37th Commonwealth Health Ministers Meeting. [photo: The Commonwealth Secretariat]
The prevailing concern at the 37th Commonwealth Health Ministers Meeting in Geneva last weekend (17 May) wasn’t health, but wealth. Or rather, in the light of US President Trump’s actions and the switch of overseas aid to defence spending across Europe, the lack of it. WHO Director-General Dr Tedros Ghebreyesus addressed the meeting, held as usual on the eve of his own ministerial, with a speech overshadowed by the swingeing cuts he has to make to his own organisation. It was a difficult time for the new Secretary General, Shirley Botchwey, to attend her first Commonwealth Ministerial.
And yet, the health challenges across the Commonwealth are stark. While progress is being made on polio (pretty much eradicated in the Commonwealth, except for Pakistan), AIDS, malaria and TB, non-communicable diseases and mental health pose increasing challenges, and the threat of another pandemic remains, even if COVID is receding in public and political consciousness. The challenge of active ageing – addressed skilfully and persuasively by the (continuing) Secretary General’s special envoy Dame Carol Black at the Samoa CHOGM last October and again in Geneva – will only increase if the rest of the health agenda leads to more people living longer.
The response to these twin sets of challenges was not, however, inspiring. Ministerial statements in the open sessions sounded very much like pitches being made to their finance ministries. Many echoed the Secretary General’s pre-event press statement, where she said “we know the truth: every investment in health is an investment in people, in productivity, in prosperity, and in the kind of future we want to build.” While true, this is only so on a time frame unlikely to impress Treasury officials. There were glimmerings of resistance from those arguing that the current cuts in global funding should prompt more sustainable domestic health financing in developing countries, but no clear roadmap for achieving that. And the initiative being taken by South Africa and the UK to promote replenishment of the Global Fund for AIDS, malaria and TB deserves support.
The final communique was adopted swiftly at the end of the meeting in closed session, and distributed immediately in hard copy, suggesting that the changes proposed in negotiation (and posted on the ministerial website in an unexpected innovation in openness) were agreed without controversy. Some of those changes watered down the few concrete commitments in the draft communique still further although the most specific (and time limited) pledge – to identify at least one age-friendly community by October 2026 in each Commonwealth country – survived. The positive work the Commonwealth does – or at least provides a forum for – is often obscured by the vague language of ministerial communiques, and a popular Commonwealth will remain unlikely without specific Commonwealth-wide ministerial commitments such as the age-friendly community target.
The communique text concentrates on reiterating past commitments and statements, as well as investment; climate change; pandemic prevention, preparedness and response; NCDs; digital innovation; and partnerships. Its conclusions commit to working together on all of the above, as well as on workforce supply, medicines and anti-microbial resistance, cancers, NCDs and ageing.
But there was evidence of good work being done, not just on active ageing, but on the health challenges posed by climate change, the commitment to Universal Health Care and one of the areas where the Commonwealth’s common language and education system makes for a potentially contentious issue of migration or poaching of health workers.
And there was some reason for civil society organisations present to feel the Secretary-General’s fine words on partnership are being followed through, although the civil society contribution to the plenary sessions (as opposed to break out groups, depending on their chairs – once again plaudits to Dame Carol Black for integrating government and civil society contributions to the active ageing breakout) was restricted to Victoria Rutter’s excellent contribution from the Commonwealth Health Professions and Partners Alliance towards the end of the open sessions.
Overall, despite the dreadful context set by President Trump, it was a gentle first ministerial for the new Secretary General (the Trade Ministerial in Namibia next month may – again because of Trump, this time due to his tariff terrorism – be more stormy). Ministers were a bit thin on the ground and more common from the small states than the richer ones – the UK sent Parliamentary Under-Secretary of State Ashley Dalton MP and Australia and Canada – possibly post-election – sent only officials. But the specialist nature of many of the medical discussions may make that less of a worry.
The prescription needed to create a healthy Commonwealth will come at a price, and it will rise the more specific the Ministerial commitments are. Shirley Botchwey’s conclusion that “we must find new ways to finance health. That includes blended finance, social impact bonds, and public-private partnerships” will need to paint a clearer picture in her increasingly eagerly anticipated strategic plan if she is to make Commonwealth citizens feel better.
Owen Tudor is the Secretary of the Commonwealth Trade Union Group and a member of the Round Table editorial board.
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