The cost of global health
Germany’s inclusion of global health in the G20 agenda in 2017 and its hosting of the very first meeting of G20 health ministers was groundbreaking, as was the serious attention that global health matters received in the final communiqué of leaders in Hamburg. The G20 had agreed to create the Health Working Group in China in 2016, and it came into being under the German presidency the following year, with the strong personal support of Chancellor Angela Merkel. Following some nervousness about whether the next G20 presidencies would maintain this high interest in health, Argentina is continuing to highlight health matters, and Japan will make it a very important part of its 2019 presidency. A strong troika for health – Germany, Argentina and Japan – is anchoring global health in the G20 agenda.
As health becomes a regular feature of G20 deliberations, some issues must remain, as they continue to need strong political support: health security, health systems strengthening and antimicrobial resistance (AMR). These were included in the declaration of the G20 health ministers at their meeting in Mar del Plata in October. That meeting provided continuity by again including a simulation for health ministers, this time on AMR. It also highlighted a high priority for Latin America: childhood malnutrition and obesity. The health ministers encouraged investment in research and development across a range of interventions – including antimicrobials, diagnostics and vaccines – while “promoting affordable and equitable access to all individuals
in need”. They also provided strong support for the product development partnership model.
Accelerating global processes
It is critical that on global health the G20 does what it does best: draw the attention of political leaders to the major health challenges that need the support of heads of state and government and of finance ministers and the investment community. The middle-income economies in the G20 – especially the BRICS members – need to make extraordinary investments in their health systems in order to respond to their populations’ health needs, especially the increasing challenges rising from the tsunami of non-communicable diseases. Here, the interface of the G20 commitments with the deliberations at the United Nations and the UN system in general is essential. G20 deliberations on health must support and accelerate global processes, not create parallel initiatives. The support expressed in the ministers’ declaration, especially for the Sustainable Development Goal (SDG) 3 action plan and several other global action plans, is an excellent example of such political synergy.
Broad involvement
This is why it is important that high-level representatives from major organisations such as the World Health Organization, the Global Fund, the Food and Agriculture Organization, the Organisation for Economic Co-operation and Development, the World Bank, the World Organization for Animal Health and Unitaid were part of the deliberations. Their involvement underlines the multisectoral nature of the issues at stake.
Now that this dialogue and approach are established, the challenge lies with Japan to undertake the critical next step. In 2019, the challenge of universal health coverage (UHC) will be taken to the United Nations General Assembly. This high-level meeting will set the stage for UHC implementation for years to come. The G20 is called upon to consider how to ensure and increase investments in UHC. It is therefore essential not only to have a health ministers’ meeting but also to place health financing on the finance track. Health ministers, finance ministers and leaders themselves must take strong steps to ensure that no one is left behind on health, so their populations are not burdened by unaffordable co-payments, catastrophic expenditures and even fall into poverty because of health costs. The World Bank is already calling for increased investment in human capital – health and education – and other financial institutions must follow, including the G20.
A political choice
The SDGs set the scene for a new development paradigm in combination with a focus on domestic financing. Transition modalities must be explored, the weakest links (especially regarding health security) must be addressed, and new financing as well as institutional mechanisms must be introduced. The G20 must reaffirm that health is a human right and that it constitutes a social contract at the national and the global levels. Above all, the G20 must make the political choice for health and take this commitment to other political bodies. The Buenos Aires Summit must set the scene and affirm that health is central to the SDGs and that only with significant health investments can the SDGs be achieved and people be able to achieve healthy lives and well-being.
