 Greetings from Savar in Bangladesh, where the fourth People's Health Assembly is just about to start. Greetings from around 1400 health activists from scores of countries around the world who are coming together to talk about the specific struggles they're working on, but mainly to also talk about the ways in which the struggle for health has been increasingly dominated by the neoliberal globalization. There's no doubt that we are facing a health crisis and we often think about health in terms of two broad areas. One is health systems and the other is about the social conditions which shape people's health. In terms of health systems, the crisis is evident in terms of lack of access to care, lack of access to decent care, lack of access to medicines. And for many people, the impoverishment which follows getting sick, partly because of the huge out-of-pocket costs many people face, partly because of unemployment and lack of social protection. In terms of the social conditions which shape people's health, let me just mention hunger. A quarter of all children under five are stunted. That means they're short for age, which means that they're not getting enough food. A billion people lack adequate access to fresh drinking water and that doesn't include the millions of women who have to walk miles to collect water. Eight hundred million people don't have access to decent sanitation. So when you think about the high levels of research into very rare diseases and compare that to the magnitude of health problems due to just the lack of resources, essentially, you have to ask why. And over the last 40, 50 years there's a very important change has taken place. In 1974, when the newly decolonised countries after the Second World War had a lot of optimism, they adopted a commitment in the United Nations called the New International Economic Order. That was adopted in 1974. And then four years later in the health sector we adopted the Alma Arta Declaration on Primary Health Care, which highlighted the need for a new international economic order as a key for delivering decent health care and the conditions for people to live in better health, achieve better health. Within a few years of the adoption, first of all, of the NIEO and then of Primary Health Care, we had a real turning point in the global economy. And that was marked most dramatically by the huge interest rate hike, which was undertaken in 1981, which was deliberately implemented in order to break the unions and stop their demands for increased wages. But it also had a devastating effect on the developing world, particularly those countries which had borrowed money when money was cheap. And following that we had the debt crisis and the IMF's imposed structural adjustment. And for many countries the health crisis got worse at this point. Towards the end of the 90s there was a reaction against this and there was a sort of progressive disgust globally with the IMF and structural adjustment. In 1993 the World Bank stepped in with a very glossy report called Investing in Health, which sought to show that health, that structural adjustment was good for your health. This is the nonsense of this proposal started to become clear in the late 1990s when in the presence of a devastating AIDS epidemic and the development of effective antiretroviral drugs, the big farmer attacked the South African government of Nelson Mandela from 1997 because they wanted to use the flexibilities which had been built into the World Trade Organization's TRIPS Agreement, that's the agreement about intellectual property, that they wanted to use that agreement to reduce the cost of AIDS treatment, of AIDS drugs. So at a time when big farmer was charging $10,000 per year per treatment year, the Indian generic companies could offer it for $350 per treatment year, but the US and the 39 drug companies thought that that was outrageous and they attacked the South African government in the courts. The global response to that was huge and big farmer lost heavily and eventually they had to withdraw and in 2001 there were two major events. One was the WHO produced a special commission on macroeconomics and health and the bottom line in that commission was and I quote, globalization is on trial. That was globalization is on trial and what was to be the response to that globalization is on trial? We must raise far more money to give for development assistance to developing countries. The other big thing which happened in 2001 was the meeting at Doha of the Ministerial Council of the WTO, the World Trade Organization, which adopted the Doha Declaration on Public Health, which said that trade should not get in the way of public health and reaffirmed the legitimacy of using the flexibilities built into that TRIPS agreement to ensure access to medicines. During the first decade of the new century there was a massive increase in development assistance, largely through big philanthropies and through the OECD rich country donors. A lot of this was good and produced big impact on getting treatment and getting vaccines, but it also had a very damaging effect on health systems because the development assistance so-called was all delivered through vertical, quite narrowly structured programs which had the effect of fragmenting existing health systems and the consequence was that because the health systems were being weakened, the health crisis was not being helped. So where do we stand now? Health crisis is not specific to health. It's about a global economic crisis and the global economic crisis is a crisis which started in the 1970s and it is essentially a crisis of overproduction that with modern technology you can produce more and more stuff for more and more people with fewer and fewer workers, but if fewer and fewer workers are being used to produce stuff then there's fewer and fewer people to buy it, notwithstanding their need. And so since that time the globe has been teetering on the brink of this economic crisis and the way the corporate world wants to respond to this crisis has been to cut wages, to move production to the cheapest offshore platforms, to insist on economic integration which means that companies can move wherever they like, but of course workers can't and the neoliberal paradigm which is part of this is about low taxes, low public expenditure, privatizing healthcare, accepting, widening inequality. So why are we here in Savar? We're in Savar for an opportunity for activists involved in health issues all around the world from many, many countries to come together to share the specificities of the struggles they are facing, to share the detail of the unique situations that people are in and the unique responses that social movements are developing in those contexts, but also to recognize the degree to which those struggles are shaped by a looming economic and environmental crisis and the policy paradigm of neoliberalism which is designed to address that crisis in the interests of the transnational capitalist class. Our job is to build solidarity across boundaries, to build an understanding, to build collaboration and to find ways of continuing to address the local issues that people are facing but in ways which also contribute to changing the macro circumstances. And in future reports from this station will be reporting on some of the key presentations, discussions, manifestations over the next four days.