Public Health
Volume 123, Issue 5 , Pages 349-350, May 2009

More than just diplomatic small talk?

Royal Society for Public Health, 3rd Floor Market Towers, 1 Nine Elms Lane, London, SW8 5NQ, UK

Article Outline

 

In April 2009, the latest summit of the Group of Twenty (G-20) took place. The G-20 is a somewhat strange body in that, whilst it is not a formally constituted, international body, it is mandated as:

“…an informal forum that promotes open and constructive discussion between industrial and emerging-market countries on key issues related to global economic stability. By contributing to the strengthening of the international financial architecture and providing opportunities for dialogue on national policies, international co-operation, and international financial institutions, the G-20 helps to support growth and development across the globe.”1

The membership of the G-20 is made up of the Finance Ministers and Governors of the Central Banks of the member states, though it is does ensure that:

“…the general public is informed about what was discussed and agreed immediately after the conclusion of the Ministerial Meeting.”2

As a result, it is hardly surprising that when the 11th meeting of G20 arrived in London, it was with the stated intention of considering the current, global financial crisis and how it could be managed. Indeed there can be few parts of the world which were not aware that Gordon Brown, the UK Prime Minister, had been on a global “whistle-stop” tour to lay some of the ground work for the summit; or that the new First Lady of the United States of America may have broken protocol by embracing Her Majesty, Queen Elizabeth II when they met. But wait, why have they been at the centre of the G-20 news cycle? After all Gordon Brown has not been the UK Chancellor of the Exchequer since 2007, and whilst Michelle Obama is an inspirational figure, she is hardly the Chairman of the US Federal Reserve. Surely we should have been hearing all about Ben Bernanke, and his contribution to the Ministerial Meeting chaired by Alistair Darling as the new financial consensus emerged? What about the contributions of the Indian Finance Minister, Pranab Mukherjee; or that of Henrique Meirelles, the President of the Brazilian Central Bank?

The answer is: we don't know. We know that there was a set-piece “Heads of Delegation” – for which read Heads of Government – dinner hosted at 10 Downing Street. Clearly, such an event will not have been without its own diplomatic aims. Who was sat next to whom, and for what reason, will have been very carefully thought through and agreed between delegations. What could be discussed – and what was to be avoided – will have been considered and appropriate briefings prepared. But at its heart, such a dinner is likely to have been more an opportunity for the deipnosophists – those who are expert in the art of table conversation – rather than the diplomatists. The simple fact is that all the hard work of the four pre-Summit working groups, and that of the Ministerial Meeting itself, happened behind closed doors, away from the media spotlight. Unlike the deliberations of the United Nations Security Council, if there were any final, late night arguments over the wording of the final communiqué – any last minute, diplomatic parentheses or tmesis inserted into the final wording – there is no record. All we have are the final versions of all the G-20's work: none of the thinking, none of the debate, nor anything of the concessions won or lost, none of the work to achieve consensus. Which is a shame because lost in that final wording is a single line that could have a profound effect on health and health care systems worldwide. In the English version of the final communiqué from the Heads of Government, the first bullet point within paragraph 25 states:

“We reaffirm our historic commitment to meeting the Millennium Development Goals and to achieving our respective ODA pledges, including commitments on Aid for Trade, debt relief, and the Gleneagles commitments, especially to sub-Saharan Africa.”3

It may not seem much – a kind of diplomatic aside almost – but it is a reiteration of the global commitment Millennium Development Goals (MDG), the eight key areas that included the aims of reducing child mortality, improving maternal health, and combating HIV/AIDS, malaria and other key diseases along with access to affordable medicines.4 It is also a reminder of the special emphasis given to the fight against HIV/AIDS in sub-Saharan Africa that the Group of Eight (G-8) made in 2005.5

The task facing some of the countries in Africa in meeting these goals is well reflected in this edition of Public Health with studies on obesity in Ghana,6 malaria prevention in Nigeria,7 testing for bacteriuria in pregnancy,8 and developing surveillance systems for non-communicable disease in developing countries.9 When reading these papers it is important to consider the economic sub-text to each of these areas of health need in countries that are the least able to mitigate the negative consequences of global recession.

Whether the deliberations of the G-20 Working Groups or the Ministerial Meeting got into this level of detail is not known. But if those who inserted the text into the final communiqué did not, there is a real risk that the concerted action on establishing a new world economic framework will affect the MDG process and create the distorted impression – like a frottage image by Dali or Max Ernst – that the MDG will be a natural consequence of the new economic order. After all, even before the global financial crises there was evidence that the old economic order was not able to meet the Gleneagles commitments.10

In January 2009, the WHO convened their own form of informal gathering of like-minded people to consider the impacts of the global economic crisis on health.10 Like the G-20, the participants drew on the expertise of the participants of a working group that had prepared much of the ground work in establishing what they considered to be an essential, five point framework for action:

1.Leadership – to make the case for health on the basis of sound evidence;

2.Monitoring and analysis – to measure the impact of financial instability or change on health;

3.Pro-poor, pro-health public spending – to help establish positive health for those least able to help themselves, whilst also promoting economic recovery;

4.Policy for the health sector – to promote universal, primary care based health care systems; and

5.New ways of doing business in international health – to take the opportunity to establish a new international health order.

The WHO document is only 34 pages long and essential reading for everyone in the business of public health and public health policy. There is much to commend its clear, unambiguous messages. Like the one sentence which was inserted into paragraph 59 (of 60) in the Working Group's background paper:

“Achievement of the Millennium Development Goals depends on getting the spending balance right between commodities, people and delivery systems.”10

Perhaps, this was what the G-20 really meant to say.

In this issue

 

In this May issue of Public Health we present papers on the usual wide range of public health concerns. In two papers we consider different aspects of surveillance. Firstly, a use of life tables to explore cause of death in Australia and a new approach to non-communicable disease surveillance for developing countries. In this vein we present new data on the growing, global epidemic of obesity, in this case amongst public service officials in Ghana. By a happy coincidence, we are also able to publish a new study on the approaches to resource allocation and equity in the health acre system in Ghana. The emergence of injury as a key public health threat in many countries is further considered in a paper from Iran. We also review the employability of older people with disability in Europe. In short communications we look at nitrate dipstick testing for bacteriuria in pregnancy and the effectiveness of insecticide-treated bed nets for malaria control in children. We are also taking the opportunity to reprint the invited commentary on the Tannahill model of Health promotion which had been affected by print gremlins during our change over to the new journal format.

Back to Article Outline

References 

  1. About G-20. Available from: http://www.g20.org/about_what_is_g20.aspx[accessed 21.04.09]
  2. Publications . Available from: http://www.g20.org/pub_index.aspx[accessed 21.04.09]
  3. Leaders' statement: the global plan for recovery and reform – London. Available from: http://www.g20.org/Documents/final-communique.pdf2 April 2009;[accessed 21.04.09]
  4. Health and the Millennium Development Goals . Available from: http://www.who.int/mdg/en/index.html[accessed 21.04.09]
  5. G8 Information Centre . Available from: http://www.g8.utoronto.ca/[accessed 21.04.09]
  6. Addo J, Smeeth L, Leon DA. Obesity in urban civil servants in Ghana: association with pre-adult wealth and adult socio-economic status. Public Health. 2009;123(5):365–370
  7. Adah GO, Mafiana CF, Sam-Wobo SO. Impact assessment of the use of insecticide-treated bed nets on parasitaemia and anaemia for malaria control in children, Obun State, Nigeria. Public Health. 2009;123(5):390–392
  8. Kodikara H, Seneviratne H, Kaluarachchi A, Corea E. Diagnostic accuracy of nitrite dipstick testing for the detection of bacteriuria of pregnancy. Public Health. 2009;123(5):393–394
  9. Alikhani S, Delavari A, Alaedini F, Kelishadi R, Rohbani S, Safaei A. A province-based surveillance system for the risk factors of non-communicable diseases: A prototype for integration of risk factor surveillance into primary healthcare systems of developing countries. Public Health. 2009;123(5):358–364
  10. WHO . The financial crisis and global health: report of a high level consultation. Geneva: WHO; 2009;Available from: http://www.who.int/topics/financial_crisis/financialcrisis_report_200902.pdf[accessed 21.04.09]

PII: S0033-3506(09)00098-5

doi:10.1016/j.puhe.2009.04.008

Public Health
Volume 123, Issue 5 , Pages 349-350, May 2009

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