// SUSTAINABLITY: HEALTH
Challenges for global health at the Johannesburg Summit – facing the paradigmatic shift
O ver the last two and a half decades the G20 has contributed to a system of mediated stability in international relations and the recent presidencies have given a strong voice to the agendas of the Global South countries. Now we see an emerging shift to a system of open rivalry and increased fragmentation that could well be reinforced through the US G20 presidency in 2026. Can the G20 withstand such a push from soft to hard power, which indicates the end of the global interdependence agenda, the rules-based order and development cooperation. John Mearsheimer terms this approach to international relations ‘offensive realism’. It brings significant challenges for global health as it reshapes a global health development agenda based on equity and cooperation to one based on sovereignty and competitiveness. The hollowing out of international organisations and the United Nations currently under way makes it ever more difficult to achieve a broad consensus on matters of global concern such as climate or health. The Sustainable Development Goals, Ilona Kickbusch, founding director, Global Health Centre, Graduate Institute of International and Development Studies
As geopolitical rivalries reshape global cooperation, health governance faces unprecedented strain. The challenge is restoring trust, equity and coordination in an increasingly divided world
118 // G20 SOUTH AFRICA: THE JOHANNESBURG SUMMIT 2025
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