COMMENTATOR (COMM): Previously on Life...

PETER MARCUSE: The world is rich enough today internationally, globally to provide decent health care to everyone on the planet.

SHEELA PATEL: The most fundamental issue of health requires that certain basic essentials are provided to the whole city.

ANNA TIBAIJUKA: The poor of the cities they are not just passive objects -most often they are solving their own problems!

COMM: Calcutta. November 2000 and people are arriving to start a revolution. Twenty years ago in 1978, the World Health Organisation meeting in Alma Ata, called for Health for All by the year 2000. Two decades later and the world is still waiting. Today, people are asking why Health for All not only hasn't happened - but why more people's health is actually getting worse.

HALFDAN MAHLER: In Alma Ata we came out with stars in our eyes - and then what happened? And why did it not happen?

DR MAISHTA GUPTA, Rural Women's NGO: For the poor, you don't have to explain that, "You need a change!" Everybody knows they need a change, they just don't know how. We don't have to teach them to say that you don't have something - they know they don't have it.

DAVID WERNER, Author 'Where There Is No Doctor': Most of the world's people don't even know what to protest yet and so our big challenge is helping people to realise what are the forces, the world-wide forces, which are affecting our health and wellbeing today.

HALFDAN MAHLER, Former Director General, WHO: Can we find our way back to that - do we have the memory? And do we think that somehow we have in this dismal picture, what's happening to the poor in the world, to resuscitate our faith that we can still make a damn difference in this miserable world of ours?

COMM: The promise of Alma Ata wasn't just a rallying call but a whole philosophy of health care for everybody by everybody.

DAVID LEGGE, Public Health La Trobe University, Australia: In 1978 a hundred and fifty countries - or whatever it was, got together and said that we need to develop a model of primary healthcare which delivers generalist services locally, which uses appropriate technology, appropriate labour force models - but very importantly which involves local communities in thinking about the problems they're facing.

JOSE GEORGE, National Alliance of People's Movements: You know very well the Alma Ata Declaration of 1978 that is Health for All by 2000, but what is the position now? Not only health is not available to all the people but the mortality rate and ill health has increased day by day.

COMM: At Calcutta's main railway station over two thousand people arrive from all over India for the National Health Assembly. Health workers, activists and campaigners from across the world have spent two years building up to a series of national rallies to revitalise the Health for All dream.

HALFDAN MAHLER (ADDRESSING WORLD HEALTH ASSEMBLY): . . .that game is so often lost

COMM: Many are a new generation who've inherited the dream, but know that more of the poor have no access to health care than ever before.

HALFDAN MAHLER: But I also believe that Health for All contains the ingredients of a genuine social revolution of our times!

DR MAISHTA GUPTA, Rural Women's NGO: Are there people who give Health for All? Health is not a commodity that you can go and buy over the counter or - it's not something somebody can give you.

MEDHA PATKAR, National Alliance of People's Movements: Health for All can never be achieved unless the people take over and their health needs to be their goal and their target and the technological choice should be the choice of the people.

DEMONSTRATORS, CALCUTTA: Globalisation, down, down, down, DOWN!

COMM: The agenda has moved on since 1978 and there's a new bogeyman: globalisation. Fifty thousand people turned out for India's National Health Assembly Rally in Calcutta. Delegates, local campaigners and school children brought one part of the city to standstill. It went on for hours and way into the night.

MANUAL SELVI, Tamil Nadu Science Forum: Village people, they don't understand this globalisation, but their basic needs: food, water and also basic hygiene are essential. This the people like. And so this kind of assembly is needed to voice these among the people. This is basically why we're taking part.

COMM: The day after the rally, but the protest goes on. Globalisation, free market economies and privatisation are all claimed as enemies of primary health care and, they say, the poor have been increasingly excluded form this New World Order, especially when it comes to medicine.

MEDHA PATKAR: The disparity's growing. On one hand the commercial, purchasable health service is available to those who are the élite sections of population. On the other hand, the downtrodden sections - those who live on the human resource and the natural resource, basically - who are fighting the battle against the monetary capitalists and the market oriented sections.

DAVID LEGGE: The maternal mortality rates of Third World countries is one of the grossest obscenities of the present regime under which we live. Compared to Western countries where you get a handful of maternal deaths per hundred thousand live births, in Third World countries you're getting up to ten per cent of women dying in childbirth. One per cent, two per cent, three per cent - whatever it is, they're far in excess of what we expect in the North!

COMM: December 1st and the most committed of the delegates are moving onto Dhaka in neighbouring Bangladesh and the international People's Health Assembly. For these health workers, it promises to be a landmark event - a new beginning to the unfinished revolution in health care - but first there are the problems of luggage, which bus to take, and passports. The Indian organising noticed there were anxious travellers - they handed out roses. The Indian delegation, not for the first time, was hatching a plan of action.

INDIAN DELEGATE: There has to be one of you getting up and saying, "These were the messages, this was the story", either at the beginning or at the end, and it has to be spontaneous because time will always be a factor!

TANNOY: . . .proceeding to Dhaka are requested to assemble at 11 o'clock!

COMM: For many of the health workers, used only to working in a few villages, this was a great adventure. Many had never been out of their home state - let alone travelled to another country.

JOSE GEORGE: This is the first time I've been outside to India, also.

DIRECTOR: So this is exciting for you?

JOSE GEORGE: Yeah, for me - I mean, it's a very exciting journey because the people from all over the states of India coming from India and going to Dhaka is something - that is something. A mood of celebration!

MANUAL SELVI, Tamil Nadu Science Forum (TRANSLATION): It's a big thing to show what we've done and things we do in front of everybody - I'm very happy to have had this opportunity.

COMM: Spirits reflected the mood of anticipation. The People's Health Assembly promised to be a watershed. So far, it had been an exciting, exhausting couple of days. The journey to Dhaka was to take eight bouncy hours, through the world's most heavily populated and disaster prone landscape.

Dhaka. On course to rank amongst the world's biggest cities in the next ten years. Here, the next day, Selvi and Joe George arrive at Gonoshasthaya Kendra, Bangladesh's premier health development centre. In the first week in December, delegates from over 90 countries attended the Peoples Health Assembly. Appalled by the state of the world's health, they came to debate what should be done.

DAVID LEGGE: The present global trading regime is unfair, and it's that unfairness - is transforming resources from the South to the North and it is killing people. That - there has to be a reform of the economic regime which this represents. However, governments - particularly Third World governments - are held hostage by this dynamic of the financial press, the money markets as, in a very immediate sense as well as in the longer term sense, the discipline of the IMF. Until there is a strong popular movement of people in the streets saying enough is enough, and forcing governments to take a stronger position, the pressure on governments will be such that, that those reforms will not take place.

FEMALE DEMONSTRATOR: Down to World Bank!

DAVID LEGGE : I think this is a very significant assembly. I think all round the Third World people who are activists in healthcare and in primary healthcare have increasingly come to realise that unless we address the social, political, economic - above all the economic - determinates of health, they are wasting their time in delivering services.

RUSSIAN DEMONSTRATOR: I am here because I fight for health for our people- Russian, not only Russian but all people.

FILIPINA DEMONSTRATOR: We are here to speak of er the health situation in the Philippines so other countries will know what's going on in our country and that - so that we'll know what's going on in their country.

MALE DEMONSTRATOR: I'm here because I believe that the right to health is an essential component of life.

DAVID WERNER, Author, 'Where There is No Doctor': Although we appear to be on the brink of disaster in many ways with global crises in health and environment and economics and - certainly a moral crisis in the world today. Nonetheless I think there is a kind of awakening process starting. The People's Health Assembly here is certainly an important contribution, a step forward to that process in, in terms of building an international coalition which bridges sectors and I hope, to some extent, bridges even socio-economic class.

HALFDAN MAHLER: I think we are here because some of us - all of you, I think - we are deeply, deeply disturbed what is happening to us in the contemporary world. With a number of forces we hardly understand, let alone control and that seem to make that moral arc - not bend towards justice but bend increasingly towards injustice.

JOSE GEORGE, National Alliance of People's Movements: So I thought that this is one major event that I have to attend - I have to know what things are going around us and what are the major changes which are happening all over the world.

COMM: The Assembly is formally opened by Zafrullah Chowdhury, Bangladesh's pioneer of Health for All and a lifelong campaigner for primary healthcare. Day one and, like those to follow, a performance with a message. This mime from the Philippine delegation lampoons the multinational companies that wean overworked mothers off breast feeding and onto synthetic baby milk. As the People's Health Assembly, much was made of local health stories told by the people themselves.

DELEGATE FROM ABURUPAM, INDIA (TRANSLATION): In half an hour I delivered a baby boy. I put him on my legs and washed him and people from here, they came and said, 'How can she come into the house? How can an outcast wash the newborn baby? How can that happen?' So I said, 'If I cut my hand and you cut yours, isn't it the same colour? If you look at your blood and my blood, isn't it the same colour? So how can you be so surprised that I've come into the house?'

COMM: But there were no caste divisions at the Assembly.

US DELEGATE PERFORMER: 'Hi! My name is Johnny! I have a wife, three kids. . .'

COMM: Every night the delegates let their hair down, leaving the political agenda for the next day.

US DELEGATE PERFORMERS: Then my boss came up to me and said, 'Johnny! Are you busy? No? Then turn this plate with your left hand!' Hi! My name is Johnny!

COMM: No government spends more on health per capita than Cuba. The point didn't go unnoticed. Under code Z59.5 the World Health Organisation classifies extreme poverty as a disease. Even in the First World, poverty leads to despair, among the unemployed of Glasgow for example.

SCOTTISH DELEGATE: More than twenty-five per cent of young men kill themselves by committing suicide. And hopefully through the Health for All assembly and through other events these voices will be heard and the voices will cry out, 'Give us jobs!'

COMM: For some, the emotion is too much.

HALFDAN MAHLER, Former Director General, WHO: It still has been kept at a level that people's emotions and their articulations of their fears have come out in a - what I would say, remarkably sincere way.

DR DEBBIE DANIELS, Doctors for Global Health: A lot of us are doctors and a lot of us are, are other types of professionals who have the potential of coming into positions of power. And there is a danger of being co-opted by that power. I think the only way to protect against that is to conscientiously daily think about being humble and your role in the scheme of things.

COMM: On Day Three, Richard Lee Skolnik from the World Bank arrived. It's what everyone had been waiting for - but nobody seemed very keen on meeting him. More important - how to deal publicly with the world's biggest donor?

DAVID WERNER: I think there's absolute place for very large and forceful protest. Like the WTO protest in Seattle, the Washington protest against the World Bank...

COMM: The Indian delegation was rounding up the troops. The World Bank provides four times as much aid for health care as the World Health Organisation but its critics claim two billion dollars a year of this benefits the rich West rather than meeting the primary health care needs of the poor in developing countries. So the delegates met again - to decide how to protest. They may not wear white coats, but these are professional health workers - not radical activists. They decide to present their case reasonably - rather than boycotting the World Bank's presence but what happened was a bit different.

Even though Selvi had never been out of her village before she wasn't shy. She grabbed the chance to make sure the World Bank was getting the right message.

ZAFRULLAH: We have promised he will have an opportunity - I'm not saying it again - he will speak and we will speak!

RICHARD LEE SKOLNIK, Regional Director, World Bank: I believe the People's Health Assembly must help empower communities and people to improve water and sanitation, nutrition which is so often forgotten, hygiene which isn't anywhere on the agenda, and health seeking behaviours. The People's Health Assembly must be a watchdog for the quality of that outcome. Focussing on quality of the services that form the basis for much that you want to do. The People's Health Assembly must be a watchdog for ensuring that health outcomes are measured and evaluated. I hope the People's Health Assembly will be a watchdog to see that the benefit of investment in health really go to the poor. I hope the People's Health Assembly will move extraordinarily forcefully on HIV which many countries have ignored, very much to their detriment. I hope the People's Health Assembly will join global initiatives and see that they best serve the poor. Finally, I hope the People's Health Assembly will lobby governments to stop wasteful expenditure on war, on subsidies for the better off and on corruption. The People's Health Assembly should lobby governments instead to use the money to invest in the health, education. . .

DELEGATES: Get out! GET OUT!

RICHARD LEE SKOLNIK: . . .and empowerment of the poor. Thank you very much. I look forward to being a part of your movement and being an active participant with you in serving the health needs of the poor. Thank you.

FEMALE DELEGATE: Now, Mr World Bank, I want to tell you - please go away from here! We don't want to hear any more of your sympathy. . .

YOUNG MALE DELEGATE: Cancel the debt!

YOUNG FEMALE DELEGATE: No to the World Bank strategies!

BANGLADESHI DELEGATE: . . . but my appeal is that can we be honest in our heart and soul and in our speech? Bangladesh being one of the biggest collaborators - I mean, the engineers of civil society of all World Bank products in this country. Now, if we express solidarity in this sort of forum and we say "Down with World Bank!" and then we become the biggest collaborators of all their products, I think that's not fair...

COMM: Despite a moderating voice, there was little meeting of minds.

FILIPINO DELEGATE: I wonder if no medicine is better than bad medicine.

COMM: The World Bank now prioritises healthcare and education in development aid but that wasn't the perception at the People's Health Assembly. Many delegates still believe World Bank aid means scrapping national health schemes - a price too high to pay. The whole system was under attack.

DAVID LEGGE: The current global trading regime - it bears many factors which discriminate against poor countries. In agriculture, in commodities, in manufacturing, in access to technology, in access to capital, and in labour there are a range of factors which discriminate against poor countries. Next? You actually find that capital is created out of people's health. That actually destroying people's health creates wealth um and so that there is a dark side in the relationship between the economy and health.

MANUAL SELVI, (TRANSLATION): The World Bank - you have to organise people against the World Bank. I'm inspired because it makes me realise how much it affects people.

DR DEBBIE DANIELS: What really should be happening is that governments should be providing basic needs - providing for the basic needs of their community, including health, including clean water and a place to live and food.

COMM: Throughout the weeklong assembly, workshop delegates debated the issues.

WORKSHOP DELEGATE: ...Er, in their policy. But if there is an international call by all the people and by all the governments that has this as a right, every country will have to present it!

COMM: Their ultimate goal was to finalise a People's Health Charter - a manifesto to take the battle for better health care forward.

DR NADINE GASMAN, Co-ordinator, People's Health Assembly': . . . To hear your opinions on why it should be interesting. To make sure that we are on the same wavelength.

COMM: The process gave everyone an opportunity to contribute. They wanted a lasting legacy - their chance to change the world health agenda.

DAVID LEGGE: That's item 58, the reference to HIV/AIDS. I think we should...

COMM: Every afternoon, they argued over the text of the charter - word by word, line by line.

COMM: With time running out, the convenors took over. They deliberated long into the night.

CONVENOR: That's, that's why it doesn't have the phrase 'domestic violence'...

COMM: Meanwhile - and also for most of the night - the conference hall had a Latin American feel. At 3.30 in the morning the Charter reached the printers.

COMM: On day five - the final day - it arrived, just in time. The Charter was presented for endorsement.

MALE CONVENOR: The attainment of the highest quality level of health and wellbeing is a fundamental human right, regardless of a persons colour, ethnic background, religion, gender, abilities, sexual orientation or class. The principals of universal comprehensive primary healthcare, envisioned in the 1978 Alma Ata declaration, should be the basis for formulating policies relating to health.

DR NADINE GASMAN: I feel hope. I don't feel fulfilled -I think it's the beginning and that we have a big challenge ahead.

JOSE GEORGE: We should have a document to show the people.

DR NADINE GASMAN: Now we have to do something and I think we have the tools.

JOSE GEORGE: Charter means it's our dream, our aspiration.

HALFDAN MAHLER: Are we now, contrary to what happened after Alma Ata, going to take our challenge more seriously?

DAVID WERNER: We need a popular revolution on a world-wide basis to oppose the élite powers that are endangering, not only the health of humanity, but the very future existence of humanity.

END