Executive Summary for all. It will then go on to further argue, Prior to this year’s Hamburg Summit, the however, that the Hamburg Summit’s relationship between the G20 and global failure to disassociate itself from the health was characterised by its stark predominant linkage of health with absence as a mainstream item on each security will likely lead to a continued summit’s agenda. Only from 2014, and the narrow focus on emerging infectious outbreak of the Ebola virus, has the topic diseases that worry the West, at the of health even been considered expense of engagement with issues of something worth deliberating. The limited socio-economic transformation. discussion that has occurred has been dominated by a narrow focus on security Background and emerging infectious diseases that For the first time in the G20’s history, the worry the West. This policy brief explores German Presidency has placed health at the processes that have led to global the centre of its agenda. The Priorities of health appearing on the agenda of this the 2017 G20 Report asserted that year’s summit, suggesting the German safeguarding against health crises was of Presidency’s “Partnerships with Africa” fundamental importance in securing have unlocked the opportunity for sustainable economic growth, with genuine progress. It will argue that the functioning health systems a prerequisite G20’s commitment to strengthening for security against the spread of diseases. health systems worldwide reflects a firm Two factors can be seen as aiding the step forward in the goal of global health long-awaited presence of health on the G20 Hamburg Summit, July 2017
G20’s agenda: 1) German Chancellor narrow emphasis on the threats posed by Angela Merkel’s long-standing interest in emerging and re-emerging infectious the topic and emphasis that “in a diseases. A G20 Health Initiative prior to connected world, the issue of health has the summit referred to health as a earned its place on the G20 agenda”; and “quintessential G20 issue”, with the 2) the G20’s commitment to an intensified emergence of infectious diseases affecting partnership with Africa. The G20 economic growth, financial stability and Presidency claims the presence of health development. The G20’s approach has, as is guided by a commitment to the UN’s a result, been challenged for its equation Sustainable Development Goals (SDGs), of global health with the absence of and a commitment to promoting the well- disease, devoid of accompanying ideas being of all people of all ages. Even those oriented around social justice. Médecins otherwise critical of the Hamburg Summit sans Frontières reminded G20 leaders have praised the presence of health in the ahead of the Hamburg Summit that Summit’s discussions. The commitment to responding to health emergencies should health for all, though, is in part a not continue to be restricted to those reflection of a Western desire to curb the infectious diseases seen as posing a threat numbers of Africans trekking through to the most powerful and wealthy of Northern Africa in search of greater countries. Rather, medical emergencies security in Europe. State failure can that primarily affect the world’s most prompt worsening health through vulnerable and marginalised should be economic instability, and the collapse of focused on as well. Until such a shift in state institutions, such as public health approach to health is realised, the views infrastructure. of non-G20 countries in the Global South around the most fundamental challenges
to their health will continue to remain Genuine steps taken towards the strikingly different from Western achievement of the UN’s SDGs may be countries’ own evaluations. hindered, however, by a continually G20 Hamburg Summit, July 2017
its source”, to use President of the EU Council Donald Tusk’s own phrase at this The Summit’s Priorities report promises year’s G20 Summit. Such investment commitment, through individual and would be a good start towards the SDG of collective action, to the swift and far- “good health and well-being” for all. reaching implementation of the SDGs. Given the Summit’s engagement with the importance of neglected tropical diseases, How Recent Summits Have Failed to as well as improved access to health, such Adequately Address Global Health pronouncements are not purely The 2017 G20 Hamburg Summit has been rhetorical. The Summit’s headline pursuit the first to consistently engage with the of a “Compact with Africa” is driven by a issue of global health, and afford it a desire to strengthen private sector prominent place on the agenda. In investment in resource-poor African contrast to the G7/8 summits, health has countries, supporting infrastructure never played a significant role in development and economic participation. deliberations. By 2014 the issue had, A focus on strengthening health however, gained increasing traction and infrastructure in combatting deaths from was included in discussions. The spread of non-communicable diseases would prove endemic infections, namely the Ebola beneficial here. There is a firm need for virus, from the developing world have the G20 to ensure the development of heightened concerns within security new tools that allow for a response to communities in the West over the medical emergencies that is affordable increased health risk to their own citizens. and accessible to all people in need. Given The Ebola outbreak prompted various that many developing countries lack the recommendations on changing structures, basic levels of infrastructure needed to processes and instruments in responding respond to medical emergencies, to disease outbreaks, some of which have investment in health infrastructure would been implemented. The crisis has been help tackle the problem of migration “at seen by some to illustrate that the G20 is G20 Hamburg Summit, July 2017
driven by a desire to ensure diseases do to implement the 2030 SDGs, with health not cross borders and threaten the West, denoted as a “sustainable development as opposed to a strategy oriented around sector” to be prioritised. While any disease prevention. German civil society mention of global health was omitted organisations have used the occasion of from the document outlining plans for the the Hamburg Summit to remind G20 Hangzhou Summit, its communiqué did leaders that health should not refer to the serious threat posed by anti- predominantly be referred to as a security microbial resistance to public health, issue, but rather that of an opportunity growth, and economic stability. and a human right, and a precondition of prosperity. Progress at the Hamburg G20 Summit?
On the subject of global health, the G20 The Obama administration announced Hamburg Summit unquestionably marks a during the 2015 Antalya Summit that the solid step forward. Merkel declared in her US would work together with thirty press conference at the conclusion of the partner countries to achieve the targets of Summit that partner countries “felt better the “global health security agenda”, as equipped to show a united front should part of a wider call for international action further pandemics occur”. She also to strengthen the capacity to detect and announced that further “progress on respond to infectious disease outbreaks. microbial resistance” had been secured. A The construction of the link between key component surrounding the current health and security in this way at the G20 urgent need to adequately address anti- has contributed to a skewering of the microbial resistance stems from the fact agenda of global health away from those that pharmaceutical companies have in most need of support, particularly in failed to support Research and impoverished African nations. By the 2016 Development (R&D) on new antibiotics. Hangzhou Summit, though, progress had Here, the commitment to foster R&D been made in the form of a commitment G20 Hamburg Summit, July 2017
outlined in the Hamburg Summit Leaders’ those infectious disease outbreaks that Declaration, notably for priority have relatively high levels of mortality, are pathogens identified by the World Health acute in their impacts, and have the Organisation (WHO), reflects significant capacity to swiftly cross borders. Such progress on the limited rhetoric of the continued focus on international disease Hangzhou Summit. Resilient local and outbreaks undermines the Summit’s national health infrastructure, oriented commitment to the Millennium around the achievement of universal Development Goal of “reaching those health coverage, is key to the successful furthest behind first”. Furthermore, while implementation of the SDG of global the Declaration commits itself to “fully health for all. The Declaration’s pledge to eradicating polio”, the Director of the build cooperation on strengthening health AIDS Healthcare Foundation lamented the systems worldwide reflects the start of complete absence of any mention of what may prove an eventual HIV/AIDS in the agenda, and the failure of transcendence of the discursive linking of some G20 countries to increase financial health and security in safeguarding the support. health concerns of the Global South.
Conclusion Predictably, the G20 Hamburg Summit has In and of itself, establishing the presence not, however, liberated itself from the of global health at this year’s Hamburg national security concerns that have Summit for the first time in the G20’s plagued much of the previous discussion short history reflects a step forward in the on health at preceding G20 summits. The fight for global health for all. The Summit, continued compliance with the WHO’s however, while committing itself to International Health Regulations (IHR) has strengthening health systems worldwide, been identified as critical in responding to has failed to fully disassociate itself from infectious disease outbreaks. The IHR, the linkage of health and security that has though, are explicitly concerned with G20 Hamburg Summit, July 2017
dominated the limited discussion of global increased funding, oriented around health at previous summits. Viewed infrastructure, is the legacy of the through the lens of security, discussion of Hamburg Summit, global health could be a health is restricted to a narrow focus on key beneficiary, with many African nations emerging infectious diseases that worry lacking the basic infrastructure necessary the West. to respond to even day-to-day medical problems. The result would be a
significant step forward towards the G20’s This G20 Summit has committed itself to commitment to global health for all at the an intensified partnership with African first summit to make the issue a priority. countries, with Merkel claiming that G20 leaders have recognised the key to Henry Poust is a Masters student in development in Africa is a mixture of Governance and Public Policy at the rapidly increased private sector University of Sheffield. investment and good governance. If