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This essay examines the power of the Bill and Melinda Gates Foundation, hereafter ‘the foundation’. Following this introduction, the foundation is briefly described. Section three then outlines ...

This essay examines the power of the Bill and Melinda Gates Foundation, hereafter ‘the foundation’. Following this introduction, the foundation is briefly described. Section three then outlines Doris Fuchs’ typology of power and provides evidence for the foundation’s projection of power in each of Fuchs’ power types. The foundation’s discursive power is particularly strong, and relies upon legitimacy among the public and in the field. Section four raises some of the ways that this legitimacy might be weakened. The essay concludes by reiterating the need for close scrutiny of the foundation, and a call for further research.

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The magic of king bill: the global power of the bill and melinda gates foundation Document Transcript

  • 1. Joseph Mitchell GGOV643 Health Term Paper The Magic of King Bill: the global power of the Bill and Melinda Gates Foundation“Innovation is the key to improving the world...When innovators work on urgent problems and deliversolutions to people in need, the results can be magical.” Bill Gates, 2012.11. IntroductionThis essay examines the power of the Bill and Melinda Gates Foundation, hereafter ‘thefoundation’. Following this introduction, the foundation is briefly described. Section three thenoutlines Doris Fuchs’ typology of power and provides evidence for the foundation’s projectionof power in each of Fuchs’ power types. The foundation’s discursive power is particularlystrong, and relies upon legitimacy among the public and in the field. Section four raises some ofthe ways that this legitimacy might be weakened. The essay concludes by reiterating the needfor close scrutiny of the foundation, and a call for further research.This essay is relevant because the subject of powerful philanthropic institutions is growing inimportance. As Bill Gates appears at world summits such as the G8 and as the mainstream pressstart to consider the work of the foundation as part of the phenomenon of the ‘superrich’ andthe rise of the ‘philanthrocapitalists’, it is right that questions are asked about the power held bythese foundations.2 This is especially true for scholars of global health. The Gates Foundationfunds projects in over 100 countries. While history suggests that philanthropic institutions areharbingers to state provision, it is clear that this is unlikely in the short term in global healthprovision.3 Indeed, the term ‘global health’ is still disputed.4 Thus it is necessary to analyse theprivate actors in the field and their use of power. This essay does not aim to judge the effects ofthe foundation’s projects, but rather to investigate the ways in which, deliberately or not, thefoundation develops and projects power.In terms of methodology, three typologies of power were considered for this essay, with Fuchs’model seeming most relevant.5 In a full research project, it would be possible to find a casestudy, such as the foundation’s involvement in the establishment of the Global Fund, or itsrelationship with the WHO over a certain time period, in order to trace the foundation’s impactas precisely as possible. However, for this short essay, desk research was performed to findprimary and secondary sources regarding the foundation. Largely, these are journalistic articlesfrom medical journals and newspapers, as well as documentation from the foundation itself. It isnonetheless hoped that the breadth of these provide a relatively robust base of evidence.1 Gates, 2012.2 The term ‘philanthocapitalism’ is from Bishop and Green, 2008.3 Bishop and Green, 2008: 13-30.4 Bozorgmehr, 2011.5 Barnett and Duvall, 2005, and Hallström and Boström, 2010 were the other two considered. Barnett andDuvall’s model is a more generalised theoretical account which applies less well to an individual actor,and Hallstrom and Bostrom’s model is highly specific to the role of NGOs in international negotiations.Both do add elements that are helpful for understanding the foundation, but could not be included in thisessay. 1
  • 2. Joseph Mitchell GGOV643 Health Term Paper2. The Bill and Melinda Gates FoundationThe foundation was created in 1994 and was run by William Gates Snr until Bill Gates resignedfrom Microsoft in 2006 to commit to the foundation full time. It is now led by three co-chairs:Bill, Melinda and William Gates Snr. Warren Buffett is the only other trustee. Perhaps mirroringthe narrative of the development of technology companies, it began operations in William Gates’basement, before now occupying a large ‘campus’ in Seattle. It is the wealthiest privatefoundation in the world.6It hosts programs in three fields: global development, global health and ‘US programs’. Each ofthese is funded to a level unimaginable by most charitable funds: the global health program hasmade grants of $15bn since 1994.7 The total spending per year is now close to $3bn.The foundation does not deliver projects itself, rather, if it can find organisations managingprojects that fit its mission and principles, it will fund them; where it finds a lack oforganisations that fit its mission, it creates new organisations. A good example of the former isPATH, a Seattle-based research organisation which has been the largest single benefactor of thefoundation, at $949m by 2007.8 In the latter case, the foundation provided $105m in order tocreate a new institute for health metrics, discussed below.3. The global power of the foundationThis section describes Fuchs’ tripartite model of business power in global politics and providesevidence for the Gates Foundation’s activity in each category. Despite not being a business, thissection shows that the foundation projects power in similar ways.In Fuchs’ model, there are three types of power: instrumental, structural and discursive. Thefirst is the power that businesses exercise over political or policy outcomes via lobbying or viacampaign finance. The second, structural power, is the power occupied by business simply by itsexistence. It explains why certain issues ‘never reach the agenda’, due to the unspoken threat ofcapital flight – and the jobs and investment that follow –should a company find a government’sregulation too onerous.9 More powerfully, structures may exist which not only allow business‘to bring about or prevent decisions by others’10, but to gain the place of the decision-makerthemselves – as seen in public-private partnerships and various standard-setting organisations.The third, discursive power, is a kind of meta-power, which shapes the language andcommunication practices around an issue area. ‘It does not only pursue interests but createsthem’, and is therefore a ‘particularly powerful power,’11 with which business can create ‘truths’about desirable policies.6 The foundation’s endowment is approximately $37bn and will grow over time as Gates and Buffettcommit the rest of their wealth. The next largest foundation is possibly the Stitchting INGKA Foundation,according to an estimate by The Economist. The third is the Wellcome Trust at $22bn.7 In the same time period, $6bn for US projects and $3bn for global development, and $1bn spent on ‘non-program grants’, which is mainly ‘family interest grants’.http://www.gatesfoundation.org/about/Pages/foundation-fact-sheet.aspx.8 McCoy et al, 2009.9 Fuchs, 2005 :775.10 Ibid.:777.11 Ibid.:778-779. 2
  • 3. Joseph Mitchell GGOV643 Health Term Paper 3.1. The Gates Foundation’s instrumental powerThe most direct form of instrumental power is campaign finance, which builds a dependencyrelationship between the donor and the (potential) legislator. While the foundation isprohibited by law from financing campaigns, Bill and Melinda Gates themselves have donatedmore than a hundred thousand dollars to political campaigns.12 More significantly, thefoundation engages in extensive lobbying, using its material wealth to hire lobbyists and policyexperts to encourage governments to pursue the foundation’s goals. As Fuchs writes, ‘politiciansand bureaucrats have become increasing dependent on the resources and inputs frombusiness.’13 The foundation’s Washington D.C. office opened ‘to support [the foundation’s] policyand advocacy activities and programs in the region,” and is home to the Managing Director forPublic Policy. In 2010, the foundation opened a London office “to support our policy, advocacy,and communications activities in Europe.”14This instrumental power is effective. The Guardian newspaper reported a member of staff fromanother health organisation as saying: “they have the ear of any [national] leadership they wantto speak to. Politicians attach themselves to Gates to get PR. Everyone loves to have a meetingwith Gates. No institution would refuse.”15 This is closely related to the discursive power ofcelebrity, which is discussed below. A specific example of instrumental power is given byBishop and Green who describe a situation in which the foundations ‘clout’ was used to‘navigate the notoriously bureaucratic Indian regulatory system’ in order to register a particulardrug that the foundation supported.16 3.2. The Gates Foundation’s structural powerHere it is necessary to slightly alter Fuchs’ typology. In this section it is not governments thatare considered as the target of structural power, but other global health organisations.17The foundation is the third biggest funder of the World Health Organization (WHO).18 In asimilar way to a national economy relying upon a business for tax revenues, investment oremployment, the WHO could be said to rely on the foundation. The design of the WHO meansthat the foundation does not receive voting rights. The foundation does, however, hold boardseats at the Global Fund to Fight AIDS, TB and Malaria, and at the Global Alliance for Vaccinesand Immunisation (GAVI), to which the foundation has made significant credit lines available –around $750m each.19 For the former, this commitment was an important demonstration ofconfidence in the face of weaker donations from member states.20 As Garrett writes, ‘the twoWashingtons – Seattle and the District of Columbia – are the last barriers to catastrophe...as12 Federal Election Commission website, search by individual contributor, accessed April 4, 2012.13 Fuchs, 2005:782.14 Marten and White, 2008, and www.gatesfoundation.org/jobs/Pages/office-locations.aspx. The otherpower of lobbyists is the ‘revolving door’ that describes the job migration between policy making andworking for lobbying firms. It is likely that considerable numbers of WHO staff have ‘crossed over’ to theGates Foundation, bringing with them internal knowledge of the WHO and contacts with the remainingWHO staffers.15 Beckett, 2010.16 Bishop and Green, 2008:65.17 Marten and White, 2008.18 Sridhar, 2009. The two larger funders are USA and UK.19 Okie, 2006.20 See the Gates Letter 2012 and Garrett, 2012. 3
  • 4. Joseph Mitchell GGOV643 Health Term Paperimportant as the totals is the shift in donor composition.’21 This reliance upon the GatesFoundation for financial and moral support can be seen as example of structural power. Itseffects are as yet unclear, but the resignation of the Fund’s Executive Director, a medicalprofessor, and his replacement by a ‘General Manager’, a former bank chairman, whose remit isto focus on results and efficiencies, is perhaps indicative.These organisations represent only part of the foundation’s broad grant-making; it has beensuggested that there are few universities or research institutions working on global health thathave not directly or indirectly received funding from Gates.22 This creates possibility thatgrantees ‘will not bite the hand that feeds them’.23 3.3. The Gates Foundation and discursive powerFuchs explains that discursive power is partly exercised by spending on communication andpartly a product of an organisation’s legitimacy. The former is controlled by the organisation,the latter is not. Fuchs suggests that business’ political legitimacy has grown as trust ingovernment has fallen.24 The foundation’s legitimacy is likely to be even stronger, given itsleader’s successful career and its charitable intent.The foundation currently projects deliberate discursive power, exemplified in two of its currentprojects. Firstly, the foundation is the partner of the 2012 Cannes Lions ‘challenge’, part of aworldwide advertising festival, which encourages industry members to produce ideas to ‘solvethe world’s biggest problems’.25 The challenge is to persuade the public that aid is a good thing.This blatant pursuit of political goals may seem surprising, but is part of the foundation’sattempt to ‘leverage’ more spending.26 It hopes to persuade publics and ultimately governmentsto increase official aid. Secondly, and for similar purposes, the foundation supports the hostingof a ‘Global Development’ news section on a UK newspaper website. The newspaper states thatit still has complete control of editorial content, but this does not account for self-censorship,nor for the fact that without the foundation’s support, it is unlikely that these stories would bepublished.27In more subtle terms, the foundation exercises considerable discursive power as a result of thelegitimacy granted to it by the public and those in the field. In this way, it projects its worldviewupon others and directs attention towards the health priorities it pursues. Bishop and Green’sconcept of ‘philanthrocapitalism’ aptly describes the foundation, in whose publications thevocabulary of business is constantly present. The foundations thinks in terms of numbers,results, metrics and, given Gates’ former career, regards technology as the solution to global21 Garrett, 2012. Again, the links between the US government and the Gates Foundation seem strong, fromanecdotal evidence from the history of job migration between the two. See, e.g., the leadership page onthe foundation’s website.22 Sridhar, 2009.23 Bishop and Green, 2008:66.24 Fuchs, 2005: 791-792.25 See www.canneschimera.com/challenge.cfm or www.grandchallenges.org/can26 Activities like this are normally carried out by smaller, campaigning organisations such as AmnestyInternational or Greenpeace. Pursuing political purposes is illegal in US and UK charity law, so theseorganisations are not registered for charitable tax relief. The Gates Foundation is so registered and wouldpresumably argue that it is not pursuing ‘legislative change’ (the US legal requirement). For an anecdotalaccount of how close it is willing to push this line, see Birnbaum, 2007.27 www.guardian.co.uk/global-development/2010/sep/14/about-this-site 4
  • 5. Joseph Mitchell GGOV643 Health Term Paperhealth. By providing considerable funding for a new Institute for Health Metrics and Evaluation(IHME) at the University of Washington, the foundation will shape what is talked about inregard to global health successes and challenges.28 The foundation’s regard for technology canbe seen in Gates’ annual letters, from staff use of terms such as ‘product development’, and theprimacy given to funding vaccine innovation. As one staff member said: ‘[technology] is reallythe only thing that can transform.’29 The point is that the foundation’s approach to business-likestrategy and the pursuit of better technology has an effect beyond the foundation. This isevidenced in the way Gates was vital to convincing government donors to commit $4bn toGAVI.30Further discursive power includes the Gates brand. Bill and Melinda are now celebrities whogarner media attention wherever they travel. Gates regularly speaks to journalists, to IvyLeague student events and to summits such as the World Economic Forum. In its support forother charities and civil society organisations, the foundation bestows its brand and conveys itspower, and influence, on those it selects.31 3.4. The foundation’s legitimacy and fragilityThe non-monetary examples above show that discursive power is ‘closely tied to legitimacy’.32 Itis not possible to control a discourse by monetary means alone, rather it is necessary to carryweight with your audience. In Fuchs’ article, this requirement of legitimacy renders businesspower quite fragile – legitimacy is easily lost in the event of an environmental disaster orcorporate scandal.33 This could be true for the foundation too, but at present it enjoys highlevels of legitimacy, given its attractive intent, its celebrity, and the narrative of the world’srichest man giving his money away to help the world.34However, this may not last. Legitimacy may be eroded over time. The foundation is nowrequired to spend $3bn a year, and has close to a 1000 staff. It might begin to developbureaucratic pathologies, and its power will be scrutinised increasingly as its missions conflictwith others.35 Critical articles in mainstream and medical presses have become more numerousover time, though they are still small compared with the total stories published on the28 The IHME’s largest impact to date has been restarting a debate on malaria, which the IMHE announcedwas killing twice as many people annually as previously thought, and thus demanding a greater focus onthis issue. IHME, http://www.healthmetricsandevaluation.org/news-events/ihme-news29 Beckett, 2010.30 Gates Letter, 2012.31 McCoy, 2009: 1650.32 Fuchs, 2005: 778.33 A particularly good example is BP. Their legitimacy to act as a political operator and to exercise powerthrough discursive means is extremely low following the Gulf Coast environmental disaster. A similarexperience, though not a complete failure, has occurred following the subprime mortgage-led financialcrisis.34 This narrative ignores the situation by which one individual is permitted to amass a personal fortune sovast it would be impossible to spend it on oneself. It also leaves aside the antitrust cases againstMicrosoft, and some of the practices the company employed to become the software giant that madeGates’ wealth.35 Barnett and Finnemore, 2005. 5
  • 6. Joseph Mitchell GGOV643 Health Term Paperfoundation.36 The next section details some of the criticisms that could weaken the legitimacy ofthe organisation.4. The problems of powerThus far this essay has tried to present a normatively neutral analysis of the foundation’spower, though it may have been clear where this power could lead to problems. This sectiondeals with the particular criticisms levelled at the foundation. They are particularly strong in thearea of discursive power. 4.1. The Gates Foundation and accountabilityThe foundation’s power to set global health priorities and influence policy action is ultimatelycrafted by only three people, who are accountable to nobody. The argument that they mustprotect their reputation is weakened by the field’s reliance on the foundation’s funding. Severalauthors have called for a critical examination of the foundation’s relationship with the WHO andsimilar agencies, or have criticised the closed, internal nature of decision-making processes.37The foundation does not systematically involve the poor in its processes. It barely engages with‘beneficiaries’, aside from fact-finding trips by Bill and Melinda. Instead, decisions are made byAmerican-educated and trained staff typically, according to a review of job adverts, coming frommanagement consulting backgrounds. These are Seattle-solutions to African problems.38This problem of accountability is exacerbated by the problem that it is not only Gates’ moneythat the foundation spends. Firstly, the foundation receives a tax break from the US government;secondly, and more importantly, as discussed above, the foundation seeks to leverage othersources, i.e. to meet its goals it must change the way that elected G8 governments spend theirmoney.39The problem also affects global agreements such as the Millennium Development Goals and theParis Declaration on Aid Effectiveness. The foundation may have played little part in thedevelopment of these concepts. As a private organisation it has no responsibility to use orpromote them. Yet these declarations were created in a relatively democratic process, in thatthere was greater public involvement in their creation. When the foundation promotes its ownlist of Grand Challenges in Global Health, it creates a risk of competition or conflict.40In sum, the lack of accountability threatens the foundation’s legitimacy. As a former president ofthe Rockefeller Foundation put it, all foundations “lack the three chastising disciplines ofAmerican life: the market test, which punishes or rewards financial performance; the ballot box36 Many of these are referenced throughout this essay. A Google Trends analysis shows that the level ofsearching for ‘Gates Foundation’ has remained relatively similar since 2004 (the first year that data fromGoogle is available), with a spike in 2006 at the point Warren Buffett announced his commitment to thefoundation. Google Trends also shows the ‘news reference volume’, which rose throughout 2008-9 andhas remained at these levels. One interesting result is that South Africa indexes very highly (second in theworld after the US) against searches for the Gates Foundation.37 McCoy et al, 2009 :1951; McNeil, 2008.38 IMHE’s board includes three women and three non-white men from 12-strong board. For prioritysetting, see e.g. Melinda Gates in Edwards, 2008:77.39 The UK Prime Minister is commended by Gates in both his 2011 and 2012 letters. This helps keep thepressure on the PM to meet the 0.7% development aid target.40 Marten and Witte, 2008; Birn, 2005: 515. 6
  • 7. Joseph Mitchell GGOV643 Health Term Paperthrough which the numbskulls can be voted out of office, and the ministrations of an irreverentpress biting at your heels every day.”41 It is difficult to see how the foundation makes anyimprovement on this, especially on the global level. 4.2. The Gates Foundation and the World Health Organisation (WHO)WHO is a more representative organisation than the foundation: any nation that wishes to be amember can join, and its legislative body, the World Health Assembly, works on the principle ofone state, one vote. The foundation provides grants for projects in over 100 countries, but relieson data as its feedback mechanism, not the voices of the poor it hopes to help.Although the foundation helps fund WHO, the literature suggests that the foundation regardsthe WHO as slow and bureaucratic. It also hires, perhaps poaches, WHO staff. The foundation’sestablishment of the Institute for Health Metrics and Evaluation in Seattle was seen by some as asnub to WHO, as data collection and information dissemination was one of its roles. IMHE saysits seeks ‘high quality’ data to build the base ‘of objective evidence about what works’. It is runby a former WHO staffer, Dr Christopher Murray, who plans to set the ‘gold standard’ for healthmetrics.42 Murray argues that IMHE is needed because WHO came under pressure from membercountries, and that the ‘institute would be independent of that.’43 This may be so, but thefoundation risks de-legitimisation if it is seen as seriously weakening an international body. 4.3. The Gates Foundation and the governments of low income countries (LICs)The most serious problem raised in regard to the foundation’s effects on LICs is the brain drainof medical staff into areas of priority for the foundation. An example comes from the GlobalFund’s work on HIV/AIDS, supported by the foundation. Medical staff working on these projectsreceive a premium above those working on those other health priorities determined by thenational health ministry, including on primary care and child health.44Another risk is that the foundation, racing to achieve its goals, subverts democratic governanceprocesses. Foundation staff have been known to take a dismissive attitude towards governmentactors.45 Bishop and Green’s example of the foundation using its ‘clout’ to ‘navigate thenotoriously bureaucratic Indian regulatory system’ betrays risks for the foundation.46 Agovernment department that serves a 1.2bn member democracy is likely to be complex andwith good reason. It is not clear whether the foundation pushed their chosen drug throughagainst the wishes of the bureaucrats, nor if they displaced something else while doing it. Ifeither was true, this type of behaviour could weaken the foundation’s legitimacy. 4.4. The Gates Foundation and myopiaThis sub-section describes the risk that the foundation’s extensive discursive power leads togroupthink, a lack of challenging ideas and an ignorance of the social determinants of health.41 Arnove and Pinede 2007:422.42 Moszynski, 2007.43 McNeil, 2008. The WHO’s response was that ‘I hope the institute will become an important partner inmeeting these goals.’ WHO, 2007.44 Pillar and Smith, 2007.45 ‘[W]e don’t just write checks and say to the health ministry, ‘here’s a bunch of money. Do what youwant.’’ Bishop and Green, 2008:69.46 Bishop and Green, 2008:65. 7
  • 8. Joseph Mitchell GGOV643 Health Term PaperDevi Sridhar has referred to the foundation as the ‘Gates Empire’, explaining that almost everyuniversity, think-tank, civil society organisation and partnership receives foundation fundingdirectly or indirectly.47 An analysis of the foundation’s Global Challenge programme between1998-2007 shows that only US and UK universities received grants, cementing discursive powerrelations, and weakening the voices of developing world academics. Moreover, the vast majorityof university grants were to just four universities : Washington, Johns Hopkins, Harvard andColumbia.48 As Birn points out, might not some of the most valuable lessons in global health betaught by Cuban health authorities?49The danger of monopolistic thinking was raised by the former WHO Head of Malaria whowarned of the unintended consequences of being involved in the funding of all relevantresearch. He argued that independent reviews were hard to find because everybody is beingfunded by the foundation. He also suggests that WHO came under pressure from the foundationto approve an anti-malarial drug for babies, which was not obviously worth approving, sayingWHO met with ‘intense and aggressive opposition’.50The philanthrocapitalist model can result in odd health outcomes, such as in a mass vaccinationcampaign for which people may be expected to walk miles to attend the mobile clinic or lab andform long line-ups for a single shot, but are forbidden to ask other health questions becausethey would slow down the line and introduce inefficiency. Yet these people might very rarelysee a trained nurse, or be in the vicinity of a doctor.51 This approach might fail to treat peoplewith dignity and respect. In focusing on ‘efficiency’, projects may fail to recognise the humanelement of the problem.Furthermore, in seeking technological solutions to global health, or what Paul Farmer called the‘magic bullet,’ the foundation ignores the vital societal, cultural and infrastructural elements ofhealth systems for improving global health.52 Accounting for these elements renders decisionson prioritisation far harder, and outside the realm of economic modelling. When the foundationignores societal contexts, or the social determinants of health, it ends up merely ‘squeezing themortality balloon’ at one end.53 Similarly, the foundation’s focus on vaccines ‘detracts from thefocus on the social determinants of health and undermines coherent and long term developmentof health systems’.54 Birn provides estimates that two-thirds of child deaths and four-fifths of alladult deaths in the developing world are preventable through existing measures. Furthermore,she argues, there is historical evidence that suggests that medicines emerge as a useful tool afterpublic health has already improved due to nutrition, habitation and sanitation improvements.55The hunt for ‘magic’ solutions, as anything more than a part of the approach could weakenglobal health efforts. Michael Edwards perhaps puts it best: “new loans, seeds and vaccines are certainly important, but there is no vaccine against the racism that denies land to „dalits‟...no technology that can deliver the47 Sridhar, 2009.48 McCoy et al, 2009:1648.49 Birn, 2005: 517.50 McNeil, 2008.51 Pillar and Smith, 2007.52 Paul Farmer, quoted in Pillar and Smith, 2007.53 Birn, 2005.54 McCoy et al, 2009:1652.55 Birn, 2005: 514. 8
  • 9. Joseph Mitchell GGOV643 Health Term Paper public health infrastructure required to combat HIV, and no market that can re-order the dysfunctional relationships between different religions and other social groups that underpin violence and insecurity.”56One final result of the groupthink may be the foundation’s inability to think laterally, given itsintense focus on ‘getting results’. This is manifest in the foundation’s endowment policy, whichonly excludes investment in Sudan and tobacco. When journalists questioned its investment inoil, gas and chemical companies, the foundation responded that its role was simply to maximisemoney for its programs – seemingly unaware of the fact that some of its programmes will benegatively affected by the companies its endowment supports.57 One critique of charitablefoundations suggested that they ‘maintain the economic and social systems that generate thevery inequality and injustice they wish to correct.’58In sum, there is a danger that the foundation’s power distorts approaches to global health,encourages a myopic focus, and even leads to internal contradictions.5. ConclusionThis essay demonstrated that the Gates Foundation projects extensive instrumental, structuraland especially discursive power. In its relations with WHO, national governments and the fieldof global public health more generally it risks being seen as unaccountable, ignorant of theimportance of the social determinants of health and a homogeniser of opinion, despite its desireto encourage innovation.The foundation is just one effect of globalisation, which has led to extreme levels of inequalityevidenced by the rise of the ‘superrich’. A globalised political response trails behind this reality,allowing the superrich to snap up football teams, or more positively, to found charitablefoundations. The structural argument against foundations is that any system that allows suchhuge wealth inequalities is broken, and that this wealth should instead be spent by governmentspursuing democratic policies. Bishop and Green’s historical review predicts that philanthropyeventually leads to state provision, but given the lack of a global state, this prediction might notbe realised soon enough for the world’s poor, even though a global tax and spend regime may bethe only way to truly ameliorate poverty and guarantee minimum standards in global publichealth.Meanwhile, the Bill and Melinda Gates Foundation is leading a growing philanthropicmovement. This essay has shown that there is a clear public interest in scrutinising theirprojections of power. Further research should focus on moving beyond anecdotal, journalisticaccounts towards deeper qualitative study, such as process-tracing. Examples could include thefoundation’s involvement in the establishment of the Global Fund, the impact of their funding ofWHO or a review across the field of global health to determine whether policy has shiftedtowards idealising technological solutions. Further, the historical argument is exciting. Researchshould examine the exact processes by which philanthropy is supplanted by the social state. It56 Edwards 2008:14. The foundation’s response is that health systems are a government’s responsibility,but given that the foundation is probably responsible for brain drain from national health ministries, andthat it is funding private health schemes, this is a weak argument. Pillar and Smith, 2007; Peoples HealthMovement et al, 2008:254.57 Heim, 2007.58 Arnove and Pinede, 2007:389. 9
  • 10. Joseph Mitchell GGOV643 Health Term Papershould suggest how to pursue a more equitable, accountable and diverse distribution of powerin global health. 10
  • 11. Joseph Mitchell GGOV643 Health Term Paper6. Bibliography and works citedArnove, Robert and Pinede, Nadine, 2007. Revisiting the "Big Three" Foundations. Critical Sociology. Vol. 33, pp. 389–425.Barnett, Michael, and Duvall, Raymond. 2005. Power in Global Governance. In Power in Global Governance, edited by Michael Barnett and Raymond Duvall, pp. 1–32. Cambridge: Cambridge University Press.Bartnett, Michael and Finnemore, Martha, 2004. Rules for the World: International Organizations in Global Politics. Ithica: Cornell University Press.Beckett, Andy, 2010. Inside the Bill and Melinda Gates Foundation. The Guardian, July 12.Bill and Melinda Gates Foundation website: gatesfoundation.org. Specific pages listed in footnotes.Bill and Melinda Gates Foundation weblogs: impatientoptimists.org. Specific pages listed in footnotes.Birn, Anne-Emmanuelle, 2005. Gatess grandest challenge: transcending technology as public health ideology. The Lancet, August 6, Vol. 366, No. 9484, pp. 514-519.Birnbaum, Jeffrey, 2007. Why the Nations Richest Man Is Looking for Government Money. Washington Post, April, 30. Available at www.washingtonpost.com/wp- dyn/content/article/2007/04/30/AR2007043001435.html accessed April 4, 2012.Bishop, Mathew, and Green, Michael, 2009. Philanthrocapitalism: How Giving Can Save the World. London: A & C Black Publishers.Boström, Magnus and Hallström, Kristina Tamm, 2010. ‘NGO Power in Global Social and Environmental Standard-Setting’, Global Environmental Politics, Vol. 10, No. 4, pp. 36-59.Bozorgmehr, Kayvan, 2010. "Rethinking the ‘global’ in global health: a dialectic approach", Globalization and Health, Vol. 6, No. 19.Cohen, John, 2002. Gates Foundation Rearranges Public Health Universe. Within Cohen, John, 2002, U.S. Vaccine Supply Falls Seriously Short, Science , New Series, Vol. 295, No. 5562, March 15, pp. 1998-2001.Cohen, John, 2005. Gates Foundation Picks Winners in Grand Challenges in Global Health, Science, July 1, Vol. 309 no. 5731 pp. 33-35.Derham, Katie, 2012. Inside Fortress Bill, [radio programme], BBC Radio 4, January 8.The Economist, 2006, ‘Forget about the Gates Foundation. The worlds biggest charity owns IKEA— and is devoted to interior design’. May 11 print edition. Available at http://www.economist.com/node/6919139?story_id=6919139, accessed April 4, 2012.Edwards, Michael, 2008. Just Another Emperor: The Myths and Realities of Philanthro-capitalism. New York/London, Demos: A Network for Ideas & Action and The Young Foundation.Fuchs, Doris, 2005. The Commanding Heights? The Strength and Fragility of Business Power in World Politics. Millennium, 33(3): 771-802.Gates, Bill (2009-2012), Bill’s Annual Letter, published on gatesfoundation.org. 11
  • 12. Joseph Mitchell GGOV643 Health Term PaperGarrett, Laurie, 2012. Money or Die: A Watershed Moment for Global Health. Foreign Affairs, March 6. Available at www.foreignaffairs.com/articles/137312/laurie-garrett/money-or-die, accessed April 5, 2012.Grand Challenges in Global Health website, grandchallenges.org. Specific pages listed in footnotes.Heim, Kristi, 2007. Gates Foundation faces multibillion-dollar dilemma. The Seattle Times, January 14.Institute for Health Metrics and Evaluation website, healthmetricsandevaluation.org. Specific pages listed in footnotes.Jack, Andrew, 2007. Keeping up with the Gates’, Financial Times, December 10, 2007. Available at FT.com, accessed Feb 1, 2012.Marten, Robert and Witte, Jan Martin, 2008. Transforming development? The role of philanthropic foundations in international development cooperation. Berlin, Germany: Global Public Policy Institute, pp. 1–40.McCoy, David et al, 2009. The Bill & Melinda Gates Foundations grant-making programme for global health, The Lancet, May 9, Vol. 373, Issue 9675, pp. 1645-1653.McNeil, Donald, 2008. Gates Foundation’s influence criticized. New York Times, Feb 16.Moszynski, Peter, 2007. Gates Foundation funds new institute to evaluate global health data. British Medical Journal, June 16; Issue 334(7606), p.1238.Nature, 2008. Editorial: A risk worth taking, October, 30, Vol. 455.Okie, Susan, 2006. Global Health: the Gates-Buffett Effect. New England Journal of Medicine, Issue 355, pp.1084-1088.Peoples Health Movement, Medact, Global Equity Gauge. Global health watch 2: an alternative world health report. London: Zed Books, 2008Piller, Charles and Smith, Doug, 2007, Unintended victims of Gates Foundation generosity, LA Times, December 16.Sridhar, Devi, 2009, Global Health - Who Can Lead? The World Today, 65, February, 2.Timmerman, Luke, 2011. Tachi Yamada, Former Gates Foundation Leader, Joins Frazier for New VC Gig. June 27, available at http://www.xconomy.com/seattle/2011/06/27/tachi-yamada- former-gates-foundation-leader-joins-frazier-for-new-vc-gig/ accessed April 5, 2012.Yamada, Tadataka, 2008. In Search of New Ideas for Global Health. New England Journal of Medicine, March 27, Issue 358, pp.1324-1325.WHO, 2007, WHO welcomes new health metrics and evaluation institute. Available at http://www.who.int/mediacentre/news/statements/2007/s12/en/index.html, accessed April 4, 2012. 12