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Accountability, Innovation and Coherence
in G8 Health Governance:
Seizing Canada's G8 Opportunity
January 25, 2010
Munk Centre for International Studies
Seeley Hall, Trinity College
University of Toronto
Program • Speakers • Background Papers • Sponsors
In 2010, Canada takes the chair of the Group of Eight (G8) major democratic countries. On June 25–26 the G8 leaders will gather in Muskoka for their annual summit, potentially along with their outreach, international organization and civil society partners. Immediately after, on June 26–27 in Toronto, Canada co-hosts with the Republic of Korea the first institutionalized summit of the Group of Twenty (G20) systemically significant states. Prime Minister Stephen Harper has identified the major themes for the G8 summit as economic recovery and open markets, climate change, development, and democracy, human rights and the rule of law. Health, in the form of maternal and children's health, is on the agenda, under the development theme.
To transform this sound start into effective results that save and improve lives around the world, policy coherence is paramount, and the challenges of accountability, innovation and consensus in G8 governance must also be met. Do G8 governments actually keep their health and other commitments? How can they and others be made more accountable and thus effective in improving global health? What are the best innovations that leading experts and stakeholders can offer for improving child and maternal health, for strengthening healthcare systems, for community care, for discovery science and research for development and for related realms? How can such smart global health initiatives be made mutually supportive among themselves and also supportive of the other advances that the G8 and G20 summits will seek in the economic and finance, climate change and security fields? And how can such global health initiatives be crafted to mobilize the support of the G8 to effectively save and improve lives?
There is understandable skepticism about whether G8 governments will actually deliver the smart, synergistic health commitments they collectively craft, amidst the other priorities and pressures that will arise after their summit is held. Many recall the ambitious promises that G8 members have made but are still struggling to fulfill. Stakeholders and citizens in the G8 democracies ask: How much and how are G8 governments currently complying with the commitments in health and other areas they made at the G8 L'Aquila Summit in Italy last summer? How well have they complied with all their G8 health commitments in the past, and how can they improve? What institutional innovation is the G8 itself crafting to augment its own accountability? And how can accountability be improved in intergovernmental organizations, donor and recipient governments, and civil society organizations themselves? A review of the available evidence shows that G8 governments largely do keep their health commitments, but that they should seek to perform better. It is thus worth trying to help G8 governors craft smart, synergistic health initiatives for the 2010 G8 Muskoka Summit and to enhance their delivery and effectiveness afterward.
Even with strong compliance, augmented accountability and enhanced effectiveness, the global health challenge will remain great and growing, as children and their mothers and other family members die prematurely in large numbers around the world, especially in fragile and vulnerable states that have been hit hard by the recent global recession. The Millennium Development Goals most closely related to health, due for delivery in 2015, are far from being achieved in most of the world's countries. This is particularly the case with regard to mortality rates among mothers and children under five, as diarrhea, malnutrition, respiratory infection and malaria continue to take their deadly toll. While all recall the G8's ambition in launching the Global Fund to Fight AIDS, Malaria and Tuberculosis, in debt relief and in doubling aid, in 2010 in the wake of the economic crisis, initiatives to enhance global health may now well have to be taken in ways that involve more innovation rather than additional money being mobilized for the cause.
There are many ways to creatively improve the design and delivery of health care for those who most need it. Strengthening healthcare systems and community care is fundamental. Science, technology and innovation are increasingly recognized as key drivers of improved global health. How can the discovery and development of drugs, vaccines, diagnostics and devices improve global health, especially when designed for developing countries and done with and by partners in those countries? What is Canada's role in such innovation? How can it partner with other countries and international foundations? What social innovations, including in health systems, delivery of drugs, vaccines and other health technologies, the global health workforce and financing mechanisms, might be championed?
These health initiatives compete for attention, resources and support with responses to similarly large and deadly challenges in the economic, environmental and security fields. It is becoming clear that all these challenges are closely intertwined in many complex ways, and that few can be solved on their own. Yet the world's major multilateral organizations still operate substantially in separate silos, focused on their specific mission, in a loosely linked global governance galaxy where great gaps remain and where too few of the necessary links are reliably forged. Health concerns thus remain inadequately integrated with the International Monetary Fund's work on global financial and economic governance, and with the United Nations work on food, climate change, good governance, peace, security, the rule of law and human rights.
It is up to leaders at both the international and national levels to create coherence among the responses to the component challenges and to integrate the initiatives and institutions dedicated to dealing with each one. Only leaders have the ability, opportunity and responsibility to craft synergistic innovations necessary for their health, finance, climate and security commitments to work together for the greater good.
To take full advantage of Canada's 2010 hosting of the G8 and G20, it is important to identify at the initial stage how G8 and G20 governance on the economy, environment and security can work together for global health and, in particular, how smart health innovations and investments can help generate the economic growth, climate mitigation and adaptation, and national and human security that all need. The task for G8 governance is to forge the connections and craft a strategy to help the global community cope with these challenges, in mutually reinforcing, cost-effective ways. In particular, the need is to identify how a comprehensive, health-first strategy can solve pressing global problems both for health and for other domains. The key is to identify how smart, synergistic global health initiatives can be guided through the G8 preparatory and negotiating processes, to be available for the leaders to adjust and accept, starting at their summits in June 2010.
To help meet this need, the Global Health Diplomacy Program and the G8 Research Group at the Munk Centre for International Studies at Trinity College in the University of Toronto, together with its partners listed above, is hosting a one-day invitational experts' conference on Monday, January 25, 2010, at the start of Canada's year as G8 and G20 host. Leading experts and stakeholders will identify and seek to improve, in turn, G8 and partner accountability, innovative global health initiatives, coherent health connections with the economy, climate change and security, and ways they can be advanced through the G8.
This conference is being held as Canada, as the G8's 2010 host, begins to develop in detail and advance the G8/G20 agenda. It does so by framing the issues, identifying promising initiatives and exploring the links, at a moment when there is considerable space for shaping the G8/G20 agenda and action. Basic background papers are available online. Open, creative thinking and exchange is encouraged at the conference. This process is designed to produce smart, synergistic, "summitable," sustainable initiatives that G8 leaders can take up and that will be effective in saving and improving lives. A premium will be placed on those integrative policy innovations that put health first, that promote maternal and children's health, healthcare systems, community care and discovery science for development, that are appropriate for G8 action starting in 2010, and that are cost effective and where Canada is well positioned to take the lead.
In order to extend the reach of the day's discussions and to enrich the G8 policy process to the greatest degree, the results will be made available to G8 governors in a report written immediately after the conference. Representatives from G8 governments will participate in the conference itself. A conference report will also be published online and distributed to a targeted list of G8/G20 officials. Other possibilities for dissemination will be explored, including through subsequent workshops or consultations with the G8/G20 sherpa teams.
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