There was a time when international declarations changed the world. Maybe some still do but increasingly leaders communicate in 140 characters, not 20-page communiqués. Even international agreements and treaties may not be worth the paper they’re written on, much less the thousands of days of staff time that go into them, according to an elegant new study.
Those of us working in health and development are often guilty of perpetuating a myth: that it matters what world leaders promise they’ll do. Usually, it doesn’t. Remember the Gleneagles Agreement signed almost exactly 10 years ago? The development élite would rather you didn’t. Oxfam said at the time, “The G8 leaders confirmed plans for aid spending which will mean – according to OECD estimates – that aid to developing countries will increase by $48bn a year by 2010, compared to 2004 levels. Oxfam calculates that this means that commitments made by the G8 over the past year will have added an extra $16bn to the global aid budget by 2010 above and beyond current trends.” Er, yes. No G8 country except the UK has come close to meetings its Gleneagles commitments. Several — Canada and France, for example — have actually cut the percentage of GDP that they spend on overseas development assistance substantially. Italy has cut it in every year but one since the 2005 meeting.
The official site of the 2014 Russian G8 meeting in Sochi (that went well) offers this great photo of the Gleneagles event. In 2007, a Russian sherpa was — allegedly — getting very frustrated during private preparations for the Berlin G8 meeting that year. The hosts kept referring back to the commitments that had been made two years earlier. In exasperation the Russian said to his German colleague, “London had just been bombed by terrorists. Everybody felt sorry for Blair. Obviously, none of us meant it.” There was broad consensus, except from the outraged British, and the sherpas moved on
International declarations on health are shamelessly ignored. As the WHO reported, “in April 2001, African Union countries meeting in Abuja, Nigeria, pledged to increase government funding for health to at least 15%, and urged donor countries to scale up support. Only one African country has reached that target. Overall [ten years later], 26 have increased the proportion of government expenditures allocated to health and 11 have reduced it since 2001. In the other 9, there is no obvious trend up or down.” Donors scaled up support massively but local funding never materialised. Then there was the 2003 Maputo Plan of Action on Sexual and Reproductive Health which guaranteed, “an integral access to sexual and reproductive rights health before 2015” across Africa. As far as I know, no-one has even bothered to measure what has happened to that one.
Health treaties (argued over and actually signed as binding commitments) are almost as bad. A paper in the American Journal of Public Health in January 2015 analyses the impact of global health treaties signed between 1892 and 2013. A literature review showed that “most studies evaluating changes in national government policies [on investment, trade and labour] found treaties had a positive effect in the direction drafters desired” but “evidence of international treaties’ effects on health is scant, making it difficult to draw reasonable inferences on what impact can be expected from new treaties that either regulate health matters or aim to promote better health outcomes. The only 2 studies that evaluated health outcomes found that human rights treaties had no impact on a variety of health indicators … and that structural adjustment agreements had a negative effect on them.”
As you watch the tedious succession of sanctimonious promises about the Sustainable Development Goals this year, remember that past behaviour is nearly always the best predictor of future outcomes.
And then remember what does change things. As the Iranian delegation got ready for the make-or-break talks on nuclear issues with Western powers, the Ayatollah Khamenei made a series of conflicting statements in domestic speeches. Was he backing the negotiators or undermining them? It was either a sophisticated attempt to manage the various power bases in Iran or a confused old man who wasn’t quite sure what he thought. Matters were resolved definitively on the Supreme Leader’s Twitter account and the Americans started negotiating seriously