Opinion Pieces

What’s Next for G20 in Global Health and Development?: Chatham House

For those who expected that the baton would be passed from G8 to G20, that wider engagement of middle income countries would herald a human rights based approach to health and development and that global governance would be transformed, this Chatham House meeting brought a useful dose of realism. G8 will remain an important focus for the global health and development agenda. G20 is unlikely to address human rights, health is unlikely to be central to its agenda, the voices of civil society organisations are not expected to be heard at its meetings and there is little prospect of better connection with the UN system. This is a personal perspective of a truly fascinating meeting, for an authoritative view check the web site at:

The Achievements and Failures of G8

The meeting was reminded of the achievements of the G8, as a rich country club, putting moral pressure, on or perhaps cajoling its members to contribute to health aid programmes and institutions. While this may be criticised as a top down aid approach with little regard for human rights or the views of aid partner countries or civil society and no connection with other UN structures, it has led to a massive expansion in aid and to major structural reform. The 2000 meeting saw the birth of the Global Fund and later the GAVI Alliance and five years later the Gleneagles G8 agreed a $60 billion increase in aid over the following five years, $25 billion to Africa. Most importantly it has monitored the actions and achievements that followed from the commitments expressed in its communiqués.

The Accountability Report shows that the increase in aid delivered fell some $15 -18 billion short of the level committed and most of this shortfall was in respect of aid to Africa ($10 billion versus $25 billion). While this may seem an indictment, in the context of other aid and development pledges it is not so bad, after all the UN commitment to provide 0.7% of GDP as aid was made 40 years ago and in aggregate aid has only reached half this level. Equally important G8 has taken a broad approach to the determinants of health and development and been prepared to address issues such as debt relief, corruption, food security, and health system strengthening. It has worked with major philanthropic organisations such as the Gates Foundation and has informal working relationships with WHO and other UN agencies. Civil society organisations may at least feel that they had a voice at Gleneagles if only as a symbolic presence.

Since 2005 it seems the sense or urgency to address global health and development at G8 has diminished somewhat. At Muskoka there was for the first time no reference back to Gleneagles commitments (other than in the Accountability Report). The new initiative to address Maternal and Child Health, while worthy, seems to have been selected from the MDG laundry list of popular commitments, rather than an attempt to address the imbalance in human rights to health or a response to the demands of African leaders for support for their health and welfare systems.

Civil society organisations are popularly represented less as partners engaged in dialogue with G8, than as jet set activists acting out ritual clashes with the local police behind barbed wire and generally disappointing their mothers and the societies they purport to represent.

The Strengths and Weaknesses of G20

G20 was formed as a meeting of Finance Ministers and Central Bank Governors to address global economic problems at a meeting in 1999 in the wake of the 1997 Asian financial crisis. It was resuscitated at the London meeting of 2009 again to address the current global economic crisis. It brings together countries representing 60% of world population, 85% of GDP, and some 95% of intellectual property.

The membership of G20 reflects the new reality of global influence in the multi polar world, with both China and India major trade and aid partners for Africa, while both themselves still receiving aid for parts of their vast countries. China is developing its own global health strategy and anyone who has visited Africa recently will be aware of its presence there. India has long been a partner for Africa, particularly in education and health, it has a long term commitment to the Pan African Network to bring health and other services to rural Africa. G20 also engages Brazil and South Africa which have claimed moral leadership in global development and health. Russia though already a member of G8 is reported to have shown a preference for working through G20, though the “Moscow process” for emerging donors resulted from the 2006 G8 meeting.

G20 suffers some of the disadvantages of G8, with no structural links to other elements of global governance or civil society. While G20 countries could be said to be more representative of global society than G8, it is still difficult to see how G20 can claim legitimacy without links back to the UN system and unlike G8 there is no mechanism for accountability. It is also important to recognise that civil society and democratic representation takes very different forms in G20 countries such as India, Brazil, China and Russia.

The lack of permanent secretariats for G8 or G20 also creates problems of continuity. Moreover the leaders and sherpas (who develop the agenda and write the communiqués) have a harder time working together in the newly formed bigger group of G20. We should not expect G20 to be innovative, with more of a “lowest common denominator” approach than could be achieved through the smaller G8 club.

Thus we must expect G20 to stick to its central remit of economic crisis management, though it has instigated a working group on development, under the auspices of the Korean Presidency. But there may be some emerging reasons to hope for better.

Reflections on the Future Role of G8 and G20 in Global Development and Health

Personally I hope that G8 will remain a continuing focus for the moral responsibility of rich countries in development and global health. Its commitment to aid and global governance are still vital and must be renewed. The flexibility and resources it brings to support innovation and the influence to address issues such as accountability of recipient and donor countries cannot be matched by G20 in the foreseeable future.

G20 can increasingly address global economic growth from the perspective of human development in poorer countries. This means looking beyond income per capita, to include progress in equity, education (particularly of women), access to health and wellbeing, water and food as central aims of global economic development, not simply as hoped for by-products. This may bring new mechanisms for aid and trade that recognise these aims.

I see scope for both G8 and G20 to develop further as fora for global governance. G8 should resist the notion of becoming a sort of alternative UN, with grandiose meetings engaging civil society and summoning UN and poor country leaders to its presence. Instead it should do what it does best, act as a club of rich member states exchanging views and developing ideas. It should ask for inputs and ideas from WHO and other UN agencies and bodies such as the African Union and it should ask its members to consult and report on the views of civil society.

G20 should resist the calls for extra seats for African and Asian countries, but instead should focus on its central remit for economic development (as redefined) and invite regional economic bodies such as the African Union and ASEAN to join. In this way all countries could establish links with G20, who should also ask members to report on civil society views and to monitor their actions in respect of commitments made through G20. The EU*, which is a member of both G8 and G20 meetings should take the lead in supporting other regional economic bodies to step into this role.

While it is tempting to call for G8 and G20 to move beyond an aid perspective to see health as a human right and an integral aspect of all policies (as in the EU approach) in reality this seems quite a distant prospect. However, it is a direction that can emerge as both bodies become engaged in the global governance process.

G8 and G20 could work better in tandem, perhaps with meetings of G20 preceding those of G8, since the former sets the scene for the latter. It would also be important to allow time between these meetings for reflection and response to improve listening. Both G8 and G20 could benefit from a more permanent form of secretariat, possibly the same infra structure could serve both, though it is also essential to preserve the fresh impetus and responsibility that is gained by successive countries hosting the meetings. G8 and G20 should both report formally to the UN with mechanisms both to listen to views from UN members and to report their views, without the necessity of seeking a general mandate for their actions. This in turn could help to reinvigorate the UN process.

Personally I do not support calls for direct civil society involvement in either G8 or G20 meetings, in my view this step would allow too much manipulation and too little genuine engagement. This does not mean that civil society should be ignored, rather the converse, I see the need for many new mechanisms for empowering civil society organisations and groups, particularly those in poor countries and regions. But I believe this can be better achieved through local and international networks that provide for the many different voices of civil society rather through selected representatives at international meetings. This said there is also a case for supporting international meetings of civil society actors if only to see what new ideas might emerge.

*You may also be interested in an article on the EU role in G20 by Dr Paolo Subacchi at