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Around the world today there are literally hundreds of networks working for structural change. But there is need for greater interdisciplinary linkages.

Some activists devoted to alternative economics, the environment, or human rights and other fields make little effort to include the health sector, and some are downright suspicious of it. This is partly because, when they think of the health sector, they think of the mainstream Medical Establishment with its conservative doctors and pharmaceutical companies who profit shamelessly from poor people's ill health. Unfortunately, they have a point.

However, those of us here at the PHA know that there is another, far more progressive side to the health sector or public health sector a bit like the "theology of liberation" within the conservative church.

Historically, in the perennial struggle for change, it is important to remember that community-based health programs and health workers around the world have played a critical role in liberating their people from oppressive powers. There are many inspiring examples.

In Nicaragua under the dictatorship of Somoza, community health workers helped to organize people to defend their health and rights. Such community organization was branded as subversive and many health workersknown as "brigadistas de salud"were targeted by death squads. A lot of brigadistas went underground and became leaders in the Sandinista resistance. After the overthrow of Somoza, these brigadistas played a key role in designing the new health ministry. With the help of strong community involvement, extraordinary improvements in health were achievedif temporarily.

Similarly in El Salvador and Guatemala community health promoters played a central role in the struggle to replace tyrannical regimes with somewhat more representative governments.

In the Philippines a national network of Community Based Health Programs helped to educate and mobilize the population in what led to the massive peaceful uprising that overthrew the dictator Ferdinand Marcos.

Likewise, the popular health movement in South Africa played an important part in the struggle to overthrow apartheid.

While we are talking about struggles for health and liberation, we must not forget Gonashasthaya Kendra, where we are gathered together here in Bangladesh. As I am sure all of you are aware, G. K. was born out of the struggle to defend the health and rights of vulnerable people during the war for liberation. Of course, after the war, the struggle for liberation from unfair laws and an unhealthy class system continues. A great deal has been achieved, but sometimes with high human costs.

Several years ago one of G. K.'s outstanding health workers was assassinated by thugs for defending poor people's water rights against a cruel landholder. In the health worker's memory, Zafrullah Chowdhury wrote the following insightful declaration:

"Primary health care is generally only lacking when other rights are also being denied. Usually it is only lacking where the greed of some goes unchecked and unrecognized (or unacknowledged) as being the cause. Once primary health care is accepted as a human right, then the primary health worker becomes, first and foremost, a political figure, involved in the life of the community and its integrity. With a sensitivity to the villagers and the community as a whole, he will be better able to diagnose and prescribe. Basically, though, he will bring about the health that is the birthright of the community by facing the more comprehensive political problems of oppression and injustice, ignorance, apathy, and misguided goodwill."

In all of the above-mentioned countries -- Mexico, Nicaragua, El Salvador, Guatemala, the Philippines, South Africa, and Bangladesh -- organized efforts at the community level helped to achieve significant improvements in health. Unfortunately, in recent years, each of these countries has experienced stagnation of their health gains and deterioration in their standard of living. These reversals are largely rooted in the global power structure. In those countries where popular uprisings had replaced repressive regimes with governments that put human needs before corporate profits, the U.S. government forcefully intervened. It used everything from illegal embargos to mercenary "counter-revolutionaries" to destabilize those pro-people states and prove to the world that such popular governments were not viable alternatives. In the last decade or so, these progressive governments have had to compromise their egalitarian ideals in order to survive within the global economy. Contributing to their setbacks have been their escalating debt burden and structural adjustment policies, as well as trade accords that weaken their self-reliance, deplete their resources, and undermine their national sovereignty.

In view of these pernicious aspects of globalization, we can understand why the International People's Health Council (IPHC) declares that "The struggle for health is the struggle for liberation from poverty, exploitation, and unfair social-economic structures."

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