Fran Baum: The Fourth People’s Health Assembly concludes by decrying the health impacts of corporate power

Governments’ protection of transnational corporations is the greatest threat to health, says Fran Baum in her wrap up of the Fourth People’s Health Assembly

It is certainly not a new insight that health is political. Virchow recognised this in the 19th century when he remarked that politics is nothing but medicine on a large scale. That this remains the case has been constantly reinforced at the Fourth People’s Health Assembly (PHA4). The most profound political and economic change over the past 20 years is that transnational corporations (TNCs) have come to rule our world and this change was evident in many discussions.

We heard that food environments, shaped by the import or production of calorie rich, low in nutritional value food, is driving a non-communicable disease epidemic in many countries. The activities of transnational mining companies are adversely affecting the lives of the communities in which they operate, as well as despoiling natural environments. Alexis Benos from Greece even called for the cessation of all activities by extractive industries in order to protect people and nature from its effects.

Our deliberations about the health sector recounted the pressures to privatise health services, outsource activities to the private sector, and reduce funding for public healthcare. Discussions about trade and health emphasised that trade agreements often limit the space for governments to legislate in favour of public health and are constructed to protect the interests of TNCs. The pharmaceutical industry makes vast profits and yet, the world over, many drugs are out of the reach of people who are poor. Thus the assembly returned repeatedly to the powerful impact of the corporate determinants of health.

One of the things I most enjoyed about the Fourth People’s Health Assembly was spending four days with 1200 people who all seem to accept that the current global and political regime, with its protection of the rights of TNCs and its creation of mind numbing economic inequalities, is the greatest threat to the health of people and planet. Usually, I find myself having to explain why people’s health behaviour isn’t the main cause of ill health but only the tip of the iceberg. Beneath the surface, everyday living conditions (such as housing, employment, opportunity to access health services, educational opportunities) drive people’s health status. These everyday living conditions are, in turn, driven by underlying political and economic factors and the corporate determinants discussed above.

Much of the discussion at the assembly painted a bleak picture of the future for the health of people and the planet. Yet the assembly also heard positive stories, ranging from innovative models of healthcare to challenges to corporate power. A presentation on the successful Cuban Latin American School of Medicine described how it provides free medical education to students from low income families. Two graduates from the US described how they were providing free healthcare in poor communities where many people have no health insurance. I was also inspired by the work of a coalition of civil society groups to support a UN binding treaty on TNCs and human rights.

For the final PHA4 session the hall was packed. The action plans from the main themes of the conference—health systems; food and nutrition; trade, health, and access to medicines; gender; environment and development; and occupation, militarisation, and war—were presented (and will soon be available at

The PHA4 ended in a spirit of incredible energy, enthusiasm, and passion. Delegates from each region of the world took turns to sing a rousing call to arms. The inspiration that comes from such passion is vital to progressive health civil society movements. These movements provide the few voices who protest the fact that many governments are failing to invest in the public infrastructure needed to promote health or to question growing corporate control over our lives and health.

Civil society groups like the People’s Health Movement can present ideas that have not been filtered by corporate and government agenda and which speak truth to power. What a shame that WHO and other UN agencies were not present to hear these voices; they presented a vision of society, which provides an alternative from the dominant narrative of neoliberalism. I left the PHA4 greatly heartened not just by the strength of our voices, but also by the fact that there were so many young people enchanted by the movement and determined to go home and fight for health, justice, and equity.  

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Fran Baum is Matthew Flinders distinguished professor of public health and foundation director of the Southgate Institute for Health, Society and Equity at Flinders University, Adelaide, Australia. She is a member and past chair of the Global Steering Council of the People’s Health Movementa global network of health activists (www. She also served as a commissioner on the World Health Organization’s Commission on the Social Determinants of Health from 2005-08.

Competing interests: I am member of the People’s Health Movement Global Steering Council and a member of the Global Health 50/50 Advisory Council.