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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
"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