A PEOPLE'S hEALTH qUIZ
(prepared by Claudio Schuftan)

DEEPEN OUR UNDERSTANDING OF THE PEOPLE'S HEALTH MOVEMENT
STUDY THE �People's Charter for Health'. *

(*: Available in over 40 languages; see www.phmovement.org)

Print off this page and ask yourselves the questions in red below (in italics and in brackets). Formulate your own definitions and explanations and think up examples that can illustrate each major point made in the text.  Discuss it with friends and colleagues.

Jot your answers in the margins and bring this annotated Charter to the IPHU Course and make sure that we clarify, develop and illustrate the Charter in the context of the Short Course.

PREAMBLE

Health is a social, economic and political issue and above all a fundamental human right. (Why? How?)

Inequality, poverty, exploitation, violence and injustice are at the root of ill-health and the deaths of poor and marginalised people. (Why? How? Since when?)

Health for all means that powerful interests have to be challenged, (Which? Where?) that globalisation has to be opposed (What is Globalisation? Why do we need to oppose it?), and that political and economic priorities have to be drastically changed. (Which? How? Working with whom?)

This Charter builds on perspectives of people whose voices have rarely been heard before, if at all. (Why? How come?) It encourages people to develop their own solutions and to hold accountable local authorities, national governments, international organisations and corporations. (What does holding accountable entail? Examples?)

Vision

Equity, ecologically-sustainable development and peace are at the heart of our vision of a better world � a world in which a healthy life for all is a reality; a world that respects, appreciates and celebrates all life and diversity; a world that enables the flowering of people's talents and abilities to enrich each other; a world in which people's voices guide the decisions that shape our lives. (What do all these terms mean? How are they linked?

What will it take to get there?)

There are more than enough resources to achieve this vision. (How is this true?  What is the evidence?)

The HEALTH Crisis  (How do we define it?)

�Illness and death every day anger us. Not because there are people who get sick or because there are people who die. We are angry because many illnesses and deaths have their roots in the economic and social policies that are imposed on us.� (�meaning we are angry about what exactly?)

(A voice from Central America)

In recent decades, economic changes world-wide have profoundly affected people's health and their access to health care and other social services. (Which changes are these?)

Despite unprecedented levels of wealth in the world, poverty and hunger are increasing. (Can you give figures?) The gap between rich and poor nations has widened, as have inequalities within countries, between social classes, between men and women and between young and old.  (Can you define the new terms and give figures? How does one measure the gaps?)

A large proportion of the world's population still lacks access to food, education, safe drinking water, sanitation, shelter, land and its resources, employment and health care services. Discrimination continues to prevail. It affects both the occurrence of disease and access to health care. (Can you give figures? What do these high or low numbers tell us? How should one understand discrimination? How would you explain the issues in �unequal access to health care'?)

The planet's natural resources are being depleted at an alarming rate. (Can you give examples?) The resulting degradation of the environment threatens everyone's health, especially the health of the poor. (Why? How?) There has been an upsurge of new conflicts while weapons of mass destruction still pose a grave threat. (Can you give examples?)

The world's resources are increasingly concentrated in the hands of a few who strive to maximise their private profit. (How come? How is this happening? Why?) Neoliberal political and economic policies (Can you define?) are made by a small group of powerful governments (Who? Can you name some?), and by international institutions such as the World Bank, the International Monetary Fund and the World Trade Organisation. (Which policies? How do they set these policies?) These policies, together with the unregulated activities of transnational corporations (What does this mean?), have had severe effects on the lives and livelihoods, health and well-being of people in both North and South. (Such as which effects in which countries?)

Public services are not fulfilling people's needs, not least because they have deteriorated as a result of cuts in governments' social budgets (Which are these?). Health services have become less accessible, more unevenly distributed and more inappropriate. (Can you explain and give examples?)

Privatisation threatens  to undermine access to health care still further and to compromise the essential principle of equity. (Can you define the new terms? Why? How?) The persistence of preventable ill health (Can you define and give examples?), the resurgence (Why resurging?) of diseases such as tuberculosis and malaria, and the emergence and spread of new diseases such as HIV/AIDS are a stark reminder of our world's lack of commitment to principles of equity and justice. (What is the global relevance of this?)

[Note how much we all (and the Charter) take(s) for granted that everybody understands, but do we all? This is NOT playing devil's advocate. It is mandatory we understand all this --inside out].

Principles of the People's Charter for Health

� The attainment of the highest possible level of health and well-being is a fundamental human right (Can you define?), regardless of a person's colour, ethnic background, religion, gender, age, abilities, sexual orientation or class. (What do you understand by this?)

�� The principles of universal, comprehensive Primary Health Care (PHC) (Can you define?),  envisioned in the 1978 Alma Ata Declaration (Can you briefly tell the story?), should be the basis for formulating policies related to health (Why? How?). Now more than ever (Why?) an equitable, participatory and intersectoral approach to health and health care is needed. (Can you define the new terms? What does this mean in practice?)

� Governments have a fundamental responsibility to ensure universal access to quality health care, education and other social services according to people's needs, not according to their ability to pay. (Why? Says who? What are the implications of this?)

� The participation of people and people's organisations is essential to the formulation, implementation and evaluation of all health and social policies and programmes. (Why? What happens if not? How do we get there?)

� Health is primarily determined by the political, economic, social and physical environment (Can you define? Why is it so determined? What are the links?) and should, along with equity and sustainable development, be a top priority in local, national and international policy-making. (Why? What are these levels in practice? To which of these levels do you have access to?)

A CALL FOR ACTION

To combat the global health crisis (Can you define again?), we need to (Why really?) take action at all levels  --individual, community, national, regional and global (Can you give examples of these levels? Who are we talking about? How can they be reached?)--  and in all sectors. (Such as which?) The demands presented below provide a basis for action.

Health As A Human Right

Health is a reflection of a society's commitment to equity and justice .(Why? How?) Health and human rights should prevail over economic and political concerns (Why? Meaning what in practice?)

This Charter calls on people of the world to:

� Support all attempts to implement the right to health. (What are the ways in which this can be done? What do you have to do about this?)

� Demand (How does one do that?) that governments and international organisations reformulate, implement and enforce policies and practices which respect the right to health (Can you define it?) (How can one contact them? Who will you contact them?)

� Build broad-based popular movements (Meaning what? How does one do that?) to pressure governments to incorporate health and human rights into national constitutions and legislation. (Can you give examples of possible pressures? Things like what are to be incorporated?)

� Fight the exploitation of people's health needs for purposes of profit. (Who does this terrible thing? How do you fight this? How do you involve people in this?)

Tackling the broader determinants of health

Economic challenges (Can you give examples?)

The economy has a profound influence on people's health. (How? How profound?) Economic policies that prioritise equity, health and social well-being can improve the health of the people as well as the economy. (Which are these? How do they ultimately affect health?�and the economy?)

Political, financial, agricultural and industrial policies (Such as which?) which respond primarily to capitalist needs (Can you define. Which are these?), imposed by national governments and international organisations (Which?), alienate (What does  this mean?) people from their lives and livelihoods (Can you define the latter?). The processes of economic globalisation and liberalisation (Can you define?) have increased inequalities between and within nations. (How? What are the links?)

Many countries of the world and especially the most powerful ones (Can you name them?) are using their resources, including economic sanctions (Can you define them?) and military interventions, to consolidate and expand their positions, with devastating effects on people's lives. (Can you give examples?)

This Charter calls on people of the world to:

� Demand radical transformation (Can you define? How different from a non-radical transformation?) of the World Trade Organisation (What and how much can you say about WTO?) and the global trading system (Being what exactly?) so that it ceases to violate social, environmental, economic and health rights of people (Can you explain this?) and begins to discriminate positively (meaning what?)in favour of countries of the South (Who are these? Why are they called so?). In order to protect public health, such transformation must include intellectual property regimes (What is this?) such as patents and the Trade Related aspects of Intellectual Property Rights (TRIPS) agreement. (Can you explain most of this here?)

� Demand the cancellation of Third World debt. (What would be involved here?)

� Demand radical transformation of the World Bank and International Monetary Fund so that these institutions reflect and actively promote the rights and interests of developing countries. (What does this mean in practice? How can we make the transformations reflect those rights? What concretely are we proposing to demand?)

- Demand effective regulation to ensure that TNCs (Can you define?) do not have negative effects (Such as?) on people's health, exploit their workforce (Meaning what?), degrade the environment or impinge on national sovereignty (Meaning what? Can you define). What are we concretely proposing to demand?)

- Ensure that governments implement agricultural policies attuned to people's needs (which are these?) and not to the demands of the market, thereby guaranteeing food security and equitable access to food (Can you define?). (How do we ensure this? What does �attuned' mean in practice?)

- Demand that national governments act to protect public health rights in intellectual property laws. (Which are these? Can you give examples? What are we concretely proposing to demand?)

� Demand the control and taxation of speculative international capital flows (What are these?). (Why do we demand this? What does this mean? How does it affect health? What are we concretely proposing to demand?)

� Insist that all economic policies (Such as?) be subject to health, equity, gender and environmental impact assessments (Can you define?) and include enforceable regulatory measures (such as?) to ensure compliance (How?). (Insisting means what?)

� Challenge growth-centred economic theories (Which are these?) and replace them with alternatives (Such as?) that create humane and sustainable societies (What do societies like this look like?). Economic theories should recognise environmental constraints, the fundamental importance of equity and health, and the contribution of unpaid labour, especially the unrecognised work of women. (Can you explain all this and how they are linked to each other and to health?)

Social and political challenges (Can you define?)

Comprehensive social policies (Like which ones?) have positive effects on people's lives and livelihoods. (How?)  Economic globalisation and privatisation (Can you define?) have profoundly disrupted communities, families and cultures. (How? Since when? Why?) Women are essential to sustaining the social fabric of societies everywhere (How come?), yet their basic needs (defined as�)are often ignored or denied, and their rights violated. (How come? By whom?)

Public institutions (Which?) have been undermined and weakened. (By whom? How? Since when?) Many of their responsibilities (Such as which?) have been transferred to the private sector, particularly corporations, or to other national and international institutions (Why? By whom?), which are rarely accountable to the people. (Why? How do they get away with it?) Furthermore, the power of political parties and trade unions has been severely curtailed (Why? How come? By whom?), while conservative and fundamentalist forces (defined as�) are on the rise. (Why? Since when? Where?) Participatory democracy (defined as�) in political organisations and civic structures (defined as�)should thrive. There is an urgent need to foster and ensure transparency and accountability. (Can you define? Why the urgency now?)

This Charter calls on people of the world to:

� Demand and support the development and implementation of comprehensive social policies (Such as?) with full participation of people. (How do we make them participate? What are we concretely proposing to demand?)

�  Ensure that all women and all men have equal rights to work, livelihoods, to freedom of expression, to political participation, to exercise religious choice, to education and to freedom from violence. (How do we ensure this? What do you have to do about this?)

�  Pressure governments to introduce and enforce legislation to protect and promote the physical, mental and spiritual health and human rights of marginalised groups. (Is there such a legislation? Where can you find it? What do you ask the government to introduce? How do you tell the government to enforce? How does one �pressure'?)

� Demand that education and health are placed at the top of the political agenda (Where is the top? Where do you find the political agenda?). This calls for free and compulsory quality education for all children and adults, particularly girl children and women, and for quality early childhood education and care. (What are we concretely proposing to demand? To be done how?)

� Demand that the activities of public institutions, such as child care services, food distribution systems, and housing provisions, benefit the health of individuals and communities. (How do all these benefit health? What are we concretely proposing to demand? What do we mean by �benefit'?)

� Condemn and seek the reversal of any policies, which result in the forced displacement of people from their lands, homes or jobs. (How do you know which ones these are? Who do you ask? How do you �condemn'? Do you ask the media to work with you?)

� Oppose fundamentalist forces (Which are these?) that threaten the rights and liberties of individuals (Such as which?), particularly the lives of women, children and minorities. (How do you oppose them?)

� Oppose sex tourism and the global traffic of women and children. (How do you know this is a problem where you live?  Who do you ask? How do you do this?)

Environmental challenges (defined as�)

Water and air pollution, rapid climate change, ozone layer depletion (Can you explain this?), nuclear energy and waste, toxic chemicals (defined as�) and pesticides, loss of biodiversity (defined as�), deforestation and soil erosion have far-reaching effects on people's health. (Why? How?) The root causes of this destruction include the unsustainable exploitation of natural resources (Meaning what?), the absence of a long-term holistic vision (Of what?), the spread of individualistic and profit-maximising behaviours (Of whom? Why?), and over-consumption by the rich (Can you explain?). This destruction must be confronted and reversed immediately and effectively. (How? Can you give examples?)

This Charter calls on people of the world to:

� Hold transnational and national corporations, public institutions and the military accountable for their destructive and hazardous activities that impact on the environment and people's health. (Can you give examples. How exactly do we hold them accountable?)

� Demand that all development projects be evaluated against health and environmental criteria (Such as which?) and that caution and restraint be applied whenever technologies or policies pose potential threats to health and the environment (the precautionary principle (defined as�). (What are we concretely proposing to demand?)

� Demand that governments rapidly commit themselves (How does a government commit itself�for example?) to reductions of greenhouse gases (Can you define and say why these are bad?) from their own territories far stricter than those set out in the international climate change agreement (Can you explain what was discussed at the Kyoto Conference?), without resorting to hazardous or inappropriate technologies and practices (Such as?).  (What are we concretely proposing to demand?)

�  Oppose the shifting of hazardous industries and toxic and radioactive waste to poorer countries and marginalised communities and encourage solutions that minimise waste production (Which are these?). (What do we do to oppose this?)

�  Reduce over-consumption and non-sustainable lifestyles (defined as�) � both in the North (Which countries?) and the South. (What tactics do we use to convince the affluent?) Pressure wealthy industrialised countries to reduce their consumption (Of what exactly?) and pollution by 90 per cent. (Why 90% and not 80?)  How do we put pressure?)

- Demand measures to ensure occupational health and safety, including worker-centred monitoring of working conditions (What exactly is this?). (What are we concretely proposing to demand? What role for employers, what role for employees?)

- Demand measures to prevent accidents and injuries in the workplace, the community and in homes. (How do we do this? What are we concretely proposing to demand?)

 - Reject patents (What exactly are these? How do they affect the poor countries?) on life and oppose bio-piracy (defined as�) of traditional and indigenous knowledge and resources. (Can you explain all this?)

� Develop people-centred, community-based indicators (What does this mean?) of environmental and social progress (How defined and measured?), and to press for the development and adoption of regular audits (Can you explain?) that measure environmental degradation and the health status of the population. (Measured how? What is the link? How do we press?)

War, violence, internal conflict and natural disasters (Can you define these three?)

War, violence, conflict and natural disasters devastate communities and destroy human dignity. (How?) They have a severe impact on the physical and mental health of their members, especially women and children. Increased arms procurement and an aggressive and corrupt international arms trade (Can you explain this trade and who is behind it?)undermine social, political and economic stability (Defined how?) and the allocation of resources to the social sector (Which includes what?).

This Charter calls on people of the world to:

� Support campaigns and movements for peace and disarmament. (Where do we find these? How do we support?)

- Support campaigns against aggression (How do we do this?), and the research, production, testing and use of weapons of mass destruction and other arms, including all types of landmines. (Where and how do we find these manufacturers and testers/users? Who do we support? By doing what?)

� Support people's initiatives (How are these different? Where can we find them?) to achieve a just and lasting peace, especially in countries with experiences of civil war and genocide (Like which?). (How do we get in touch with them? What do we offer them?)

� Condemn the use of child soldiers, and the abuse and rape, torture and killing of women and children. (Can you explain all these?). (What does it mean practically for us to condemn?)

- Demand the end of occupation as one of the most destructive tools to human dignity. (By doing more exactly what types of actions?)

- Oppose the militarisation of humanitarian relief interventions (Can you give examples?).  (What are we concretely opposing and how do we go about it?)

� Demand the radical transformation (Do you know what this means?) of the UN Security Council (Can you explain what this is and why it needs reforming?) so that it functions democratically (Is it not democratic? Why? Can you explain what �veto power' means?). (What are we concretely proposing to demand?)

 - Demand that the United Nations and individual states (the US? UK?) end all kinds of sanctions (What are these?) used as an instrument of aggression which can damage the health of civilian populations (How do they damage health? What are the links?). (What are we concretely proposing to demand?)

� Encourage independent, people-based initiatives (Such as?) to declare neighbourhoods, communities and cities areas of peace and zones free of weapons.  (What are we concretely proposing to encourage? How does one �declare'?)

� Support actions and campaigns (Of whom? Where do we find them?) for the prevention and reduction of aggressive and violent behaviour (Against whom?), especially in men, and the fostering of peaceful coexistence (Among whom?) (Can you explain more?)

� Support actions and campaigns (Of whom? To be found where?) for the prevention of natural disasters and the reduction of subsequent human suffering. (How more exactly do we do this?)

A PEOPLE-Centered HEALTH SECTOR

This Charter calls for the provision of universal and comprehensive primary health care (Can you define and give the  background?), irrespective of people's ability to pay (Why irrespective?). Health services must be democratic and accountable (Meaning exactly what?) with sufficient resources to achieve this. (How much is sufficient (or what is in sufficient)?)

This Charter calls on people of the world to:

-  Oppose international and national policies that privatise health care and turn it into a commodity (What is a commodity?). (Where do you find these policies? How do you  oppose them?)

� Demand that governments promote, finance and provide comprehensive Primary Health Care as the most effective way of addressing health problems and organising public health services (Why the most effective? What are examples of less effective?) so as to ensure free and universal access (Can you define this concept?).  (What are we concretely proposing to demand?)

- Pressure governments to adopt, implement and enforce national health and drug policies. (Such as?) (What exactly are these supposed to call for?  How will they help? How do we pressure?)

- Demand that governments oppose the privatisation of public health services (Why? Those who can pay should pay?) and ensure effective regulation (What would be in-effective?) of the private medical sector (Why is this needed? Don't they regulate themselves?), including charitable and NGO medical services (Who are these? Cab you give examples? What are we concretely proposing to demand?)

- Demand a radical transformation of the World Health Organization (WHO) so that it responds to health challenges in a manner which benefits the poor (Is it not doing so already?), avoids vertical approaches(what are these?), ensures intersectoral work (Meaning what?), involves people's organisations (Such as who other than PHM?) in the World Health Assembly (What is this?), and ensures independence from corporate interests (What are these? Do we mean these are influencing WHO? How? Who? When?). (What are we concretely proposing to demand? How do we do this?  An we aim so high?)

� Promote, support and engage in actions (Such as?) that encourage people's power and control (What is this? How does it manifest itself?) in decision-making in health at all levels (Such as?), including patient and consumer rights (What are these?). (How does one promote all these?)

� Support, recognise and promote traditional and holistic healing systems (defined as�) and practitioners and their integration into Primary Health Care. (Why do we need to integrate them?)

� Demand changes in the training of health personnel (Why is this needed? What is happening with the current training?) so that they become more problem-oriented and practice-based (Is it not already?), understand better the impact of global issues (What are these? Can you give examples?) in their communities (How does the global affect their small communities?), and are encouraged to work with and respect the community and its diversities (Such as?). (What are we concretely proposing to demand?)

� Demystify (Meaning what?) medical and health technologies (Such as?) (including medicines) (Why?) and demand that they be subordinated to the health needs of the people. (What does �subordinate' mean?  How and why do we do this?)

� Demand that research in health, including genetic research (What is this?) and the development of medicines and reproductive technologies (What are these?), is carried out in a participatory, needs-based manner (What exactly are theses manners?) by accountable (Meaning what?) institutions (Such as?). It should be people- and public health-oriented (Meaning what?), respecting universal ethical principles (Which are these? Set by whom?). (What are we concretely proposing to demand?)

� Support people's rights (Which are these?) to reproductive and sexual self-determination (What is this?) and oppose all coercive (Defined as�) measures in population and family planning policies (Such as?). This support includes the right to the full range of safe and effective methods of fertility regulation. (We support and we oppose? What are you concretely expected to do?)

People's participation for a healthy world (defined as�)

Strong people's organisations (When are they strong?) and movements (What is the difference between organisation and movement?) are fundamental (Why?) to more democratic, transparent and accountable decision-making processes (How are they so fundamental? Nobody asks their opinion�much less let them co-decide!). It is essential (Why? Aren't the leaders with the donors going to make the changes?) that people's civil, political, economic, social and cultural rights (defined as�) are ensured. While governments have the primary responsibility (Why governments?) for promoting a more equitable approach (How is an equitable approach different?) to health and human rights, a wide range of civil society (Defined as�) groups and movements, and the media (Who are these?) have an important role to play in ensuring people's power and control in policy development and in the monitoring (Can you define and say who's responsibility it is?) of its implementation.

This Charter calls on people of the world to:

� Build and strengthen people's organisations (Such as?) to create a basis for analysis and action. (What are the elements of such a basis? How do you build it? With whom do you have to work?)

� Promote, support and engage (What is the difference among these three?) in actions (Such as?) that encourage people's involvement in decision-making in public services (Such as?) at all levels. (Such as?)

� Demand that people's organisations be represented in local, national and international for a (What is a forum?) that are relevant to health (Such as?). (What are we concretely proposing to demand?)

� Support local initiatives towards participatory democracy (Can you define? What other types of democracy are there?) through the establishment of people-centred solidarity networks (What are these?) across the world (North? South?).

The People's Health Assembly and the Charter

The idea of a People's Health Assembly (PHA) has been discussed for more than a decade. In 1998 a number of organisations launched the PHA process and started to plan a large international Assembly meeting, held in Bangladesh at the end of 2000. A range of pre- and post-Assembly activities were initiated including regional workshops, the collection of people's health-related stories and the drafting of a People's Charter for Health.

The present Charter builds upon the views of citizens and people's organisations from around the world, and was first approved and opened for endorsement at the Assembly meeting in Savar, Bangladesh, in December 2000.(Can you give a synoptic history?)

The Charter is an expression of our common concerns, our vision (And what beyond vision?  The Charter is now five years old: are visions enough?) of a better and healthier world, and of our calls for radical action (Such as?�and after calls, what? Is anybody responding to PHM's calls?) It is a tool for advocacy and a rallying point (And what beyond these?) around which a global health movement can gather (To do what?) and other (Why other?) networks and coalitions can be formed (Such as which ones would be needed?).

Claudio