Comment about the Bangkok Charter

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The preliminary version of the Bangkok Charter reinforces the principles and values of social justice and equity of the Ottawa Charter. It also says that health promotion is equity-driven. For me, it is very important to emphasize once more these important concepts. I celebrate these declarations. We all know that since the time of the Ottawa Charter, there have been very few results in reducing health inequities and inequalities in developing countries and in some developed countries. The efforts of politicians have not been remarkable. Social investment of governments is still insufficient to produce a real impact in the living conditions of vulnerable groups. It seems that the economic resources are limited for accomplishing goals of equity because the growth of private companies is privileged. For instance, the lucrative banking sector in each country is impressive. The increase in earnings of private multinational companies is overwhelming. Some of their budgets are greater than the total budget of some developing countries.

The globalization of the economic model is highly responsible of this perversity. In many countries, it is more important to save a private group from bankruptcy than it is to save a public hospital.  The damage from the “bad side” of globalization has been discussed by many authors. For example, Joseph Stiglitz in his recent book on globalization analyses the role of multinational/global institutions that deal with macro-economic policies in the international context and strongly criticizes the way that they and the International Monetary Fund (IMF) influence economic policy in poor countries. This author, as well as B. De Sousa Santos, confirms that globalization has great benefits, like greater connectivity in the world and access to knowledge, but both authors openly condemn the dominion of markets and the investments in the international arena producing every day more frustration and inequity in the global economy, characterized by oppression and a lack of social justice. The IUHPE has also played a leadership role in the production and dissemination of information on the harmful effects of globalization on the world’s health.

“The economic power moves from the level of nations to the level of the planet, and from the public field to the sphere of private interests” (Passet,2001, p.133). The issues of public interest like “health” have been relegated because of the increasing importance of private issues. Public health interventions have been neglected in recent years in developing countries as a result of the privatization of health care. 

But my comment on the new Charter is derived from the antecedents that I mention above; business corporations and multinational enterprises are very much responsible for the predominant economic model in the western world. This type of capitalism is not acceptable for poor countries and poor groups in any country.

The Bangkok Charter declares that “the globalization process underscore the central importance of health for poverty reduction and the wider economic and social development of nations” (18/index.htm). I strongly agree with this statement but question its words when the Charter asks for cooperation from the business and corporate sector: “Work with the business and corporate sector to develop healthy workplace and business practices, and enforce the necessary regulations”. From my point of view, this request is too weak and limited; we should demand a greater change in their behaviors and practices that are killing the small industries and the economies of the less developed nations. We should demand that they do not invade the health sector with big trusts of medical care regulated by the laws of the market which increase health inequalities. We should strongly tell them that the world is less just and less equitable today and that poverty has increased in our developing countries. They have an obligation to modify this situation in a favorable direction. They must believe that this inequity is a “time bomb” for all the people in the world.