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Even before the recent pandemic H1N1 influenza had broken out, demonstrating that safe isolation is nonexistent in a globalised world, German philosopher Peter Sloterdijk had coined the term co-immunism. The word refers both to protection from disease and the communalism aspects of communism. “Co-immunism” links health, prosperity and commonality. Medico’s 40th anniversary 2008 was an opportunity looking for a new framework, one describing new forms of global interdependence and the resulting common interest, as well as pointing to new starting points for further action. How should aid and solidarity be redefined in current circumstances? What are the practical implications for aid? These were the questions Medico dealt with throughout its anniversary year, discussing with donors and project regional partners at numerous events large and small. Medico’s “Solidarity now!” conference in Frankfurt in May 2008 was a special momentum in this process.
The misery of the others
During the conference, theologian Michael Ramminger spoke of the “controlled philanthropy” also appearing in different guises in privileged countries as the crisis worsens. Ever more excluded people are provided by this kind of philanthropy with basic necessities while plugging the growing holes in the welfare state. Charity Food banks serving free meals are just one example. In 1997 there were a total of 90 in Germany. Ten years or so later, that figure is nearly ten times higher. 30,000 volunteers in Germany distribute 100,000 tons of food annually, providing 480,000 people with food on a regular basis. The ever growing number of these charities,essentially soup kitchens, indicate that we are in a process of structural alignment worldwide. Thus, the wide-ning gulf between rich and poor is answered by a wellmeaning readiness to help, while the formal right to assistance and humane living conditions is constantly erased. According to Ramminger, exclusion and poverty are discussed in our media-dominated society all the time. But, photo by photo, information bit by bit, “this poverty is being turned into something that only seems to affect other people.” Thus, exploitation and marginalisation are no longer seen as causes but become “natural and inevitable”. And this has an impact on aid everywhere. Ramminger pointed out, “This process reached the big aid agencies and many NGOs long ago, meaning that they are unable to think beyond the next project.” Compassion and empathy are limited in focus to practical aid given immediately. The right to have rights is reduced to the right to food. Philanthropy, with its limits thus defined, has no say in other key intersections of the prevailing power discourse.
Among equals
Despite major differences in wealth levels among the excluded, the individual’s situation is structurally similar everywhere - once someone drops out, there is no way back. Regardless of country, the individual concerned is unable to participate in society or gain recognition from it, with all the psychosocial effects this entails. We must take this fact into consideration if we want to redefine active solidarity. Public discussions marking 40 years of Medico’s work showed that, for Medico, helping people in need has always gone hand in hand with promoting human rights, both in theory and practice. However,north/south globalisation means that things are changing for Medico, too. Solidarity is still a matter of redistribution, but we can see the emergence of a solidarity between equals, or at least between people equally threatened - whether by an environmental disaster affecting everybody, by the patenting and privatisation of knowledge (including commercialisation of life-sustaining access to seeds and medicine), or by new forms of apartheid focusing on enemies and using fear-mongering tactics in order to legitimise inequality.
Voices that advocate alternative policies and take into account the specific context seem to be disadvantaged against the ready-made and one-fits-all solutions of free markets.Indeed, before the current economic crisis, critics of neoliberalism seemed to stand no chance of thwarting the purportedly inevitable course taken. Right now, Vandana Shiva’s countermodel to free trade, described by the Indian civil rights activist at the Medico conference with the word “commons”, already sounds far more plausible. In the debate to redefine solidarity, commons - public goods or policy areas and activities that should be managed for the public’s benefit - are crucial to conceiving a different, more human globalisation. Thinking globally means thinking in terms of everyone’s access to these “commons”.
Sparks of hope
As well as grappling with these issues in theory, Medico International spent 2008 looking to provide active examples through projects and campaign work. We focused, in particular, on new types of solidarity networks capable of influencing the global situation. The People’s Health Movement (PHM), which Medico is a part of, is a good example. Thanks to determined action by PHM,those who see health as a common are regaining influence in the World Health Organisation (WHO). 2008 marked the 30th anniversary of the Alma Ata Conference, which coined the slogan “Health for all” to aim for Health as a common public good. Coinciding with this 30th anniversary, PHM health experts contributed to a WHO report on the social determinants of health. This calls for a return to the Alma Ata principles and,reiterated health in terms of what are the base of it: namely, every individual’s social, cultural and democratic living conditions. The devastation caused by healthcommercialisation is contrasted with alternative principles and a different understanding of health and human being.
The second edition of “Global Health Watch”, published in 2008, is very much part of that process. Both globally and in terms of health as a public good, this is a hugely significant alternative report on the world’s health situation. Critically examining the international institution activities that directly influence health and health policy, covering the World Bank, International Monetary Fund to the WHO. Another initiative in this global network is the International People’s Health University (IPHU). This “traveling” university is increasingly training activists as well as doctors and health workers on issues such as: how healthcare can be designed as a public good, what health ethics are required for this and how to collect, develop and communicate experience gained in the health movement. All these networking, training and lobbying activities were supported by Medico funding.
Other activities of Medico dealt with access to essential medicines, including freedom from patents as well aslocal production. Another area we are concentrating on are strategies for a global, solidarity-based health insurance. Thus, for example, we support a patient’s fund in El Salvador and a Bangladeshi health insurance scheme providing cover for the poorest of the poor. Whether such pilot projects will eventually lead to global alternatives is “completely unclear and uncertain”, to quote the physician and social historian Karl-Heinz Roth at the Medico conference. But, according to Roth, these social appropriation processes give reason for hope despite the many disastrous trends in the world.
Global commons
Excerpts from contributions to the "Solidarity now!" conference
Vandana Shiva: Resisting fear
When we actually realise that diversity is no hindrance to solidarity, new ways of living on this world will open up to us. We must take back the right to define what it means to be a person living on this planet in 2008. We call this “earth democracy”. We must include every single person who is denied food or is a victim of the unjust wars waged across the planet. And while we all jointly seek a solution in solidarity with one another, we must fearlessly combat the theft of our common wealth. The ultimate resistance is resistance against fear.
Ilija Trojanow: A visionary humanity
We are quick to express empathy and solidarity when disaster strikes. Only if we develop a visionary humanity, can we turn these reactions into an ability to fight against institutionalised violence and the fundamental problems which underlie all disasters and make them worse. However, our dealings with non-European cultures and religion are still subject to a hypocritical, 19th century rhetoric. This has always been present in the great, liberal project, as we are taught to call it in our schools. One of liberalism’s forefathers was John Stewart Mill who preached universal human rights; elsewhere, though, he wrote that, naturally, such rights did not apply to Indians. That same contradiction has remained with us from the early 19th century into the present day - one law for us, another for them. The incredible opportunity afforded to us by a visionary humanity comes from recognising one basic fact: what is important to us can only be created by ongoing, fruitful, dynamic exchange. And that can only be achieved by merging with what is currently foreign to us. The danger in the 21st century is not too much foreign influence, but too little.
Karl-Heinz Roth: Social appropriation
Social appropriation has been happening over the last 20 or 30 years as a form of resistance to the new laissez-faire capitalism, particularly at local and regional level. We are talking here about anything from landless farmers movements to the social appropriation of insurance schemes managed by their members. These local and regional tendencies have long been in contact with one another. They are connected through networks and social movements which participate in them, represent them, cooperate with them or assist them. And this is also where I would situate Medico’s activities. However, social appropriation is pretty meaningless, if it is not grounded on solid foundations - without legal status, not institutionalised. This would be the importance of networks and social movements since they already coordinate and link up the global initiatives. They could go one step further and create structures and organistions legalize the social gains and make them irreversible.