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I have a confession. Sometimes I get discouraged. I, like many of you health promoters and activists here at this Assembly, have spent most of my adult life living and working in marginalized communities. On the positive side, I have taken part in initiatives where disadvantaged people, empowered through a process of "discovery-based learning," have analyzed the causes of their hardships and ill health, and have taken action to improve their situation. I have wept with them at their losses, and have joined in celebrating their achievements. In this process, as in all community endeavors, we have had our high points and low points. And, for a number of years, we were indeed optimistic. The overall situation of disadvantaged people really seemed to be improving.

But, unfortunately, those times have changed. As we have heard through many testimonials at this Assembly, in recent years a lot of the earlier gains in people's well-being are steadily being eroded. These reversals are harder to combat because they are not caused by local events that a single community or nation can come to grips with. Rather they have their roots in distant but overarching policies mandated by decision-makers at the transnational or global level. In the face of such sweeping yet inaccessible forces, local communities and their health workers too often feel disempowered.

Gains and Reversals of Health in Mexico: the impact of NAFTA

On this note, I would like to share with you a bit of my own experience in Mexico. There is an old saying, "Poor Mexico, so far from God and so close to the United States." For over 3 decades I have worked with poor farming families in Mexico's western mountains range. As many of you have seen in your own countries, the history of community-based experiences in Mexico has been one of early advances followed by disheartening reversals. From the 1960s to the 1980s, the villagers' collective struggle for health led to measurable improvements. Under-fives child mortality dropped from one-in-three to about one-in-20. Far fewer children were malnourished. Fewer mothers died in childbirth. In many ways people's quality of life improved, as did their self-confidence in their ability to change their world.

Important to these achievements during those early years, the villager-run health program evolved through 3 phases:

-- The first phase focused on Curative Care: the immediate felt need of mothers with sick and dying children.

-- The second phase focused on Prevention. People observed that common maladies like diarrhea, worms, and scabies kept coming back again and again, so they took action to prevent them. Measures ranged from water systems and latrines to immunization and community gardens.

-- The 3rd phase focused on Sociopolitical Action. Village health workers helped people analyze the root causes of their health-related problems. They found such problems often arose from the ways in which the strong took advantage of the weak.

For example, a big cause of hunger and poor health had to do with land tenure and share cropping. These problems arose from the government's failure to respect its own laws. After the Mexican Revolution of 1910, in which the peasantry fought for "land and liberty," the new Constitution included potentially excellent agrarian reform laws intended to protect the rights of small farmers. However, due to institutionalized corruption, many wealthy ranchers kept title to their huge land holdings, which far exceeded the acreage legally permitted.

Hence many landless farmers became sharecroppers on rich people's land. In exchange, they had to give the landlord half their harvest. Therefore, despite their hard work, they seldom had enough food for their hungry families. So they had to borrow back part of their own crop. For every sack of grain they borrowed at planting time, they had to return three sacks at harvest time. Trapped by this usurious loan system, poor families became further impoverished by escalating debt.

To combat this deep-rooted exploitation, village health workers educated landless farmers about the Mexican Constitution. Demanding their constitutional rights, the peasants organized and began to invade the illegally large land holdings. As the peasant organization grew in numbers and strength, it successfully reclaimed over 50 percent of the illegally large holdings, which it divided among the poor.

The impact on health was impressive. If, in those days, you were to ask village mothers why fewer children died than in the past, they would tell you that the curative and preventive health services had helped a bit. They would insist, however, that the biggest reason for children's better health was the people's sociopolitical action. Redistributing land meant more food. More food meant better health. It was that simple.

The villagers had come to realize that the root causes of hunger and poor health are social and political. Although basic health services are essential, the overall health and quality of life of people in disadvantaged communities can only be improved through organized struggle for equal opportunities and equal rights.

During the late 1980s, despite growing hardships related to Mexico's huge debt, the peasant organization continued to invade and redistribute the unconstitutionally large land holdings. And health indicators continued to improve.

But in the early 90s, things began to change for the worse. The global reach of the neoliberal market system created a whole new level of obstacles. Foremost of these was NAFTA, the North American Free Trade Agreement, implemented in 1994. In preparation for NAFTA, the United States government required Mexico to change its Constitution and annul its agrarian reform laws. This was done so that big American agribusiness could buy up huge parcels of Mexican farmland to grow vegetables at slave wages, for export.

Thus NAFTA put an abrupt end to the peasants' redistribution of the large land holdings. If poor farmers continued the land invasions, rather than being proud citizens defending their constitutional rights, now they would be common criminals and treated as such.

Both in rural and urban Mexico, NAFTA has had distressing results, for the poor but also for the shrinking middle-class. As farmland has reverted to giant neocolonial plantations, more than 2 million Mexican peasants have left the countryside for the mushrooming city slums. With this mass urban influx of hungry people competing for jobs, real wages have dropped by 40 percent in the last six years. Since NAFTA began, the population living below the poverty line has increased from 47 to 53 percent. The percentage of malnourished children has also risen and diseases of squalor, like cholera, have reappeared. The numbers of homeless people and street children have skyrocketed. And so have crime, violence, and drug trafficking ...

Meanwhile, the rich get richer. Despite the deepening deprivation of its growing underclass, today Mexico has more billionaires per capita than any other nation. The country's extreme inequality has led to a rash of robbery and kidnaping, as impoverished young people with little hope for the future take an angry shortcut to redistribution of wealth. Their grandfathers fought a national revolution to achieve land and liberty, and won, at least for several decades. But now, much of what they fought for has been lost, thanks to the global economy. And the prospects of fighting the United States government and the global power structure seem far less hopeful. Kidnaping is a safer option.

For the people of a poor country to stand up against inequitable forces of today's global economy, the odds are overpowering. It would be like David trying to fight Goliath, when David's hands are tied behind his back and Goliath has nuclear arms. For this reason, to fight today's Goliaths, we need international grassroots coalitions! The People's Health Assembly is a ground-breaking step in this direction.

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