Health at the G20: Countdown and growing expectations

The G20 (Group of Twenty) is an international forum comprising the countries with the largest economies in the world, which currently plays a central role in coordinating economic policies with a global impact and which aims, at least rhetorically, to promote inclusive growth, reduce inequalities and respond to global challenges. Since its creation in 1999, the group has played a key role in promoting cooperation and finding joint solutions to the economic challenges facing the international community.

After the global financial crisis in 2008, G20's role considerably expanded and it became a meeting forum for Heads of State and Government of the group's member countries, further dealing with issues such as health, education, employment, climate change and sustainable development (AITH; FREITAS; ESTEPHANIO, 2023).

The G20 comprises 19 countries (Argentina, Australia, Brazil, Canada, China, France, Germany, India, Indonesia, Italy, Japan, Korea, Mexico, Russia, Saudi Arabia, South Africa, Turkey, the United Kingdom and the United States) and two regional bodies: the European Union and the African Union (the latter included in this year 2023). G20 members account for around 85% of global GDP, over 75% of global trade and around two-thirds of the world's population (G20 SECRETARIAT, 2023a).

Government discussions in the group are divided into two tracks: (i) Sherpas and (ii) Finance. The first relates to thematic areas such as work, health, the environment, education, etc. The second, global economic and financial issues, which gave rise to the G20. Concomitantly, civil society (C20), women (W20), science and technology institutions (S20), think tanks (T20), municipal governments (cities) (U20), Parliament (P20), companies and private businesses (B20), among other agents, are also discussed in the Engagement Groups.

As of December 1st, 2023, Brazil assumed the presidency of the G20, which rotates from a member of the group for one year, shared by the previous presidency (India) and the one that will follow (South Africa), in the so-called troika. Under the slogan Building a Just World and a Sustainable Planet, Brazil's presidency of the G20 will have three priorities: (i) social inclusion and the fight against inequality, hunger and poverty; (ii) energy transition and sustainable development in its three aspects (social, economic and environmental); and (iii) reform of global governance institutions reflecting the geopolitics of the present.

Specifically on the first priority, the Brazilian government hopes to launch a Global Alliance against Hunger and Poverty. A special Task Force will be created, whose mission will be to develop the global alliance. According to minister Wellington Dias, the alliance will seek to raise financial resources and knowledge to support the implementation and expansion of actions, policies and programs to fight against hunger and poverty at national and global levels. Although it is being discussed within the framework of the G20, all countries that wish to join the alliance will be welcome, according to Brazil's Minister of Development, Social Assistance, Family and Fight against Hunger (MDS, 2023).

Moreover, the Brazilian government wants to bring unprecedented social participation to the G20. Through the initiative called G20 Social, Brazil seeks to ensure a space for the different voices, struggles and demands of the populations of the twenty largest economies in the world, further coordinating the activities of the engagement groups (1) and various other non-governmental initiatives involving the societies of all countries in the group (AGÊNCIA GOV, 2023).

Going beyond the expected results, such as the global alliance and others, holding the group's presidency gives Brazil the power to guide discussions on major global problems, from its own perspective and position. Considering that G20 does not have a secretariat, and that its declarations and positions are made upon the consensus of its members, the power to set the agenda for discussions is quite significant in achieving political success at the end of the presidency.

How do discussions on global health figure in the G20?

Specifically concerning the discussion on health, there is a Health Working Group (HEALTH WG), within the framework of the Sherpas Track, which, since its creation in 2017, has worked to improve dialogue and provide input to major global health issues to G20 leaders. Such issues include prevention, preparedness and response (PPR) of health systems for health emergencies, the One Health approach, Digital Health, Universal Health Coverage, compliance with International Health Regulations (IHR) standards, and sustainable financing, among others. (G20 SECRETARIAT, 2023b).

For the HEALTH WG, Brazil's presidency, led by the Ministry of Health, will focus on building resilient health systems and, to this end, it will prioritize: (i) Pandemic Prevention, Preparedness and Response, focused on local and regional production of medicines, vaccines and strategic health supplies; (ii) Digital health, for the expansion of telehealth, integration and analysis of data from national health systems; (iii) Equity in the access to health innovations; and (iv) Climate change and health, facilitating developing countries' access to technologies necessary to address the impacts of climate change on health.

In addition to the HEALTH WG, discussions on global health also take place in the Finance Track, within the framework of the Joint Finance and Health Task Force (JFHTF), which was created during Italy's presidency in 2021. The Task Force aims to strengthen global dialogue and cooperation on issues related to pandemic prevention, preparedness and response (PPR), developing coordination agreements between the Ministries of Finance and Health and promoting collective action, among other initiatives. Priorities for this task force during Brazil's presidency have not yet been disclosed; however, Minister Fernando Haddad disclosed that, within the Finance Track, the priorities defined by the Ministry of Finance and the Central Bank of Brazil are to work to prevent risks through effective coordination between economic and financial policies in order to develop a new approach to fair international taxation and to find solutions to remedy inequalities (AGÊNCIA GOV, 2023).

Health is also addressed in the engagement groups, mainly in the T20 (a group that gathers the think tanks of the G20 members), the S20 ("S" for Science, a group which gathers scientific institutions of the G20 members) and the C20 (a group which gathers civil society organizations engaged in G20 debates). Unlike the Sherpas and Finance Tracks, where discussions are necessarily dealt with at government level – and which are therefore guided by the principles that guide the actions of the federal government – the discussions on health in the engagement groups are freer, and they can even scientifically criticize the direction of the discussions and the priorities set by governments.

What is already known about the G20 in Brazil, and how does health figure in the discussions?

Concept notes on the priorities of Brazil's presidency for the G20, as well as on the priorities of all working groups and task forces comprising the Sherpas and Finance Tracks, will be published on 12/01/2023. These notes should detail the priorities and context of their definitions, the schedule of meetings, the expected results, as well as other relevant information so that both society in general and the other G20 member countries can understand, assess and engage in the discussions.

According to a publication in Agência Gov, the meetings of the Sherpas and Finance Tracks will begin on 12/11/2023, in Brasília/DF. The declarations and other acts to be adopted by the G20 leaders at the Rio de Janeiro Summit in November 2024 will then begin to be negotiated. The overall timetable for Brazil's presidency of the G20 also includes three phases: (i) videoconference meetings in January and February, covering all fifteen working groups; (ii) technical and in-person meetings, between March and June, in various Brazilian cities and regions; and (iii) ministerial, in-person meetings, equally distributed throughout the country, in August to October. The meetings are in preparation for the G20 Heads of State and Government Summit in Rio de Janeiro on November 18th and 19th, 2024.

Fiocruz maintains full articulation with the Ministry of Health and the Ministry of Foreign Affairs as to its role in government discussions as a strategic institution of the Brazilian State, as well as with the institutions responsible for the engagement groups T20 (Institute for Applied Economic Research [IPEA], Alexandre de Gusmão Foundation [FUNAG] and Brazilian Center for International Relations [CEBRI]) and S20 (Brazilian Academy of Sciences [ABC]), with regard to their capacity for research and critical analysis of health-related topics and its social determinants.

These organizations aim to provide technical and scientific knowledge on health, global health, health diplomacy, food and nutrition security, the 2030 Agenda and its goals for sustainable development, health and the environment, among other issues related to the main health challenges worldwide either through publications, technical papers, or by organizing events parallel to the official G20 program.

For 120 years, since its creation, Fiocruz has been an institution committed to life, health and the quality of human, animal and planetary life. In this sense, it is deeply concerned about the course of institutionalized political violence that the world has been taking in recent years, with the outbreak of more than a hundred military conflicts (2) that have produced thousands of dead, injured and physically and mentally disabled, some for the rest of their lives, in addition to an explosion in global military spending (3) (over USD 2.2 trillion in 2022) to the detriment of resources for the implementation of development and peace. In response, it has held discussions on the role of health as a bridge to peace in ongoing military conflicts, with particular concern for the immense humanitarian and health tragedy in the occupied Palestinian territories, especially in Gaza.

Among the initiatives it intends to propose to the G20 health group is the 'health as a bridge to peace' strategy, which aims to develop commonly agreed commitments to promote peace and firmly defend human life and the integrity of health facilities and their professionals, in addition to coordinating and improving the effectiveness of humanitarian and health aid from G20 countries in military conflicts.

These proposals are in line with recurring pronouncements by President Lula, such as at the recent virtual summit of the G20 (4) and BRICS (5), and by chancellor Mauro Vieira, including at the United Nations Security Council meeting on November 29th (6).

Fiocruz, through its Observatory on Global Health and Health Diplomacy, coordinated by the Center for International Relations in Health, will continue to monitor the G20 every two weeks, and it has already published and will publish several critical analyses of the group's activities through the CRIS Notebooks (7).

Through the presidency of the G20, in the continuity (without continuism) of the presidencies of Indonesia (2022) and India (2023), Brazil will continue to give voice to the Global South in the club of the world's richest. A clue to Brazil's conduct can be gleaned from President Lula's stirring speeches at the G77 Summit (8), in Cuba, on September 16, 2023; from the speech with which he opened the 78th. United Nations General Assembly (9), in New York, on September 19, 2023; or from his speech at the closing of the G20 Summit10, in New Delhi, on September 10, 2023, when he said:

"Fifteen years ago, this group consolidated itself as one of the main global governance bodies in the wake of a crisis that shook the world economy. Our joint action allowed us to face the most critical moments, but it was insufficient to remedy the structural mistakes of neoliberalism. The global financial architecture has changed little, and the foundations for a new economic governance have not been laid. New urgencies arose. The challenges have accumulated and became worse. We live in a world where wealth is more concentrated. In which millions of human beings are still starving. In which sustainable development is always under threat. Where governance institutions still reflect the reality of the middle of the last century. We will only be able to tackle all these problems if we address the issue of inequality. Inequality of income, access to health, education and food, gender and race, and representation are at the root of all these anomalies. If we want to make a difference, we have to put reducing inequalities at the center of the international agenda."

The world expects a lot from Brazil's presidency of the G20. In health, professionals and researchers in the sector, scientific institutions such as Fiocruz, universities and research institutes, as well as social activists in health, are ready to collaborate in achieving the strategic objectives of this endeavor that begins on December 1st, 2023.

References

AGÊNCIA GOV. Presidente instala Comissão Nacional do G20, 2023. Acessed on 11/26/2023.

AITH, F.; FREITAS, R. DE; ESTEPHANIO, J. M. La révision du règlement sanitaire international (RSI) au G20. Journal de Droit de la Santé et de l’Assurance Maladie, v. 37, p. 173–177, 2023.

G20 SECRETARIAT. About G20G20 INDIA. [s.l: s.n.]. Accessed on: Aug. 24th, 2023a.

G20 SECRETARIAT. G20 - Background Brief. [s.l.: s.n.].

MINISTÉRIO DO DESENVOLVIMENTO E ASSISTÊNCIA SOCIAL, FAMÍLIA E COMBATE À FOME (MDS). Wellington Dias avança em proposta brasileira de criação da Aliança Global contra a Fome e a Pobreza durante Cúpula Global em Londres, 2023. Accessed on 11/21/2023.

*João Miguel Estephanio and Pedro Burger are senior researchers at the Center for International Relations in Health (CRIS) of the Oswaldo Cruz Foundation (Fiocruz); Paulo M. Buss is the director of CRIS/Fiocruz; and Mário Moreira is the president of Fiocruz

This article was originally published by Le Monde Diplomatique Brasil, with this extended version at CEE.