A forgotten element of the Alma-Ata Declaration

Calling for a new international economic order

Von Thomas Schwarz

If you look at the title of my input, you might be a surprised to find a call for a New International Economic Order in the final declaration of a WHO conference on Primary Health Care, such as the one in Alma-Ata (Almaty) in 1978. And you might be surprised that I still refer to it, 40 years later.

Calling for a new international economic order

Präsentation von Thomas Schwarz am MMS Symposium 2018. Foto: Christoph Engeli / MMS

 

So what is the story?

The Alma-Ata call for New International Economic Order was a child of its time, issued within a specific geopolitical context, and with clear connotations. The inclusion of this call in the 1978 Alma-Ata Declaration marked, in a way, already the end of this time.

In the early 1970s, struggling with the “unfinished” decolonization and experiencing the devastating effects of the 1973 global oil crisis that exposed the vulnerability of the economies, the so-called “developing” countries called for a revision of the international economic system in their favour, replacing the Bretton Woods system, which had benefited the leading states that had created it after World War II.

Presentation by Thomas Schwarz at the MMS Symposium 2018  © Network Medicus Mundi Switzerland

 

The call for a New International Economic Order was taken up by the group of Non-Aligned Countries. It focused on all countries having a fair share of the benefit of the exploitation of the world’s and their own natural resources, and was initially even taken up by the UNGA who adopted, in 1974, a “Declaration on the Establishment of a New International Economic Order”, together with a Programme of Action and a Charter of Economic Rights and Duties of States. The introduction of the UNGA Declaration is still an inspiration:

“We, the Members of the United Nations, having convened a special session of the General Assembly to study for the first time the problems of raw materials and development, devoted to the consideration of the most important economic problems facing the world community, bearing in mind the spirit, purposes and principles of the Charter of the United Nations to promote the economic advancement and social progress of all peoples, solemnly proclaim our united determination to work urgently for the Establishment of a New International Economic Order based on equity, sovereign equality, interdependence, common interest and cooperation among all States, irrespective of their economic and social systems which shall correct inequalities and redress existing injustices, make it possible to eliminate the widening gap between the developed and the developing countries and ensure steadily accelerating economic and social development and peace and justice for present and future generations.”

“Declaration on the Establishment of a New International Economic Order”, UN General Assembly 1974

The more concrete key elements of the call for a New International Economic Order included:

  • The entitlement of developing countries to regulate and control the activities of multinational corporations operating within their territory, including the right to nationalize or expropriate foreign property on conditions favourable to them.
  • The review of international terms of trade to ensure stable, equitable, and remunerative prices for raw materials, generalized non-reciprocal and non-discriminatory tariff preferences, as well as transfer of technology to developing countries.
  • The call that economic and technical assistance shall be provided without any strings attached.


As you might imagine, virtually no part of the New International Economic Order was implemented. Quoting Wikipedia:

“Instead, from the 1980s onward, the Bretton Woods framework was replaced with the Washington Consensus and economic globalization on terms often described as neoliberal. The economic reach of multinational corporations, rather than being circumscribed, was expanded significantly. Trade in commodities shifted away from state-dominated cartels towards increasingly financialized markets. (...) The formation of the World Trade Organization and the proliferation of free trade agreements compelled the reduction of barriers to trade, generally on strictly reciprocal terms.”

So yes, before the current times of a “global political and economic disorder” with the deconstruction of the neoliberalist globalisation project for the benefit of rude national self-interest, a new global economic order was in fact established, but it was just the mirror opposite of the dream and call of the 1970s.

 

MMI colleagues Linda Mans and Itai Rusike at the Astana “flashmob”. Photo: MMI

 

The neglected element of the Alma-Ata Declaration

Unfortunately I have not been able to find a contemporary eyewitness nor documents to tell me how exactly the call for a New International Economic Order made it into the Declaration of Alma-Ata nor why it has been immediately forgotten, dropped or neglected afterwards, not even figuring in the formal conference report.

My hypothesis is that the two are interrelated: Pushed by non-aligned countries, the conference host USSR successfully demanded the inclusion of the reference to the New International Economic Order in the Declaration. But WHO, under the pressure of the “industrialized” countries, was not at ease with it, realizing that, if they include it in the Alma-Ata call for Comprehensive Primary Health Care (that was revolutionary as such and anyhow included action on social determinants of health), they would overburden the package, risking its blunt rejection.

So in the arena of global health policy, the call for a New International Economic Order was a lost case from the beginning, although there is nothing wrong with the related part of the Alma-Ata Declaration:

“The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries. Economic and social development, based on a New International Economic Order, is of basic importance to the fullest attainment of health for all and to the reduction of the gap between the health status of the developing and developed countries.”

Declaration of Alma-Ata, 1978

Independent of its weak or inexistent formal reception and implementation, the call for a New International Economic Order is one of these “great” slogans (such as “Health for All”) that have formed and inspired generations of global health activists. It has been taken up, for example, in the People's Charter for Health adopted by the first People’s Health Assembly in Savar, Bangladesh, in 2000. And it today remains a key reference for the People’s Health Movement.

The need to transform the economic order to improve access to health was again strongly framed with the report of the WHO Commission on Social Determinants of Health (2008) and later on in the Rio Declaration. To quote the report of the Commission:

“A toxic combination … of poor social policies and programmes, unfair economic arrangements, and bad politics … is responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible.”
WHO Commission on Social Determinants of Health (2008)

In fact, the task to transform the global economic order to address inequalities and enable countries to generate resources for decent health care and tackle the root causes of poor health remains as important and urgent today as it was 40 or 50 years ago.

  • We need to secure global common goods and to regulate global public “bads”, economic externalities that damage the living environment and drive poverty.
  • We need to redistribute the enormous wealth and capital available in the world ensuring essential public services and social protection.
  • We need to make sure that global economy is sustainable, regenerative and circular in nature as to remain within the ecological ceilings that planet earth provides while providing a dignified living for all.

 

The People’s Health Movement framed it in its response to the consultation on the Declaration for last month’s Astana Global Conference on Primary Health Care (the Alma-Ata Jubilee conference) as follows:

“The current global economic system has failed to satisfy the basic needs of much of humanity or to operate within the confines of environmental sustainability. The system is characterised by extreme inequality and poorly regulated markets, and dominated by the interests of a small rich minority in the corporate and financial sectors. If we want to achieve social goals such as health for all, and do so while simultaneously tackling climate change and achieving true environmental sustainability, then we need to redesign the global economic system to realise these aims.”

People’s Health Movement, 2018

And, at the Astana Conference itself, the MMI Network successfully submitted a proposal for a "café session" on "Calling for a New Global Economic Order - the forgotten element of the Alma-Ata Declaration". We convened a group of civil society colleagues for a powerful short flash-mob, providing reflections on economic justice, cooperation and solidarity as preconditions for Primary Health Care. Our session was expected to be a reminder and eye-opener that Primary Health Care cannot be just “organized” or left over to partnerships, but requires political, economic and social transformation beyond the health sector. Watch the video!

Flashmob at the Astana Primary Health Care Conference: „We call for a new global economic order!” Photo: MMI

 

Inspiration, desperation, or business as usual?

It was in the early 1990s when I read the Alma-Ata Declaration and its call for a New International Economic Order a first time, when I started to work as a Secretary of Medicus Mundi Switzerland and the Declaration was given to me as a Bible and compass for our work. Since then, I have been floating between inspiration and desperation:

If the transformation of the global economic (and political) system is a precondition to achieving health for all, and if we do a reality check, looking at who has the power, whose interests dominate national and global economic policies and practices: Is talking or dreaming about a revolution not just a hopeless case?

I am pretty sure that many in this room, here in Switzerland, still feel the same. In a “realistic” approach, and to overcome desperation, we tend to leave the “big question” besides. Instead of calling for a revolution, we try to do our job, in the place where we are, as good and decently as possible. You know what I mean:

-          We engage in health cooperation to relieve distress, poverty and need

-          We promote partnership and mutual accountability with the people and communities

-          We call for effective aid

-          We advocate at a national or international level for good governance and for the regulation of the private sector  

-          ...

Somehow in-between these poles, the MMI Network addressed some of the ambivalence of our own work in the field of international health cooperation in its discussion papers on Universal Health Coverage (2013) and on “Health Cooperation: Its relevance, legitimacy and effectiveness as a contribution to achieving universal access to health” (2016).

And I am happy that some of the “big” questions also found their way in a Manifesto of Medicus Mundi Switzerland launched at today’s conference.

As organisations active in public health, we know that, above and beyond individual aspects, it is the social, economic and environmental factors that determine whether or not someone falls ill. It is undisputed that the degree of inequality determines the state of a population’s health. Against this backdrop, we are aware that our own work can contribute to the perpetuation of injustice.

Nevertheless, we cannot, and will not, leave anyone alone in misery without help. However, we also realise that, in association with our partners here in Switzerland and around the world, we need to tackle and change the conditions that make people ill.

Manifesto of Medicus Mundi Switzerland, November 2018

 

Das Medicus Mundi Symposium 2018 im Pullmann Hotel Basel. Foto: Christoph Engeli / MMS

 

So what to take along?

If I still refer today to the Alma-Ata call for a New Global Economic Order, it is because I insist that the existing system of international aid and the associated charity and partnership narratives risks legitimising an unfair economic framework which prevents national self-determination and weakens the building of strong and people owned local health systems.

If I refer today to the Alma-Ata call for a New Global Economic Order, I do it as a reminder and eye-opener that PHC cannot be just “organized” or left over to partnerships, but requires transformation beyond the health sector. And it needs to be built on solidarity between people within and across nations and regions.

If I refer today to the Alma-Ata call for a New Global Economic Order and kindly ask you to consider aiming higher, addressing the root causes and not just treating the symptoms, I accept that some of you shake your heads, especially as you hear this from a well-established white old male Swiss middle-class bureaucrat...

Let me end with quoting the “2030 Agenda for Sustainable Development” adopted in September 2015 by the UN General Agenda - a current holistic vision of the political and societal transformation needed.

“We resolve, between now and 2030, to end poverty and hunger everywhere; to combat inequalities within and among countries; to build peaceful, just and inclusive societies; to protect human rights and promote gender equality and the empowerment of women and girls; and to ensure the lasting protection of the planet and its natural resources. We resolve also to create conditions for sustainable, inclusive and sustained economic growth, shared prosperity and decent work for all, taking into account different levels of national development and capacities.”

2030 Agenda for Sustainable Development, UN General Assembly 2015

Without discussing it further, it shall remind us that there is still a space for political will and action between dream, resignation and business as usual. Let us work on extending this space, even in the current times.

Thank you. 

References

 

Thomas Schwarz

Thomas Schwarz, is Executive Secretary of Medicus Mundi International – Network Health for All (MMI), a Network of organizations working in the field of international health cooperation and global health policy. MMI promotes access to health and health care as a fundamental human right (“Health for All”) and supports the efforts undertaken in this respect by its members. MMI is in official relations with the WHO and a member of various networks and partnerships including the People’s Health Movement and Beyond2015. Thomas Schwarz worked as director of the Network Medicus Mundi Switzerland for 11 years (1996-2007). He is a dedicated civil society networker and global health advocate, focusing over the last years on issues such as global health governance and the WHO reform and political and economic determinants of health and health systems.

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