Synthesis Working group "Health, social protection" FST Porto Alegre 2012

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Act against the global health crisis
Working group "Health, social protection" FST Porto Alegre 2012

The crisis of capitalism, the ecological and food crisis which are linked and the growing social inequalities have aggravated the health situation of people worldwide, this situation leads to various disorders and diseases that reverse progress made up to now.To take just one example, life expectancy in the U.S. (leading world power) is a lasting trend of decrease (from 77.9 years to 77.8 years between 2007 and 2008) a study published December 14, 2010 states that in 1998, a 20 year old male could expect to live another 45 years away from a serious illness (heart disease, cancer or diabetes). This number fell to 43.8 in 2006. A decrease of 1.2 years ... in 8 years.

The crux of the health crisis lies in the fact that simultaneously with the degradation of the health and social situation there are in almost all countries attacks on public health systems by increasing merchandisation which is exacerbating North/South inequalities and social inequalities within each country. The poorest layers of the population and women are the first victims. These reforms appear to be programmed or planned worldwide as they are similar. They fully meet the demands of financial markets, health and pharmaceutical multinationals. One can observe the simultaneous acceleration and attacks against the rights of the population in terms of healthcare in the form of privatization and destruction of non-market social protections.

One of the arguments which is advanced, particularly in Europe, is the (false) pretext for reducing public deficits imposed by austerity policies (Ex: public spending in France is not increasing 52.8% of GDP in the 90’s, 52.9% in the 2000’s - source Le Monde). Yet it is precisely the rescue of the financial system and safeguarding of profits that have aggravated an illegitimate debt and serve as a pretext for the majority of governments to destroy the financing of public health systems.

This contradiction is increasing and becoming a source of mobilization and many social movements worldwide fighting against the privatization process of health.

The subject of healthcare is a major factor in mobilsation because it is a fundamental right not recognized as such by the capitalist system. To give perspective to these struggles, SF participants in Porto Alegre, preparatory summit of 20 nations in Rio, proposed to act together for an alternative system of social protection without borders, based on the existence of inseparable economic , social, civic and  political rights. A health system based on needs and not the management of resources, based on prevention, universality, accessibility, quality, state responsibility (public service), on the statutory and working conditions for health professionals, as well as training to ensure quality of care and caring. A system of Healhcare Democracy managed by the the population and healthcare professionels. A genuine policy of prevention of health risks at work.

To face this situation, here are the policies to mobilize for and the policies to fight against:

Access to care, Proximity

For :

- Access to health care as an inalienable right for everyone, everywhere and at all times, even in difficult to access or sparsely populated areas.

- Reimbursement in all healthcare systems of Long Duration diseases (eg cancers, HIV, malaria, diabetes, hypertension ...)


- All measures aiming at the selection, discrimination and exclusion of individuals regarding resources or therapies

- Systems of insurance packages or franchises,

- Fees of professionals beyond reimbursement systems,

- The disbursement of prescribed drugs,

An effective public service present everywhere


- A 100% public healthcare service  (including primary care, prevention, education, the fight upstream against the causes of disease), a medical-social and social sector, public and nonprofit, developed on throughout the territories, with sufficient resources to meet the needs of all populations,

- A public emergency shelter and housing service, without access conditions or restrictions whatsoever, for the rights of all needy and insecure poor people,

- A public hospital system providing access to quality care and close coordination with all health professionals, and with all stakeholders,

- Maintaining and developing local facilities: health centers, abortion clinics, centers for prevention in psychiatry, emergency shelters...

- An emergency plan for healthcare at school and work,

- A public psychiatric sector coordinating and ensuring continuity of care, considering patients as sick people and not as dangers to society

- Increasing the number of trained health professionals, recruitment to meet the needs and the requirement of a balanced distribution of healthcare throughout the territory,

- Independent public research,

- A public pharmaceutical policy integrating research, production and control.

- Job stability, stable organization of work and social rights (family, retirement, etc.) taking into account the difficulty of the health professions.

- A staff of professionals based on care needs, care and prevention

- The phasing out of private for profit healthcare companies


- Job cuts, closures of activities, closures of services, authoritarian regrouping in all of the health, medical-social and social sectors.

- The dismantling of public psychiatric care and the instrumentalisation of it to create security fears.  

- The application of financial profitability criteria in hospitals and in all healthcare institutions,

- The privatization of activities and facilities,

- The competition between healthcare facilities,

- The organized looting of medical or health professionals from one country to another,

- degraded working conditions and precarious status for health professionals,

- Just-in-time hospital management.

Secure Funding based on solidarity


- Social protection, open to the entire population, based on the principle "everyone contributes according to their ability and receives according to their needs"

- Social protection for which funding is guaranteed and based on the redistribution of wealth.

- Support for the loss of autonomy within the framework of social security with the guarantee of a universal right guaranteed at 100%

- The total disconnection of the financing of social protection from the financial markets, private banks, insurance and profit structures,

- A move towards the removal of all the "extra charges".

- A 100% financing of healthcare by employers of all diseases and conditions related to working conditions.


- Any transfer of welfare benefits to the mandatory health-complementary private insurance,

-Any exemptions for employers from social security contributions or other healthcare contributions,

- Closed budgets and "pricing of each act" for the financing of health facilities leading to the financial strangulation of institutions and structures.

- All private funding which is conditioned by a private stake  in  management or other interest.

Healthcare Democracy


- The definition of the democratic needs of the population, development and monitoring of projects, involving users, professionals, elected on an equal footing,

- A real representation of users, staff and elected representatives in decision-making at all levels.

- The right of workers' to decide on working conditions to help prevent diseases related to occupational causes.

The global mobilization against capitalism of June 5, 2012 decided by the Assembly of Social Movements of January 28, 2012 in Porto Alegre, the European Conference of Defence of the health and welfare held in Paris in May 2012 or the summit of peoples at Rio +20 in June 2012, are appointments that will further the exchange of experiences, discussion, actions, and move forward on policy proposals to address the global health crisis for social justice and Environmental, against the merchanisation of life in defense of the "common ".

Annex :
Recent victories against the privatization of healthcare.

Share of GDP for social protection = 12.8%
State budget for health = 4%
Life expectancy = 69.7 years
Romania suffers from one of the worst two years of austerity cures. In late December, the government of Emil Boc attacked the healthcare system. This was to be the last straw and the starting point of the movement of outraged Romanians. The Romanian healthcare system is ailing. But the planned reforms will only benefit the private insurance funds. While Romania spends only 4% of its GDP on health, compared to 8% of the EU average, it is still going to cut spending by opening up to "private operators". The proposed privatization of emergency services was explosive and it happens that the man who founded this service, Raed Arafat (Palestinian-born doctor)who is extremely popular, currently Deputy Secretary of State is hostile to these reforms. He has publicly opposed the privatization and resigned. This action has encouraged the explosion of indignation that swept Romania in recent days. Peaceful mobilizations have spread throughout the country, very socially mixed, with a significant proportion of young people. Police violence has injured several dozen. Thousands of people took up the slogans of December 1989: "We are dying of hunger", "follow us". But they also demand the resignation of President Basescu. Faced with growing opposition aroused by his project, The President has announced its withdrawal. But this change did not calm the population, and Romanians continued to march through the streets of the country, extending their demands  to austerity raging since 2009. "We are tired of having to  swallow everything from pay cuts in 2010 to corruption" ...

Share of GDP for social protection = 28.7%
State budget for health = 10.6%
Life expectancy = 79.4 years

In a context of violent attacks and closures of local hospitals in Germany, on January 29, 2012, the people of Dresden (Germany, Saxony) 84% voted in favor of keeping hospitals under municipal ownership and therefore against privatization. The necessary minimum of voters (at least 25% participation) was exceeded with 37% voting. So this blocks
plans to privatize hospitals for three years. A victory!

Municipal authorities had intended to merge the two municipal hospitals into a limited company, remaining public but can be privatized at any time by selling shares. An "Alliance for hospitals" was formed, composed of, among others, the staff of both hospitals, the Verdi union, the collective "Hands off hospitals", political organisations such as the SPD , Die Linke and SAV (Sozialistische Alternative) ... 37,000 people signed the petition for the maintenance of municipal status of hospitals.

In the referendum of January 29, the question was: "Do you agree that the hospital Dresden-Dresden-Neustadt and Friedrich keep the status of Municipal enterprises of Dresden?" The "yes" won by 84% of the votes cast. The same privatization model is projected in Stuttgart ...

Share of GDP for social protection = 16.3%
State budget for health = 7.3%
Life expectancy = 74.9 years

Excerpt from  Pravda, Slovak newspaper:
Although the projected transformation of 31 public hospitals into private limited companies has been suspended until after the elections next March, " doctors continue to resign." Approximately 2,400 public sector practitioners are threatening to leave their posts in protest against the project of the Ministry of Health. The Slovak Chamber of Physicians considers this project as «privatization by stealth" which will potentially worsen working conditions. They also demand that their salaries be increased to reach between 2,000 and 4,000 euros per month, and more government subsidies for the healthcare sector. "Promises are not enough for them, they want guarantees." The reform project will be the subject of a special debate in Parliament on November 11, at the initiative of Robert Fico’s opposition party Smer, , who, according to Slovak Spectator, seeks permanent abandonment of the project.

Share of GDP for social protection = 26.1%
State budget for health = 7.8%
Life expectancy = 80 years

The reform of the NHS, the public healthcare system which is popular in the UK despite some shortcomings, is subject to a reform project aiming to introduce private funding. It is also about redundancies  among the 1.7 million NHS workers, closure of hospitals and adapting reimbursements to patients behavior (obesity, alcohol, ...) which is deeply shocking for professionals and associations . The Royal College (public doctors) medical, emergency doctors, psychiatrists, midwives, radiographers and the national association of users have made their opposition ​​public to this reform. Internal tensions within the  government but also the movement of the ‘Outraged’ in Romania which appeared following the reform of Romanian healthcare two days earlier, forced the UK Health Minister Mr. Lansley to announce changes to the reform.

Share of GDP for social protection = 12.5%
State budget for health = 5%
Life expectancy = 72.7 years

Brazil experienced a major healthcare reform after the fall of the dictatorship in the late 80s. It allowed the establishment of a health system with minimal public financing through social contributions called SUS (Single Health System), it is free but not universal, it leaves room for private insurance and a network of private clinics in addition. It works with a democratic system from the municipal healthcare level to the federal level with national health conferences - CNS- which make decisions on healthcare policy.

It is precisely in this context, during the 14th CNS that the "National Front against the privatization of health" composed of associations, political parties and unions won a huge victory: The rejection of the government's privatization.
The Ministry of Health ( Minister Alexandre Padilha, a militant of healthcare reform ...) had proposed to amend the fundamental Healthcare law by providing opportunities for funding by private foundations, public interest associations, private health service companies and public-private hospital partnerships, in a new governance of the healthcare system. The conflict is hardening with the government refusing to accept the vote of the conference. The 200 signatories of Front against privatization announced that they would call for mass mobilizations if healthcare democracy is not respected by the government.

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