Some reflections on the Third People’s Health Assembly in Cape Town: A sharp alternative vision, but a Herculean task ahead to make this a better world

I’m just back from the third People’s Health assembly in Cape Town, and will try to give an account of my impressions there based on the plenaries, sessions and workshops I attended. In the coming days and weeks, a few blog posts will also be published on the INCO/GHI workshops in Cape Town, on HRH and accountability of Ngos in GHIs – stay tuned for that.

Around 800 hardened activists and progressive scientists (“activist” researchers, if you want) attended the Assembly. As it was my first visit to South-Africa (and even Africa in general), as well as my first PHM event, I mainly went as a humble observer. I have to say, the event was neatly organized, and the many volunteers did a great job.

The theme was ‘Health for all now’ – it’s not a coincidence that Universal Health Coverage didn’t feature in the title (see below). Yet, given the current momentum, obviously many discussions were held on the drive towards UHC. The discussions led to a ‘Call to action’ that was presented on the final day, and that will be finetuned in the coming weeks. The alternative vision in the document is very inspiring, and definitely not ‘pie-in-the-sky’ or ‘hot air’ – the last day’s version of the document was a nuanced and incisive piece of work. The PHM’s analysis of the current crisis of capitalism is correct, to a large extent, although perhaps a bit too ‘marxist’ at times – to get an idea, many speakers still addressed the participants as ‘Comrades’, and they routinely described globalization as ‘neoliberal globalization’. So there’s not much wrong with the analysis. The problem is: how do we create this different world that is so sorely needed? A blueprint for detailed policies is urgently needed which decision makers can then use the next time a crisis strikes, as this time, the only tools they had available to tackle the crisis were neoliberal ones (remark: obviously a big part of the current austerity policies is also ideologically driven, like in the UK or Canada).

The PHM’s call to action gives some reasonable suggestions, like the great need for communicating an alternative discourse, and setting up a large social movement, linking all progressive organisations and networks – networks can be established for example with activists working on extractive industries. But the task the PHM faces is Herculean, as becomes clear as soon as you open one of the glossy African magazines, full of stories on landgrabbing, fancy real estate projects for the upper-middle class on the edge of African big cities, etc. As some PHM activists acknowledge, capitalism is very, very resilient – and I would add to that, it also seems to fit human nature, to a great extent. But as David Legge said in one of the workshops, “the PHM is not about realism, or pragmatism, it’s about conceiving a different, better world”.  I do think though that even in this ideal world of social justice and health equity, we will need market mechanisms – see also my blog post  on the need to reconcile ‘buen vivir’ & ‘Pacha Mama’ and the green economy. Needless to say, not every PHM activist has the same opinion. Having said that, the PHA did put a lot of emphasis on (global and national) tax issues. Macro-economic policies should be determined by health provision, and not the other way around (as is the case now).

There were big groups from Africa (South-Africans obviously, but also plenty of others from East and West-Africa), Latin-America, India, some other Asians… – all with their own rhetorical style, accent of English (some “massacred” English, obviously) as well as their own way of chanting and dancing – the ‘toi toi’ of the South Africans was especially uplifting. A nice spin-off: it’s also great sports for the many obese African ladies.  The Latin-American participants were energizing and noisy too, as well as woolly – time management and Latin Americans do not go together. On the third day we also witnessed a strong Indian appeal from a bunch of Indian PHM activists – “Free us from…” (then listing a whole series of neoliberal crooks, including Monsanto, and, yes, also Bill Gates – the PHM is not very nuanced about Gates, to say the least). I agree in an ideal world the Gates foundation wouldn’t be necessary – he wouldn’t have all that money to hand out in the first place – but in this imperfect world I do see the benefits of a ‘division of labour’, whereby the PHM and other social movements argue for political change, and Gates does what he knows best – a business and technological approach. The track record of the Gates Foundation is mixed, and there’s much to be said about the sources of revenue or the enormous influence of the foundation on global health policy, I admit, but it’s nevertheless true that he does open doors, for example at the World Economic Forum in Davos (another event that wouldn’t be necessary in an ideal world, yes). What I want to say, Gates is not Koch.

The other Asians were somewhat less militant. Just like in Bangkok, at the UHC conference early this year, a (female) Thai presenter invited us to sing the lyrics of a cheesy song ‘we are the leaves on the trees…’. Not exactly the kind of song you’d expect at a radical PHM event. By the way, a lot of Spanish was spoken at the Assembly, but little French.

There were hardly any Americans or Chinese – the People’s Health Movement is obviously not strong in these countries, although there was of course huge competition from the Family Planning summit in London, the upcoming Aids conference in the US, holidays etc. But that doesn’t explain everything. Many Americans are probably a bit uncomfortable with the radical political stance and the ‘right to health’ campaigning of the PHM. As for the Chinese, well, they don’t really “do” social movements, and we all know why. I attended a session ‘Challenging the Empire’ which featured one of the rare Americans, an Occupy Oakland activist – his anarchistic and anti-capitalist stance, as well as the Occupy Oakland ‘Fuck the police’ mantra are not exactly in line with Harvard’s and Johns Hopkins’ global health discourse, to say the least. By the way, in his opinion, one of the key achievements of the Occupy Movement in the US, apart from raising class consciousness, has been to change the character of US activism for decades to come – from now on, it will be anti-capitalist.

It’s a gap though, the lack of Americans and Chinese, and one the PHM should try to fill in the coming years. By way of suggestion, perhaps it would be an idea to invite Melinda Gates on the next People’s Health Assembly – she seems less technology focused than her husband, after all.

But let’s highlight some of the things said during various plenaries, subplenaries and workshops I attended and which struck a chord with me for some reason.

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