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Looking back at the Alma-Ata Jubilee conference (3/3)

Astana Global PHC Conference: Civil society café session on "Calling for a New Global Economic Order - the forgotten element of the Alma-Ata Declaration"

Astana Global PHC Conference: Civil society café session on "Calling for a New Global Economic Order - the forgotten element of the Alma-Ata Declaration"

Reacting to a call by the conference organizers, 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 herewith express our gratitude to our colleagues at People’s Health Movement, Community Working Group on Health, German Institute for Medical Mission, Wemos, Health Poverty Action, International Association for Hospice and Palliative Care, Bread for the World and Public Services International and others who contributed to making this session happen and our voices heard.

The following report by Thomas Schwarz, Medicus Mundi International Network, combines his personal assessments with input by (local and remote) participants and material jointly drafted as part of the concept note for the session.

See also his two other Astana blogs:


The call for a "New International Economic Order"

The call for a "New International Economic Order"

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.

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 Conference of Alma-Ata (1978) referred to the call for a New International Economic Order and included it in its final declaration. Unfortunately we have not been able to find a contemporary eyewitness nor documents to tell us 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.

Independent of its weak or inexistent formal reception and implementation, this call remained, such as the whole declaration, one of the great slogans (such as “Health for All”) that have formed and inspired generations of global health activists.

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.

In its response to the consultation of the Astana Declaration, the People’s Health Movement framed the continued challenge 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.” Other civil society organizations expressed the same concern.

Quoting the proposal for the café session: “We reiterate this call for a new global economic order (NGEO) to facilitate a safe and just space for humanity. This NGEO would be a means for securing global common goods. The NGEO would guarantee a social foundation for all while at the same time safeguarding an ecological ceiling so that planetary boundaries are respected. This embedded economy would follow a human rights based approach. It would regulate global public “bads”, economic externalities that damage the living environment and drive poverty. It would redistribute the enormous wealth and capital available in the world ensuring essential public services and social protection. The NGEO would be regenerative and circular in nature as to remain within the ecological ceilings that planet earth provides while providing a dignified living for all.

It is vital that we build solidarity between people within and across nations and regions. The existing system of international aid and the associated charity narrative risk legitimising an unfair economic framework which prevents national self-determination and weakens the building of strong and resilient local health systems. Health for all requires the redistribution of wealth nationally and globally.

The provision of health care is costly in any society. A health system based on Primary Health Care principles will be able to achieve health for all at a reasonable cost even while countries develop the capacity for more technologically intensive health care.“

A more comprehensive review of the history of the 1970s call for a New International Economic Order can be found in my input to a symposium of Medicus Mundi Switzerland.


The “flash mob” café session

The “flash mob” café session

Referring to a preparatory civil society workshop and statement (18 May 2018 in Geneva), the café session at the Astana conference, set up in a “flash mob” style, provided reflections on economic justice, cooperation and solidarity as preconditions for PHC. It was 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.

In the view of the organizers of the civil society session, the call for a New International Economic Order – and all in all the political dimension of PHC - risked to get lost in the more diplomatic and technical approach to PHC of the Astana conference and its formal programme.

Realizing the limited space given to civil society contributions and the fact that it was difficult to gather a greater number of civil society representatives at the Astana conference, the organizers decided to have the session as a kind of flash mob, where various colleagues are invited to make a short, compelling statement why the Alma-Ata call for an New International Economic Order is still valid.

Some voices were gathered ahead of the conference via online call, such as the following selection:

40 years after Alma Ata …economic inequalities have grown worse! Poverty is a major determinant of poor health and in too many places in the world access to quality health services is dependent on the ability to pay instead of real need. Nations should unite to create a just social and economic order, to protect human dignity, and uphold human rights including the right to health! (Barbara Fienied, The Netherlands)

Just few relevant examples: Neo-liberal policies still impair the capacity of resource-limited countries to feed themselves. Adding to investment reduction in food production and support for peasant and small farmers, state-managed food reserves have been dismantled and governments have failed to protect farmers and consumers against sudden price fluctuations, while being ‘forced’ to liberalize€ their agricultural markets through reducing import duties. Land grabbing and evictions, including for biofuel agribusiness, are on the rise in Africa and elsewhere under national governments complacency and a widespread corruption. Health threats from waste continue to thrive on socio-economic inequalities: while high-income countries produce mass consumption and rapid discarding of products (i.e. waste), poor countries incur the concentration and uncontrolled dumping of waste which enhances its dangers to health. Overall, an array of inter-sectorial policies is called for the governments should embrace to achieve equitable global health goals (including through a ‘degrowth’ approach and the safeguard of climate and food access), while ending the misalignment among the right to health, trade rules, and the current patent system. (Daniele Dionisio, Italy)

The core idea underpinning the NIEO was the need to structure positive discrimination in favour of low and middle income countries in the regulation of global trade and finance. Given the advantages in trade relations which accrue to the already-rich-countries such positive discrimination would be a pre-requisite for meaningful economic development for many L&MICs. With the debt crisis, structural adjustment and the death of the Doha Development Agenda the prospect of positive discrimination under the contemporary (chaotic) regime of trade regulation is bleak. (...) Health for all depends on equitable and sustainable economic development which will not be achieved until we have an equitable and sustainable global economic order. For too many people it is already too late but we owe it to our children and our children's children and to the billions at higher risk to establish such a new global economic order ... now! (David Legge, Australia)

The richest 1% of the world is getting 82% of the wealth, while extreme poverty and hunger persist. An international economic order that facilitates such inequality, in my view, is sick to the bone. The resources accumulated in the hands of the few, would more than suffice to end extreme poverty. We need a New International Economic Order, for justice, equal opportunities and to save our planet. (Mariska Meurs, The Netherlands)

Health for all can only be achieved if "nobody is left behind" and that means that we have to reach forgotten and neglected People in our World today, but it also means that we have to fight poverty through a change in the economic order of today. (Gisela Schneider, Germany)

The Alma Ata declaration was so much more ambitious and comprehensive in its vision and scope! It called for an economic order that would serve the attainment of health and reduce inequalities in health globally, while also recognising that the promotion and protection of people’s health is essential for socio-economic development. Its language on state duties and public rights is unambiguous. Its principles are no less relevant today than in 1978, even if changing contexts, health profiles and knowledge demand creativity in how it is applied. The original Alma-Ata Declaration has inspired positive thinking, action and change for 40 years including in Zimbabwe and that it should neither be replaced nor watered down. (Itai Rusike, Zimbabwe)

40 years ago in Alma-Ata, it was realised that health for all could be attained only with a New International Economic Order which puts people over profit. The fact that health  for all was not realised by 2000 and quality healthcare still remains a mirage for the immense majority of the human population reflects failure the increasing role of profit-driven interests in shaping global governance. PSI is strongly of the view that establishing a New Global Economic Order that puts people over profit is essential for attaining universal access to quality healthcare. We thus wholly support the call for a New Global Economic Order. (Baba Aye, Nigeria/Switzerland)

More civil society voices can be found on the short video clip of the session that Linda Mans, Wemos, made and disseminated, through social media, immediately after the session. Both the “speech balloon” we created for the announcement of the session and the successful dissemination of the video contributed to the success of the session that, despite the overall difficulties for civil society to get heard at the Astana Conference, found its attention.

Thomas Schwarz
1 November 2018


This report is work in progress. Civil society colleagues and other participants are invited to provide feedback and further input.

Session announcement: here
Session video: here

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