Summary: Working Group on Health Promotion

Role of civil society organizations in health

This session presented several views on the action and interaction of UN and civil society organizations working in the field of health. 

The World Health Organization and NGOs
Ms. Margareta Skold of WHO's Civil Society Initiative, presented WHO's perspective on civil society. Under Dr. Brundtland (Director-General since 1998), the Commitment has been working with a broad range of actors and has deepened a broad approach to health as a central issue for human development, for human rights and as a means for reducing poverty. The weakening of the nation-state and the changing world environment occurred in the last decades have altered world relations: in fact, NGOs are now providing services, rather than just lobbying. Civil society organizations can be broadly defined as voluntary and independent from the state and the market, and they are often located somewhere in the social arena between state and citizens. Their definition is still being debated and in particular the distinction between for-profit and non-profit organizations. In terms of mutual advantage, NGOs are excellent advocates of WHO policy at all levels. Through the World Health Organization, they can dialogue with Member States and can attend governing body meetings. WHO and civil society organizations need to agree on a clear vision and some joint principles as a solid basis for collaborative work.

People's Health Movement
Dr. Mike Rowson presented a brief history of the People's Health Movement. He pointed out that the fundamental distinction between state and market, or between BINGOs (business interest) and PINGOs (public interest), was only a part of the problem, as many civil society organizations (especially the global CSOs) are largely supported by the usual range of donors, which includes of course private foundations and government development agencies with their various influences and biases. It is therefore not always easy for NGOs to maintain an independent and sometimes critical perspective.

The People's Health Movement is a worldwide "network of networks" of health groups and many of them are "grassroots". In Dhaka, Bangladesh, the People's Health Assembly (PHA) was held with 14,000 participants in 2000. The PHA Charter that was developed at this assembly is neither a Bible nor a guide, but it does set out some basic principles, including for example the Government's primary role in the provision of services, the critical importance of people's participation and a focus on the underlying determinants of health. The latter, which was once central to WHO's vision of Health for All, has been lost. The World Health Organization appears to be run by its department of statistics, which itself is guided primarily by the principle of cost effectiveness as the yardstick for the value of all health interventions. As an example of the WHO's shift away from the principles of primary health care, Dr. Rowson pointed the use of the term "unsafe feeding practices" (rather than malnutrition) as a critical determinant of poor health! Health for the PHM is inseparable from social surroundings and poverty is explicitly recognized as the critical determinant of poor health and disease. Eradication of poverty is a long-term goal that will not be achieved in the life of a project; but unfortunately, donors expect (and demand) quick and easy results.

Ms. Judith Richter focused on the implications of the definition of civil society for public policy making. The shift in UN terminology from NGO to CSO needs close examination. No assessment of the value of civil society participation in health work can be made without making the distinction between BINGOs and PINGOs (see above). BINGOs are in fact the political lobby arm of industry. The world's citizens may have more or less influence on the global agenda depending on whether the CSO includes or excludes this business and/or its lobbying associations. In the 1997 UN reform, corporations were included as civil society partners with a role of "shapers of policy" on an equal footing with NGOs and academic and research institutions. Furthermore, with the Global Compact initiated by Kofi Annan, business has become the privileged civil society partner. Dr. Richter recommended a return to a concept of civil society, which is useful for the advocacy of public interests. For this, UN agencies need to distinguish clearly between citizen associations and organizations of capital. She warned that if UN agencies make no such distinction, democracy—the rule by the people—will increasingly be replaced by plutocracy—the rule of money.

Surprising issues
Health workers should be a major target of the WHO and CSOs and we should also remember that 20-30% of health needs in developing countries are met by NGOs. Through a database of health workers, far more relevant and practical information could be disseminated.

Conclusions and recommendations
Several speakers pointed out that the United Nations and its specialized agencies should be free from corporate influence and must define and make distinctions between civil society, non-governmental organizations, the private sector, for-profit and not-for-profit associations. NGOs (public interest) should be able to speak at the World Health Assembly (currently debate is closed after Member States have spoken). Further, WHO should develop tools to identify conflicts of interest. A code of ethical conduct also needs to be drawn up.

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