Shortcomings

Perhaps the greatest strengths of the People's Health Assembly were 1) building a sense of international solidarity, and 2) enabling a process of catharsis. People from disadvantaged groups around the globe had a unique chance to air their grievances...and did so with eloquence and passion.

But lamentation alone does not lead to liberation. Critical analysis, grass-roots organizing, and carefully planned strategic action do. Or at least they have a better chance of doing so.

Insufficient direction

Some of us feel that the biggest weakness of the PHA event in Bangladesh was its preordained lack of direction, in both content and facilitation. While most of us had a general sense of where we wanted to go, and an embryonic vision of the people- and environment-friendly social order, there wasn't enough strategic planning about how to get there, not enough unifying clarification of key issues nor a comprehensive analysis of causes. Each day there was a plethora of concurrent and sometimes competing sessions, full of sound and fury. But their significance was muted by lack of feedback to the plenary sessions. It was hard to get a sense of where the Assembly was going, or what actions we might take.

Increasingly during the Assembly, a number of concerned participants, as well as progressive journalists, approached the steering group with worries that the analytic process seemed spotty and disjointed. Their big questions were, "But where is all this leading?" and "Yes, but how do we get there?" While utopian goals and sweeping demands were endlessly repeated, relatively few practical suggestions were made for specific actions that individuals and organizations could take.

Too laissez-faire

One problem was balance. Although a set of carefully prepared background and issue papers had been written in advance of the Assembly, and although highly knowledgeable activists and even the authors of the papers were present and willing to contribute, little time was allotted in plenary sessions for analytic overview of the key issues or exploration of workable solutions.

In planning the Assembly's agenda it had been decided--rightly or wrongly--that it was more important to give lots of time for testimonials and input from those groups and participants who rarely have a chance to speak out. Indeed, we had argued strongly for giving plenty of time to their stories, ideas, and suggestions. But, in retrospect, perhaps the pendulum swung too far in the direction of laissez-faire.

Some interpret this dilemma within the PHA process as springing from ideological differences, in which the PHA planning group was divided into two camps: First there were those who feel that in a forum for change everyone should be free to speak out as she or he wishes. Those who are usually silenced should be given the first chance. The process should be open-ended. Free speech is the path to liberation. They are willing to sacrifice a degree of structure and studied analysis for the sake of full and equal participation. The second group believes in a degree of guidance, or facilitation with a certain sense of direction. People have the right to hear the views and learn from the analysis of those who are more fully informed of the issues at hand. Thus a public forum should not simply be a "free-for-all" but rather a well-planned educational process which can help guide people to come to realistic conclusions and formulate practical plans of action.

This is a strategic debate and there will be no easy answers. In today's world, perhaps more than ever, there can be no freedom without a strategy based upon thoughtfulness, responsibility, and collective action. However, for better or for worse, the People's Health Assembly was programed in a way that encouraged a lot of free expression of diverse experience and views. Unfortunately, it lacked sufficient facilitated direction--and unifying analysis--to carry it forward toward a workable plan of action. Although the last day was devoted to "The Way Forward," few people came away with a clear sense of what might be the next step that they or their groups could or should take. Speakers too often spoke in utopian generalities, such as, "We must stop the World Bank from putting corporate greed before human need," or "governments should regulate the health-endangering practices of the free market." But rarely did they give any practical suggestions of how to convert these dreams into reality. There were lots of slogans and applause, but too little sense of direction.

With this critique, however, we do not mean to imply that there were no excellent speakers. Indeed, many were superlative and their presentations deepened our understanding of important issues. Missing was an integrated framework tying the main issues and presentations together, to keep the discussion moving forward rationally.

Not sufficiently multi-sectoral

Another shortcoming of the PHA event was that it--in spite of our best intentions--was dominated by the health sector. Although we planners agreed and many speakers emphasized that "health is determined more by social, political, economic and environmental factors than by medical services or public health measures per se," important sectors other than health were inadequately represented.

Indeed, some golden opportunities were missed. For example, Vandana Shiva--one of the world's leading activists for environmental sustainability as it relates to social justice--had agreed to come to the Assembly. (She had been urged to do so by her sister, Dr. Mira Shiva, a member of the PHA steering group.) But because Vandana was not slated to speak at a plenary, she decided not to attend, rightly feeling she could make more of a contribution elsewhere.

For similar reasons the ground breaking NGO, Partners in Health, which had hoped to present its eye-opening evaluation of the World Bank's Year 2000 World Development Report on "Attacking Poverty," also decided not to attend the Assembly.

Also absent among the speakers at the PHA plenaries were leaders in the field of alternative economics, such as the International Forum on Globalization, and TOES (The Other Economic Summit). This is truly unfortunate. If the People's Health Assembly hopes to gain leverage in making the forces behind the global market more accountable to the world's people, it is imperative that the coalition it is trying to build embrace the full spectrum of sectors and movements that relate to human and environmental health and well-being.

Too much rabble rousing; not enough dialectical debate (Shouting down the World Bank)

An internal confrontation on the third day of the PHA threatened to bring the entire assembly to a screeching halt. Scheduled to speak was Richard Skolnik, Director of the World Bank's Regional Division of Health, Nutrition, and Population for Southern Asia. That morning, the Indian contingent at the PHA (more than 200 strong) decided to boycott the session. Although planners of the Assembly argued that they had invited Mr. Skolnik in hopes of an enlightening debate, the Indians were adamant that the World Bank had no place at the People's Assembly. The decision to invite the Bank, they said, had been made undemocratically by the planning committee, and it was the obligation of justice-seeking participants to protest it. The planning group suggested a middle ground. Fifteen minutes could be allotted before Mr. Skolnik was scheduled to speak. The planners could present their reasons why he had been invited. The Indians could present their grounds for his exclusion. Then the entire audience could decide by vote. This would permit a democratic decision about the inclusion of a woefully undemocratic institution.

But the possibilities for a middle ground solution were swept aside by Zafrullah Chowdhury, the Director of Gonashasthaya Kendra, who had personally promised Mr. Skolnik that he would be given a respectful, protest-free forum to debate the Bank's position. Consequently, when Mr. Skolnik rose to speak, the Indian contingent, spread out through the audience, stood up with jeers and placards of protest. Zafrullah jumped on the stage and shouted back. He tried to explain to the raging crowd that while the high-level summits of the World Bank fully merited demonstrative protests, and even civil disobedience, that it was uncalled for to obstruct a mutual opportunity for dialogue and debate. Even on the battlefield there is a place for a truce, or time-out, to explore the possibilities of a less bloody way forward.

The shouting match continued for about 15 minutes. Then it suddenly quieted down and the audience allowed the World Bank spokesman to speak. The point had been made.

For many of us, paradoxically, this World Bank session turned out to be one of the most pivotal and educational events at the PHA. Some of us learned more from it than from any other session in the 6-day Assembly. For example, to counter the arguments of the World Bank, the people's movements need to be much better informed and well-documented in what they say. Indeed, Mr. Skolnik made many excellent points, and cited numerous actions of the Bank's Health Division that appear strikingly similar to those advocated by the People's Health Charter. He stressed the importance of prevention, outreach to underserved areas, women's rights, provision of essential drugs, sustainability, and assurance that all people's basic health needs are equitably met. He gave examples of interventions where the World Bank has encouraged governments to invest more in primary health care than in costly tertiary care for the rich. A lot of what he said sounded disturbingly progressive. In fact, if we in the audience had not known the speaker was from the World Bank, we might have erred on the side of cheering rather than booing him--which of course everyone did.

It was not so much what Mr. Skolnik said, as what he carefully omitted saying, that revealed the wolf in sheep's clothing. While he stressed the importance of "reducing poverty" as key to approaching Health for All, he failed to mention how World Bank policies outside the health sector have helped to concentrate wealth in the hands of transnational corporations and to widen the gap between rich and poor. He skirted around the negative impact of the Bank's "structural adjustment policies" (SAPs) which--with their demand for privatization of medical care and cutbacks in public spending--have made it harder for poor people to get the health care they need. In short, it is not what the speaker said, but what he didn't say, that showed the Bank's true colors.

After Mr. Skolnik sat down, three well-known critics of the World Bank and IMF were given the floor, and each made illuminating or provocative points. The most cogent arguments exposing weaknesses and inconsistencies of the World Bank were presented by David Legge, an Australian and key player in the International People's Health Council. It was unfortunate that much of the substance of David's talk did not receive the same attention as the two other speakers who, though they too made some penetrating observations, tended to be more committed to oratory than substance. To their statements like, "The World Bank is an enemy of people! We must close them down!" the audience thundered jubilantly, "Down with the Bank!"

Language and communication

What was disturbing was that while some members of the audience were very tuned to the issues, others were more into applauding or hooting than careful listening. And sometimes they missed their cue. Sometimes they would clap when they should have gasped, and booed when they should have clapped. In terms of critical awareness (which is essential in the struggle for change,) we still have a way to go.

In fairness, part of the problem was language. The plenary sessions were entirely in English, and then the range of accents and locution was such that even listeners whose first language was English had a hard time understanding. The Latin American contingent got so frustrated at being "left out" that at one point they threatened to boycott the Assembly and to hold their own separate meeting instead.

It would have helped had the facilitators and speakers received guidelines in advance on basic methods of effective large-group communication. (David Werner had been invited to help lead a pre-conference session on this topic, but the invitation reached him so late that he had already a previous obligation. In the end, the session never took place.)

One method used to assist communication, especially for those with difficulty in English, was to use overhead projectors to show the script of key presentations on large screens. However, no guidelines had been given as to the size of print for projection. As a result, many scripts appeared in such small print that for much of the huge audience they were impossible to read.