Proposal for the Ancona Declaration, 2024 / European Network “Health is not for Sale” [ENG][FRA][ESP][ITA]

**European Network “Health is not for sale” within the Campaign “G7-Health: Not on my Body”, Ancona (Italy) Oct. 9-11, 2024**

International Session “Public Healthcare under commercialisation pressures: critical international perspectives”, Oct. 11, 2024, Cinema Azzurro, Via Tagliamento, 39 Ancona (Italy)

Proposal for the 2024 Ancona Declaration

“Healthcare and Public Health for All” (HPHA)

(October 2024)

The European Network “Health is not for Sale” and other organizations against healthcare privatization met in Ancona (Italy) to dispute the contents of the G7-Health meeting there on Oct. 9-11, 2024 and to challenge its governments’ commercial, neoliberal and reductionist approach to health.

An alternative, progressive, global call for action based on the universal right to an equal, solidaristic, humanitarian free healthcare to all people, independent on racial, religious, political, economic, social or any other status, is proposed and launched. In order to achieve this goal a Declaration has been constructed and proposed to the International Session “Public Healthcare under commercialisation pressures: critical international perspectives”, Oct. 11, 2024 at Cinema Azzurro, Via Tagliamento, 39 Ancona (Italy). The draft developed before the Meeting, distributed to the participants through email and other informatic means, has been posted on the Campaign website (https://nog7ancona.noblogs.org/). The Declaration, revised based on the contributions and comments received at maurizio.manno@unina.it with copy to nog7ancona@protonmail.com by Thursday, Oct. 10, 2024, has been endorsed by the “G7-Health: Not on my Body” General Assembly on Friday, Oct. 11, and re-posted on the website to be made available globally. The Declaration, supplemented by an additional item, the ninth, approved by the General Assembly on 11 October, will be updated regularly, based on input from the international community of healthcare and public health activists.

Introduction: The Public Health paradox

Huge developments have been achieved globally in recent years, in both molecular and clinical medical sciences, as well as in new drugs, remarkably performing diagnostic tools, lightfast communication and information technologies, and many others. Despite these, preventive action, diagnostics, therapeutics and healthcare in general has declined for the vast majority of the world population. In relative terms and, in many areas, even absolute terms. Access to primary care, in form of time, distance and services available, is limited or even lacking in many countries or regions of the world. Not to say about public health coverage, effectiveness and efficiency. Individual personal costs for healthcare are growing to a degree that even in rich or relatively wealthy countries a significant part of the population has increasingly to renounce to even basic cures. In high or upper-middle income countries, according to the WHO/World Bank classification, both those with insurance-based systems and those with a free public system, appear to be equally affected. Not to speak of lower-middle, or low, income countries where most people face severe deficiency and some total shortage of health facilities and services.

The reasons for the decline in healthcare are complex. Political instability, economic and social deprivation, constitutive weakness or progressive decline of public healthcare infrastructures are important causes in some countries. Low investments, poor compensation and motivation of the sanitary personnel, incompetence or private interest in short or long term healthcare and public health management are more relevant in others. Free-market health policies, particularly those for medicines, as shown in the recent Covid-19 pandemic, proved to be inadequate or even unable, if not accomplice, to cope with the emergency situation. Recently, the effects of the World Bank strategies on low-income countries and the results of the EU austerity on the European member states during the 2008 economic crisis, are probably the main factors leading to heavy cuts and commercialization of health services, resulting in the current, ever increasing privatization of structures and personnel. The aim, indeed, of a private health system, not service, is constitutively to achieve economic profit, while the aim of a public health service, not system, is or should be to provide free healthcare to the entire population. All these factors have created a vicious circle which increases inequalities and inefficiency in healthcare worldwide.

The goal of the present event is to discuss the main weaknesses and challenges for healthcare and public health globally today and, possibly, to identify proposals of actions for effective and sustainable solutions glocally. We also want to address the ethical bases and the practical sustainibility for ideal health systems strongly based on prevention, personalised healthcare, spare of public resources and respect of local communities and their human, cultural and social traditions. The conference intends to be systematic and universalistic in the analysis but, at the same time, pragmatic and concrete in its outcome. The conference message is constitutively censorious towards the contents of the G7-Health meeting to be held in Ancona 9-11 October 2024, as it considers the private-oriented, market-based and commercial approach of the G7 governments to healthcare and public health to be biased, substantially unethical and inadequate to promote a universal, equable, free healthcare and public health for all, in all conditions.

Purposes

The aim of this document is to verify the state of the art and the current opinion, among the various organizations in different parts of the world, on the status and progress achieved globally by healthcare and public health as a universal right to all everywhere. An international campaign will be set up to revise and promote the global diffusion of the Declaration as a mean to boost WHO in its effort to achieve, everywhere to everyone, the right to be healthy. The fundamental purposes if the Declaration, therefore, are, but not limited to, the following:

to reaffirm universal, equitable, free healthcare and public health as fundamental human rights for all, and to ask the UN to modify the art. 25 of the Universal Declaration of Human Rights (UDHR).
to boost WHO to take action towards governments and stakeholders for a stronger attention to the socio-economical determinants of health and to promote social justice globally, as a binding base for all WHO initiatives at any level.
To promote equity, democracy, effectiveness and impartiality in the legislation, management and evaluation of healthcare systems and services.

Proposed Declaration

The Assembly of the campaign “G7 Health: Not on my Body, including the activists of the European Network “Health is not for Sale” and the other organizations taking part in the initiatives in contrast with the G7 Health meeting held in Ancona, Italy, in October 9-11, 2024, is proposing for assessment and endorsement the following 9 points.

Healthcare and public health are a fundamental universal human right for all people, particularly the more vulnerables for age, gender, health status or other fragilities, and for all women who should have the right to control their own fertility and reproduction autonomously. These rights must be promoted, protected and guaranteed in all circumstances, including war and natural, economical or political disasters.
We stimulate WHO in promoting the implementation of the 17 goals of the 2030 Agenda for a sustainable development covering all social, environmental and economic determinants of health in both developed and developing countries, taking into account common objectives but also differential national and regional realities, capacities, levels of development and context, including sanitary resources and environmental catastrophes.
We want the governments to provide sufficient and fair public funding for healthcare in order to prevent shortage of health personnel and to guarantee the highest quality of care for patients and the best working conditions for healthcare professionals through an adequate and constant recruitment in order to protect the weakest countries from the escape of professionals to the richest.
We want that accessibility to healthcare be guaranteed to all individuals, including economic, geographic, cultural, temporal and logistic. We want national, regional and international pharmaceutical policies that serves the needs of all citizens and the South of the world, not those of “Big Pharma”.
We sustain public health systems and services, paid for by the people and working for the people, not for profit. We strongly support, therefore, local, national, regional and international policies that protect people and health workers from commercial drifts, profit-oriented management and financial managers.
An efford should be made globally at all levels to enforce democracy and democratic processes in healthcare and public health, through a constitutive participation to decisions of qualified patients’ representatives and healthcare workers’ unions.
An international consensus is called for in order to achieve an open, shared, and balanced handling of conflicts of interest in the administration and management of healthcare and public health, according to the highest etical and professional standards.
We strongly believe that, in order to achieve the goal of healthcare and public health for all, a costant pressure should be mantained on the activity of the goverments and of WHO to restore and update the democratic principles present in the updated 1978 Alma Ata Declaration.
We reaffirm for all health workers the right-duty, enshrined in the Hippocratic oath, to treat all patients, with equal scruples and commitment, regardless of any difference in race, religion, nationality, social status and political ideology, and we call for a halt to the genocide in Palestine and for the international community to be allowed to bring all necessary humanitarian aid to the civilian population exhausted by a year of war.

4. References

1. WHO website (Sept. 20, 2024)

WHO called to return to the Declaration of Alma-Ata

International conference on primary health care

The Alma-Ata Declaration of 1978 emerged as a major milestone of the twentieth century in the field of public health, and it identified primary health care as the key to the attainment of the goal of Health for All. The following are excerpts from the Declaration:

The Conference strongly reaffirms that health, which is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.
The existing gross inequality in the health status of the people, particularly between developed and developing countries as well as within countries, is politically, socially, and economically unacceptable and is, therefore, of common concern to all countries.
The people have a right and duty to participate individually and collectively in the planning and implementation of their health care.
Primary health care is essential health care based on practical, scientifically sound, and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. It forms an integral part both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family, and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first elements of a continuing health care process.
An acceptable level of health for all the people of the world by the year 2000 can be attained through a fuller and better use of the world’s resources, a considerable part of which is now spent on armaments and military conflicts. A genuine policy of independence, peace, détente, and disarmament could and should release additional resources that could well be devoted to peaceful aims and in particular to the acceleration of social and economic development of which primary health care, as an essential part, should be allotted its proper share.

Comment: Despite or, rather, because of the very high profile and ambition of the three-page, ten-point Alma Ata Declaration, its target, i.e. the achievement of an “acceptable level of health for all the people of the world by the year 2000” has fallen far before the expectations.

2. https://oldwp.phmovement.org/phm-declaration-at-8th-global-conference-on-health-promotion-2013-2 (Sept. 20, 2024)

PHM Declaration at 8th Global Conference on Health Promotion (2013)

July 4, 2019 by gargeya

Promoting Health for All and Social Justice in the Era of Global Capitalism

A call to action by the People’s Health Movement at the 8^th Global Conference on Health Promotion

Helsinki, Finland (14 June 2013)

Comment: Activists from the People’s Health Movement met during the WHO 8^th Global Conference on Health Promotion to critique the official Conference Statement and develop a progressive call for action based on strong social justice principles.

3. https://www.un.org/en/about-us/universal-declaration-of-human-rights (20 Sept. 2024)

Universal Declaration of Human Rights

Art. 25

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.(….)

[VERSION FRANÇAISE]

[VERSIÓN ESPAÑOL]

[VERSIONE ITALIANO]

International contributions

Content of the videos presented at the International Session “Public Healthcare under commercialisation pressures: critical international perspectives”, Oct. 11, 2024, Cinema Azzurro, Via Tagliamento, 39 Ancona (Italy)

The European Forum for Primary Care was initiated in 2005 by interested parties from several countries. The aim of the Forum is to improve the health of the European population by promoting a strong and high quality primary care. Maria is a Board member of the Forum and is presenting the current main activities and initiatives.
Public Services International (PSI) is a Global Union Federation of more than 700 trade unions representing 30 million workers in 154 countries. PSI interacts with the UN, ILO, WHO and other regional and global organisations in defending trade union and workers’ rights and in fighting for universal access to quality public services. Baba is responsible for the Health sector in PSI.
The White Tide (Marea Blanca) is a large movement born twelve years ago in Madrid and now expanded in all Spain. White Tide is organizing this year the one hundredth large national demonstration. Carmen is the speaker of the movement and will explain the experience of White Tide and the current situation concerning healthcare and the national Health Service in Spain.
The People’s Health movement (PHM) is a global network of networks of grassroots health activists, civil society organizations and academic institutions, particularly from low and middle income countries (L&MIC). PHM is present in around 70 countries and is working on various programmes on Primary Health Care, addressing the Social, Environmental and Economic Determinants of Health. Ana is a cochair of PHM and she is based in Croatia.
The People’s Health movement – India (PHM-India) is the regional branch of PHM in the Indian subcontinent. Dr. Abhay Shukla is a Public health physician, specialized in Community Medicine from the All India Institute of Medical Sciences, New Delhi. Abhay is a very active organizer of PHM-India and is presenting data on the current status of regional healthcare and public health in India, including the devastating economic impact of Covid on the population.
The final four short videos will discuss the growing difficulties of the Public Health Service in Italy, once one of the best in the world, and present the direct actions carried out by local, regional and national groups/organizations in defence of the healthcare system in four regions in Italy: Lombardy, Campania, Sicily and Veneto.