Chapter XIV - Protecting and Promoting Human Health

   This document has been made available in electronic format
      by the International Co-operative Alliance ICA

  Contribution of Co-operative Enterprises and the International
     Co-operative Movement to Implementation of UN AGENDA 21:
       Programme of Action for Sustainable Development 

                     Prepared jointly by
             the International Co-operative Alliance
                      the United Nations
  Department for Policy Coordination and Sustainable Development

                 Geneva and New York, April 1995

        For information purposes only. Not an official
   document of the United Nations and not officially edited.

                       CHAPTER XIV


A.  Relevant characteristics of health co-operatives and
    their broad contribution to sustainable development

    Health co-operatives include those which are set up by
individuals, usually within a certain community or work-place,
in order to help them meet their own health care needs: these are
user- or client-owned health co-operatives. A second type of
health co-operative is that established by a group of health
professionals - usually doctors - in order to benefit from bulk
purchasing, shared administrative and technical services, and the
bringing together within a single network of a variety of
specialists which strengthen the range and flexibility of
services provided within a community.  These are a type of
service provider co-operative. In some cases health co-operatives
are jointly established and owned by clients (actual and
potential) and service providers.

   Health co-operatives are nationally significant in Japan and
Brazil;  they are regionally important in Spain (particularly in
Catalonia) and in the United States of America (particularly in
the North-West, Mid-West and North-East); and they exist in some
areas in Benin, Canada, Chile, Colombia, El Salvador, India,
Italy, Malaysia, Mexico, Panama, Philippines, Sri Lanka, Sweden
and the United Kingdom.   In Japan both the Japanese Consumers'
Co-operative Union and the National Federation of Agricultural
Co-operatives have established health co-operatives on behalf of
their members: they play an important role in rural and low-
income urban areas. In Sri Lanka the savings and credit movement,
in the Philippines co-operative rural banks and in India the
sugar producers' co-operative system have all established health

   Health co-operatives are significant in that the are capable
of filling gaps caused when public services are inadequate,
usually because of insufficient funding, and when private for-
profit services consider that profits would be insufficient
because of high costs (for example in rural areas) or because of
the poverty of the population. They are also significant where
the population is dissatisfied with the character of health
services available, and wishes to control the provision of
services - usually in order to strengthen preventive approaches. 

  Consequently, health co-operatives are able to play a most
important role in meeting the needs of populations which are
economically, locationally or socio-culturally disadvantaged,
including thereby the poor, rural populations, women, and
indigenous peoples, amongst others. They are relevant, therefore,
to sections of national society which are significant to the task
of achieving sustainable development.

B.  Contribution of health co-operatives to environmental   
    and occupational health

   The co-operative movement is significant also in its emphasis
upon acceptable working conditions for worker-members and
employees, and hence a significant attention to occupational
health. The consumer co-operative movement is concerned
particularly with consumer health. Insurance co-operative
enterprises support health care among their policy-owning
members. Housing co-operatives contribute to the health of their
members, as well as to public health in the community, as do
water and sanitation co-operatives and community development co-

     Agricultural co-operative movements have taken action to
improve occupational health. For example, in 1991 the Japanese
Union of Agricultural Co-operatives adopted guidelines on which
was based a safety campaign including safety of agricultural
products and of persons engaged in chemical spraying. 162/

     Consumer co-operative movements in most advanced market
economies have given concentrated attention to the elimination
of products from their retail outlets which are harmful to

     In some countries co-operative banks have adopted a policy
of avoiding the use of their financial resources in a manner
likely to be injurious to human health. For example, in the
United Kingdom, the Co-operative Bank adopted in May 1992 an
"Ethical Stance" which stated, among other things, that it would
try to ensure its financial services were not exploited for the
purposes of drug trafficking by the continued application and
development of its already successful internal monitoring and
control procedures. It would not provide financial services to
tobacco product manufacturers. 163/

    Some national co-operative movements in developing market
economies have worked on improving health in homes, particularly
for women.   For example, the Co-operative Federation of Nigeria
has developed fuel-efficient stoves which produce much less air
pollution.  164/

C.  Contributions of health co-operatives to the alleviation
    of poverty

    In an increasing number of countries health co-operatives are
meeting needs not catered for by public systems or by private
for-profit health care enterprises.  Some are concerned
specifically to meet the needs of low and medium-income
households in rural regions, as well as in inner cities.

    In the United States, for example, community health centres
democratically governed, community-owned medical care providers
are significant in communities not well served by other health
systems. In 1994 the National Association of Community Health
Centres estimated that there were 900 such co-operatively
structured enterprises, of which 500 were funded by the United
States Public Health Service. Some provided services primarily
to migrant farm workers. For example, the Yakima Valley
Farmworkers' Clinic operated seven clinics in south-central
Washington and north-central Oregon.  In 1992 it served 45,250
medical and dental patients, of which 29,400 were migrant or
seasonal farm workers. 68 per cent had incomes at or below the
federal poverty line. In Milwaukee, Wisconsin, the Sixteenth
Street Community Health Centre is the primary provider for
largely Hispanic and Indochinese residents in a neighbourhood
designated by the State of Wisconsin as a Health Manpower
Shortage Area and a Medically Underserved Area. 165/

    In the United States also most of the co-operative health
maintenance organizations - health systems owned by actual or
potential clients within a designated region - provided
subsidised or free services to low-income residents. 166/

D. Contribution of health co-operatives to the advancement
   of women

   The health co-operatives identified above, as well as many
other types of co-operative concerned with the health of members
and the communities in which they live and work, are of
particular significance for women because they address conditions
in which women are most closely involved, for example, as
agricultural producers, as service sector employees, as managers
and workers in the household sector.  Moreover, they are
concerned specifically with the health status of those sections
of the population not adequately covered by either public or
private for-profit health services. They address in particular
the health needs of the poor - and hence poor women, as well as
of rural populations - and hence particularly rural women, and
inner city communities - of which women make up a majority.

162/ ICA News, No. 3, 1992, p. 17.
163/ Review of International Co-operation, vol. 86, No. 4
     (1993), p. 75.
164/ ICA NEWS, No. 3, 1992, p. 26.
165/ National Cooperative Bank, op.cit., p. 10.
166/ Ibid., p. 8.