Successful health promotion for the future requires strong, smart, sustained support from all levels: individual citizens, their communities, corporations, local and national governments, and the most consequential centres of global governance. All produce successful solutions to inspire and lead the others. Yet all still have much to do, to cope with the escalating, expanding, intersecting threats to physical and mental health and well-being from infectious and chronic diseases, climate change and environmental degradation, conflict, and digital technologies, especially those that harm vulnerable people and children the most.
Nowhere are the needs and opportunities greater than at the highest level of global governance, centred in the institutions of the multilateral United Nations galaxy and its World Health Organization, and the leaders-led G7 from the Global North, BRICS+ from the Global South and the G20 embracing both.
The WHO, created in 1948, historically and legally stands at the centre of global health governance. Its constitutionhighlights health promotion as a foundational principle and organisational function, stating that health is “a state of complete physical, mental and social well-being”, and “the achievement of any State in the promotion and protection of health is of value to all”. The WHO co-sponsored and organised the first International Conference on Health Promotionin Ottawa in 1986 and directed the crafting of the landmark Ottawa Charter. The WHO’s other achievements in health promotion include pioneering the Framework Convention on Tobacco Control in 2003.
Global governance under pressure
Today, as health challenges grow, the United States has announced its intention to leave the WHO. The US and other traditional supporters are severely reducing funding for health there and in the Global South. The WHO’s response has been reforming to focus on its core mission of promoting health, setting norms and standards, and responding to emergencies by convening all key actors in global health to align their strategies, instruments and finances on shared goals.
The UN system is key to achieving this reform. Yet its recent high-level meetings on health – on non-communicable diseases and mental health in September 2025, on HIV/AIDS in June 2026 and on pandemic preparedness in September 2026 – attracted few country leaders. The Sustainable Development Goal on health, overseen by the United Nations Development Programme, is far from being met by 2030. The International Telecommunication Union is only starting to see how artificial intelligence can be governed to help rather than harm peoples’ health. And the World Bank is now reducing its recently expanded focus on health as a driver of development.
The G7 major democratic powers’ summits, started in 1975, are trying to fill the gap. From 1996 to 2025 G7 leaders made 612 commitments on health. Their governments implemented them during the following year at a level of 76%. At the most recent summit in Evian in June, G7 leaders added 55 health commitments: 13 on cancer, 11 on the recent Ebola outbreak in the Democratic Republic of Congo, 10 on digital safety for minors and 21 on drug smuggling. But there was little discussion of health promotion, despite the growing need to proactively promote brain health in an ageing world.
SUMMIT RESPONSES
The bigger, broader G20, comprising systemically significant states evenly balanced between the Global North and South, started its summits in 2008 and health governance in 2014, responding to the Congo’s Ebola outbreak that year. G20 leaders added a special summit in March 2020 in response to the Covid-19 pandemic erupting then. G20 leaders’ 117 health commitments by 2024 were implemented at a level of 70%. Yet the most recent summit in Johannesburg in 2025 added only nine health commitments, with six on pandemic prevention, preparedness, response and funding. Only one focused on health promotion – on providing integrated people-centred health services including mental health. And health is not even on the agenda of the forthcoming G20 Miami Summit on 14–15 December 2026.
The BRICS, created as a summit in 2009 by Brazil, Russia, India, China and soon South Africa, as the biggest regional powers of the Global South, started making health commitments in 2011 and made 54 by 2025. However, they peaked in Beijing in 2022 at 14 and plunged to five or fewer since, as the BRICS expanded to its current 11 members and 10 partners. At the BRICS+ summit in Rio de Janeiro on 6 July 2025, its four health commitments dealt with health generally or with pandemics, rather than health promotion. This followed its earlier focus on HIV/AIDS, tuberculosis, malaria, Ebola, antimicrobial resistance, Covid-19 and vaccines. BRICS implementation of leaders’ priority health commitments is 92%.
At the 2026 BRICS+ summit in New Delhi on 11–12 September, leaders made 224 commitments, with 19 on health, including on healthy lifestyles, universal health coverage and digital health. But none were on health promotion or its major components and none linked health to climate change and its intensified extreme weather events.
Thus, the badly needed strengthening of health promotion in global governance depends heavily on the inspiration, lessons and pressure from the pioneers at all levels.
What lies ahead
This eighth annual issue in the Health: A Political Choice series presents successful solutions for global governance institutions and those at all levels to build upon in charting new pathways for future health promotion throughout the Global North and South.
Led by leaders’ introductions, with spotlights throughout, this year’s edition explores the concepts of well-being as a political framework and the economics of health for all. Contributors discuss the importance of healthy environments through climate, urban planning, housing, labour and social security, followed by a section on the digital determinants of health. A special section with four articles curated by Health Promotion International’s Samantha Thomas uses the lens of the Ottawa Charter to examine progress made since 1986. The final two sections focus on how health promotion can move systems through policy changes and through good governance and accountability.
