G20 performance on health

Making more health commitments correlates with higher compliance in this area and is just one of several measures the G20 leaders could take to boost progress in global health care

The G20 Bali Summit put the global health architecture among its three priorities, with an emphasis on global collaboration to advance post-pandemic recovery and encourage strengthening global health resilience to make the global health system more equitable, inclusive and responsive to crises. Given the significant shock to the global health system from the Covid-19 pandemic, G20 leaders need to take an ambitious and collaborative approach to tackle the most pressing health challenges.

Conclusions

From their first summit in Washington in 2008 to the most recent one in Rome in 2021, G20 leaders produced a total of 12,220 words on health in their communiqués. This 8.6% average per summit is much lower than the 34% average for the G20’s top issue of macroeconomic growth. There have been several documents dealing with health, averaging 2.2 per summit, with most released at the 2013 St Petersburg Summit. The 2020 Riyadh Summit had the highest focus on health, with 68% of the total words, surpassing the previous high of 14% at the 2019 Osaka Summit. At Rome, the leaders dedicated 16% of their words to health.

Commitments

G20 summits have produced a total of 124 commitments on health. The first were made at the 2014 Brisbane Summit, responding to the Ebola crisis, with 33 (16%) of its commitments on health. G20 leaders produced two (2%) commitments at the 2015 Antalya Summit and three (1%) at the 2016 Hangzhou Summit. The number jumped to 19 (4%) at the 2017 Hamburg Summit and decreased to four (3%) at the 2018 Buenos Aires Summit. The 2019 Osaka and 2020 Riyadh summits produced 14 each (10% and 13%, respectively). The 2021 Rome Summit made a new peak of 35 (15%) commitments on health.

Compliance

The G20 Research Group has assessed 19 of these 124 health commitments for compliance by G20 members. Compliance averaged 72%, slightly higher than the G20’s overall, all-subject average of 71%. Compliance with commitments made at the 2014 Brisbane Summit averaged 72%, subsequently declining to 65% for the 2015 Antalya Summit and only 30% for the 2016 Hangzhou Summit. It then jumped back to 65% for the 2017 Hamburg Summit, 64% for the 2018 Buenos Aires Summit and 66% for the 2019 Osaka Summit. It soared to 90% for the 2020 Riyadh Summit, the first since the Covid-19 pandemic arrived. By June 2022, compliance with the health commitments made at the 2021 Rome Summit was already 79%.

Causes and corrections

The shock of the Ebola outbreak in 2014 and Covid-19 in 2020 pushed G20 leaders to perform better on health. Although such global shocks are beyond G20 leaders’ immediate direct control, there are nonetheless steps they can take to improve compliance with their health commitments.

First, G20 leaders can make more health commitments. Research shows that more commitments on health usually accompany higher compliance scores. 

Second, they should make more ambitious commitments that focus on strengthening the global health infrastructure, universal health coverage and pandemic preparedness. Commitments that explicitly mentioned cooperating to strengthen health systems, working towards universal health coverage and strengthening pandemic preparedness achieved above-average compliance.

Third, holding meetings of health ministers, which first began in 2017, appears to correspond with higher compliance, especially with a lag. This follows the overall trend of higher compliance for commitments made at summits coming after a ministerial meeting relating to the issue they govern. G20 leaders should thus continue to have health ministers meet before the summit to identify and prepare key issues for cooperation.

At Bali, G20 leaders should produce a high number of ambitious health commitments on strengthening the global health architecture and improving pandemic preparedness. They should also build on the work of their health ministers who will have met several times under Indonesia’s presidency.

With the world still coping with Covid-19, the G20 has an opportunity to apply the lessons learnt on global health cooperation, information sharing and pandemic preparedness. The priority placed on the global health architecture by Indonesia’s G20 presidency bodes well for the leaders’ performance at Bali. If they can successfully build on the increased attention to and compliance on health in recent years, they can set truly ambitious health targets and achieve the success needed to build a resilient global health architecture and prevent another global health disaster.