Opinion Pieces

The G8 and global health: getting hip with the times

Despite rumours to the contrary, last week’s G8 meeting in Muskoka, Canada confirmed to the world that this highly influential club of powerful countries plus the EU has no intention of being phased out in the near future. While their influence on global economic affairs has been eclipsed by the G20, the G8 will remain an influential forum to address the most pressing issues in development, peace and global security (Summit Conclusions). This year has brought a totally new element into play: the first ever G8 accountability report. The Muskoka Accountability Report, commissioned at the 2009 L’Aquila Summit, aims to assess actions taken and their results against the commitments that the G8 has made for development over the last 30 years.

Health has long been singled out as a priority area within the development agenda of the G8. Their health commitments include the strengthening of health systems in developing countries, improving maternal and child health, and fighting HIV, TB, Malaria, Polio, Measles, and other neglected infectious diseases. The accountability report focuses a subchapter and an annex on health, providing a laundry list of activities and the billions of U.S. dollars in commitments and funds already disbursed by Canada, France, Germany, Italy, Japan, Russia, the UK, the US and the EU to achieve them. The Group of 8 is particularly proud of their roles in establishing and replenishing the Global Fund to Fight AIDS, Tuberculosis and Malaria, the funds they have put into vaccines and microbicides research and development, and their cutting-edge work on new innovative financing mechanisms such as the IFFim, the AMC and UNITAID/airline tax, which work as incentives for R&D, as well as aid for access to medicines. The G8 also shows that they are “hip” to the conclusions of international health and development debates of the last 3-4 years on “vertical vs. horizontal” (that both are needed!), and are proud to show that they have put substantial resources into horizontal programmes to build health systems capacity in developing countries for service delivery as well as R&D.

One thing is for sure, a lot of money has been spent since 2000 with more committed over the next 20 years. However, surprising or not, the report’s conclusions on health are still rather glum:

“In some areas, although there has been substantial progress, G8 commitments have not produced the results hoped for. Despite significant investment and good progress, polio has not yet been eradicated. Maternal deaths remain high – estimated to be between 340,000 and 536,000. And while there has been a global reduction in child mortality, the number of under-five deaths in sub-Saharan Africa increased by almost 400,000 between 1990 and 2007.”

Overall, the conclusion the G8 draws from this report is that “important progress has been made in many areas, but more needs to be done.” But does this mean it should be more of the same? When so many dedicated resources have achieved disappointing results I think it calls for a change in strategy.

Getting hip with global governance

The G8’s new focus on health systems has shown it can keep up with the times, and while it may be ironic, (given that the Group was founded to serve as an innovative forum to address global challenges and cut through bureaucratic red tape) I think it’s time for the G8 to get “hip” with 21st century governance.

Whether you prefer to speak of “stove-pipes” or “silos” there is nothing extraordinary about the idea that the challenges governance must address today demand public policies that cut across traditional fields of policy-making and involve new types of actors. And whether you want to talk about harmonization, alignment, coherence, consistency or complementarity there is also nothing new about the need to improve coordination and reduce the fragmentation of efforts for development. But governance in the 21st century can’t be just about establishing public-private sector partnerships and rebranding aid recipient countries as empowered “partners” who own their development strategies. It is also not just about balancing aid channelled through civil society with aid meant to build government capacity through direct budget support. Don’t get me wrong, this is all very much needed, but in short, we have seen ample progress made regarding how we address global health and development challenges with too little reflection on what this work actually amounts to.

What the G8 is doing looks a lot like what has always been done in public policy. A priority area is identified, a budget is made available, and programmes are made to address that priority. The G8 has priorities in health, priorities that deal with water and sanitation, priorities on fighting corruption, on economic development, education, food security, energy and the environment, and peace and security. The priorities the G8 are choosing are better and better, they are more interconnected and synergies are created. The global community have also developed much more sophisticated methods for carry out work in these areas, but reading the G8 Accountability Report it still feels like we are only connecting the dots rhetorically. The report acknowledges that all these issues are interconnected but when it comes down to business the work that the G8 is funding still seems to address each topic on its own. The G8 is funding great work in each area but are they setting-up the ever more intricate inter-ministerial-inter-departmental-inter-disciplinary-inter-sectoral networks needed to work at the interfaces of these priorities? That’s a mouthful, and it is healthy to keep a sense of humour about this jargon, but that shouldn’t stop us from taking it seriously. The G8, for example, wants to fight corruption. One example of where they are doing that is in the extractive industries (i.e. mining). Great, but why not also make fighting corruption in water and sanitation and in health systems also an explicit priority? Or what about economic development, the priority of priorities, the overarching priority? Health is seen as a factor for economic development, but why aren’t we also addressing the implications unequal economic development is having on the determinants of health at the same time?

Furthermore, after two decades of discussing globalization it has become accepted wisdom that as global linkages increase many challenges take on cross-border dimensions, which require collective action between several states and, at times, between all states. Yet, despite this, most capacities and infrastructures remain at the national level, while resources for international institutions remain inadequate. The health annex in the Accountability Report boasts a collection of data on where the G8 countries and the EC are putting their development money for health, including a list of contributions to multilateral institutions. But this information lacks meaning without a further breakdown. For example in the case of the World Health Organization, we can’t see how much of these figures are earmarked for specific projects and how much are allocated for the WHO to fulfill its constitutional mandate. The G8 is good at channeling money through the multilateral system, but is it also working to build a multilateral system that can serve a purpose beyond a funnel for development? For example, how is the G8 supporting the provision of public goods at the global level? We can’t know; public goods are not a concept featured in this report.

Getting serious about social justice

It is also high-time for the G8 to make health an issue of social justice. This means considering new strategies to realize their commitments to addressing equity and the social determinants of health. The accountability report recognises that change may be needed to fulfil G8’s intentions. In its very brief section on general recommendations to the G8 the report states that:

“G8 commitments are a product of the political process and reflect G8 agreement on a common approach to respond to major global issues. Commitments are also not static; they evolve to address new and changing circumstances and approaches.”

Social justice is certainly not a new approach, but the circumstances we’re working in have indeed changed. WHO Director General Margaret Chan put it best in her introduction to the 2008 World Health Report “Primary Health Care-now more than ever” (PDF) when she said, “While our global health context has changed remarkably over six decades, the values that lie at the core of the WHO Constitution and those that informed the Alma-Ata Declaration have been tested and remain true. Yet, despite enormous progress in health globally, our collective failures to deliver in line with these values are painfully obvious and deserve our greatest attention.”

The G8 strives to provide leadership in the face of the 21s century’s most pressing challenges. They are not meant to solve the world’s problems all alone, but to set agendas and act as a catalyst to stimulate responses from other nations. It’s time that universal primary health care entered into their vocabulary. Otherwise the G8 really risks losing its relevance in a world too crowded to support just more of the same. Values such as equity, universality and solidarity are the stated core health values of almost all the members of the Group. These are the values for global health espoused by the EU in its new framework policy on global health, and by the UK, France, Germany and Italy in their support to the same policy in their EU Council Conclusions on the EU Role in Global Health. But despite this, these values really do not stand out as values of the G8-and I don’t see why not.

Addressing global challenges, including global health, from the perspective of these values can move the focus of our actions to the social, political and economic factors which determine the existence and severity of the challenges. A social justice approach can move our actions from coping with, to stemming these challenges where they originate. This combined with efforts designed to span and work at the interface of key priorities could help fill the gaps where the G8 has thus far fallen short. The G8 has indeed come to the right conclusion, more needs to be done; but, the accountability report disappoints when it comes to providing recommendations for moving forward. To achieve the results hoped for the G8 must do more than just the same for longer.

A copy of the Muskoka Accountability Report can be found at:

A special Accountability Report focused solely on health and food security has been commissioned for presentation at the 2011 G8 meeting in Nice, France.