health coverage, the healthcare workforce, the health-related Sustainable Development Goals, the infectious diseases of AIDS, tuberculosis, malaria and polio, and the negotiations of the new Pandemic Agreement and Fund. But only the commitment on water, sanitation and hygiene linked health to climate change and biodiversity. And the many on climate change and conflicts made no explicit links to health, while mis- and disinformation were absent everywhere. The BRICS, based on Brazil, Russia, India, China and South Africa and now expanded to include five smaller members, has also addressed health. Overall its leaders seek to reform the existing global system to build one that puts their priorities and influence at the centre – which could bring further fragmentation. At their most recent summit in Rio in July, leaders made only four commitments on health, for 17th place among subjects. These health commitments all related to strengthening the existing global health architecture, including securing the Pandemic Agreement. To be sure, their first focus was on climate change, where they made 44 commitments, but none explicitly were linked to health. Nor did any of the eight commitments on regional security, in sixth place. FINDING HOPE IN INNOVATION, COOPERATION AND LOCAL ACTION Yet amidst this growing gloom are several signs of hope, as individuals and institutions are inspired to respond more, in proven and innovative ways. Progress is being made on producing and implementing a pandemic accord and, painfully although now paused, on plastics. On financing, China, other donor countries, recipient countries and philanthropists are stepping up as the US steps back. The Green Climate Fund emphasises the health benefits of its project financing, as its new replenishment round is scheduled to start soon. And many actors are pioneering ways to address JOHN KIRTON John Kirton is the director of the Global Governance Program, which includes the Global Health Diplomacy Program, the G20 Research Group, the G7 Research Group and the BRICS Research Group, all based at Trinity College in the University of Toronto, where he is a professor emeritus of political science. He is co-author, most recently, of Reconfiguring the Global Governance of Climate Change , and co-editor of a series of G7 and G20 summit publications including G7 Canada: The 2025 Kananaskis Summit and G20 Brazil: The 2024 Rio Summit. He and Ilona Kickbusch are also co-editors of, most recently, Health: A Political Choice – Building Resilience and Trust. X-TWITTER @jjkirton www.g7g20.utoronto.ca
the major threats in ways that improve people’s health and well-being. This edition of Health: A Political Choice explores the impacts of these larger political, ecological, societal, technological and security trends on global health and its governance. It examines how key global health actors are searching for and finding the solutions that work – many of which are local, national or regional in scope. It reflects on the results of major initiatives from the UN, the WHO, and the summits of UN Climate, the G7, G20 and the BRICS. It focuses on four major threats – climate change, pandemics, mis- and disinformation, and conflict – and the search for solutions from scientific, technological and global governance innovation. Distinguished contributors share approaches that have been most successful, describe the uphill battles to implement them and propose how to move forward. As always, this edition includes voices from government, international organisations, philanthropy, business, civil society, think tanks and academia. A special section, curated by Jeremy Farrar of the WHO, focuses on science, research, innovation and technology, all of which have moved to centre stage in global health, while wavering between cooperation and competition. This edition also features several spotlights on issues that deserve particular attention: on planetary health, pandemics, mis- and disinformation, and human security. After introductions by leading authorities from the global health and global governance worlds, it presents sections on: • Planetary health and climate change • Pandemics • Scientific innovation, research and technology • Health information integrity • Security from war, conflict and crime • Improving global health institutions and instruments. ▪
Health: A Political Choice – The Future of Health in a Fractured World 23
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