Back in November, I blogged about what the G20 might mean for health, and argued that drawing any substantive conclusions then was premature. The issue of the G20 in health was taken up in a big way by the new Global Health Security Centre at Chatham House which organized a one day conference on ‘What’s next for the G20? Investing in health and development’.
For those who were not able to attend I thought it would be useful to highlight the issues that were debated.
Three main challenges came out on what a G20 focused on development might mean for health.
- Representativeness: The G20 members are selected on the basis of GDP, not development success. Thus the G20 (self-association group) lacks the legitimacy to act on behalf of the world – and therefore needs to handle its relationship to the UN (which does) carefully. Does having more countries at the table automatically mean better articulation of the concerns for the world’s poor?
- Capacity: The G8 works in health because the ‘sherpas’ know each other personally, and they put major work into the communiqué. With the G20, it is more difficult: the sheer number of individuals means that the resulting communiqué might become the lowest common denominator. How can membership be expanded without losing capacity?
- Political will: The G20 is no longer a small group of donors with a mandate to help recipient countries – driven by guilt or reputational concerns – but rather a mixed group with countries such as India and China still facing major domestic poverty and development problems. How can consensus be reached on what to do globally when some of the participant countries still struggle on how to address basic domestic health challenges such as malnutrition (estimated to affect 40% of Indian children) and lack of water and sanitation?
There was also a persuasive case made for why the G20 must involve itself in global health. The G20 communique (paragraph 47) notes the creation of a working group on development. Justified how? Health and development are perceived as key sources of sustainable economic growth and stability, both core G20 areas. Thus to address development is to address global economic imbalances. The question here is about strategy- development is more than ODA, the narrower approach being how the G8 has approached health (e.g. through financial commitments).
A participant from Africa made an equally important point, noting that whether it is the G8 or G20 makes little difference to global health since change needs to occur at the national level, and regardless of the forum, the health community needs to demand delivery. The simple message: let’s stop focusing on who is saying what and where, but what is happening to health in poor countries and ensuring commitments are delivered on.
The ‘elephant in the room’ throughout the day was whether global health might break the back of the G20; that is, not what the G20 might mean for health, but what health might mean for the G20. The real test will be how the South Korean government, the first non-G8 host of the G20, resolves the tension between keeping the G20 the premier economic forum, thus not overburdening it with health, climate change and the other major global challenges, and enlarging its mandate on development.