G8, G20: Questions for Global Health

The back-to-back sequence of the G8 and G20 meetings in Canada this weekend reflects the dramatic shift in global power now unfolding. New financial and economic giants, such as China and Brazil, are ascending to greater influence over world affairs, while some G8 nations are sinking into economic doldrums. Many former G7/8 "sherpas"--as the organizers for each country’s delegation are called--say the G8 is on its last legs. The next week will reveal whether they are correct. Even if France is able to host both summits in 2011, the outcome of Canada’s 2010 effort will reveal whether the old, elite G8 still has any real influence.

For health and development advocates this is not a trivial matter. Traditionally, the G8 has been seen as a club of rich countries that sensed some responsibility was associated with their wealth. This has made the G8 vulnerable to what we have dubbed "the Great Global Guilt Trip." Every year for well over a decade, it has become customary for a range of UN agencies, nongovernmental advocacy groups, the World Bank, and a broad range of civil society organizations to push the host government to take up their causes. Typically, host governments latch onto a theme--such as control of infectious diseases or debt forgiveness for sub-Saharan African nations--and the sherpas toil mightily in the lead-up to the summit. Long before presidents and prime ministers arrive, the sherpas and ministers of finance put together some sort of health or development agreement with rough financial commitments attached. The exponential increase in global health funding that now puts more than $25 billion worth of resources into the field annually was largely realized through this Great Global Guilt Trip.

But the G20 nations are not vulnerable to such pleas to share their wealth. Most of the G20 are emerging-market nations, still striving to realize the infrastructures of rich countries--roads, schools, energy systems, clinics, universities. If cries of guilt are to be heard in Jakarta, Cairo, Buenos Aires, or Pretoria, they will come first and foremost from the citizenries of the nations in which those grand capitals reside. For countries like India, South Africa, China, Brazil, and Indonesia, the G20 is a mechanism to open markets and escalate their push into the global economy.

In contrast, the traditionally wealthy nations are trying to fix their battered fiscal houses, and share no blueprint for how to do so. They are coming to the summits deeply divided, licking their wounds

Meanwhile, the global health community faces two tough challenges. First, the world is approaching the five-year countdown on the Millennium Development Goals (MDGs), three of which are direct health targets. None of these targets is likely to be achieved without bold changes in strategic approaches, along with infusions of billions of more dollars on a sustained (if not radically increased) basis. The second challenge is internal. Fear of shrinking financial resources, coupled with arguments over global health priorities, has weakened the global health advocacy community. Many prominent leaders in this community are dedicating more time to attacking other interest groups and advocacy platforms than to focusing world attention on the still-dire need for survival of millions of people every year.

This year Canadian Prime Minister Stephen Harper announced that achieving MDGs 4 and 5--the survival of infants, children under five years of age, and women during and after childbearing--was his designated priority for the G8 summit. The part of the summit dedicated to maternal and child survival would feature a series of "very simple things," Harper initially stated, and would exclude any aspect of family planning, birth control, or abortion. A politely Canadian hew and cry ensued, and U.S. Secretary of State Hillary Clinton paid Harper a visit. The result has been a sherpa document that closely follows World Health Organization (WHO) recommendations on family planning and health systems support to improve maternal and child survival in very poor countries. As a positive start, Harper announced earlier this month a $1 billion (Canadian) commitment to the maternal and child health scheme.

But that same week, a draft communiqué for the summit was leaked to Canadian reporters, who noted that the communiqué dropped all the 2005 Gleneagles G8 commitments to increase support for the developing world--reaching $25 billion for African health and development and $25 billion for all other poor nations by this year. Instead, it states: "A decade of policy commitments and joint efforts with our partners has brought significant progress towards the millennium development goals, but both developed and developing nations must do more; meanwhile the [financial] crisis has jeopardized advancement towards meeting some of the 2015 targets. Renewed mutual commitments are required."

Last year at the L’Aquila G8 Summit, the chief resolution called for "an Accountability Report," comparing a decade’s worth of commitments made at G8 summits to actual money delivered to the various health and development efforts. That analysis, the Muskoka Accountability Report, finds that the G8 has actually kept about three-fifths of its commitments. Put another way, the G8 is, in 2010, $10 billion shy of meeting its promises. In health areas, the disparities between G8 promises and actual expenditures are:

This year, if the G8 agenda is shoved aside, and the G20 battle between stimulus and austerity takes over the discussion, it is unlikely that any substantive agreement on the maternal and child health initiative will emerge--certainly nothing more than Canada’s $1 billion (Canadian) commitment and the sherpa communiqué language. It will be hard for German Chancellor Angela Merkel or British Prime Minister David Cameron--having just told their own people to brace for a painful period of austerity-- to write billion euro or pound checks for maternal health programs in eighty poor countries. If some form of solidarity on the financial debates cannot be reached, the Great Global Guilt Trip is truly over.

Reaching common ground on the global financial issues will be difficult, and if the smaller (and wealthier) G8 cannot put its differences aside long enough to reach consensus on the maternal and child health effort, the issue will definitely not be entertained by the G20. Most of the G20 has already threatened to squash anything that smacks of "mission creep," and the sole mission is economic growth. In a time of shifting global power, the future of health and development remains uncertain.