G20 performance on health

Based on key compliance data, there are two strategies that G20 leaders can employ to move beyond reacting to health emergencies and focus on addressing long-term health challenges

Although Covid-19 put health at the forefront of the G20’s agenda in recent years, G20 leaders first addressed health at the inaugural summit in Washington DC in 2008. There they affirmed the importance of the Millennium Development Goals (many of which were related to health) and committed to addressing critical challenges, including disease.

Since then, the G20 has continued to play an important role in global health, notably during the Ebola epidemic starting in 2014 and the Covid-19 pandemic spreading in 2020. Nonetheless, G20 leaders can build on their past efforts to improve G20 health performance at the 2023 New Delhi Summit.

Conclusions

G20 leaders’ communiqués have dedicated 15,055 words to health, averaging 886 words, or 10%, at each summit. Leaders have produced only one stand-alone document on health: the 2014 G20 Leaders’ Brisbane Statement on Ebola.

Health has been mentioned at every summit. After a slow start, it has become a significant focus since the Covid-19 pandemic. Health received the most words in 2020, when the Riyadh Summit was held virtually due to the pandemic, with 3,862 words, for 68% of the communiqué. This surpassed previous highs at St Petersburg in 2013 with 1,340 words (5%) and at Osaka in 2019 with 934 words (14%). At Rome in 2021, the leaders gave 1,545 words to health (16%), rising at Bali in 2022 to 2,904 words (29%).

Commitments

G20 leaders made 141 health commitments from 2008 to 2022, on infectious diseases, health systems, antimicrobial resistance, data sharing, ageing and more.

The first health commitments were made at the 2014 Brisbane Summit in response to the Ebola epidemic, with 33 commitments, or 16%. This dropped to two (2%) at the 2015 Antalya Summit and three (1%) at the 2016 Hangzhou Summit. It increased to 19 (4%) at the 2017 Hamburg Summit, followed by another decline to four (3%) at Buenos Aires in 2018.

It rose at the 2019 Osaka Summit to 14 (10%) and again, in response to Covid-19, to 14 (13%) at the 2020 Riyadh Summit. It peaked at 35 (16%) at the 2021 Rome Summit, then decreased to 17 (8%) at the 2022 Bali Summit.

Compliance

The G20 Research Group has assessed 24 health commitments for members’ compliance. Overall, compliance averages 70%, slightly below the 71% average across all subjects. Health compliance averaged 72% with commitments made at Brisbane in 2014. It decreased to 65% for the 2015 Antalya Summit and to 30% for the 2016 Hangzhou Summit – the lowest compliance ever. Compliance increased to 66% for the 2017 Hamburg Summit, 64% for the 2018 Buenos Aires Summit and 66% for the 2019 Osaka Summit. It then rose to 71% for the 2020 Riyadh Summit, and reached a high of 80% for the 2021 Rome Summit. By April 2023, compliance with commitments made at the 2022 Bali Summit was 74%.

Causes and corrections

The G20’s high compliance with health commitments made in 2014, 2020, 2021 and 2022 is partly due to the shock-activated vulnerability from Ebola in 2014 and Covid-19 in 2020. But leaders can employ two strategies to move beyond crisis response to sustain and strengthen their performance on health.

First, the highest compliance occurred when leaders made more health commitments. The four highest complying summits averaged 25 commitments each and 74% compliance. The five lowest complying summits averaged only eight commitments and 58% compliance. 

Second, compliance has risen since G20 health ministers began meeting in 2017. Between 2014 and 2016 compliance averaged 56%. Between 2017 and 2022, including interim compliance, the average was 70%. The health ministers’ meeting in August 2023, before their leaders’ meeting in September, bodes well for compliance with the health commitments at the New Delhi Summit.

At New Delhi, G20 leaders should mandate their health ministers to continue working together and build on the work and momentum created by their health ministers to produce a high number of ambitious health commitments. G20 leaders can move beyond reacting to health emergencies and focus on addressing long-term health challenges to create better, more equitable health outcomes for all.