The strong links between finance and health have been recognised for some time. Direct financing for health worker salaries and medicines is a long-standing issue. And health has a considerable impact on the economy.
Health has been important for sustaining work- force productivity since the industrial revolution.
International summits set rules for quarantine to prevent the spread of plague and cholera, while balancing concerns for trade.
More recently, the financial crisis put health security at risk as a result of increasing poverty, falling remittances and unemployment.
The health community has been slow to realise this. The World Health Organization, run by technocrats for 192 health ministers, declared the importance of social protection, but clearly has no mandate beyond the traditional health sector.
The World Bank group did respond, guided by its political masters, the G20. It set up a Rapid Social Response Programme to protect the social safety nets vital to health and development. Shutting down tax havens may also help return tens of billions of dollars to countries desperate to support their public infrastructure.
The streets of Geneva and New York are littered with the bones of fervent would-be United Nations reformists. Yet here too, in reforming the International Monetary Fund (IMF), the G20 appears to have had some success. Its legitimacy, in representing the interests of two out of every three people on the planet means it has real potential to support further multilateral rationalisation and coordination.
Is this a new beginning for reformists and governance gurus? Well, there are some indications that the G20 might just be interested. The leaders’ statement last September highlights the importance of improving the confusing architecture that supports health and development, describing it as ‘essential to our efforts to promote global financial stability, foster sustainable development and lift the lives of the poorest’.
However, the complexity of policy, finance and delivery in health means that the arrangements are bewildering. At least 26 UN agencies, twenty global and regional funds, ninety global health initiatives and forty bilateral donors are active in global health. The G20 is in an ideal position to lend political support to improve efficiency and results.
For example, a single source of funding, based on the success of the Global Fund to Fight Aids, Tuberculosis and Malaria, could potentially free national governments to focus on strengthening their public health systems, rather than reporting to donors on the use of varying amounts of bilateral and multilateral funds.
But this is about much more than who pays the bills. The G20 also has an opportunity to affect the conceptual and strategic debate around health and development. Diseases not only transcend boundaries, but their origins are often linked to infrastructure and development that are the basis of good public health.
German Chancellor Angela Merkel and the heads of the World Bank and the IMF, among others, have called on the G20 to ensure that broader common goals are also dealt with. They have highlighted how gross domestic product (GDP), the main indicator of growth, could include social, employment and environmental factors. They also asked the G20 to recognise ‘the financial efforts and political commitment’ required to advance the implementation of the Millennium Development Goals. All these make an important contribution to health.
So the broader factors that determine health may get the strategic attention they need in the G20. But in terms of direct results, little attention is being paid at this stage. The G8 had a strong role here, focusing on HIV/AIDS, tuberculosis and malaria, and more recently water and sanitation, food security and maternal health. In sub-Saharan Africa alone, the gains in life expectancy fought for in the first half of the last century are rapidly being reversed by HIV/AIDS. Support for universal access to treatment should help slow this process.
Nonetheless, G8 performance on aid commitments has been criticised, particularly by major non-governmental organisations. With some of its members’ aid budgets falling, the G8 has failed to follow through on its commitments, particularly on a target to double aid to Africa in the last five years.
As the foreign policy of the G20 states increasingly focuses on regional and international development, the issue of coherence and strategic direction becomes all the more important. Naturally, some members of the G20 will be reluctant to take positions that require financial commitment. They themselves face major challenges for basic resources in coming decades. Their own development needs are also significant, with poverty and malnutrition still substantial issues in countries such as China and India.
The security risks of chronic illnesses and environmental degradation are difficult to quantify at times, but there is increasing recognition that social and economic stability are affected. South Africa, Brazil, Indonesia and France, as co-signatories of the Oslo Declaration on Global Health and Foreign Policy, have highlighted these links and may be influential in the developing debate.
The landscape of economic and political power remains fluid. Ideas and interests that deserve attention are yet to receive it. However, a broader understanding of human development, including the basics of survival, could be a pillar on which the G20 builds its future agenda.
However informal or economically focused, the G20 is making a direct difference to people’s lives and its members are starting to recognise this. The G20 summits this month and in November are potentially decisive in how it contributes to a more secure world.
Engagement with health issues could be one of the most powerful tools.