Solutions for the 21st century
National and supranational governance requires reform to address the grand challenges of this century, and the G20 must lead by example, moving beyond a narrow focus on GDP growth and towards other essential metrics
We must strive to build a world where policy decisions are based on what matters: the life and health of people and the planet. As the Covid-19 pandemic reminds us, if, in regular times, humanity fails to value what equips us to tackle its most significant challenges, when new challenges arise, no amount of money thrown at them at the last minute will fix their root causes.
The World Health Organization Council on the Economics of Health For All believes that the G20 is uniquely positioned to call for fundamental reforms to the global financial architecture that better equip all countries to tackle the grand challenges that humanity is facing – providing Health For All and reversing the current spiral towards climate breakdown and widespread antimicrobial resistance.
The international institutions created in the aftermath of World War II were not designed to handle today’s multiple global crises, including the war in Ukraine and Covid-19 on top of a climate emergency. Their mandate needs urgent revision to recognise their unique position in addressing the massive collective coordination and financing challenges that undermine the provision of global common goods, including Health For All and climate action.
An untenable debt burden is strangling fiscal space in low- and middle-income countries. Many have had to take high-interest loans to respond to the pandemic and manage the consequences of a climate crisis driven almost entirely by high-income G20 members. The G20 must partner with the International Monetary Fund and the United Nations to create a more effective, equitable global debt restructuring mechanism that levels the playing field with low- and middle-income countries, brings together all sovereign and private creditors, and prevents rating agencies from punishing the many countries in desperate need of relief.
G20 leaders should immediately support a new issuance of special drawing rights to help address the mounting liquidity crisis in low- and middle-income countries. They should use their position as the largest IMF shareholders to demand that it prioritises new models for rolling out debt-for-health and debt-for-nature swaps at scale (as well as for other Sustainable Development Goals) to create more fiscal space for urgent domestic investment in these areas.
Likewise, the G20 should endorse the adoption of natural disaster and pandemic debt suspension trigger clauses, along the lines of what Barbados recently introduced in its September 2022 debt for marine conservation conversion, as another means to help countries temporarily increase fiscal space to contend with external shocks.
Furthermore, the G20 should spearhead much-needed reforms regarding minimum corporate tax rates, specifically by supporting a process to amend the Organisation for Economic Co-operation and Development’s Inclusive Framework to more equally balance the interests and needs of low- and middle-income countries.
Increasing investment
G20 governments must support domestic and global efforts to ramp up investment in public-sector capacity, instead of gutting it through austerity and chronic outsourcing, typically with no public interest stipulations or protections regarding access and equity. Countries at all income levels need solid public-sector capacity to implement successful mission-driven industrial policies and partner with the private sector to deliver innovation for the common good.
On human health, this includes building the local manufacturing capacity for essential health vaccines, diagnostics and therapeutics in low- and middle-income countries, as well as ensuring that patents for essential medicines in all countries are not so broad and upstream that they stifle equitable access for the majority of people for decades. G20 governments need to drive concerted global action to address antimicrobial resistance, a silent pandemic that has become an existential threat to populations around the world, on course to cause 10 million additional deaths every year by 2050.
On planetary health, the G20 urgently needs to spearhead a ‘moonshot’ that reverses continued government failure to act at anything like the speed and scale required to stop the climate crisis and avert catastrophic human impacts in the coming years. The health costs associated with climate change are already significant. Almost 25% of deaths worldwide are related to the environment. The death toll related to environmental factors in lower- and middle-income countries is also higher than in high-income countries. At the upcoming COP27, G20 leaders must go beyond their nationally determined contributions to dramatically increase the amounts of public and private finance for climate change mitigation and adaptation to at least 2% of global gross domestic product. G20 members must also urgently eliminate all direct and indirect fossil fuel subsidies, estimated to be $5.9 trillion globally.
Finally, G20 leaders must set an example by creating a new paradigm that moves beyond a narrow focus on GDP growth to include Health For All as an essential metric for policymaking and performance. The council has provided alternative models to complement GDP growth that better reflect Health For All and well-being across societies – from food growing and cooking to cleaning, childcare and other unpaid household and community activities, as well as environmental conservation and climate impacts. G20 members must lead in moving away from a narrow focus on short-term financial gains as the bellwether of national and global progress and broaden their metrics to include the health of both people and planet as the ultimate objective of policymaking.
