The improved health of the world’s citizens goes hand in hand with sustainable economic growth, hence the need for a G20 Global Health Working Group, argues the Nossal Institute for Global Health.
In recent decades, the world has developed in unprecedented ways. These developments have profoundly impacted global health – the causes of ill-health within countries, the types of diseases that dominate the public health landscape, and the variety of actors involved in addressing them. Within this shifting agenda, it is possible to identify the trends and challenges that will dominate the agenda in coming years. It is also possible to envisage a greater role for the G20as a participant in finding solutions – as a contributor to and beneficiary of development, health is integrally linked to the G20’s mandate of economic growth.
The state of global health
Global health has changed in remarkable ways. There has been a fundamental shift in the global disease burden, with communicable diseases now accounting for a markedly smaller percentage of global disease than was the case for much of the 20th century. Reduction, but not elimination, of these conditions has been assisted by innovation (including the development of vaccines), and fostered by an expanding global economy and reductions in global poverty. In many countries (both developed and developing), these conditions have been overtaken by non-communicable diseases (NCDs), which are now the predominantcause of death in all regions except Africa. Despite average improvement, poverty alleviation and control of infectious diseases remains a major challenge, particularly for the nearly one billion people living in urban slums in the developing world, and because of the constant threat of SARS and influenza.
In recent decades, two trends have emerged that will increasingly impact global health. Firstly, the rapid spread of urbanisation has created conditions, which both promote and hinder improvements in health. As global health economist Chandra Kumar has reported, in the past 50 years, the share ofpopulation in urban areas in Asia has risen from 31.5 per cent to 42.5 per cent, and by 2025 this share will rise to 50 per cent.
Urbanisation can facilitate good health by increasing access to education, economic opportunities and healthcare, but on the other hand it can also detrimentally impact public health by altering lifestyles (including food and alcohol consumption, physical activity, work patterns, smoking and sexual behaviour), increasing exposure to pollution, and reducing adequate water supply, sanitation and housing. Slum dwellersoften see little of the so-called “urban advantage” – they suffer disproportionately from infectious diseases, malnutrition, increasing costs of food, poor access to education and healthcare, threat of eviction, and informal employment. Worse, due to ongoing challenges associated with traditional gender roles and discrimination, these constraints continue to be greater for girls and women.
A second related trend is that of climate change. The Intergovernmental Panel onClimate Change’s last three Assessment Reports have escalated awareness that climate change will increasingly be implicated in a growing burden of disease and premature death, and is likely to place further stress on access to food and water.
Health equates to wealth
Globally, these shifts are, in fact, profoundly important – and it can be argued that the G20 is well-placed to play an enhanced role in global health. Putting aside its many other benefits, good health is intimately related to the G20’s core agenda: fostering international economic cooperation and growth. Healthier communities and countries are wealthier communities and countries. Healthy people alleviate pressure on hospitals and health budgets, and are more able to participate in economic activities. They spend money on education, consumer goods and food, rather than healthcare. On the other hand, increasing levels of chronic ill health and disability (particularly as consequences of NCDs and population ageing) erode economic growth and require diversion of increasing amounts of resources for the treatment of the chronically ill. This trend coincides with another consequence of population ageing: a reduction in the number of tax payers to support rising healthcare costs.
The G20’s diverse membership also positions it to play a unique role in encouraging global health cooperation. Notably, the G20 brings together traditional aid donors (such as the US, UK and Australia) with newer donors from emerging economies (China, India and Indonesia). Both groups have broad experience in addressing publichealth both domestically and through aid, so partnerships among member countries have the potential to band together a range of comparative advantages. Establishing a G20 Global Health Working Group or Expert Group could foster this engagement by building upon a role played historically by the G8 – including increasing commitment to address HIV, tuberculosis and malaria.
Collaboration is the key
Global health collaboration among the G20’s diverse membership could play a major role in finding solutions to emerging global health challenges, including the emergence of NCDs. Factors that influence social and economic development are increasingly global and regional, and require cooperation and collective action. The facilitation of regional cooperation could help address transnational problems such as treating drug-resistant malaria or tuberculosis, or improving the regulation of therapeutic goods to enhance access to safer, quality medicines. Collaboration might also contribute to answering important health policy questions – including how to enable universal access to quality, affordable healthcare; and how to ensure that being female, elderly, from an ethnic minority group, or living with a disability is no longer a barrier to being healthy.
But the major reason the G20 is well- positioned to contribute to global health is because causes of ill-health and necessary responses often exist outside of the health sector. All too often, health is segregated from those sectors with which it is integrally related. By applying a health lens to global policy issues addressed by the G20 – including trade, employment participation, taxation and economic growth – the G20 and its members have the opportunity to ensure that the principle of good health is embedded in all sectors and policies. Global health will not be the only winner, as benefits will flow to all those involved in strengthening the global economy.
Professor Graham Brown is the Director of the Nossal Institute for Global Health.
Sam Byfield is the Non-Communicable Diseases Coordinator at the Nossal Institute for Global Health.
This is an extract from G20: Words into Action Brisbane 2014, to be published by Faircount Media in association with the Australian Institute of International Affairs in October 2014.