Global Health: A “License to Print Money”?

Bill Gates could have spent his money on art museums or vanity projects. He could have spent his money on cancer research, or on the development of space technology. He chose instead to tackle the diseases of the poor. He chose to go to Africa with much of his money. – Peoples Health Movement et al. (2008)

I can’t find a free online version of this paper I’m reading for class but I want to share the major points because it is important to be critical of philanthropy as much as anything else. If that sounds counter-intuitive, maybe it’s because philanthropy, by definition is an act of benevolence. But when the history of corporate philanthropy is assessed, particularly American philanthropy, it’s painfully easy to find examples of the rich using Corporate Social Responsibility to avoid paying tax. Without further ado, let’s get down to the findings of the above-mentioned assessment, which was performed on the Gates Foundation:

1. Investments worth at least $8.7 billion were in companies whose activities were contrary to the Foundation’s charitable goals. When asked why, the Foundation responded that it does not ‘rank’ companies because “there are dozens of factors that could be considered, almost all of which are outside the Foundation’s areas of expertise.”;
2. There is a lack of accountability and transparency within the Foundation. Interviewees working for/with the Foundation described a lack of checks and balances normally present within other organizations. Interestingly, other global health actors are held accountable to the Gates Foundation but not vice versa;
3. Considering the immensity of the Foundation’s funds, it is unquestionably a dominant actor in the global health movement and there are several examples of the Foundation using its influence to set the agenda (e.g. it provides a third of WHO’s funding and has influenced WHO to focus on malaria research);
4. The Foundation’s approach to global health is market friendly and venture capitalist. It focuses on technical solutions rather than structural ones in its demand for “high ‘return, but in the form of attributable and measurable social or health outcomes”;
5. In addition to the above point, the focus on technological solutions would lead to wider achievements if the strengthening of health systems were also addressed. But the Foundation does not “want to hear about systems strengthening, they said it was for governments” (though more recently, there has been a shift in focus), and finally;
6. Ties to the pharmaceuticals industry have led health activists to question whether the Foundation is “converting global health problems into business opportunities”.

The report does not suggest that the Gates Foundation is not doing good for the global health agenda. It is simply pointing out flaws within the organization that are both serious and potentially detrimental to the overall success of international initiatives. When one organization exerts as much influence on the world health agenda as the Gates Foundation does, it is important to question the legitimacy of that agent’s power. Is it helping or hindering what is right and just?

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