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An Opportunity Missed: Health and the G7 Charlevoix Summit

Olivia Smith, G7 Research Group
July 24, 2018

On December 14, 2017, Canada announced its priorities for the G7 summit that it would host on June 8-9, 2018, in Charlevoix, Quebec. Those priorities were economic growth that works for everyone; jobs of the future; gender equality and women's empowerment; climate change, oceans and clean energy; and peace and security. The Canadian G7 presidency was intended to be ambitious and forward looking, above all by furthering the feminist foreign policy set out by Prime Minister Justin Trudeau's government by mainstreaming gender across the G7 summit agenda as a whole.

Despite the ultimately vindicated concerns about the potential disruption by United States president Donald Trump of the summit's performance, Charlevoix was, by many metrics, a success: $3.8 billion was pledged to educate girls in humanitarian crises, a landmark plastics charter was adopted (with Japan and the United States as notable absentees), the principles of free trade were strongly affirmed, and a consensus communiqué was achieved — despite President Trump's subsequent un-endorsement of it. Gender and the environment were the primary focus for action, together constituting over half of all commitments made at the summit.

There was, however, one critical area largely absent from Canada's initial priorities and the G7 leaders' concluding communiqué: health.

Only nine of the 315 commitments made at the Charlevoix Summit were on health. Some of these were action oriented, but others were reiterations of support for ongoing initiatives, such as those concerning adolescent health and the 2019 replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The leaders of the G7 also committed to bring greater attention to mental health, to support strong and sustainable health systems, and to fight polio, tuberculosis, and antimicrobial drug resistance. However, there was no meeting of the G7 health ministers during Canada's year as G7 host. Many of the health commitments made lacked identifiable mechanisms for the achievement of their goals. No new funds were raised in support of most health commitments.

In the shadow of the $40 billion raised to support of maternal, newborn, and child health from the 2010 Muskoka Summit, and considering the robust and ambitious set of health-related commitments made at the G7's 2017 Taormina Summit and health ministers meeting, Charlevoix's performance on health was disappointing.

This was not the first time that health had taken a backseat at the G7/8. Although some summits have been notable for their health-related commitments and advances, others have focused on other subjects. Health, which is an area of such great importance for morality and security, ought to be consistently afforded an important place at the G7, other current challenges often dictate the content of communiqués.

The lost opportunity of the Charlevoix Summit, therefore, was not necessarily the lack of focus on health. Rather, Charlevoix's neglect of health was regrettable precisely because health is an integral and foundational component of many of the priorities actually pursued at the summit. Most of the priorities of Canada's G7 presidency — notably gender equality and women's empowerment, and inclusive economic growth — are inextricably connected with health. Any pursuit of them will fall short in the absence of a health-inclusive perspective.

Charlevoix, with its unambiguous emphasis on gender, was a superb but lost opportunity to highlight and take action on the gender-health connection. To Canada's credit, the Whistler Declaration on Unlocking the Power of Adolescent Girls for Sustainable Development, released by the G7 development ministers on June 2, 2018, featured a commitment to address gender-based violence and promote adolescent health. As well, the Whistler ministerial meetings made 18 commitments on gender-based violence — a significant achievement. However, the G7's acknowledgement of the connection between gender and health was not as deep and broad as the problem it addressed.

Consider the connection between health and the status of women: gender is a major determinant of health, significantly impacting the intersecting economic, social, political, domestic and cultural conditions that render a given individual more or less likely to experience ill health. Inequities in health throughout societies — such as the empirically verified inequities that arise as a consequence of race, socioeconomic position, sexuality and access to education — are largely the result of social processes and constructs, encompassing political, economic and cultural realities. Understood as distinct from biological sex, gender is among the most deeply rooted and potent of these social constructs. Gender thus ought to be a central analytical category in the study of health, and health ought to be afforded a similarly privileged position in the analysis of gender and gender inequality. Gender is, of course, far from monolithic, and there are undeniable and important variations in women's quality of life and access to liberty attributable to other forces of structural inequality; however, the impacts of these structural inequities are magnified when they are experienced by women.

Gender has an undeniable effect on women's care-seeking behaviour, on their ability to access care and on the quality of care they receive. Women are frequently unable to access adequate health care due to domestic obligations, familial pressures, cultural attitudes and stigmas, internalized gender norms, and insufficient access to economic resources and education. The World Health Organization indicates that more than half of the people on this planet lack access to basic, essential health services, and a disproportionate amount of those people are women and girls. Across a woman's life cycle, she is uniquely vulnerable to gender- and sex-specific health risks such as sexual and gender-based violence; limited or no access to contraceptives and safe, legal abortion; and potential complications from pregnancy. Women are thus, on the whole, more susceptible to the negative biological and social effects of ill health, and are more likely to experience potentially life-threatening health crises and illnesses in the first place.

Health inequity is a gendered issue; gender equity cannot be achieved if action is not taken on gender-based inequities in health.

The connection between gender and economic prosperity was acknowledged at Charlevoix, but the link between health and the economy was not. Nor was the more complex tripartite linkage between gender, the economy and health. Performance in health care and economic prosperity are strongly correlated; poor public health and weak health systems are a significant drag on equitable, long-term sustainable development. A growing body of evidence, verified by institutions such as the World Bank and the International Monetary Fund, supports the conclusion that better public and individual health contributes positively to the rate of annual growth in gross domestic product per capita, and that gains in health care are absolutely critical in meeting and exceeding goals in economic development. This is because a healthier population is a more productive population, a more educated population and a population less vulnerable to political and social upheaval.

Public health is, in many respects, a substratum of society, and personal health is a substratum of individual life. In the G7's efforts to pursue economic growth that works for everyone and to combat gender inequality, ensuring that all people have access to affordable, comprehensive, high-quality health-care — ideally, publicly provided and universal — should be a priority. With Charlevoix's strong focus on gender equality and inclusive economic growth, health should have been far more squarely on the agenda. Charlevoix was a success in many respects. But the lack of focus on the link between health and the priorities pursued at the summit may very well limit the extent of Charlevoix's substantive, real-world impact. The consequences for many, in both the short and the long term, will be severe.

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Olivia Smith
Olivia Smith is a third-year student at Trinity College in the University of Toronto pursuing studies in international relations, philosophy, and peace, conflict and justice studies. She is a researcher with the G20 and G7 Research Groups, as well as a research assistant to Professor John Kirton. An alumna of the Trinity One program in international relations, she is interested in human security and global governance, specifically in environmental and resource-based conflict, global environmental and health governance, and ethics in the context of the international system. Follow her at @_oliviaesmith.

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