The responsibility of defining future health and non-health priorities falls into the hands of our leaders, and policymakers must consider the impacts of the initiatives and programmes they support – and how they inform one another
In the past three years the world has been grappling with the consequences of the Covid-19 pandemic, an ongoing war in Europe, renewed migration flows putting vulnerable communities in distress and natural disasters increasingly affected by climate change. These developments are imposing severe inflationary pressures and economic burdens on our societies. Achieving the Sustainable Development Goals by 2030 seems a distant reverie.
At the heart of these challenges, we have the G20 and G7, originally created for international economic cooperation but over the years widening their mandates to include global health as a determinant of economic growth, social integrity and well-being.
G20 and G7 Zeitenwende
Both the G20 and the G7 were born of geopolitical and financial crises. The G20 at the finance ministers’ level was created following the Asian financial crisis in 1999 and G7 leaders first met in 1975 as a direct result of the 1973 oil crisis.
With widening mandates, the G20 and G7 have become all-inclusive platforms for policy coordination and leverage across policymakers and stakeholders from the public and private sectors. This trend has led to a plethora of communiqués with little convergence between the two forums.
While we should appreciate multilayered and inclusive policy coordination, for international rules and norms to prove relevant, they cannot merely be affirmed by joint declarations. As Henry Kissinger says, they must be fostered by common conviction.
That conviction must be strengthened by convergence within and between the G20 and G7 and by concrete, impact-driven initiatives that last within the cycles of the past, current and incoming presidencies, if not longer, as current and future challenges do not respect borders.
Health has featured higher on G20 and G7 agendas since the G7 health ministers began meeting annually in 2015 and G20 ministers in 2017. Common challenges including the need to prepare for future pandemics, develop a One Health approach, tackle antimicrobial resistance and promote universal health coverage featured early. But Covid-19 triggered a new recognition of the impact of global health on all areas of daily life. Each crisis has a different cause, but the common feature is the systemic underappreciation of risk – and the same applies to health. Despite the G20 health ministers’ pandemic simulation exercise in 2017, the reactive approach to Covid-19 has cost $13.8 trillion in gross domestic product, about five times more than the Chernobyl disaster.
The tremendous unity and collaboration during the Covid-19 pandemic helped supply the world with tests, therapeutics, medical supplies and vaccines, via G20 initiatives such as the ACT-Accelerator. Yet the many lessons learnt from the crisis have led to the awakening that health means wealth, and that health is a good investment rather than a sheer cost for finance ministers.
What I call the Zeitenwende has kicked in among global health actors, health and finance ministers, and the investor community about the changing role of global health and the global health architecture. Calls for stronger dialogue among G20 and G7 health and finance ministers have led to the G20 Joint Finance and Health Task Force created in 2021 and the G7 Impact Investment Initiative for Global Health in 2023. The G20 task force promotes best practices, collective action and stewardship of resources to address financing gaps in pandemic preparedness and response. The G7 Triple I aims to share best practices for impact investment with a view to achieving universal health coverage. With ever-decreasing budgets for global health, due to the many multipolar challenges, shrinking resources from governments and development finance institutions, and low- and middle-income countries struggling with debt, the G20’s 2024 and 2025 presidencies of Brazil and South Africa and the G7 presidencies of Italy and Canada have an increasing responsibility to help close these funding gaps, moving sustainable finance for health higher on the political agendas if we are to achieve SDG 3 on good health and well-being by 2030.
A new G20 cycle in 2026
Global health has featured high for the G20 and G7 presidencies in 2023. India and Japan have done excellent work in keeping the existing and new initiatives prominent, committing to the central role of the World Health Organization at the core of health coordination and diplomacy, and recognising the need for more convergence between the G20 and G7. At this year’s United Nations General Assembly three high-level meetings focused on ending tuberculosis, delivering universal health coverage, and strengthening pandemic prevention, preparedness and response.
This first observation may be a relief. However, health is slipping down the international political agendas and becoming fragmented. Silos are re-emerging as the rally for funds increases. Climate change, nature preservation and biodiversity challenges are taking centre stage. Yet there should not be competition within the global health community or other communities, let alone a competition and creation of new forums outside of the G20, G7 or WHO.
The recent G20 New Delhi Leaders’ Declaration highlighted the importance of reinvigorating multilateralism. The next two years are critical for global governance and global health diplomacy before the second G20 presidency cycle starts in 2026. To address the global challenges of the 21st century, the world should not fall back onto traditional building blocks. Multilateral forums should promote collaboration between the Global South and the Global North. Current and future crises require proactive diplomatic efforts, starting at the top on the agendas of the G20, G7 and multilateral development banks, as well as from the bottom by integrating parliaments into processes to bridge communications gaps between constituents and their governments and the international agendas.
The world requires more accountability, collaboration and transparency within the G20 and G7, parliaments, and the global health and other communities. A systems rethink is needed. Opportunities lie in strengthening universal health coverage, supply chains, health systems, primary health care and the healthcare workforce. Without systems change in global health and the global health financing architecture, infectious or non-communicable diseases cannot be prevented effectively and the global health community will turn in circles in damage control mode.
It is equally the responsibility of countries and parliaments to define future health and non-health priorities, including climate change, in ways independent of electoral cycles. Health and climate change affect each other and our lives and economies. Policymakers must consider the impacts of the initiatives and programmes they support. Nearly 50% of people worldwide live in countries that spend more on servicing foreign debt than on health care – a 25% rise since 2020.
We have two years before the G20 hosting cycle restarts. This gives the global health community and G20/G7 leaders time to apply a new approach to sustainable finance in global health by bridging the valley between the investor and health communities and bridging the democratic deficit that emerged during the pandemic. Time will tell whether this will be an opportunity or a challenge for global governance.