with tests, therapeutics, medical supplies and vaccines, via G20 initiatives such as the ACT-Accelerator. Yet the many lessons learnt from the crisis have led to the awakening that health means wealth, and that health is a good investment rather than a sheer cost for finance ministers. What I call the Zeitenwende has kicked in among global health actors, health and finance ministers, and the investor community about the changing role of global health and the global health architecture. Calls for stronger dialogue among G20 and G7 health and finance ministers have led to the G20 Joint Finance and Health Task Force created in 2021 and the G7 Impact Investment Initiative for Global Health in 2023. The G20 task force promotes best practices, collective action and stewardship of resources to address financing gaps in pandemic preparedness and response. The G7 Triple I aims to share best practices for impact investment with a view to achieving universal health coverage. With ever-decreasing budgets for global health, due to the many multipolar challenges, shrinking resources from governments and development finance institutions, and low- and middle-income countries struggling with debt, the G20’s 2024 and 2025 presidencies of Brazil and South Africa and the G7 presidencies of Italy and Canada have an increasing responsibility to help close these funding gaps, moving sustainable finance for health higher on the political agendas if we are to achieve SDG 3 on good health and well-being by 2030. A NEW G20 CYCLE IN 2026 Global health has featured high for the G20 and G7 presidencies in 2023. India and Japan have done excellent work in keeping the existing and new initiatives prominent, committing to the central role of the World Health Organization at the core of health coordination and diplomacy, and recognising the need for more convergence between the G20 and G7. At this year’s United Nations General Assembly three high-level meetings focused on ending tuberculosis, delivering universal health coverage, and strengthening pandemic prevention, preparedness and response. This first observation may be a relief. However, health is slipping down the international political agendas and becoming fragmented. Silos are re-emerging as the rally for funds increases. Climate change, nature preservation and biodiversity challenges are taking centre stage. Yet there should not be competition within the global health community or other communities, let alone a competition and creation of new forums outside of the G20, G7 or WHO. The recent G20 New Delhi Leaders’ Declaration highlighted the importance of reinvigorating multilateralism. The next two years are critical for global governance and global health diplomacy before the second G20 presidency cycle starts in 2026. To address the global challenges of the 21st century, the
HATICE BETON Hatice Beton is co-founder and executive director of the G20 and G7 Health and Development Partnership. She has also supported Business 20, Civil 20 and Think 20 taskforces and platforms on their global health diplomacy strategy. She is the CEO of Sovereign Strategy, a global political consulting firm. She has previous experience working in government agencies and international organisations in New York and Brussels. X-TWITTER @ hatice_beton g20healthpartnership.com
world should not fall back onto traditional building blocks. Multilateral forums should promote collaboration between the Global South and the Global North. Current and future
crises require proactive diplomatic efforts, starting at the top on the agendas of the G20, G7 and multilateral development banks, as well as from the bottom by integrating parliaments into processes to bridge communications gaps between constituents and their governments and the international agendas. The world requires more accountability, collaboration and transparency within the G20 and G7, parliaments, and the global health and other communities. A systems rethink is needed. Opportunities lie in strengthening universal health coverage, supply chains, health systems, primary health care and the healthcare workforce. Without systems change in global health and the global health financing architecture, infectious or non-communicable diseases cannot be prevented effectively and the global health community will turn in circles in damage control mode. It is equally the responsibility of countries and parliaments to define future health and non-health priorities, including climate change, in ways independent of electoral cycles. Health and climate change affect each other and our lives and economies. Policymakers must consider the impacts of the initiatives and programmes they support. Nearly 50% of people worldwide live in countries that spend more on servicing foreign debt than on health care – a 25% rise since 2020. We have two years before the G20 hosting cycle restarts. This gives the global health community and G20/G7 leaders time to apply a new approach to sustainable finance in global health by bridging the valley between the investor and health communities and bridging the democratic deficit that emerged during the pandemic. Time will tell whether this will be an opportunity or a challenge for global governance. ▪
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Health: A Political Choice – From Fragmentation to Integration
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