"Health for All" Activists Visit Germany

This weekend in Berlin, Gesundheit Berlin, a Berlin-based organization concerned with health issues, will host the 10th annual Conference on Poverty and Health. While the conference has traditionally focused on domestic German issues, this year, organizers have asked Medico International, a Frankfurt-based non-profit group that works to ensure access to healthcare for people around the world, to host a series of workshops on globalization and health.

Medico International has invited leading representatives of the "People's Health Movement" (PHM) to speak at the workshops and -- in the week leading up to the conference -- is taking them on a tour of Germany for a series of panel discussions.

Making the case in Germany

Just a year after Germany's healthcare reforms went into effect, leading some to wonder if the days of a generous social welfare system and solidarity were coming to an end, the PHM representatives touring Germany at the invitation of Medico International say they have a sympathetic audience for their message of "health for all."

On Monday in Bielefeld, the PHM experts, including Maria Zuniga, the local coordinator of the International People's Health Council (IPHC), and David Sanders, the director of the People's Health Movement in South Africa, met with students and local health activists. On Wednesday, at the Friedrich Ebert Foundation in Bonn, they'll attend a public seminar on the creation of a People's Health Charta and answer the question, "Why is a People's Health Charta relevant outside the developing world?"

Zuniga of the IPHC said she has found many reasons. "Many of the things happening in Germany, such as the increasing privatization of health care and the price of medicines -- are issues around the world." she said. “We aren't that far away from each other.”

But will the lessons and strategies used by healthcare activists in third world countries prove applicable in Germany and will Germany be able to resist the trend towards so-called neo-liberal health policies?

"Health for all" an uphill battle

The people's health movement grew up in recent years as a direct reaction to what Zuniga and others involved in similar work describe as neo-liberal health policies: in short, making healthcare a commodity people have to pay for, rather than a fundamental human right funded by public money.

Things looked very different 25 years ago, when the World Health Organization (WHO), the top United Nation's body dealing with health, promised "health for all" by 2000 and persuaded health ministers from 131 countries to sign up to the historic Alma Ata Declaration. But a quarter of a century later, little has changed and -- in some cases -- the situation has actually gotten worse for the world's poor, said Zuniga.

In some areas, infant mortality rates have gone up, and the emergence of new diseases, such as HIV, have revealed the inability of many country's healthcare system to cope with a crisis. What's more, some diseases once thought to be all but eradicated, among them tuberculosis and malaria, have re-emerged in hard to treat forms.

In the 25 years since Alma Ata, governments have moved towards the idea of health as a commodity, she said. "So many people, in countries around the world, grow up thinking they don't have a right to health care."

Common problems, different causes

The reasons for the change vary. In poorer countries, like Nicaragua, where Zuniga comes from, World Bank and International Monetary Fund Policies encouraged local governments to cut social and healthcare budgets in order to free up money to pay debt.

In Germany, government officials have struggled to find a way to regain a competitive edge in a globalized economy, and it was widely believed that non-wage labor costs, the cost of paying for healthcare premiums, was contributing to the country's high cost of production. Similar reasoning led to healthcare cuts elsewhere in Europe.

In 2001, at a meeting in Bangalore, the People's Health Movement umbrella organization signed up members to the People's Charter for Health, which individual members have since used to re-establish healthcare as a top priority at all levels of government.

Germany: reform poses new challenges

According to Dr. Thomas Seibert, of Medico International, German healthcare officials can learn a lot from the experiences of their People's Health Movement guests from abroad. Most importantly, he sees this weekend's conference as an opportunity for the two sides to exchange experiences and strategies.

"People concerned with healthcare conditions in Germany will not be able to change things as long as they continue to think of these issues in an exclusively domestic context," he said.

In Germany, experts remain divided on whether the year-old reforms, which, among other things, saw the introduction of a €10 ($13) fee for a patient's first quarterly visit to the doctor, have negatively impacted people's access to quality healthcare. Insurance companies concede that people are going to the doctor less, but it has not yet been established if that's because they can't afford the quarterly fee or are simply not making unnecessary visits because part of the cost comes out of their own pocket.

Seibert concedes that healthcare activists fighting for "health for all" face an uphill battle in Germany and elsewhere and that the movement has few friends in institutionalized politics. Some would say the trend towards neo-liberal healthcare is irreversible, while others, including Seiber, still hold out hope for a bottom-up, grassroots about-face.