University of Toronto

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Munk School of Global Affairs

Implementing Global Summit Commitments on Health

John Kirton, Professor of Political Science, University of Toronto
Andy Knight, Professor of Political Science, University of Alberta
C. James Hospedales, Executive Director, Caribbean Public Health Association

Paper prepared for the 59th Annual Convention of the International Studies Association, on "Power of Rules and Rule of Power," San Francisco, April 4-7, 2018. Version of April 2, 2018.


Driven by mounting human and economic costs from, the international transmission of infectious disease and the expanding epidemic of non-communicable diseases (NCDs), national leaders have increasingly addressed such health priorities at their key global summits of the G7, G20, BRICS and United Nations. How well and why have they complied with the precise, future-oriented, politically-binding informal rules on health that they made there and how can their compliance be improved? This study, by international relations scholars and a leading global health practitioner, examines the commitments and compliance of the soft law G7, G20 and BRICS summits and the hard law UN High Level Meeting on NCDs in 2011. Among the causes at the systemic, international institutional, member country and individual leader level, it focused on low cost accountability measures that are under the leaders' direct control, that they have used before, and that they can use again to improve implementation. It suggests how the health community centered in the World Health Organization, Pan American Health Organization and Caribbean Public Health Agency can join with the foreign policy community centered at the UN in an effective, whole-of-global governance approach, in support of the Agenda 2030 Sustainable Development Goals and the UN HLM on NCDs in 2018.


In recent decades, global health governance has expanded enormously, moving beyond the traditional World Health Organization (WHO) and its regional affiliates to embrace the United Nations as a whole, the summits of the Group of Seven (G7) major market democracies, the Group of Twenty (G20) systemically significant states, the big emerging countries of Brazil, Russia, India, China and South Africa (BRICS) and a plethora of philanthropic and other non-governmental actors. Much of their focus has been on the major infectious diseases and their deadly outbreak events, led by HIV/AIDS. Only recently has attention turned to the major, chronic, non-communicable diseases (NCDs) of cancer, heart and stroke, diabetes and chronic respiratory disease. These have become the number one killer of human life and balanced budgets in both the global north and south, especially as the population in many countries ages. And even when policy and programs are in place, the chronic nature of NCDs represent challenges for patients and families to adhere lifelong to medication and lifestyle change. It was thus appropriate that NCDs, absent from the UN's three health Millennium Development Goals (MDGs) adopted in 2000, were added, with leadership from Caribbean countries, as a component target in the one health goal of the 17 Sustainable Development Goals (SDGs) approved by a UN summit in September 2015. To advance the achievement of this target, the UN is mounting its third High-Level Meeting (HLM) on NCDs in 2018, following those in 2011 and 2014.

To suggest how this HLM and other global summits in 2018 can craft health commitments that are likely to be complied with, this paper builds on previous studies, notably that presented at the International Studies Association in 2015 (Kirton and Bracht 2015). That study found that the 54 G7 health commitments assessed for compliance, had 76% average compliance, with compliance raised by the commitment-embedded catalysts of a core international organization and a one-year timetable, but lowered by those of a non-core other international organization, a multi-year timetable and a link to the G7 finance ministers' forum. The catalysts of a core international organization, along with a specified agent had also raised compliance with the 27 commitments of CARICOM's pioneering Port of Spain Summit (POSS) on NCDs in 2007 (Hospedales et al. 2011; Kirton and Bracht 2015; Kirton and Fitzgibbon 2014).

This paper adds an examination of the compliance of 65 G7, six G20 and three BRICS health commitments, and of 15 UNHLM NCD commitments in 2011. It focuses on those compliance catalysts earlier found to have had an important impact on G7, G20 and BRICS compliance, both overall and in the closely connected filed of climate change, as reported in the newly published book edited by John Kirton and Marina Larionova in 2018, Accountability for Effectiveness in Global Governance (Routledge: New York).

This current paper finds that G7 health compliance rose slightly to 77% and was increased by the catalysts of a core international organization (the World Health Organization) and now of a non-core, other international organization (notably the money mobilizing Global Fund). G20 health compliance at 73%, was not affected by any of the catalysts the G20 employed, specifically a reference to civil society, a past summit or a remit mandate to a subsequent summit. BRICS health compliance was 80%, with the catalyst of a non-core, other international organizations lowering compliance with the one commitment in which it appeared. UNHLM 2011 NCD compliance seems to have been raised by the catalyst of a core international organization (WHO) and international law, but lowered by those of civil society and specified agent.

While these are preliminary, suggestive findings, they tell a consistent tale. Across all four summit institutions, the catalyst of a core international organization (and sometimes a non-core, other international organization such as the Global Fund) seem to raise compliance. The catalyst of a one-year timetable could raise compliance in the informal annual G7. International law could do so in the formal UN's sporadic summits. In short, the hard law instruments of formal rules contained in international law help members comply with their soft law summit commitments made at the hard law UN, while the core international organization that underscores hard law does so at the soft law G7. The clear policy message for the UNHLM on NCDs in 2018 is to rely more on the WHO and its legal instruments such as the Framework Convention on Tobacco Control (FCTC) if compliance is what summit leaders want.

G7 Summit Health Compliance

The G7 major market democracies were founded as a fully soft law, plurilateral summit institution (PSI) in 1795 with six members — the United States, Japan, Germany, United Kingdom, France and Italy. They added Canada in 1976, the EU in 1977 and Russia from 1998 to 2013. The G7 governed health at its annual summits continuously since 1979, save for a gap in 1994-5 (Kirton 2012; Kirton and Bracht 2015). Health as a subject took an all-time high of 26% of the public communiqué in 2010, where the summit's centerpiece achievement was the Muskoka Initiative on Maternal, Newborn and Child Health. The G7 had begun by addressing health issues within its own members, including cancer and research but then shifted to focus on the infectious and other diseases of great concern in Africa, notably HIV/AIDS, malaria, TB, polio and maternal and child health (Kirton and Mannell 2007; Kirton, Kulik, Bracht and Guebert 2014). It gave very little attention to NCDs.


Since starting in 1980 through to 2017, the G7 produced 403 health commitments, among the 5,188 it made overall (see Appendix A). This made health the third highest subject of G7 decision-making, surpassed only by development with 669 commitments and energy with 433. In the 34 years from 1975 to 2008, the G7 had made 234 health commitments (Kirton, Roudev, Sunderland, Kunz and Guebert 2010). In the most recent decade from 2009 to 2017 it added 169.


The 2015 study had found that of the 54 commitments measured for first year compliance, the average score was +0.51 on the scientific scale where -1.00 is no compliance, 0 is partial compliance and +1.00 is full compliance. This represents 76% on the popular 100-point scale. G7 health compliance was led by Canada at +0.80. Compliance was regularly quite strong, save for a drop into negative territory in 2010. The current study, based now on 65 commitments assessed for compliance through to 2016, finds that compliance rose slightly to +0.54 on the scientific scale or 77%.

Causes of Compliance

Three successive studies had assessed the causes of G7 health compliance. The first, based on 30 assessed commitments from 1996-2005, assessed the accountability measure of compliance catalysts, finding that compliance was raised by the inclusion in the commitment of a one year timetable and a core international organization (WHO) but lowered by non-core other international organizations. This last finding could flow from the WHO's desire for a monopoly and reluctance to have other international organizations, or competition or "buck-passing," among them when more than one is invoked (Kirton, Roudev and Sunderland 2007). The second study based on 35 assessed commitments from 1996-2005, confirmed these findings, adding that compliance was lowered by a multi-year timetable and a reference to the G8 finance ministers (Kirton, Roudev, Sunderland, Kunz 2009). The third study based on 46 assessed commitments from 1980-2009 found that a specific "cocktail" of catalysts caused the compliance of each individual member country to change (Kirton and Guebert 2009).

The current study, assessing the 65 commitments now assessed for compliance through to 2016, focuses on those catalysts previously found to have had an impact on average compliance (see Appendix B). It asks if each in isolation still has a similar impact. Core international organization the (WHO) does. For the seven out of 65 commitments with this catalyst, the average compliance was 85%, well above the 77% average for the 65 assessed commitments as a whole. A one year timetable could also have a similar effect. For the seven out of 65 commitments in which it appears, compliance averaged 79%. However the addition of the 2010 commitment which asked for the immediate mobilization of $5 billion for maternal, newborn and child health was assessed at -0.56 compliance, lower in the average to 72%. A reference to a non-core other international organization, raised average compliance to 82%, although most of these 12 commitments referred only to the money mobilizing Global Fund. The 12 commitments with a reference to a multiyear timetable averaged compliance of 78%, suggesting at best a minimal compliance effect.

G20 Summit Health Compliance

The G20 summit, started in 2008, increasingly dealt directly with health, with a great surge of attention to the infectious disease of Ebola at its ninth summit, held in Brisbane, Australia on November 15-16, 2014 (Kirton 2014; Kulik 2014). Since its start the G20 had addressed the UN's Millennium Development Goals (MDGs), whose eight goals contained three on health, respectively on child and maternal health and HIV/AIDS, malaria and tuberculosis. Pittsburgh in September 2009 saw an increase in health-specific references due to the five health-related paragraphs in the communiqué. Leaders noted their concern about the capacity of low-income countries to protect spending in areas such as health and their responsibility to invest in people by providing health care.

References to health dropped back to two paragraphs at Toronto in June 2010. Here, in the macroeconomic Framework for Strong, Sustainable, and Balanced Growth, leaders agreed to strengthen social safety nets including public health care. At Seoul in November 2010 health references surged to 10 paragraphs. In addition to reiterating support for the MDGs, leaders committed to identifying the links between health problems and life-long skills development, and the impact of NCDs (Kirton, Bracht and Kulik 2015). At Cannes in 2011, health references declined to six paragraphs. Leaders recognized the importance of investing in social protection floors such as access to health care and safe and nutritious food. At Los Cabos in 2012, health references decreased further to four paragraphs, focused mainly on the MDGs. But at St. Petersburg in 2013 health references soared to a new peak of 12 paragraphs, covering issues such as hunger and malnutrition, the MDGs, and the long-term financing of health insurance.


At its first eight summits, the G20 made no core health commitments. Health-related commitments dealt with the MDGs, access to health care and spending in the health sector. On access, the first commitment came at Cannes, where leaders committed to tighten limits on central government and health insurance expenditures. The second came at Los Cabos, where leaders supported innovation in health care.

Brisbane in 2014 produced 33 health commitments. Three came in the overall three page concluding communiqué on November 16th and 30 in the separately issued Statement on Ebola issued the day before. The 33 commitments on health was the second highest number on any subject. It was only one below the 34 on macroeconomic policy, which had been the G20 summits' core concern from the start and the singular focus for its Australian host in 2014. Of the 33 health commitments, 17 or about half were explicitly dedicated directly to the Ebola epidemic ravaging West Africa. The other half contained commitments that were more relevant to NCDs. Two promised to implement the International Health Regulations. Four committed to strengthen health systems in general, to deal with "infectious diseases like Ebola." Six pledged to mobilize resources against the threat posed by infectious disease to strong, sustainable and balanced growth, thus forging an instrumental link from health to the G20's core economic goal. Two promised vigilance and responsiveness in general. One addressed anti-microbial resistance (AMR).


G20 compliance with health-related commitments was first assessed by examining the scores for the three commitments on the MDGs (Kirton and Bracht 2015). Here compliance was a low 57% (or +0.14 on the 200-point scientific scale). The first commitment, from the London Summit scored 0.00, the second, from Pittsburgh −0.05 and the third from Seoul +0.19.

The current study, based on six core health commitments assessed for compliance from 2014-2015, shows average compliance of a much higher +0.45 or 73%. It dropped somewhat from 2014 at +42.5 to 2015 at +0.30.

Causes of Compliance

Of the six commitments, three had compliance catalysts in the form of a reference to civil society, declared iteration through reference to a past summit and a remit mandate to the subsequent summit. These three had average compliance of +0.33 (based on an equal weighting of the commitments). The three without catalysts averaged compliance of +0.43 (due largely to the +0.95 compliance for the commitment: "we also commit to fight antimicrobial resistance"). This very preliminary evidence suggests that the three compliance catalysts in question did not raise compliance, nor did they seem confidently to lower it. This is consistent with the results in the G7 health governance case, as none of these particular catalysts were found to affect compliance there.

BRICS Summit Health Compliance


The BRICS at its annual stand-alone summits from 2014 to 2017 produced seven core health and three health-related commitments. It started making health-related commitments at Fortaleza in 2014, with two (see Appendix C). It added six core health commitments and a health-related one at Ufa in 2015. At Goa in 2016 it produced one core health commitment and no health-related ones. None of these commitments dealt directly with NCDs.


Compliance with the three assessed BRICS health commitments from 2011 to 2016 averaged +0.60 or 80%. This is above the BRICS average across all summits and issues of +0.54 or 77% (based on 48 commitments assessed). Health compliance started strong with +1.00 in 2011 on HIV, but fell to +0.40 in 2015 on Ebola and remained at +0.40 in 2016 on AMR.


The one commitment with a compliance catalyst, BRICS 2016-39 on AMR, read "[We welcome the High Level Meeting on Anti-Microbial Resistance (AMR) during UNGA-71, which addresses the serious threat that AMR poses to public health, growth and global economic stability]. We will seek to identify possibilities for cooperation among our health and/or regulatory authorities, with a view to share best practices and discuss challenges, as well as identifying potential areas for convergence." Its compliance of +0.40 was lower than the average of the other two assessed health commitments at +0.70. Its catalyst was a reference to a "non-core other international organization" — a catalyst previously found to have lowered compliance in the G7 health case. The fact that it was invoked in regard to a UN health subject-specific summit — the HLM — did not coincide with higher compliance.

The UNHLM on NCDs, 2011

This record of compliance with soft law summit commitments in the three global PSIs can be compared with the compliance with summit commitments created by hard law bodies with large organizational secretariats and formal rules. The archetype is the United Nations, a long established, large, highly multilateral organization that does not have regularly scheduled comprehensive summits and that only began to have ad hoc single-issue summits in 1990. The second such summit on health, following the first on HIV/AIDS, was the UNHLM on the prevention and control of NCDs held in September 2011.

The 2011 UNHLM on NCDs flowed directly from and due to the world's first summit devoted to NCDs, held by CARICOM as a special summit in September 2007 in Port of Spain, Trinidad and Tobago (Kirton et al. forthcoming). Unlike the UN, this regional international organization has regularly scheduled comprehensive summits at a frequency of two per year, in addition to special single subject summits of which the NCD summit was one. This 2007 summit produced 27 commitments. One year later the 20 members had complied with these commitments at an average of 43% (Kirton and Bracht 2015).


At the end of the 2011 UNHLM summit, attended by 35 country leaders, its outcome document contained 205 precise, future-oriented, politically-obligatory commitments. A follow up UNHLM on NCDs in 2014, with no country leaders attending, produced 104 commitments.


Thus far, 15 UNHLM-2011 commitments have been assessed for the compliance of the 40 members from the western hemisphere during the year after the summit was held. This analysis shows that the average level of compliance across all 15 assessed commitments was a low +0.05 or 53% (see Appendix D). The 20 small countries of the Caribbean Community had an average compliance of 52%, while the non-CARICOM members of the hemisphere had average compliance of 51%. The two members of the G7 from the hemisphere, the U.S. and Canada, had average compliance of 72%. The five hemispheric members of the G20 — the U.S., Canada, Mexico, Brazil and Argentina — had average compliance of 64%.

Causes of Compliance

At first glance, the key cause of compliance would appear to be the realists' relatively capability of the country. This higher compliance of the powerful G7 and then the G20 members reflects the economic capability of those members, relative to the smaller and poorer members of the CARICOM and other states. This confirms the finding of an earlier study, based on compliance assessments of 10 UNHLM 2011 commitments, which found that CARICOM members had an average compliance of +0.12 and that "those countries with greater capabilities, like higher GDP and populations, are more likely to comply (Kulik and Bracht 2016: 11). It also found that compliance was caused by a country's vulnerability to the major NCDs and by three country-level gender variables — "the number of female students in tertiary education, the number of years with a female head of state and the number of female parliamentarians."

Yet in the current study of 15 commitments, a major puzzle immediately appears. For the very small, largely poor 19 members of CARICOM, including Haiti, had a slightly higher average compliance of 52% in comparison to the other members of the hemisphere, including the powerful G7 and G20 ones, at 51%. Why is CARICOM complying above its weight?

The answer appears to lie in the global first mover advantage CARICOM members had by pioneering the world's first summit on NCDs at Port of Spain in 2007. A detailed tracing of the political and diplomatic process shows that the 2011 UNHLM was pioneered by CARICOM from the start (Hospedales et. al. 2011; Samuels, Kirton and Guebert 2014; Kirton et al. forthcoming). A preliminary input-output analysis shows that the 2011 UNHLM commitments that matched the 27 2007 Port of Spain ones had higher one year compliance than those that did not and that CARICOM members had higher compliance with all.

To further confirm this "CARICOM POS" effect, it is useful to control for the independent compliance-creating effect of the compliance catalysts that count in the G7, G20 and BRICS, as they appeared in the 15 assessed 2011 UNHLM ones. This analysis begins by comparing the three assessed 2011 UNHLM commitments with the highest compliance with those three with the lowest compliance, to see if the former trilogy contain more catalysts, and ones of a particular sort, than the latter did.

This very preliminary analysis suggests the independent compliance-enhancing effect of a core international organization (the WHO) and of international law, as these two catalysts were uniquely contained in the commitment with the highest compliance of the 15 — that on the FCTC.

In contrast, the catalysts of civil society and specified agent appear to have a compliance-reducing effect, as both were uniquely contained in two of the three commitments with the lowest compliance scores. More broadly, the hard law of international law and organizations, rather than the softer instruments of civil society and communities seem to bind as far as compliance with UN summit commitments is concerned.



This paper finds that G7 health compliance has risen to 78% and was increased by the commitment-embedded catalysts of a core international organization (the World Health Organization) and another international organization (notably the Global Fund) (see Appendix E). G20 health compliance at 73% was not affected by any of the catalysts it employed — civil society, declared iteration through reference to a past summit or a remit mandate to the subsequent summit. BRICS health compliance was 80%, with the catalyst of a non-core other international organizations seeming to lower compliance with the one commitment where it appeared. UNHLM 2011 NCD compliance seems to be raised by a core international organization (the WHO) and international law (the FCTC), but lowered by the catalysts of civil society and specified agent. The latter may be due to insufficient political follow-through on the part of civil society, led by the organizations dedicated to NCD prevention and control.

While these are preliminary, suggestive findings, they tell a consistent tale. Across all four institutions, they suggest that the commitment-embedded catalyst of a core international organization raised compliance and that of a non-core other international organization can also raise it in the specific case of the special purpose Global Fund. The catalyst of a one year timetable could raise compliance in the annual informal G7, as international law could in the sporadic summits of the formal UN. In short, the hard law instruments of formal rules contained in international law and international organizations help members comply with their soft law summit commitments at the hard law UN and the soft law G7. In both cases the clear policy message is to rely more on the WHO and its legal instruments such as the FCTC if compliance is what summit leaders want, while crafting other international organizations such as the Global Fund to lend a hand.

Suggestions for Further Research

To move beyond these preliminary, suggestive findings about what accountability measures and other causes might raise members' compliance in global summit institutions of both an informal soft law and formal hard law, several steps for further research stand out. They are led by the need for more compliance assessments, more catalysts such as gender, more accountability measures and more control causes, more comparisons with other issue areas (starting with the cognate, connected ones of climate change and development) and more summit institutions beyond the four considered here and the regional CARICOM. In the latter case, the most promising addition would be a study of compliance with the commitments made at CARICOM's special summit in November 2014 on the public health threat of Chikungunya and Ebola, and how support from the hemispheric Pan American Health Organization and global WHO did and could improve compliance. Here a sole reliance on the catalyst of international law broadly defined — in the form of the International Health Regulations — could be insufficient. Could a "Global Fund" for NCDs play a role?

To help guide this research, three hypotheses arise from these results.

First, institutions with fewer members have higher compliance, with the BRICS 5 at 80%, the G7 at 77%, the G20 at 73% and the UN with its more than 190 members at only 53%. This is consistent, political scientists will readily note, with the liberal-institutionalist claim that fewer members make monitoring of cheating colleagues easier and the constructivist claim that it makes peer pressure and club cohesion stronger. It also means, public health practitioners will properly add, that 53x190 means more lives saved than 80x5, assuming a constant rate of ambition in the commitments that all four bodies make.

Second, the age of the PSI, and the experience and opportunities for iteration that longevity brings, seems insignificant, as the youngest BRICS has higher compliance than the oldest G7 one, and then the formal multilateral UN from 1945 and its summit meetings since 1990.

Third, the presence and strength of a dedicated secretariat and the other features of formal international organizations do not raise compliance, as the unencumbered G7 has much higher compliance than the heavily organized, legalized UN. Yet while the G7 may not need a secretariat of its own, it does need to rely on the WHO to help comply with the commitments its leaders make.

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Hospedales, C.J., T.A. Samuels, R. Cummings, G. Gallop and E. Greene (2011), "Raising the Priority of Chronic Noncommunicable Diseases in the Caribbean." Revista panamericana de salud publica 30(4): 393-400.

Kelley, Patrick W. (2011), "Antimicrobial resistance in the age of noncommunicable diseases," Revista panamericana de salud publica 30(6): 515-518.

Kirton, John (2012), "Improving Summit Success for Health in the Global Information Age," Paper prepared for the annual convention of the International Studies Association, San Diego, 1-4 April.

Kirton, John (2014), "The G20 Discovers Global Health at Brisbane," November 15.

Kirton, John, Jenevieve Mannell (2007), "Explaining G8 Health Governance," in Andrew F. Cooper, John J. Kirton and Ted Schrecker, eds., Governing Global Health: Challenge, Response, Innovation (Ashgate: Aldershot), pp. 115-146.

Kirton, John, Julia Kulik, Caroline Bracht, and Jenilee Guebert (2014), "Connecting Climate Change and Health Through Global Summitry," World Medical and Health Policy 6(1): 73–100. doi: 10.1002/wmh3.83.

Kirton, John, Nick Roudev, Laura Sunderland, Katherine Kunz and Jenilee Guebert (2010), "Health Compliance in the G8 and APEC: The World Health Organization's Role," in John J. Kirton, Marina Larionova and Paolo Savona, eds., Making Global Economic Governance Effective: Hard and Soft Law Institutions in a Crowded World (Farnham: Ashgate), pp. 217-229.

Kirton, John, Nick Roudev and Laura Sunderland (2007), "Making G8 Leaders Deliver: An Analysis of Compliance and Health Commitments, 1996-2006, Bulletin of the World Health Organization 85(3): 192-199.

Kirton, John, Nikolai Roudev, Laura Sunderland and Catherine Kunz (2009), "Explaining Compliance with G8 Health Commitments, 1996-2006," in Andrew F. Cooper and John J. Kirton, eds., Innovation in Global Health Governance: Critical Cases (Ashgate: Aldershot), pp. 257-84.

Kirton, John and Jenilee Guebert (2009), "Canada's G8 Health Diplomacy," Canadian Foreign Policy 15(3): 85-107.

Kirton, John and Caroline Bracht (2015), "Explaining Compliance with Regional and Global Summit Commitments: CARICOM, UN, G8 and G20 Action on Non-Communicable Disease," Paper presented at the annual convention of the International Studies Association, New Orleans, February 21.

Kirton, John, Caroline Bracht and Julia Kulik (2015), "Slowly Succeeding: G20 Social Policy Governance," in Alexandra Kaasch and Kerstin Martens, eds., Actors and Agency in Global Social Governance (Oxford: Oxford University Press), pp. 153-74.

Kirton, John and Joy Fitzgibbon (2014), Examining the Success of Summits from the Sub-regional to Global Level: Nutrition and Non-Communicable Disease," Paper prepared for a Panel on Global Health and Development: Power and Agenda Setting," for the annual convention of the International Studies Association, Toronto, March 27.

Kirton, John and James Hospedales (2016), "Opportunities for G20 Health Governance at Hangzhou and Hamburg," Lowy Monitor, August 30.

Kirton, John, Andy W. Knight, C. James Hospedales, Dinah Hippolyte and Julia Kulik (forthcoming). "Regional and Global Impacts of the Port of Spain Declaration," Revista panamericana de salud publica.

Kirton, John and Marina Larionova, eds. (2018), Accountability for Effectiveness in Global Governance (Abingdon: Routledge).

Kulik, Julia (2014) "Slow Learners Confront a Swift Disease: The Brisbane G20's Response to Ebola," November 16.

Kulik, Julia and Caroline Bracht (2016), "Enhancing Health Security and Gender Equity through Compliance with CARICOM and UN Summit Commitments on Non-communicable Diseases," Paper prepared for the annual convention of the International Studies Association, Atlanta, March 19.

Samuels, T. Alafia, John Kirton and Jenilee Guebert (2014), "Monitoring Compliance with High-Level Commitments in Health: The Case of the CARICOM Summit on Chronic Non-Communicable Diseases." World Health Bulletin 2014(92): 270-76B. doi:

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Appendix A: All G7 Summit Commitments by Issue Area, 1975-2017

1975-2017 Total
Development 669
Energy 433
Health 403
Terrorism 372
Trade 333
Climate change 315
Nonproliferation 308
Crime and corruption 288
Macroeconomic policy 259
Food and agriculture 252
Regional security 210
Environment 187
Gender 132
Financial regulation 121
Education 95
Information and communication technology 88
Labour and employment 75
Democracy 68
Human rights 65
Good governance 61
Nuclear safety 59
Peace and security 53
Accountability 51
East-West relations (Russia) 51
Drugs 43
International cooperation 42
Reform of United Nations/international financial institutions 37
Transparency 27
Conflict prevention 26
Microeconomic policy 21
Social policy 20
Migration and refugees 16
Infrastructure 8
Total 5,188

Note: Includes years when the G7 met as G6 and G8.

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Appendix B: Catalysts Causing G7 Health Compliance, 1980-2016

Catalysts (all = 65) Before Present Compliance Difference
Core international organization (World Health Organization) + 7/65 85% +8%
One-year timetable + 7/65 79% +2%
  + 8/65 72% −5%
Other international organizations (Global Fund) 12/65 82% +5%
Multi-year timetable 12/65 78% +1%

Notes: N of commitments assessed for compliance totals 65 from 1980-2016. Average compliance is +0.54 or 77%.

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Appendix C: BRICS Health Commitments, 2014-2016

2014 Fortaleza, Core Health=0, Health-Related=2

Health Related

2014-5: To better reflect the advancement of the social policies of the BRICS and the positive impacts of its economic growth, we instruct our National Institutes of Statistics and the Ministries of Health and Education to work on the development of joint methodologies for social indicators to be incorporated in the BRICS Joint Statistical Publication. (social policy)

2014-72: we reaffirm our determination to ensure sexual and reproductive health and reproductive rights for all (human rights)

2015 Ufa, Core Health=6, Health-Related=1

2015-71: In this regard we will work together in such areas as: Management of risks related to emerging infections with pandemic potential (health)

2015-72: [In this regard we will work together in such areas as:] Compliance with commitments to stop the spread of, and eradicate, communicable diseases that hamper development (HIV/AIDS, tuberculosis, malaria, "neglected" tropical diseases, poliomyelitis, measles) (health)

2015-73: [In this regard we will work together in such areas as:] Research, development, production and supply of medicines aimed at providing increased access to prevention and treatment of communicable diseases (health)

2015-74: We confirm our commitment to do what is necessary individually and collectively to support these efforts [international response to Ebola virus disease] addressing emergency and longer-term systematic issues and gaps in preparedness and response on national, regional and global level (health)

2015-75: [We confirm our commitment to] further assist affected countries in combating the disease (health)

2015-76: [We confirm our commitment] to contribute to the ongoing efforts to strengthen health sectors across the region including through the WHO and other international organizations (health)


2015-68: We reiterate our commitment to ensure sexual and reproductive health and reproductive rights for all (human rights)

2016 Goa, Core Health=, Health-Related=0

2016-39: [We welcome the High Level meeting on Anti-Microbial Resistance (AMR) during UNGA-71, which addresses the serious threat that AMR poses to public health, growth and global economic stability.] We will seek to identify possibilities for cooperation among our health and/or regulatory authorities, with a view to share best practices and discuss challenges, as well as identifying potential areas for convergence. (health)

Compiled by Julia Kulik, November 23, 2016.

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Appendix D: First-Year Compliance UNHLM 2011



(Canada + US)
2011-001 Multisectoral Tobacco +0.25 +0.11 +0.38 +0.20 0
2011-015 Physical Activity Fiscal −0.10 −0.16 −0.05 +0.60 +1
2011-017 Cost-Effective Tobacco −0.48 −0.58 −0.38 +0.60 +1
2011-029 Tobacco Fiscal +0.23 0 +0.38 +0.40 +0.50
2011-040 Alcohol Education −0.35 −0.37 −0.33 −0.40 0
2011-043 Physical Activity Education −0.33 +0.21 −0.80 −0.20 0
2011-068 FCTC +0.68 +0.95 +0.43 +0.20 0
2011-72 Salt −0.85 −0.89 −0.90 −0.60 +1
2011-75 Trans fats +0.13 0 −0.20 +1 +1
2011-115 Gender, prevention +0.25 +0.31 +0.19 0 0
2011-116 Gender, control +0.10 +0.10 +0.09 +0.60 0
2011-118 Youth obesity +0.13 +0.37 −0.10 +0.40 +1
2011-152 Primary health care +0.20 0 +0.38 −0.20 0
2011-153 Social protection +0.48 +0.21 +0.71 +0.40 0
2011-154 Maternal, newborn and child health +0.40 +0.21 +0.52 +1 +1
Average +0.05 +0.03 +0.02 +0.27


Notes: FCTC = Framework Convention on Tobacco Control. Compiled by Brittaney Warren, March 14, 2018.

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Appendix E: Summary of Results

Assessments Compliance Core international organization One-year timetable Other international organizations Multiyear timetable G7 finance ministers International law Civil society Specified agent
G7 1975 65 78%









G20 2008 6 73%









BRICS 2009 3 80%








United Nations High-Level Meeting 2011 15 53%







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