What do you think about when you hear the word 'health'? A doctor with a stethoscope, laboratory test tubes, coloured pills? Wrong answer, grassroots health activists say. You should be thinking first of clean drinking water, nutritious food, a safe work environment and essential health care made accessible at the community level. Yes, even in times of influenza A.
A large spectrum of grassroots health activists – nearly one hundred sponsored by the World Council of Churches (WCC) – gathered in Geneva in mid May to press these issues within the global public health discussion. From 18 to 22 May they are participating in the 62nd World Health Assembly, the annual gathering of the World Health Organization (WHO).
In addition to preparedness for the possible influenza A (H1N1) pandemic, the WHO assembly is discussing two resolutions which are crucial to its longer term strategy of revitalizing primary health care and addressing the social determinants of health. It is a timely approach in a world where diarrhoea kills nearly two million children every year.
Social determinants of health are factors with high impact on public health, namely: access to clean drinking water and adequate sanitation, adequate supply of safe food, nutrition and housing, healthy occupational and environmental conditions and access to health-related education and information. They are social because they are largely shaped by the distribution of money, power and resources in the society.
Primary health care, according to the WHO's definition, "is essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and at a cost that the community and country can afford". Focused on the main health problems in a given community, primary health care is aimed to tackle unacceptable inequalities.
As counterintuitive as it may seem, in order to achieve better health for more people the key is to "de-medicalize" the approach to health, says Oscar Feo Istúriz, executive secretary of the Andean Health Organization, a South American intergovernmental body.
"We need to bridge the gap between the discursive recognition of the social determinants of health and a practice centred on the axis [of] hospital – doctor – disease", he adds. "Today, our ministries of health are actually ministries of illness."
Free health for all
Feo Istúriz was among the participants at a civil society forum held ahead of the WHO assembly by the People's Health Movement, the WCC and the Third World Network among other organizations. In addition to civil society organizations, the forum gathered representatives from delegations of member states as well as the WHO secretariat.
Participants at the forum have asked the WHO member states to "privilege the interests of people and public health over commercial and corporate interests". They stressed the need to "ensure health care is free at the point of access for all, with a focus on equitable access for the poor". In order to achieve that, "at least five per cent of national income and 15 per cent of national budgets [should be dedicated] to health services", they stated.
Emphasizing the "central role and responsibility of governments in ensuring universal access to health", the forum participants stressed the need to "increase [the] capacities of the public sector in health care provision, health research and health related industry […] and strengthen national public health programs".
They demanded the "empowerment of local populations to participate in the building of health care structures that are accountable to the needs of communities". Grassroots and community organizations, indigenous groups and faith-based organizations are "building blocks in the design and implementation of primary health care".
Pandemics highlight inequalities
"Implementing primary health care and addressing the social determinants of health is even more important when the world faces potential pandemic diseases like influenza A", says Manoj Kurian, WCC programme executive for health and healing.
"The health inequities that these approaches aim to tackle are more evident when rich countries stockpile antiviral treatments and buy in advance influenza A vaccines that have yet to be developed and produced" adds Kurian.
According to him, "in many poor countries churches and other faith based organizations are so busy and stretched providing health services, that it is not easy for them to ask the difficult questions. They too need to rediscover primary health care not just as a technical tool to be applied to health systems, but as a radically different approach to promoting and preserving health."
"Civil society organizations play a crucial role in revitalizing the debate on primary health care and on social determinants of health", Eugenio Villar, coordinator of the WHO department on Ethics, Equity, Trade and Human Rights, said at the civil society forum.
"On the one hand they convey the concerns of the voiceless, which need to be heard at the global level; on the other hand they bring back to their contexts the global debates, thus playing a protagonist role through political action in the processes of health reform."
After a period in which the agenda of health sector reforms pushed by international financial institutions made health "a commodity rather than a right", Villar says the WHO is reaffirming the crucial role of primary health care "today more than ever".
(c) Juan Michel is media relations officer for the World Council of Churches, based in Geneva. He is from Argentina.
Call from the civil society forum on Equity, Justice and Health: http://www.oikoumene.org/?id=6831 
WCC work on health and healing: http://www.oikoumene.org/?id=3129 
62nd World Health Assembly: http://www.who.int/mediacentre/events/2009/wha62/en/index.html