Intended for healthcare professionals

Opinion

Unmatched opportunity: Brazil must use its G20 presidency to focus on transformative global pacts

BMJ 2024; 386 doi: https://doi.org/10.1136/bmj.q1571 (Published 23 July 2024) Cite this as: BMJ 2024;386:q1571

Read the series: Latin America’s global leadership in health

  1. Paulo M Buss, director12 3,
  2. João Miguel Estephanio, adviser for international affairs4,
  3. Vitoria Kavanami, assistant researcher4,
  4. Pedro Burger, senior researcher4
  1. 1WHO-PAHO Collaborative Center for Global Health Diplomacy and South-South Cooperation, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
  2. 2National Academy of Medicine, Brazil
  3. 3Latin-American Alliance for Global Health
  4. 4Fiocruz Center for Global Health and Health Diplomacy, Rio de Janeiro, Brazil
  1. Correspondence to: P M Buss paulo.buss{at}fiocruz.br

Paolo Buss and colleagues lay out three health priorities for Brazil to advance on the G20's stated agenda to build a just world and a sustainable planet

The G20 presidency increases Brazil’s ability to promote transformative global pacts that are urgent and necessary to tackle the “polycrisis” (political, social, economic, environmental, and health) affecting the world’s population.1 The G20 member countries have a moral and ethical obligation to implement these pacts as they proclaim themselves to be the richest and most advanced in the world. Brazil has taken on this responsibility during its G20 presidency by setting priorities that direct the G20 towards establishing these global pacts.

A brief examination of recent statements by the United Nations12 and the main plurilateral blocs (eg, G7, G77, BRICS)3456789 reveals a common aim: we need a global pact to implement the UN sustainable development goals (SDGs) in their entirety, leaving no one behind.10 The SDGs are all recognised as determinants of health (political, social, economic, and environmental) and must be fully achieved to ensure global equity with long lived, healthy, and productive populations.

Three priorities

The priorities formulated by the Brazilian G20 presidency can tackle almost all the main SDGs while encouraging global leaders to adopt more inclusive and equitable multilateralism. Under the motto, “Building a just world and a sustainable planet,” the priorities proposed by Brazil in the G20 are social inclusion and the fight against hunger and poverty; energy transitions and the promotion of sustainable development; and reform of global governance institutions.11 Member countries welcomed these priorities in extensive G20 meetings,12 and they have been discussing mechanisms to implement them across over 100 thematic meetings.

The first priority is an initiative to tackle two powerful dimensions of the social determinants of health,13 embodied in the proposal to create the G20 Global Alliance Against Hunger and Poverty,14 which is itself a great transformative pact. It promotes countries’ engagement and action through effective public policies to reduce hunger and poverty, cutting the roots of inequities and promoting sustainable development, including health.

The second priority includes pacts related to green transition, tackling the climate crisis, reducing deforestation, biodiversity loss, and pollution, as well as implementing sustainability in cities and reducing natural disasters. These pacts are also transformative, considering not only human health but planetary health, since extreme climate change is causing environmental disasters, food insecurity, and enabling vectors of infectious disease to spread.

The third priority aims to reinvigorate and transform multilateralism, a precondition for achieving peace, stability, wellbeing, and social development. Current global governance has failed to confront important challenges, as the wars in Ukraine, Gaza, and other military conflicts have shown. Greater representation from the global south is an important step towards multilateral reform. A virtuous and supportive alliance between the G20 and the UN, as well as the global south (represented by the G77 and the Non-Aligned Movement) would enable a robust global response to political, social, economic, and environmental challenges.

Brazil is also pursuing two ambitious transformative initiatives in the G20 health agenda.15 The first is an alliance for local and regional production, innovation, and access, which would focus on neglected populations and diseases and tackle health inequities, mainly in low and middle income countries. The second is a debt for health mechanism, which aims to encourage creditors to participate in debt relief in exchange for investments in health infrastructure through debt swaps among main international creditors and debtor countries.16

Nevertheless, Brazil should also consider in its ambitious initiatives the launch of a health as a bridge for peace strategy, which we defend in the policy brief that will be published by T20 Brazil soon.17 In addition to calls from WHO and other UN humanitarian aid bodies and global civil society, this strategy aims to protect health services and professionals, as well as the civilian population, in areas of conflict. It would allow injured people to be treated or removed from conflict zones, the maintenance of essential health services, and the continued supply of drinking water, food, medicine, and basic hygiene products.

Brazil has the unique position to promote these transformative pacts because it is part of a large number of plurilateral organisations, including the G20, G77, and BRICS+, and it has a proactive role in the UN system. The country will face various barriers to implementing these pacts that can be overcome through its strong and harmonious diplomatic relations with the self-proclaimed superpowers, such as the US, China, Russia, and the EU, and with the leading countries in the global south, including China, India, and South Africa.

Brazil should use its political credentials and take this opportunity to bring the G77 and other representative groups from the global south to the table in November 2024 during the G20 leaders’ summit in Rio de Janeiro. Together these nations could adopt a strong joint declaration, containing these transformative pacts, whose common goal is the implementation of the SDGs to progress towards global equity within and between countries.

This would be just the first step, since the upcoming global political schedule might allow this transformation to endure. After handing over the G20 presidency to South Africa in 2025, Brazil will assume the BRICS+ presidency and will host the decisive UN Climate Change Conference (COP 30), where it will be possible to consolidate the commitments achieved in the G20.

Footnotes

  • Competing interests: None declared.

  • Provenance and peer review: Commissioned; externally peer reviewed.

  • This article is part of The BMJ’s spotlight on Latin America’s global leadership in health (bmj.com/health-in-latin-america).

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