Global Health Summit 2023 — Population, Ageing and Universal Health Coverage
The 2023 Global Health Summit (Rome, May 18–19 2023) convened G7 health ministers and WHO Director-General Tedros around population-level health challenges: ageing workforces, post-COVID excess mortality, UHC coverage gaps, and the demographic determinants of pandemic preparedness.
Summit overview
The third Global Health Summit convened at Villa Pamphilj in Rome on 18–19 May 2023, during Italy's G7 presidency. Established by the 2021 Rome Declaration as a standing G7 health ministerial format, the summit brings together G7 health ministers, the WHO Director-General, World Bank leadership, and invited global-south partners to address shared health threats and governance gaps. The 2023 edition, held in the shadow of post-COVID recovery, focused heavily on the demographic foundations of health system resilience: ageing populations, universal health coverage, and pandemic preparedness infrastructure.
WHO Director-General Tedros Adhanom Ghebreyesus opened with a warning that the post-COVID "recovery" in global life expectancy was masking deep structural divergence: high-income countries were rebounding while low-income countries remained below 2019 benchmarks, partly because COVID vaccine distribution had been deeply unequal. See our post-COVID life expectancy article for the data.
Session highlights
Health workforce under demographic pressure
The WHO Health Workforce 2030 report projects a global shortfall of 10 million health workers by 2030, with 80% of the deficit concentrated in sub-Saharan Africa and South and South-East Asia. The paradox: ageing populations in high-income countries need more health workers, but those same countries have ageing health workforces. Germany, Japan, and Italy all have median physician ages above 50. Sessions debated task-shifting (expanding nurse and community health worker scope of practice) and managed migration of health workers from lower-income countries — the latter raising ethical questions about depleting already-scarce medical capacity in source countries.
UHC and the population left behind
The joint WHO/World Bank UHC monitoring report — released alongside the summit — showed the UHC Service Coverage Index at 68/100 globally in 2021, up from 45 in 2000, but with progress stalling during COVID. An estimated 4.5 billion people still lack access to essential health services; 1.3 billion face catastrophic health expenditure. The summit committed to tracking UHC as a demographic indicator alongside conventional population statistics, recognising that UHC coverage affects both fertility decisions (access to family planning) and mortality trajectories — both core inputs to the demographic transition model.
Long-term care: the missing infrastructure
With 1 in 6 people globally set to be over 65 by 2050 (see our ageing populations article), long-term care infrastructure was flagged as critically underdeveloped even in G7 nations. Japan's experience — 29% aged 65+, a public long-term care insurance system (kaigo hoken) introduced in 2000 — was presented as the most developed model, but even Japan faces staffing shortfalls of 320,000 care workers by 2025. OECD data show that most G7 countries spend 1–2% of GDP on formal long-term care; Japan spends 2.5%. The session concluded that demographic projections demand a doubling of long-term care investment in most high-income countries within 20 years.
Pandemic preparedness and demographic vulnerability
A joint WHO/World Bank session examined why COVID-19 mortality was so disproportionately concentrated in older age groups — globally, 80%+ of COVID deaths were in people aged 60+ — and what this implies for pandemic preparedness in a more aged world. The session reviewed the draft Pandemic Accord (then under negotiation) and its provisions for equitable vaccine distribution — the failure of which had been documented in IUSSP 2021 sessions. The age structure of a country now features in WHO's pandemic vulnerability assessment framework.
Population and health: the demographic nexus
The central message of the 2023 summit was that health system design can no longer be separated from demographic planning. Countries with rapidly ageing populations — Japan (median age 49), South Korea (43), Germany (45) — face fundamentally different health system design requirements than countries with young, growing populations — Nigeria (median age 17), Niger (15), Uganda (16). The old-age dependency ratio, traditionally used in pension planning, has now entered health financing models as a core input.
The World Bank Health, Nutrition and Population team presented modelling showing that for each 1-percentage-point increase in the old-age dependency ratio, national health spending typically increases by 0.4–0.7% of GDP, holding income constant. For G7 countries projecting dependency ratios above 50 by 2050, this implies structural health spending increases of 5–8% of GDP over 30 years — with or without improvements in the efficiency of care delivery.
This directly intersects with the natural increase slowdown: countries with low fertility and low natural increase are simultaneously managing healthcare-cost growth with shrinking working-age tax bases. The fiscal arithmetic is increasingly challenging, and the summit's communiqué called for integrating demographic projections into national health financing plans for the first time.
Frequently asked questions
What is the Global Health Summit?
The Global Health Summit is a high-level G7 format convening health ministers and international health organisation heads. It was established via the 2021 Rome Declaration as a standing G7 health ministerial format, held alongside the annual G7 Leaders' Summit.
What population-ageing themes featured at the 2023 summit?
Three main themes: (1) Health workforce shortages — WHO projects a global shortfall of 10 million health workers by 2030. (2) Pension and long-term care financing as dependency ratios rise toward 50+ in G7 countries. (3) Post-COVID life expectancy recovery divergence between high- and low-income countries. See our post-COVID life expectancy article.
What is Universal Health Coverage and where does the world stand?
UHC means all people receive the health services they need without financial hardship. The WHO/World Bank UHC monitoring report 2023 put the UHC Service Coverage Index at 68/100 globally in 2021. About 4.5 billion people still lack access to essential health services.
How does population ageing stress health systems specifically?
Three channels: (1) Demand — older people use health services 3–5× more than younger adults; (2) Workforce — health workers themselves age out; (3) Long-term care — dementia and multi-morbidity require new infrastructure. Japan, with median age 49, is furthest along. See our ageing populations 2024 article for detail.