Global Health Diplomacy to Promote Universal Health Coverage at the 2019 Osaka G20 Summit

09-27-2019: Yasushi Katsuma

No.275

As an outcome of the 2019 G20 Osaka Summit in June, the consensus on universal health coverage (UHC) among the leaders of powerful economies is significant, as it will encourage other UN member states to treat UHC as an umbrella concept in achieving Sustainable Development Goal 3 at the UN High-Level Meeting on UHC in September 2019.
G20 finance and health ministers organized a joint session for the first time, agreeing that investing in health at an early stage of development is important for sustainable and inclusive growth, which will be instrumental for developing countries to justify mobilization of their domestic resources for UHC.
The 2019 G20 Osaka Summit has served as one of the milestone events for Japan's global health diplomacy to promote human security, in which Japan took a whole-of-society approach in order to strengthen partnerships and engage in policy dialogues with G20 Engagement Groups.

The heads of state and government of the Group of 20 (G20) met in Osaka on 28-29 June in 2019, and adopted the G20 Osaka Leaders' Declarationⁱ, in which global health is one of the major issues addressed. Paragraph 30 of the Declaration, the first paragraph in the section "Global Health," summarizes the consensus reached among G20 leaders on universal health coverage (UHC). As an outcome of the 2019 G20 Osaka Summit, the consensus on UHC is significant for the following five reasons.

First, G20 heads of state and government recall the commitment to the 2030 Agenda for Sustainable Development and the Sustainable Development Goals (SDGs) made by all member states of the United Nations (UN) in 2015, and have identified the urgent need to formulate a global health action plan so that Goal 3 (to ensure healthy lives and promote well-being for all at all ages) and Target 3.8 (UHC) can be achieved by all stakeholders in a harmonized manner.

Second, they have raised expectations for the UN High-Level Meeting (UN HLM) on UHC to be held in New York on 23 September 2019, by adopting a broader definition of UHC. In other words, UHC is treated not as just one of the health issues, but rather as an umbrella concept under which all health issues related to Goal 3, including infectious diseases control and more robust healthcare systems, can be tackled in a coordinated way.

Third, before the heads of state and government met, G20 finance and health ministers were convened to organize a joint session for the first time on 6 June 2019, and endorsed the G20 Shared Understanding on the Importance of UHC Financing in Developing Countriesⁱⁱ. The finance ministers of powerful economies have agreed that investing in health at an early stage of development is important for sustainable and inclusive growth, with evidence provided by the World Bank, and encouraged developing countries to mobilize their domestic resources for UHC.

Fourth, Japan took a whole-of-society approach in order to strengthen partnerships and engage in policy dialogues with G20 Engagement Groups. Although the G20 Summit is an inter-governmental process, many non-governmental actors, particularly G20 Engagement Groups, were given opportunities to provide the Japanese government with policy recommendations. For example, the Civil 20 (C20) published C20 Policy Pack 2019ⁱⁱⁱ, containing a policy paper on global health prepared jointly by a number of civil society organizations, in April 2019. The C20 Global Health Working Group organized a roundtable in Tokyo on 19 April, inviting Japanese government officials from the Ministry of Health, Labor and Welfare, the Ministry of Foreign Affairs, and the Ministry of Finance, as well as some members of the Think 20 (T20) Health Working Group. A C20 policy paper on global health was presented, and views on UHC, healthy and active ageing, and health security were exchanged among the participants.

T20 is a research and policy advice network for the G20, and consists of a number of Task Forces. Its Task Force 1 focused on the 2030 Agenda for Sustainable Development, and published 11 policy briefs. The T20 Working Group on UHC produced one of the policy briefs entitled Deliberate Next Steps toward a New Globalism for Universal Health Coverage (UHC)^iv in March 2019. The policy brief consists of four proposals: 1) leaving no one behind; 2) prioritizing reliable domestic financing and cost-effective best buys; 3) harnessing innovation and access to technology judiciously; and 4) supporting common monitoring mechanisms, mutual learning platforms, and coordinated international cooperation for UHC. A workshop was organized in Tokyo on 19 February 2019, and Japanese government officials invited, in order to present the policy brief and exchange ideas on the recommendations.

In addition to the above official G20 Engagement Groups, two interesting private initiatives were taken to advocate for UHC. One is the Health Professional Meeting (H20) organized by the World Medical Association (WMA) and the Japan Medical Association (JMA) in Tokyo on 13-14 June 2019, in which the Memorandum of Tokyo on UHC and the Medical Profession^v was adopted. The other is the Biopharmaceutical CEOs Roundtable (BCR) organized by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) in Tokyo on 3-4 June 2019. The IFPMA prepared a joint statement^vi signed by pharmaceutical manufacturers in Japan, the US and Europe, and presented it to Prime Minister Shinzo Abe in anticipation of Japan's leadership in accelerating progress towards UHC, in resolving unmet medical needs, and in transforming to a new healthcare system utilizing various medical data.

Fifth and last, the 2019 G20 Osaka Summit has served as one of the milestone events for Japan's global health diplomacy to promote human security. The Government of Japan adopted Japan's Strategy on Global Health Diplomacy^vii in June 2013. Based on a firm belief that health is indispensable in achieving human security, the Strategy presents a vision of prioritizing global health in Japan's diplomacy and mainstreaming UHC in the global agenda, while extending international cooperation to developing countries, particularly in Africa and Asia.

After UHC was included in the SDGs as Target 3.8 in 2015, Japan hosted the first UHC Forum with the World Bank, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) among others in Tokyo on 13-14 December 2017 in order to further mainstream UHC in the global agenda. The co-organizers adopted the Tokyo Declaration on UHCviii, calling for greater commitment to strengthen global momentum towards UHC, to accelerate country-led processes towards UHC, and to nurture innovation for UHC.

Japan also organized the Tokyo International Conference on African Development (TICAD) in Yokohama in 2013 and 2019, in which UHC was discussed with the heads of state and government of African countries. At TICAD 7 held on 28-30 August 2019, the Yokohama Declaration 2019^ix was adopted, in which the commitment to promote UHC agreed at the 2013 TICAD 6 was reiterated.

For the above five reasons, the consensus on UHC at the 2019 Osaka G20 Summit is significant. The consensus reached among powerful economies of the G20, as well as the strengthened partnerships with international organizations and non-governmental actors, are expected to further accelerate global momentum towards UHC in the forthcoming milestone events, including the UN HLM on UHC in New York in September, the G20 Health Ministers' Meeting in Okayama in October 2019, the 2^nd UHC Forum in Bangkok in January and February 2020, and the Nutrition for Growth Summit coinciding with the 2020 Tokyo Olympic and Paralympic Games.

Yasushi Katsuma is a Professor in the Graduate School of Asia-Pacific Studies (GSAPS) at Waseda University, and Director of Global Health Affairs and Governance at the Institute for Global Health Policy Research (iGHP) in the National Center for Global Health and Medicine (NCGM).

The views expressed in this piece are the author's own and should not be attributed to The Association of Japanese Institutes of Strategic Studies.

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