Brittaney Warren, director of compliance for the G20 Research Group, highlights the commitments required by G20 leaders to boost progress towards universal health coverage
Health will be a prominent subject at the G20 Osaka Summit. Following the initiative of the German presidency in 2017, Japan will host a post-summit health ministerial meeting in Okayama and, for the first time, G20 health ministers will meet with their finance colleagues on the sidelines of their leaders’ summit at Osaka. At all three gatherings, universal health coverage will be a key focus. With a human-centred future society, inspired by Japan’s innovative Society 5.0 development plan serving as the overarching theme of the Osaka Summit, how digitisation can improve health will likely feature too.
Given the importance of health to all individuals’ ability to live productive, meaningful and long lives, the G20’s performance on health matters for everyone on the planet now and in the coming years.
The G20 has addressed health since its first summit in Washington DC in 2008. Its health agenda has risen in importance and broadened, although with many spikes and dips along the way.
At Washington, G20 leaders identified “disease” as a “critical challenge”, along with climate change and food security, in 118 words. The 2009 London Summit saw a 50% drop to only 59 words on health. There was a steep rise to 284 words at the Pittsburgh Summit later that year. Another swing followed in 2010, with a dip to 139 words at Toronto and then a rise to 634 words at Seoul. Attention declined to 470 words at Cannes in 2011 and 250 words at Los Cabos in 2012. A big jump to 1,340 words came at the 2013 St Petersburg Summit. Brisbane in 2014 produced 769 words. Antalya in 2015 declined to 481 words and Hangzhou in 2016 to 234 words. There was then a sharp rise to 707 words at the 2017 Hamburg Summit, with a final drop to 316 words at the 2018 Buenos Aires Summit.
From 2008 to 2018, the G20 made 61 collective, politically binding, future-oriented commitments on health. The first came at Brisbane in 2014. Here G20 leaders made 33 commitments, all on the Ebola outbreak. Antalya in 2015 made two, on health systems strengthening. Hangzhou in 2016 made three, on anti-microbial resistance. The 2017 Hamburg Summit made 19. Of these, 11 were on AMR, seven on health systems strengthening and one on polio. The 2018 Buenos Aires Summit made four: one each on obesity; health systems strengthening; universal health coverage; and the Global Fund for AIDS, Tuberculosis, and Malaria. The G20 has also made other commitments related to health, including on air pollution and the link between plastics and health.
The G20 Research Group has assessed eight of the 61 core health commitments for members’ compliance with them. They averaged 71% compliance. This is on par with the G20’s average compliance across all subjects. Of the four assessed health commitments from the 2014 Brisbane Summit, the three on Ebola averaged compliance of 63% and the one on AMR had 98%. The two assessed commitments from the 2015 Antalya Summit averaged 65%. The one from the 2016 Hangzhou Summit, on AMR, had compliance of only 30%. The one from the 2017 Hamburg Summit, on strengthening healthcare systems, had 98%.
Compliance was led by the United Kingdom and the United States with 100% and 94%, respectively. They were followed closely by the European Union, Germany and Canada with 88% each. Then came France, Japan and Australia, each with 82%, China and South Africa with 75% each, Russia and India with 69% each, and Korea, Saudi Arabia and Brazil with 63% each. At the bottom were Turkey and Italy with 57% each, and Mexico and Argentina with 38% each.
Although the G20 has complied with its health commitments moderately well, substantial improvements can and should be made. It can use accountability measures that are in the leaders’ direct control. Research shows that, on some issues, holding a pre-ministerial meeting correlates with a higher number of commitments, which in turn correlates with higher compliance. At the four summits where the G20 made health commitments, the two that made the most had significantly higher health compliance, of 87%, compared with the two summits with the lowest number of commitments, which had compliance of only 48%.
Linking health to other subjects, such as environmental pollution, could also help improve compliance. Indeed, compliance with the somewhat similar 2018 G7 environment ministers’ commitment linking air pollution with health had the highest compliance (75%) of the three priority commitments assessed from that meeting.