Despite strong compliance on health commitments in some years, there is room for improvement – and 2020 could be the catalyst for better performance as the G20 rallies to fight COVID-19
In the lead-up to the 2020 Riyadh Summit, the international focus has been on the global COVID-19 pandemic. Under Saudi Arabia’s presidency, G20 leaders responded with the Extraordinary G20 Leaders’ Summit on 26 March 2020, and their health ministers have met once on their own and once with the finance ministers, in addition to their originally scheduled meeting and three meetings of the Health Working Group. This is an enormous surge in G20 governance of health, a subject on the leaders’ agenda at every summit since their first in 2008.
G20 leaders produced a total of 6,744 words on health in their communiqués from 2008 to 2019. This averages 482 words (4%) per summit. They have released 34 documents dealing with health, averaging two per summit. The 2013 St Petersburg Summit produced the highest number of such documents with five, followed by the 2016 Hangzhou Summit with four.
Since 2009, G20 leaders have consistently, with one exception, produced at least 200 words per summit on health. At Washington they dedicated 118 words (3%) to health, followed by 59 words (1%) at the 2009 London Summit and 284 (3%) at the 2009 Pittsburgh Summit. The number dropped to 139 (1%) at the 2010 Toronto Summit, then jumped to 643 (4%) at the 2010 Seoul Summit. It dipped to 470 words (3%) at the 2011 Cannes Summit and 250 words (2%) at the 2012 Los Cabos Summit. The peak came at the 2013 St Petersburg Summit with 1,340 words (5%). The 2014 Brisbane Summit had 769 words (8%), followed by a drop to 481 words (3%) at the 2015 Antalya Summit and 234 words (1%) at the 2016 Hangzhou Summit. The number of words rose to 707 (2%) at the 2017 Hamburg Summit, but declined to 316 (4%) at the 2018 Buenos Aires Summit. The 2019 Osaka Summit had a spike to 934 words (14%).
Although G20 leaders have discussed health since 2008, they only began making commitments on the subject in 2014. They made a total of 75 commitments on health, beginning at the 2014 Brisbane Summit with 33 (16%). They made two (4%) at the 2015 Antalya Summit and three (1%) at the 2016 Hangzhou Summit. The 2017 Hamburg Summit jumped to 19 commitments (4%). The 2018 Buenos Aires Summit made only four commitments (3%). The 2019 Osaka Summit made 14 commitments (10%), including one on improving public health preparedness and response through the World Health Organization.
The G20 Research Group has assessed 11 health commitments for compliance and found an average of 69%. Compliance with commitments made at 2014 Brisbane averaged 72%, then declined to 60% for 2015 Antalya and 30% for 2016 Hangzhou. It spiked to 98% for 2017 Hamburg and 93% for 2018 Buenos Aires. Interim compliance on health for the 2019 Osaka Summit by May 2020 was 69%.
Four health commitments made at the leaders’ extraordinary summit in March 2020 have been assessed for compliance. The interim average two months later was 63%, with the highest compliance on health system strengthening at 78% and the lowest on digital health technologies at 35%.
Causes and corrections
Although there has been strong compliance in some years, there is room for improvement. Higher compliance can be achieved by making more commitments at each summit on health and decreasing the amount of words dedicated to health to focus on specific areas of health.
The three summits with the highest compliance averaged 88%, with an average portion of 6% of all commitments made at the summit. The summits with the lowest compliance averaged 53% and had an average of 3% of all commitments made. Conversely, the highest complying summits dedicated an average 3% of words to health at the summit, and the lowest complying summits dedicated an average of 4%. This suggests that the G20 can improve compliance with its health commitments by making more of them, while addressing a narrow breadth of topics and using fewer words.
Finally, it may serve the G20 well to increase the links between health and other issues such as the environment, climate change, gender or sustainable development. Such connections could help the G20 achieve higher compliance with its health commitments.