G20 Health Ministers and international organisations meeting in Polokwane, South Africa, are focusing their attention on an urgent shared threat to public health: inequalities. Delegates from across the word have highlighted how entrenched gaps in wealth, income and access to basic services within and between countries are undermining governments’ collective capacity to protect everyone’s health.
Informing deliberations at the meeting is the landmark new report, Breaking the inequality-pandemic cycle: building true health security in a global age, which revealed a vicious cycle: how inequality is making pandemics more likely, more deadly and more costly; and how pandemics are increasing inequalities. The report was produced by the independent expert group, the Global Council on Inequality, AIDS and Pandemics, convened by UNAIDS Executive Director Winnie Byanyima, and co-chaired by Nobel laureate Joseph E. Stiglitz, Executive Chairperson of the One Economy Foundation and former First Lady of Namibia Monica Geingos, and renowned epidemiologist Professor Sir Michael Marmot. It brings together economists, public health experts, civil society activists and current and former government leaders.
The Global Council held the international launch of the report on Monday this week in Johannesburg, and then presented the report to President Cyril Ramaphosa in Cape Town on Tuesday, before heading up to Polokwane to address health ministers on Thursday and Friday. As well as identifying the inequality-pandemic cycle, the Global Council has also set out practical steps that can be taken to break the cycle.
South African Health Minister Aaron Motsoaledi welcomed the Global Council report, noting that “the inequality story it highlights resonates so powerfully with our South African story. We defeated the division of Apartheid, but we are still challenged by the division in services between the richest and the majority. We can only ensure public health by enabling access for everyone, through strengthening the public health system. A more equitable system is vital for overcoming pandemics and other emergencies.”
South Africa, as the 2025 G20 chair, has put tackling inequality at the heart of its G20 agenda. Ms Byanyima praised South Africa for its leadership in advancing access to medicines, on debt and financing, and for its drive for universal health coverage through national health insurance. “President Ramaphosa is lighting the way to a world that is both fairer and safer. Inequality is bad for public health. International action to address inequality will benefit everyone,” she remarked.
“The Global Council,” Ms Byanyima noted, “has recommended new approaches that would ensure that health innovations are clearly considered as global public goods in times of pandemics, and that there is sufficient capacity across the world to produce them quickly. We can inspire innovation with prizes rather than patents. We must have automatic Intellectual Property waivers when the World Health Organisation declares a pandemic. And we must make serious multilateral investments in the Global South for research, development and manufacturing capacities for pandemic-related health innovations. This can be done through the Global Coalition on Local and Regional Production, Innovation and Equitable Access, which was established by the G20 just last year.”
Ms Byanyima highlighted also the urgency of action on debt. “To fight inequalities, countries need to spend their tax revenues on health and the social determinants of health, such as education, affordable housing and social protection systems. Instead, they are pressured into austerity measures in order to repay debt. The debt crisis is getting worse. During COVID the external debt of low-income countries rose 12%, and the world’s 26 poorest economies are deeper in debt today than at any time since 2006. And these countries are forced to pay higher interest on their debt. More than a third of the population of the planet—3.3 billion people—live in countries that spend more on interest payments than on health care. There simply is not enough fiscal space to effectively fight the pandemics we have today. And when a new pandemic hits, too many countries do not have the financial capacity to respond. This is why our Council has called for immediate and comprehensive debt restructuring and relief, using a differentiated approach that ensures that the resulting fiscal space is used for investments in health and the social determinants of health, instead of bailing out private creditors.”
Co-Chair of the Global Council Joseph E Stiglitz spoke to ministers on the importance of universal health coverage, highlighting the convergence between the report’s analysis and the international and domestic reforms being pursued by South Africa.
“In pandemics,” Professor Stiglitz shared, “we must reach everyone quickly with a package of services to reduce transmission and severe illness and death. Those countries without a universal healthcare system have a harder time getting vaccines and therapeutics to everyone because they have to set up a new system each time.”
“In contrast,” Professor Stiglitz noted, “universal health coverage is inequality-responsive. Countries with universal healthcare systems have more equality in health. UHC not only improves average health outcomes, it reduces avoidable deaths fastest in poorer and marginalised groups, helping close inequality gaps in survival. Evidence from countries such as Brazil, Thailand, Mexico, Rwanda shows that UHC reduces catastrophic health spending, expands health access for the poorest, and accelerates declines in avoidable deaths in HIV- and TB-affected communities, thereby directly narrowing health inequalities.”
Helen Clark, former Prime Minister of New Zealand, and a member of the Global Council, highlighted that “UHC is one of the most powerful tools for reducing inequality. By pooling financial resources and ensuring that everyone — rich and poor alike — receives care based on need, not wealth, national health insurance can narrow both health and income disparities.”
“The Covid-19 pandemic,” Ms Clark noted, “was a painful reminder that effective health security cannot exist without universal access to quality health services. Countries that had already built robust, publicly financed systems were able to respond faster and recover more resiliently. We need to build a new era of public financing.”
Civil society organisations taking part in the meetings concurred: “The dependence on private finance for health is taking the world in an unsafe direction. Publicly financed healthcare is vital to narrow inequalities and enable countries to overcome current and future pandemics,” said Oxfam’s Anna Marriott.
John Ataguba, Professor and Canada Research Chair in Health Economics, University of Manitoba, Executive Director, AfHEA, and a member of the Global Council, highlighted the connections between the national and international dimensions of inequality, and why collective action is vital in addressing both. “Just as solidarity within countries is essential to public health, so too is solidarity between countries,” remarked Professor Ataguba. “We are interdependent. International reforms on debt and on access to medicines, by helping protect public health globally, would be ultimately in the interests of all countries, North and South. Leaders can choose to implement the proven policies that will ensure the world can overcome current health crises and be ready to prevent or defeat the health crises set to come. The deadly inequality-pandemic cycle is not fate. Together we can act to break the cycle.”