EDITORS’ INTRODUCTIONS global governance by heads of state and government” “ Integration requires a whole-of-government approach and thus active
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for the leading vaccines and pharmaceuticals. Its global health governance has made major contributions, notably by joining with the UN in 2000–2001 to launch the Global Fund against HIV/AIDS, Tuberculosis and Malaria. Yet the G7 has done little on mental health, dementia and the other health needs of the ageing populations in Japan and Italy, and beyond in Korea, China and elsewhere. Moreover, the G7 has no members from the Global South, where the greatest burden of disease now lies, where more capacity is needed most and where many cost-effective innovations exist. As leaders of often inward-looking democratic countries, G7 governors are constrained by what their voting publics want for themselves at home. Their ability to provide genuinely global health governance depends critically on how they can inspire, initiate, join or support more inclusive summit forums. THE G20 The G20’s systemically significant states are one such forum. Its leaders came together in 2008 to address the American-turned-global financial crisis erupting then. With an equal number of members from developed and developing countries, it contains 85% of the world’s economy and two-thirds of its population. It thus has the capacity to produce effective global health governance for all. Its direct global health governance began in 2014, in response to the deadly Ebola outbreak in Africa. From then to 2022, G20 summits devoted 10% of their attention to health in their outcome documents, produced 141 commitments and complied with them at an average of 70%. On 9–10 September 2023, G20 leaders in New Delhi produced 25 health commitments, second only to their 47 development ones. G20 health ministers’ meetings began in 2017 in Berlin, which made 51 commitments. They culminated in August 2023 in Gandhinagar, India, where they made 28 commitments. But the leaders’ 25 health commitments at New Delhi represented only 10% of their 242 commitments, even though Covid-19 infections and deaths had started to rise again. Unlike 2021, when Italy hosted the G20, the special G20 summit India as host has added for November 2023 will focus on development, not health. The G20 remains largely a responsive rather than a proactive, preventive body – except regarding universal health coverage and antimicrobial resistance – and is subject to the all-too-familiar cycle of panic then neglect.
global and far greater. And there is doubt that member states will raise their share of assessed contributions. Their failure here would increase the fragmentation within the WHO, with each member voluntarily providing what and when it wants, to address the particular disease or instrument it prefers. While this can produce platforms to support other health-inducing activities, as the major funding to combat HIV/ AIDS shows, it tends to favour responses to acute outbreak events, rather than action to prevent them, or to strengthen the social, economic and ecological determinants of health. THE G7 Integration requires a whole-of-government approach and thus active global governance by heads of state and government. They alone have the domestic political authority, comprehensive vision and responsibility to act on all the major components and causes of health. A major contribution has thus come from the annual summits of the G7 major democratic powers, formed in 1975 and acting on health since 1979. G7 summits have given health up to 72% of their outcome documents, made 687 collective, precise, future-oriented, politically binding decisions, and complied with them at an average of 78%. This year, the G7 summit in Hiroshima on 19–21 May produced 34 health commitments. The health ministers’ meeting, in Nagasaki on 13–14 May, focused on strengthening global pandemic prevention, preparedness and response (referred to as PPPR), universal health coverage and health innovation, emphasising antimicrobial resistance and a One Health approach. Together G7 members possess a predominance of the global capabilities required for effective global health governance, notably in finance, scientific capacity and the intellectual property
THE UNITED NATIONS Attention thus shifts to the fully inclusive UN
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HEALTH: A POLITICAL CHOICE Health: A Political Choice – From Fragmentation to Integration
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