concerns families, clinicians, children, etc.” And thus, the final declaration issued by the People’s Summit noted, with similar and striking fervency to the 1970s: “The alternatives are in our people, our history, our customs, knowledge, practices and production systems […]The defense of public spaces in cities with democratic governance and popular participation, cooperative and inclusive economy, food sovereignty, a new paradigm of production, distribution and consumption, and the change of the energy matrix, are examples of real alternatives to the current urban agro-industrial system… [we] … reaffirm the urgency to distribute wealth, fight racism, and guarantee the rights to land, the city, the environment, water, education, culture, as well as the liberty of expression and the democratization of communication.”
Reading the final declaration, I remembered the enormous and at times risky efforts of the health professionals and postgraduate students of the 1970s, who passionately and collectively penned calls for change, edifying the health and social movements of the time (CEBES, MTSM) which constantly flagged “disproportions” and inequity. Back then, the issue was the increase of GDP and production at the cost of lessening wages, spiralling infant mortality, work-related accidents, pervasive “clientelism” in the hospitals as well as mercurial privatization strategies. The national picture today is very different from the Brazil of forty years ago, but the call for equity and new forms of solidarity and expression in health, culture and society remains strong.
In Brazil, the aims and goals of such events as the RIO+20, , resonate deep within national memory. The international deliberation of health, access, sustainability and human rights does not occur without touching upon the stock of sensitive, living memories. Health in Brazil is a social affair, necessitating the participation of social groups in policy building processes and research into innovative mechanisms that ensure the direct and indirect participation of citizens. Participation has been, for the best part of the last 40 years, a strategy of social democratization. This said, the diversity and impact of social movements in public health system design is something possibly unique to Brazil. Whilst Flamengo Beach witnessed 30,000 people on a daily basis articulating a collective voice for diversity, and environmental and social justice against what is now described by the Cúpula dos Povos as the “mercantilization of life” rather than the “mercantilization of industry”, the RIO+20 summit employed a shared vocabulary, such as: “sustainability”, “equity”, “poverty eradication”, “commitment”, “accountability”, “actors”, “inclusion”, “promotion”, “universal health coverage”, etc.
We have all read the final document, and there is no need to reiterate the goals. WHO Director General Margaret Chan recently expressed at the Pacific Health Summit that strategic innovation was the building block for paving the way forward. There is however, the question of striking the balance at the grass roots level. If the People’s Summit represented the voice of a wide group of people (and judging by the Twitter reactions to the Rio+20, NGO and public opinion, it very much did) and if the Rio+20 represented a concerted effort to re-affirm the commitments outlined in the Johannesburg Conference of 2002 and the Rio Declaration of 2011, then over the next decade we will see whether the balance can indeed be struck between social demand, legislative enterprise and policy design. It shall also become apparent whether the voices which make up the diversity of populations and their needs, as well as the concerns of the global community as a whole, can be heard and indeed participate in the process of structuring the future we want.
What we saw and heard at the Rio+20 in Copacobana, and the Cúpula dos Povos in Flamengo, was the mirrored necessity for dialogue between policy makers and social groups, between social process and public policy, as well as the symmetry between policy and practice.