G20 performance on health
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G20 Summit

G20 performance on health

Joanna Davies

Building on progress made with the One Health initiative under India’s stewardship in 2023, G20 leaders at Rio de Janeiro should prioritise health commitments, bolster WHO support and enhance coordination on pandemic preparedness, climate health and digital inclusion

G20 leaders have continued to implement strategies that integrate primary, secondary and tertiary public health interventions, while also fostering the development and maintenance of international medical emergency prevention, preparedness, response and recovery. Additionally, they are working to mitigate the negative health impacts of climate change and food insecurity. Under India’s 2023 presidency, members strengthened their One Health initiative by invoking artificial intelligence and evidence-based traditional and complementary medicine, while also improving mental health. For 2024, Brazil has made health a key component of its top G20 priority to reduce inequality.

Deliberation

G20 leaders’ communiqués have dedicated 16,379 words to health, averaging 9% at each summit. Health has appeared at every summit since the first in 2008. Global public health care has appeared since the 2010 Toronto Summit.

In 2013, leaders dedicated 1,340 words to health (versus only 250 the year before and the highest to that date), and encouraged compliance with the International Health Regulations. Health became a significant focus with the Ebola epidemic in 2014, taking 8% of the communiqué. It did not rise above 8% until the 2019 Osaka Summit, when it took 14%. Amid the Covid-19 pandemic in 2020, G20 leaders dedicated the most words to health to date, accounting for 68% of the communiqué. In 2021 they dedicated 16% to health. This rose in 2022 to 29%, then dropped in 2023 to 13%.

Decisions

G20 leaders made 166 health commitments, starting in 2014. These covered infectious diseases, health systems, antimicrobial resistance, data sharing, ageing and more. In 2014, they produced their first specific health-related document – the Brisbane Statement on Ebola – which included 33 health commitments, accounting for 16% of the total. This dropped to two (2%) in 2015 and three (1%) in 2016. It increased to 19 (4%) in 2017. It declined
to four (3%) in 2018, rose in 2019 to 14 (10%) and, in response to Covid-19, 14 (13%) in 2020.

The number peaked at 35 (16%) in 2021, then decreased to 17 (8%) in 2022, before rising in 2023 to 25 (10%).

Compliance

The G20 Research Group has assessed members’ compliance with 28 health commitments. Compliance averaged 70%, just below the 71% overall average.

Compliance averaged 72% with the health commitments made in 2014. It decreased to 65% for 2015 and to 30% for 2016 – the lowest. Compliance increased to 66% for 2017, 64% for 2018 and 66% for 2019. It then steadily rose to 71% for 2020 and 76% for 2021, and further to 78% for 2022. By May 2024, interim compliance had reached 75% for the 2023 New Delhi Summit.

Causes and corrections

Several patterns in health compliance indicate opportunities for the G20 to improve its compliance.

More health commitments accompany higher compliance. The five highest health-complying summits averaged 25 health commitments each and 74% compliance. The five lowest-complying summits averaged only eight commitments and 58% compliance. This suggests the G20 should make more commitments
on health to raise compliance.

Specific health subjects have higher compliance. Commitments on One Health and the Sustainable Development Goals averaged 90% and 78%, respectively. High compliance also came with commitments on data and digitalisation, averaging 82%. Above the overall average were general commitments on pandemic preparedness and response, with 73%.

Health shocks stimulate compliance. Summits with high compliance responded to the Ebola outbreak and Covid-19. However, commitments referencing a specific pandemic (including antimicrobial resistance) had only 64% compliance. Moreover, commitments with an explicit reference to the core international body on health – the World Health Organization – had only 65%.

Ministerial meetings matter too. Since G20 health ministers began meeting in 2017 until six months after the 2023 New Delhi Summit, compliance averaged 71%. When the health ministers did not meet, between 2014 and 2016, compliance averaged just 56%. G20 finance and health ministers first met jointly in 2021, enhancing their collaboration under the Joint Finance and Health Task Force; as a result, compliance since 2021 has sustained a promising trend.

Conclusion

Drawing from these findings, G20 leaders at the Rio Summit should:

  • Make more health commitments, especially on One Health, and also on pandemic preparedness and response, climate and environmental health, and technology and knowledge transfer;
  • Make more health commitments linked to the SDGs, including the digital-related SDG targets, such as digital inclusion, along with cross-border data sharing and disinformation campaigns;
  • Increase support for the WHO, especially the International Health Regulations, the pandemic agreement and its protocol;
  • Agree to hold more pre-summit health ministerial meetings, while also supporting specific initiatives and working groups, starting by welcoming the Global Initiative on Digital Health and building on the G20 Health Working Group’s work on AMR; and
  • Better align health and environmental surveillance for AMR, climate change and biodiversity loss, food insecurity, safety and nutrition.