This year people in bars and at football matches were asking about the Group of 8 (G8) nations summit in Gleneagles, Scotland. Such unprecedented popular interest was prompted by Bob Geldof's Live 8 concerts and the Make Poverty History campaign. These initiatives were organised to raise awareness about African poverty and to pressure politicians into tackling the preventable global burden of disease afflicting billions of people living in low-income settings. When asked if his lobbying had paid off, Geldof said, “A great justice has been done”. He should have said “No”. While the concerts were successful as entertainment and the Make Poverty History campaign certainly raised awareness, they failed as political levers for change.
What did the G8 achieve? One objective of the summit was to design policies to help Africa meet the UN Millennium Development Goals (MDGs) by 2015. The first MDG calls for the eradication of extreme poverty and hunger. The G8 achieved almost nothing new here, despite the impressive rhetoric of the final Gleneagles communiqué. The G8 pledged to forgive debt for many of Africa's poorest countries and to increase total aid to developing nations by US$50 billion by 2010. But that investment is too little too late. Debt forgiveness, for example, translates into only an additional $1·5 billion per year of additional resources for development. In a carefully worked out blueprint for meeting the MDGs, the Millennium Project, led by the economist Jeffrey Sachs, concluded that in 2006 a further $70 billion was required beyond existing commitments. Writing in The Lancet
earlier this year, Sachs argued
that if the tide of decline in Africa was to be reversed, 2005 had to be a breakthrough year: “in 2005 the world must start building capacity, improving policies, and delivering the investments needed to meet the goals”, he wrote. G8 leaders have so far fallen well short of what is needed in terms of investment. Were their pledges in specific areas more positive?
In addressing the sixth MDG, the fight against HIV/AIDS, malaria, and tuberculosis, G8 leaders ignored completely the advice of the world's development community. They offered no specific time-bound policy commitments on African health systems, malaria, tuberculosis, or universal access to antiretrovirals. The harsh critic might go as far as to say that their response was utterly complacent. On tuberculosis, for example, the best the G8 could offer was support for a high-level conference of health ministers in 2006. One wonders how much more talking has to take place before the scale of the political and financial commitment that is required is understood? Reducing child mortality (MDG4) and improving maternal health (MDG5) did not even merit discussion in the lengthy final statement on Africa by G8 leaders.
The G8 summit was supposed to be a time for the leaders of the world's most powerful industrial nations to do good. Inevitably, their attention turned to terrorism when London suffered its first post-9/11 bombing attacks on the opening day of the meeting. Those attacks, together with the deaths and terrible injuries that they caused, rightly created a sense of solidarity among G8 leaders and their African guests at Gleneagles. But the lack of dissent by those representing nations at greatest threat from poverty, while diplomatically understandable, was tactically in error. Leaders from countries such as South Africa, Nigeria, and Tanzania missed an important opportunity to publicly hold donor countries accountable for their failure to deliver on their frequently repeated promises.
The next opportunity for the leaders of the world's wealthiest nations to help those living in extreme poverty is the Millennium Summit in September. When heads-of-state of 192 countries meet in New York, they must radically change their approach. Diplomacy must give way to peaceful direct action. The G8 failed to heed the massive public call to put in place policies to make poverty history. That failure must not distract the now enormous international movement for social justice from continuing its campaign. Health is at the very heart of that effort.
Doctors have a vital part to play in producing the evidence and leading the advocacy to defeat extreme poverty and to tackle preventable disease. While the products of Gleneagles are a bitter disappointment, they provide the spur for further passionate engagement by the biomedical community with political leaders. Medicine has a critical role in translating that passion into practice.