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Analysis

G20, G7 and BRICS Health Governance Leaves Mental Health in the Dark

Natasha Pirzada, G20 Research Group
September 10, 2023

India has three priority areas on health as part of its G20 presidency being held on September 9–10, 2023. These are health emergency prevention, preparedness, and response, with a focus on antimicrobial resistance and the One Health framework; strengthening vaccine cooperation; and digital health innovations. One key area that has been largely left in the dark, both under India's priorities and throughout the G20's history, is mental health. The G7 and BRICS have also paid little attention to mental health.

The Overall Mental Health Trend

Mental health in the G20, G7 and BRICS forums is fleetingly mentioned. Of the three institutions, "mental health" first appeared at the 2013 BRICS health ministerial meeting and was elevated to the leaders' level in 2015. The G7 followed, putting mental health on its leaders' agenda at its 2016 Ise-Shima Summit. The G20 was last, putting mental health on its leaders' agenda at its 2019 Osaka Summit. Thus, mental health at the G7 and G20 were both a Japanese initiative.

The Research Groups have monitored the compliance of the G20, G7 and BRICS with their commitments on health and on mental health. Starting in the year when mental health first appeared as a summit issue – 2013 at the BRICS – the total number of health commitments across all three institutions is 61 compared to five on mental health. Apart from the BRICS, which has no health commitments assessed, both the G7 and G20 have performed worse on their mental health commitments since 2013 than on all health commitments. Of the two institutions, the G7 performs better: its overall health compliance averages 76% and its mental health compliance averages 65%. The G20's overall health compliance averages 64% and mental health averages 58%.

2013–2015: BRICS Summit Paves the Way on Mental Health at the Ministerial Level

On January 11, 2013, the importance of mental health was emphasized in the BRICS health ministers' communiqué in Delhi, before both the G7 and G20 recognized it. BRICS health ministers recognized "the need to combat mental disorders through a multi-pronged approach including the World Health Assembly Resolution 65.4, consideration of a Comprehensive Mental Health Action Plan through sharing of innovations in the field of mental health promotion, diagnosis and management, exchange of best practices and experiences amongst BRICS countries."

On October 30, 2015, the BRICS health ministers in Moscow outlined "that mental health is an extremely important public health issue and that mental well-being is fundamental to a good quality of life and the productivity of individuals, families and communities. The Ministers resolved to collaborate in promoting mental health and well-being in order to bring better health and socio-economic benefits."

BRICS leaders followed, and in their 2015 Ufa Declaration reaffirmed "the right of every person, without any distinction, to the highest attainable standard of physical and mental health and to the quality of life that is necessary to maintain his or her own health and well-being and the health and well-being of his or her family."

2016–2018: G7 Leaders Follow BRICS on Mental Health

On May 24, 2016, on the sidelines of the 69th World Health Assembly in Geneva BRICS leaders emphasized that "prevention and control of NCDs including Cancer, Cardio-vascular diseases, Diabetes, Chronic Obstructive Airway and Pulmonary diseases, as well as mental health are essential to reduce premature mortality, enhance productivity and improve quality of life. Agreed to strengthen collaboration to address the prevention and control of NCDs and their risk factors and in this context looked forward to the BRICS high-level panel discussion on health promotion to be organized at the 9th Global Conference on Health Promotion in 2016 in Shanghai."

Soon after the BRICS, at the G7 Ise-Shima Summit on May 26–27, 2016, the G7 leaders emphasized the need for health systems to develop universal health coverage, which included addressing noncommunicable diseases. On mental health, they committed to "promoting women's, children's, and adolescents' mental and physical health, ensuring sexual and reproductive health and rights without discrimination of any kind."

On December 16, 2016, the BRICS health ministers in Delhi "agreed to cooperate for combating mental disorders, including autism and neuro-development disorders, through a multi-pronged approach encompassing a mental health policy, a life cycle approach to address the needs of such individuals throughout life, sharing of innovations in the field of mental health promotion, diagnosis and management and exchange of best practices and experiences."

At the 2017 Taormina Summit, G7 leaders committed to strengthening health systems and pursuing policies that helped address physical and mental health. At the 2018 Charlevoix Summit, G7 leaders reaffirmed their commitment to "bringing greater attention to mental health" by promoting access to quality and affordable healthcare.

Compliance

The G7 Research Group measured three mental health commitments made at the 2016 and 2017 summits. The G7's compliance averaged 25% from the 2017 summit and 75% in from the 2018 summit. In 2017 this mental health compliance was the same as overall health compliance, but much higher than overall health compliance in 2018 at only 53%.

For the G20, mental health was first advanced at the health ministers' meeting under Argentina's 2018 G20 presidency.

2019–2022: The G20 Takes the Mental Health Reins and Adds Brain Health

Mental health was elevated to the leaders' level at the 2021 G20 Rome Summit, where leaders committed to promote mental health and reinforce their health ministers' major commitments from 2019 on dementia.

In 2020 under Saudi Arabia's presidency, G20 health ministers recognized that the Covid-19 pandemic helped cast even more light on mental health. Both the G20 leaders at the Riyadh Summit and the World Health Organization (WHO) advocated greater preparedness and response to post-pandemic mental health crisis.

Italy's 2021 G20 presidency created the G20 Joint Finance-Health Task Force created at its G20 Health- Finance Ministers Meeting in Rome. It sought to enhance the financial collaboration and global cooperation on issues relating to pandemic prevention preparedness and response. But mental health was overlooked.

Furthermore, on the eve of the G20 health ministers' meeting in Rome on September 5–6, 2021, there was a side event advocating the importance of combatting mental health challenges. The Think 20's Task Force 1 on Global Health and Covid-19 emphasized the importance of tackling the root causes of social factors that have aggravated the impact of the pandemic. This call to the importance of mental health was strengthened when the WHO also reiterated that the world was failing to address the dementia challenge.

In this period, the G7 also kept mental health on its agenda. The 2019 Biarritz Summit acknowledged the physical and mental health needs of survivors of sexual violence through the adoption of the Declaration on Gender Equality and Women's Empowerment. And the 2021 Cornwall Summit, G7 leaders committed to "support a robust global recovery from COVID-19, ensuring that countries are able to effectively address the indirect impacts on physical and mental health and broader socio-economic consequences of the [Covid-19] pandemic." They also emphasized coordination between the financial and health sectors in order to effectively mobilize resources to combat the pandemic in the 2021 Carbis Bay Declaration, but did not adequately address the global mental health crisis.

At the BRICS New Delhi Summit in 2021, the COVAX facility and strengthening its financial sector was addressed, but mental health was abandoned.

Compliance

The G20's compliance with its mental health commitments from 2019 averaged 56% and from 2021 it averaged 60%. This was lower than the overall average for health in these years which was 67% in 2019 and 75% in 2021.

The G7 compliance on mental health was measured in three years. For commitments made in 2017 it averaged 25%, for 2018 it averaged 75% and for 2021 it averaged 91%. For overall health, for commitments made in 2017 compliance also averaged 25%, for 2018 it was lower at 53% and for 2021 it was slightly lower at 91%.

2022: G20, G7 and BRICS Leave Mental Health in the Dark

During Indonesia's G20 presidency in 2022 mental health was addressed by neither the health ministers nor the leaders. However, at the health ministers' meeting Indonesia highlighted six key actions on health to be discussed at the summit, including the Joint Finance and Health Task Force.

On June 28, 2022, at the Elmau Summit, G7 leaders committed to "continuing to address noncommunicable diseases including mental health, recognising the need for accessible and effective mental health services."

At the 2022 BRICS summit in Beijing there was an entire section on combatting Covid-19, but no mention of mental health.

Lead-up to the 2023 G20 New Delhi Summit

Mental health was not a subject at the 2023 G20 New Delhi health ministers' meetings even though India is a pioneering advocate of yoga and traditional medicine. As a result, although we did not expect to feature much at the summit, there was one mention in the G20 New Delhi Leaders' Declaration: to "remain committed to strengthening the global health architecture, with the World Health Organization (WHO) at its core, and building more resilient, equitable, sustainable, and inclusive health systems to achieve Universal Health Coverage, implement One Health approach, enhance pandemic preparedness and strengthen existing infectious diseases surveillance systems" the leaders pledged to "promote and improve access to mental health services and psychosocial support in an inclusive manner."

At the G7 Hiroshima Summit on May 19–21, 2023, G7 leaders included a reference to mental health under the umbrella of noncommunicable diseases in their Leaders' Declaration. They said, "We reaffirm the essential role of [universal health coverage] in addressing various health challenges significantly set back by the pandemic, including in humanitarian contexts, such as tackling communicable diseases including HIV/AIDS, tuberculosis, hepatitis, malaria, polio, measles, cholera, and neglected tropical diseases (NTDs), antimicrobial resistance (AMR), non-communicable diseases (NCDs) including mental health conditions, realizing comprehensive sexual and reproductive health and rights (SRHR) for all, and promoting routine immunization, healthy ageing, and water, sanitation and hygiene (WASH)."

The 2023 BRICS Summit in Johannesburg did not mention mental health.

Conclusion

Mental health has been, at best, an on/off agenda item for the G20, G7 and BRICS. The health ministerial meeting leading up to the 2023 G20 Summit in New Delhi did not emphasize mental health but did support the World Health Organization, including by endorsing its Gujarat Declaration on Traditional Medicine. The G20 however, continues to follow the G7 with its fleeting attention to mental health at its own 2023 Hiroshima Summit.

Appendix A: G7/8 Health Governance

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Appendix B: G20 Health Governance

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Appendix C: BRICS Health Governance

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