In her pursuit for stronger global health governance cooperation under the aegis of the G20, Angela Merkel is showing what can be achieved when leaders are both experienced and driven enough to steer the G20 towards achieving useful and effective outcomes. Although the challenge of finding meaningful consensus between leaders in global governance forums appears to have increased in recent times – the recent G7 leaders meeting at Taormina being a notable example – small wins can and should still be pursued.
For the G20, a forum without any permanent secretariat, and whose distinctive comparative advantage is the fact that it is a forum for leaders, designed to be run by leaders, the capacity to facilitate a noticeable impact on global governance ultimately hinges on leaders taking the reins and ensuring that the agenda is one of their own making. Here, Angela Merkel’s distinct advantage is that as the only G20 leader to have attended every G20 leaders’ summit since 2008, she has seen what works and what does not.
In essence, leaders should be dictating agendas to bureaucrats, rather than the other way around. In contrast, several G20 summits over the last decade have struggled to ‘take-off’ under the guidance of leaders who were either new to the global stage, or who were not as familiar or comfortable with hosting large-scale informal world-leader forums (a characteristic particular to the G7 and G20). Encouragingly, there are at least three aspects of the recently concluded health ministers’ meeting that suggest Merkel is working to make the most of her remaining tenure as G20 chair.
Firstly, she went to the meeting
In her remarks to the health ministers, Merkel emphasised this was the only G20 ministerial meeting she would attend in 2017. It is rare to see a G20 host leader take such interest in the granular details of the G20 process so far ahead of the leaders’ meeting. Admittedly, the German chancellor’s attendance was almost obligatory, as the decision to include a meeting of health ministers meeting in the G20 calendar was made by her office, and therefore required a high-level justification. Still, in delivering her justification, the Chancellor demonstrated a deep understanding of the multi-faceted elements of the G20, and made a strong case for linking economic and health policy (discussed below).
The direct presence of the Chancellor also sent a strong signal not only to the participating ministers, but also to the wider G20 community, that Germany is keen to push health up the G20 agenda. In the leadup to Hamburg, other G20 members and leaders might be well-advised to engage in some quid pro quo diplomacy when working to promote their own G20 priorities by ensuring they are attentive to the health agenda and Merkel’s personal interest in health governance.
The health ministers meeting added to G20 case for policy coherency
As indicated above, in her speech to G20 health ministers, the Chancellor delivered a refreshingly clear justification for why health ought to be on the G20 agenda. Established in 2008 to bring the international economy back on-line after the global financial crisis, the G20’s main ‘bread and butter’ issues will always be those that are geared towards enhancing stable and resilient economic growth. Financial regulation, trade facilitation, and resource mobilisation have therefore been obvious perennials on the G20 agenda. In contrast, the promotion of health cooperation may seem, to some, as a distraction from the core agenda, especially given G20 leaders have consistently dedicated themselves to overcoming ten years of sluggish and inequitable growth in GDP.
However, as Merkel skilfully argued, at the behest of civil society and other quarters, the G20 no longer simply refers to ‘growth’ as the be all and end all. ‘Inclusive growth’, rather, is now the policy ‘north-star’ around which the whole G20 agenda is expected to revolve. And as Merkel explained, “Gross Domestic Product is not in itself sufficient to describe the inclusive growth on which we really need to be focusing…”, a point she later elaborated on by promoting the kind of inclusive growth that is envisioned in the 2030 Agenda for Sustainable Development, which cites universal healthcare as one of its 17 goals. For Merkel, universal healthcare therefore goes “hand in hand with economic issues… investment in healthcare systems also means investment in economic systems and improves the prospects of all countries…”.
Merkel’s case for policy coherency, whereby healthier citizens are more able to participate in a system of sustainable and inclusive economic growth, and from which the rewards are ploughed back in to maintaining the health and quality of citizens’ lives, gives the German Chancellor an extra rhetorical arrow with which to respond to populist anti-globalist sentiment. As there is likely to be a strong turnout at Hamburg from protestors opposed to the G20, its agenda, and some of the leaders in attendance, the G20 agenda in 2017 must be clearly about more than just boosting GDP (whether this signal is received by protestors or even attending leaders is another question, but the effort should still be made).
Meaningful contributions to health policy
Beyond strategy and rhetoric, the G20 health ministers meeting can also be welcomed for making actually meaningful contributions to global health governance. The proper locus for the coordination of global health policy is the World Health Organization, however there are still other policy avenues, initiatives and actions that have been pursued by G20 health ministers in 2017 that have ‘added value’ to the global health system.
In its support for the ‘One Health’ initiative, for example, which calls upon governments to better understand the relationships between animal health, population health, and the natural environment, the G20 has bolstered global efforts to identify and prevent the outbreak of dangerous diseases, or at least contain them as early as possible. Specifically, the cooperation between both G20 agriculture and health ministers this year is an encouraging sign that governments from the world’s largest economies are increasingly aware of the multiple ways in which good public health outcomes are often interdependent with the strength of non-health focused regulatory frameworks (for example, the regulation of antibiotics in farming to combat growing anti-microbial resistance among humans).
G20 health ministers were also brought face to face with the frailties of the existing global health governance system by having to work together in response to a simulated global health pandemic. How much this exercise influenced the final communique of the health ministers is unclear, however the ministers did commit to strengthen systems of regional data sharing and emergency response planning, and to work towards giving the WHO and the new WHO Contingency Fund for Emergencies, as well as the World Bank’s Pandemic Emergency Financing Facility, the resource base to respond effectively to global health emergencies. What this means in terms of actual financial commitments by G20 members remains to be seen, however the message to attending ministers was clear – fund these efforts or live with the deadly risk of working within a global health system under-equipped for a major international health emergency.
Work remains for health ministers – but it’s an encouraging start
Doubts will likely remain in coming years over the ongoing usefulness and contribution of health ministers to the G20 agenda. Whether the incoming Argentine G20 Presidency can maintain Merkel’s enthusiasm for health policy may in turn depend on the degree to which President Mauricio Macri can muster the same level of interest in the topic (Or at least that of his health minister). And in addition to the concerns of those who remain unpersuaded that health belongs in the G20, various global health advocates have found cause to critique the outcomes from the Health Ministers’ meeting. Some have accused it of being overly securitised in focus and placing too much emphasis on preparing for global health emergencies as a way to ‘protect’ rich countries from the health problems of poor countries, rather than simply promoting good public health systems in their own right. Others have called out the G20 for failing to condemn the practices of large pharmaceutical companies looking to profiteer off life-saving medicines in low-income countries (or off those on low-incomes in countries without UHC).
Still, from a whole-of-G20 perspective, and at a time when progress on key issues like trade and climate change is difficult, health may be one of the big G20 ‘winners’ in 2017. And given the increasingly difficult challenge of making positive a contribution to global governance in any global forum, a G20 win, on health policy or otherwise, ought to earn Angela Merkel deserved credit.