Declaration of Tunis – 5th World Social Forum on Health and Social Security
We, the social movements, civil society organizations and stakeholders in the social field, members of the World Social Forum on Health and Social Security, as another expression of people’s voices, faces, wisdom, and knowledge, state as follows:
1- The international crisis of capitalism is of a systemic and civilizing nature, expressed in the economies and societies of the Geopolitical North – United States and Europe -, which has only increased the neoliberal prescriptions, structural adjustments, destruction of rights and citizenships, strongly affecting the healthy quality of life of their people. That is, the crisis does not imply to think the political and social processes either as post-capitalism or as a postcolonial world-system, although it has opened up serious gaps and ruptures, for instance, in Latin America and Caribbean, where there are processes under way in an effort to achieve a post-neoliberalism with social change and emancipation.
2- The international crisis in its financial dimension has shown a strong international political decision, that is: in less than two weeks after the bankruptcy of Lehman Brothers, the current social system and the most important states, such as the United States and the European Union, provided bailout of thousands of billions dollars or euros to the global financial system, demonstrating that less than 8% of those costs could meet 100% of the Millennium Development Goals, ending hunger, poverty and avoidable deaths throughout the world. In other words, this social system as well as the forms of organization of our societies of accelerated capital accumulation, commodification, and destruction of life, are clearly concerned about saving banks and multinational corporations, but not about saving lives, not even the Mother Earth’s ecosystem.
3- There should be an open discussion on the evident fact that the Millennium Development Goals (MDGs) have not been achieved, even though they are expressions of “minimum” and/or “basic” goals, clearly representing a monocultural view of the development models for the people’s quality of life, but not expressing nor identifying nor discussing the interests of the status quo and of those responsible for the inequalities, inequities, poverties, and exclusions that prevail in the world. It is obvious that the MDGs – although they have represented some progress in healthcare and in response to diseases neglected by the pharmacological medical-industrial complex and by the health market -, have, to a great extent, enhanced the fragmentation of agendas, struggles, dreams and responses of both civil society movements and the states themselves, due to their own fragmentation, e.g., Gender, Water and Sanitation, or health-related issues (infant or maternal mortality; diseases such as HIV/AIDS). Each of the goals has specific agendas and policies, often subjecting the responses to the logic of international cooperation and the “official support for development” between North and South with neoliberal and monocultural hegemonies.
4- In this framework, the discussion on Universal Health Coverage – UHC, as a post-2015 goal presents a number of dangers and challenges that should be brought to light in the national, regional and international scenes, constituting the following tensions:
* UHC is expected to be a way of re-launching the logic and plans of “health insurance”, as well as expanding the market for capital accumulation in the public health field; setting up “assisting-healing” insurances for illness coverage, with basic minimum packages of “explicit guarantees”; through means-testing, defining who is and who is not “poor” to receive “the benefit”; with public-private mix management and competence, and the primacy of commodification, privatization and stratification-segmentation of our societies in: healthcare for the “poor” with “poor insurances”; “healthcare for formal workers”; and “healthcare for the rich” with out-of-pocket payments, but still benefiting from a system of subsidies, exemptions and regressive taxation, which represent resource transfer from the poor to the rich. This universal coverage will only deepen inequalities and inequities among our peoples.
These proposals of the technocrats of the World Bank, Inter-American Development Bank (IDB) and International Labour Organization (ILO) itself – with their campaign of “minimum social protection floors”, even winning over a sector within the world trade union movement -, are not the best way of addressing the problems, needs and priorities to protect our people’s lives.
* We must not allow ourselves to be misled by the words: “Universal Health Coverage”, “Social Protection in Health”, “Financial Access to Healthcare Services”, “Minimum Social Protection Floors”; these are proposals that come from technocracies, organisms, and international geopolitical interests of capital.
Undoubtedly, the “universal health access” towards the political access to universal social security systems, including health within the framework of social determinants of health postulated by the World Health Organization (WHO), could be an important and fundamental proposal for the creation of new universal health systems for a healthy quality of life, albeit insufficient to address the multidimensional international crisis and the interdependence of rights. WHO will have the challenge of facing interests that are predominant in other international multilateral organisms, the big business itself, and multinational economic groups, if it really wants to achieve progress towards people’s right to health. Otherwise, it may once again see itself trapped in privileges and reforms committed to commodification of life and health.
Within this context and framework:
5- At the WSF on Health and Social Security, we found ourselves redefining the development of Universal Social Security Systems of public, universal, integral and egalitarian nature, recognizing the interdependence of rights expressed as needs, which translate the universalization of a broader citizenship’s rights into a social protection system, with an ambition of redistributing wealth, establishing universal unified health systems as well as universal public systems of social security and welfare, promoting popular participation and power throughout the public policy process: formulation, planning, management, monitoring, regulation, and evaluation.
6- At the WSF on Health and Social Security, we understand that it is fundamental to reform states into social rule of law states, with national identity, institutionality, models of management, territoriality and plurinationality, providing a clear boost to the recovery of the public sphere with popular protagonism, gender equity, and intercultural dialogue.
7- At the WSF on Health and Social Security, we propose that it is not possible to discuss the universalization of rights process if we do not put financing at the centre of our concerns, that is, the political economy of universalism – production and distribution. We need comprehensive reforms towards progressivity and justice of our tax systems, in order to effectively build equitable and egalitarian societies. We propose that tax justice be adopted as a post-2015 goal, at national and global levels, affecting customs systems and international trade, as well as eliminating tax havens.
8- At the WSF on Health and Social Security, we believe that it is fundamental to rethink and build new democracies and new states, which effectively incorporate as good governance principles modalities of deliberative democracy, social democracy, where social justice should be integral to political democracy, and social accounting should prevail over financial accounting in the state management, looking for full guarantees of human rights for a health quality of life; or as proposed by the indigenous native peasant peoples of Abya Yala (Americas) to promote a paradigm of Good Living or Living Well, that is, ecological knowledge, solidarity, cooperation, complementarity, and care for life and harmony with nature.
9- At the WSF on Health and Social Security, we are called upon to promote democratization and overcome technocratization of the process of debate and discussion of MDGs post-2015, Social Protection Floors and “Universal Health Coverage”, with active and protagonist participation of the people (not only NGOs or international agencies), as well as to appeal to our popular and progressive governments around the world, especially Latin America and Caribbean, to build a common voice and position from Union of South American Nations (UNASUR), Bolivarian Alliance for the Peoples of Our America (ALBA), and Community of Latin American and Caribbean States (CELAC) to propose a new paradigm for the development of our nations and good living of our people.