Making G8 Leaders Deliver: An Analysis of Compliance and Health Commitments, 1996-2006/comment Les Dirigeants Du G8 Ont Honore Leurs Engagements Dans le Domaine Sanitaire De 1996 a 2006/analisis del Cumplimiento De Los Compromisos De Los Lideres del G8 En Materia De Salud (1996-2006)

Introduction How can international institutions encourage their member governments to commit to and comply with actions to improve global public health? This question is important for health policymakers, who now have a diverse array of institutional instruments to choose from when allotting scarce resources to achieve their goals. At the international level, governments still use long-established, functionally focused, ministerial-guided multilateral organizations such as the World Health Organization and other organizations of the United Nations system. (1) However, governments increasingly have access to newer, informal, summit-delivered plurilateral institutions, most notably those of the Group of Eight (G8). (2) Since 1996 the G8 has given particular attention to health issues, for example at its annual summit in St Petersburg in 2006. (3) Health policy-makers need to know which international institutions to rely upon. In addition, these organizations need to work together more effectively, as mutual reinforcers rather than rivals, in order to meet global health needs. For the purposes of this paper, health encompasses all references to public health, human health and well-being, ageing, infectious disease, health-related international organizations and initiatives, drug use, drug conventions, pharmaceuticals, medications, potable water, biotechnology and the impact of bio-terrorism on human health. To assess the contribution of the newer G8 summit-centred system, it is important to ask whether attention from the leaders of the most powerful countries actually makes a difference to the health of people around the world. This question has given rise to a broad debate. (4) Critics argue that the G8 has failed in terms of fundraising, and has been unable to raise the large amounts of money needed to combat human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and other diseases. In addition, the old UN system organizations have been unable to induce their own members to provide the necessary funds. (5,6) Other critics argue that the G8 has done too much of the wrong thing. They claim that its members remain attached to neo-liberal principles that are vital to improving health, and thus display fatal indifference to new patterns of disease. (7-10) Still different critics claim that the G8 fails to deliver on health because it is easily distracted by other issues, has a narrow audience and places a premium on short-term public relations success. (11-13) Those who are supportive of the G8, however, argue that the G8 is emerging as the global-health governor. This is not out of choice, but as a consequence of the poor performance of the old multilateral organizations and the high technical and economic capacity of G8 members. (14,15) Other supporters view the G8 as a potential leader in the health field as a whole, and claim that the G8 is already forging a new path for global health governance in an era in which globalized markets threaten to overwhelm Member States. (16) Commentators have described the G8 as the emerging centre of 21st century global health governance. (17-22) This is because of the inclusive, multi-stakeholder model on which the G8 is now based, and stems from the identified need for task-oriented collaboration between the private and public sectors as the model for future global health governance. (17-22) To advance this debate, we carried out an evidence-based assessment of G8 health governance and explored its impact on foreign policy and the domestic behaviour of G8 Member States. These include Canada, France, Germany, Italy, Japan, the Russian Federation, the United Kingdom, the United States and the European Union (EU). (2) Drawing on the concert equality model that uses six governance functions to explain institutional performance, we will first assess the G8's performance with respect to its health commitments. These six functions are: supporting the domestic management of policies and politics; deliberating on key issues; defining new directions and future commitments; taking collective decisions about specific commitments; delivering these decisions through members' compliance with their commitments; and developing global governance by creating new and directing existing international institutions. …

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