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