This document analyzes the power and influence of the Bill and Melinda Gates Foundation through examining its instrumental, structural, and discursive power based on Doris Fuchs' typology of power. It finds that the foundation wields significant power through lobbying governments, holding board seats and providing major funding to global health organizations, and shaping discussions and priorities in global health through its communications and funding of research. However, it notes that the foundation's power relies on its perceived legitimacy, which could erode over time if it develops bureaucratic problems or faces more critical scrutiny of its activities and influence.
The magic of king bill: the global power of the bill and melinda gates foundation
1. Joseph Mitchell GGOV643 Health Term Paper
The Magic of King Bill: the global power of the
Bill and Melinda Gates Foundation
âInnovation is the key to improving the world...When innovators work on urgent problems and deliver
solutions to people in need, the results can be magical.â Bill Gates, 2012.1
1. Introduction
This essay examines the power of the Bill and Melinda Gates Foundation, hereafter âthe
foundationâ. Following this introduction, the foundation is briefly described. Section three then
outlines Doris Fuchsâ typology of power and provides evidence for the foundationâs projection
of power in each of Fuchsâ power types. The foundationâs 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.
This essay is relevant because the subject of powerful philanthropic institutions is growing in
importance. As Bill Gates appears at world summits such as the G8 and as the mainstream press
start to consider the work of the foundation as part of the phenomenon of the âsuperrichâ and
the rise of the âphilanthrocapitalistsâ, it is right that questions are asked about the power held by
these foundations.2 This is especially true for scholars of global health. The Gates Foundation
funds projects in over 100 countries. While history suggests that philanthropic institutions are
harbingers to state provision, it is clear that this is unlikely in the short term in global health
provision.3 Indeed, the term âglobal healthâ is still disputed.4 Thus it is necessary to analyse the
private actors in the field and their use of power. This essay does not aim to judge the effects of
the foundationâs projects, but rather to investigate the ways in which, deliberately or not, the
foundation develops and projects power.
In terms of methodology, three typologies of power were considered for this essay, with Fuchsâ
model seeming most relevant.5 In a full research project, it would be possible to find a case
study, such as the foundationâs involvement in the establishment of the Global Fund, or its
relationship with the WHO over a certain time period, in order to trace the foundationâs impact
as precisely as possible. However, for this short essay, desk research was performed to find
primary and secondary sources regarding the foundation. Largely, these are journalistic articles
from medical journals and newspapers, as well as documentation from the foundation itself. It is
nonetheless hoped that the breadth of these provide a relatively robust base of evidence.
1 Gates, 2012.
2 The term âphilanthocapitalismâ 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 and
Duvallâs model is a more generalised theoretical account which applies less well to an individual actor,
and Hallstrom and Bostromâs 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 this
essay.
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2. Joseph Mitchell GGOV643 Health Term Paper
2. The Bill and Melinda Gates Foundation
The foundation was created in 1994 and was run by William Gates Snr until Bill Gates resigned
from 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 mirroring
the narrative of the development of technology companies, it began operations in William Gatesâ
basement, before now occupying a large âcampusâ in Seattle. It is the wealthiest private
foundation in the world.6
It hosts programs in three fields: global development, global health and âUS programsâ. Each of
these is funded to a level unimaginable by most charitable funds: the global health program has
made 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 managing
projects that fit its mission and principles, it will fund them; where it finds a lack of
organisations that fit its mission, it creates new organisations. A good example of the former is
PATH, a Seattle-based research organisation which has been the largest single benefactor of the
foundation, at $949m by 2007.8 In the latter case, the foundation provided $105m in order to
create a new institute for health metrics, discussed below.
3. The global power of the foundation
This section describes Fuchsâ tripartite model of business power in global politics and provides
evidence for the Gates Foundationâs activity in each category. Despite not being a business, this
section shows that the foundation projects power in similar ways.
In Fuchsâ model, there are three types of power: instrumental, structural and discursive. The
first is the power that businesses exercise over political or policy outcomes via lobbying or via
campaign finance. The second, structural power, is the power occupied by business simply by its
existence. It explains why certain issues ânever reach the agendaâ, due to the unspoken threat of
capital flight â and the jobs and investment that follow âshould a company find a governmentâs
regulation too onerous.9 More powerfully, structures may exist which not only allow business
âto bring about or prevent decisions by othersâ10, but to gain the place of the decision-maker
themselves â 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 and
communication practices around an issue area. âIt does not only pursue interests but creates
themâ, and is therefore a âparticularly powerful power,â11 with which business can create âtruthsâ
about desirable policies.
6 The foundationâs endowment is approximately $37bn and will grow over time as Gates and Buffett
commit 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 ânon-
program grantsâ, which is mainly âfamily interest grantsâ.
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.
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3.1. The Gates Foundationâs instrumental power
The most direct form of instrumental power is campaign finance, which builds a dependency
relationship between the donor and the (potential) legislator. While the foundation is
prohibited by law from financing campaigns, Bill and Melinda Gates themselves have donated
more than a hundred thousand dollars to political campaigns.12 More significantly, the
foundation engages in extensive lobbying, using its material wealth to hire lobbyists and policy
experts to encourage governments to pursue the foundationâs goals. As Fuchs writes, âpoliticians
and bureaucrats have become increasing dependent on the resources and inputs from
business.â13 The foundationâs Washington D.C. office opened âto support [the foundationâs] policy
and advocacy activities and programs in the region,â and is home to the Managing Director for
Public Policy. In 2010, the foundation opened a London office âto support our policy, advocacy,
and communications activities in Europe.â14
This instrumental power is effective. The Guardian newspaper reported a member of staff from
another health organisation as saying: âthey have the ear of any [national] leadership they want
to speak to. Politicians attach themselves to Gates to get PR. Everyone loves to have a meeting
with Gates. No institution would refuse.â15 This is closely related to the discursive power of
celebrity, which is discussed below. A specific example of instrumental power is given by
Bishop and Green who describe a situation in which the foundations âcloutâ was used to
ânavigate the notoriously bureaucratic Indian regulatory systemâ in order to register a particular
drug that the foundation supported.16
3.2. The Gates Foundationâs structural power
Here it is necessary to slightly alter Fuchsâ typology. In this section it is not governments that
are considered as the target of structural power, but other global health organisations.17
The foundation is the third biggest funder of the World Health Organization (WHO).18 In a
similar way to a national economy relying upon a business for tax revenues, investment or
employment, the WHO could be said to rely on the foundation. The design of the WHO means
that the foundation does not receive voting rights. The foundation does, however, hold board
seats at the Global Fund to Fight AIDS, TB and Malaria, and at the Global Alliance for Vaccines
and Immunisation (GAVI), to which the foundation has made significant credit lines available â
around $750m each.19 For the former, this commitment was an important demonstration of
confidence in the face of weaker donations from member states.20 As Garrett writes, âthe two
Washingtons â Seattle and the District of Columbia â are the last barriers to catastrophe...as
12 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 other
power of lobbyists is the ârevolving doorâ that describes the job migration between policy making and
working for lobbying firms. It is likely that considerable numbers of WHO staff have âcrossed overâ to the
Gates Foundation, bringing with them internal knowledge of the WHO and contacts with the remaining
WHO 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.
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4. Joseph Mitchell GGOV643 Health Term Paper
important as the totals is the shift in donor composition.â21 This reliance upon the Gates
Foundation for financial and moral support can be seen as example of structural power. Its
effects are as yet unclear, but the resignation of the Fundâs Executive Director, a medical
professor, and his replacement by a âGeneral Managerâ, a former bank chairman, whose remit is
to focus on results and efficiencies, is perhaps indicative.
These organisations represent only part of the foundationâs broad grant-making; it has been
suggested that there are few universities or research institutions working on global health that
have not directly or indirectly received funding from Gates.22 This creates possibility that
grantees âwill not bite the hand that feeds themâ.23
3.3. The Gates Foundation and discursive power
Fuchs explains that discursive power is partly exercised by spending on communication and
partly a product of an organisationâs legitimacy. The former is controlled by the organisation,
the latter is not. Fuchs suggests that businessâ political legitimacy has grown as trust in
government has fallen.24 The foundationâs legitimacy is likely to be even stronger, given its
leaderâs successful career and its charitable intent.
The foundation currently projects deliberate discursive power, exemplified in two of its current
projects. Firstly, the foundation is the partner of the 2012 Cannes Lions âchallengeâ, part of a
worldwide advertising festival, which encourages industry members to produce ideas to âsolve
the worldâs biggest problemsâ.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 foundationâs
attempt to âleverageâ more spending.26 It hopes to persuade publics and ultimately governments
to increase official aid. Secondly, and for similar purposes, the foundation supports the hosting
of a âGlobal Developmentâ news section on a UK newspaper website. The newspaper states that
it still has complete control of editorial content, but this does not account for self-censorship,
nor for the fact that without the foundationâs support, it is unlikely that these stories would be
published.27
In more subtle terms, the foundation exercises considerable discursive power as a result of the
legitimacy granted to it by the public and those in the field. In this way, it projects its worldview
upon others and directs attention towards the health priorities it pursues. Bishop and Greenâs
concept of âphilanthrocapitalismâ aptly describes the foundation, in whose publications the
vocabulary of business is constantly present. The foundations thinks in terms of numbers,
results, metrics and, given Gatesâ former career, regards technology as the solution to global
21 Garrett, 2012. Again, the links between the US government and the Gates Foundation seem strong, from
anecdotal evidence from the history of job migration between the two. See, e.g., the leadership page on
the foundationâs 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/can
26 Activities like this are normally carried out by smaller, campaigning organisations such as Amnesty
International or Greenpeace. Pursuing political purposes is illegal in US and UK charity law, so these
organisations are not registered for charitable tax relief. The Gates Foundation is so registered and would
presumably argue that it is not pursuing âlegislative changeâ (the US legal requirement). For an anecdotal
account 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
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health. 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 in
regard to global health successes and challenges.28 The foundationâs regard for technology can
be seen in Gatesâ annual letters, from staff use of terms such as âproduct developmentâ, and the
primacy given to funding vaccine innovation. As one staff member said: â[technology] is really
the only thing that can transform.â29 The point is that the foundationâs approach to business-like
strategy and the pursuit of better technology has an effect beyond the foundation. This is
evidenced in the way Gates was vital to convincing government donors to commit $4bn to
GAVI.30
Further discursive power includes the Gates brand. Bill and Melinda are now celebrities who
garner media attention wherever they travel. Gates regularly speaks to journalists, to Ivy
League student events and to summits such as the World Economic Forum. In its support for
other charities and civil society organisations, the foundation bestows its brand and conveys its
power, and influence, on those it selects.31
3.4. The foundationâs legitimacy and fragility
The non-monetary examples above show that discursive power is âclosely tied to legitimacyâ.32 It
is not possible to control a discourse by monetary means alone, rather it is necessary to carry
weight with your audience. In Fuchsâ article, this requirement of legitimacy renders business
power quite fragile â legitimacy is easily lost in the event of an environmental disaster or
corporate scandal.33 This could be true for the foundation too, but at present it enjoys high
levels of legitimacy, given its attractive intent, its celebrity, and the narrative of the worldâs
richest man giving his money away to help the world.34
However, this may not last. Legitimacy may be eroded over time. The foundation is now
required to spend $3bn a year, and has close to a 1000 staff. It might begin to develop
bureaucratic pathologies, and its power will be scrutinised increasingly as its missions conflict
with others.35 Critical articles in mainstream and medical presses have become more numerous
over time, though they are still small compared with the total stories published on the
28 The IHMEâs largest impact to date has been restarting a debate on malaria, which the IMHE announced
was killing twice as many people annually as previously thought, and thus demanding a greater focus on
this issue. IHME, http://www.healthmetricsandevaluation.org/news-events/ihme-news
29 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 power
through discursive means is extremely low following the Gulf Coast environmental disaster. A similar
experience, though not a complete failure, has occurred following the subprime mortgage-led financial
crisis.
34 This narrative ignores the situation by which one individual is permitted to amass a personal fortune so
vast it would be impossible to spend it on oneself. It also leaves aside the antitrust cases against
Microsoft, and some of the practices the company employed to become the software giant that made
Gatesâ wealth.
35 Barnett and Finnemore, 2005.
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foundation.36 The next section details some of the criticisms that could weaken the legitimacy of
the organisation.
4. The problems of power
Thus far this essay has tried to present a normatively neutral analysis of the foundationâs
power, though it may have been clear where this power could lead to problems. This section
deals with the particular criticisms levelled at the foundation. They are particularly strong in the
area of discursive power.
4.1. The Gates Foundation and accountability
The foundationâs power to set global health priorities and influence policy action is ultimately
crafted by only three people, who are accountable to nobody. The argument that they must
protect their reputation is weakened by the fieldâs reliance on the foundationâs funding. Several
authors have called for a critical examination of the foundationâs relationship with the WHO and
similar agencies, or have criticised the closed, internal nature of decision-making processes.37
The foundation does not systematically involve the poor in its processes. It barely engages with
âbeneficiariesâ, aside from fact-finding trips by Bill and Melinda. Instead, decisions are made by
American-educated and trained staff typically, according to a review of job adverts, coming from
management consulting backgrounds. These are Seattle-solutions to African problems.38
This problem of accountability is exacerbated by the problem that it is not only Gatesâ money
that 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 other
sources, i.e. to meet its goals it must change the way that elected G8 governments spend their
money.39
The problem also affects global agreements such as the Millennium Development Goals and the
Paris Declaration on Aid Effectiveness. The foundation may have played little part in the
development of these concepts. As a private organisation it has no responsibility to use or
promote them. Yet these declarations were created in a relatively democratic process, in that
there was greater public involvement in their creation. When the foundation promotes its own
list of Grand Challenges in Global Health, it creates a risk of competition or conflict.40
In sum, the lack of accountability threatens the foundationâs legitimacy. As a former president of
the Rockefeller Foundation put it, all foundations âlack the three chastising disciplines of
American life: the market test, which punishes or rewards financial performance; the ballot box
36 Many of these are referenced throughout this essay. A Google Trends analysis shows that the level of
searching for âGates Foundationâ has remained relatively similar since 2004 (the first year that data from
Google is available), with a spike in 2006 at the point Warren Buffett announced his commitment to the
foundation. Google Trends also shows the ânews reference volumeâ, which rose throughout 2008-9 and
has remained at these levels. One interesting result is that South Africa indexes very highly (second in the
world after the US) against searches for the Gates Foundation.
37 McCoy et al, 2009 :1951; McNeil, 2008.
38 IMHEâs board includes three women and three non-white men from 12-strong board. For priority
setting, 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 the
pressure on the PM to meet the 0.7% development aid target.
40 Marten and Witte, 2008; Birn, 2005: 515.
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through which the numbskulls can be voted out of office, and the ministrations of an irreverent
press biting at your heels every day.â41 It is difficult to see how the foundation makes any
improvement 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 a
member can join, and its legislative body, the World Health Assembly, works on the principle of
one state, one vote. The foundation provides grants for projects in over 100 countries, but relies
on 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 regards
the WHO as slow and bureaucratic. It also hires, perhaps poaches, WHO staff. The foundationâs
establishment of the Institute for Health Metrics and Evaluation in Seattle was seen by some as a
snub to WHO, as data collection and information dissemination was one of its roles. IMHE says
its seeks âhigh qualityâ data to build the base âof objective evidence about what worksâ. It is run
by a former WHO staffer, Dr Christopher Murray, who plans to set the âgold standardâ for health
metrics.42 Murray argues that IMHE is needed because WHO came under pressure from member
countries, and that the âinstitute would be independent of that.â43 This may be so, but the
foundation 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 foundationâs effects on LICs is the brain drain
of medical staff into areas of priority for the foundation. An example comes from the Global
Fundâs work on HIV/AIDS, supported by the foundation. Medical staff working on these projects
receive a premium above those working on those other health priorities determined by the
national health ministry, including on primary care and child health.44
Another risk is that the foundation, racing to achieve its goals, subverts democratic governance
processes. Foundation staff have been known to take a dismissive attitude towards government
actors.45 Bishop and Greenâs example of the foundation using its âcloutâ to ânavigate the
notoriously bureaucratic Indian regulatory systemâ betrays risks for the foundation.46 A
government department that serves a 1.2bn member democracy is likely to be complex and
with good reason. It is not clear whether the foundation pushed their chosen drug through
against the wishes of the bureaucrats, nor if they displaced something else while doing it. If
either was true, this type of behaviour could weaken the foundationâs legitimacy.
4.4. The Gates Foundation and myopia
This sub-section describes the risk that the foundationâs extensive discursive power leads to
groupthink, 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 WHOâs response was that âI hope the institute will become an important partner in
meeting these goals.â WHO, 2007.
44 Pillar and Smith, 2007.
45 â[W]e donât just write checks and say to the health ministry, âhereâs a bunch of money. Do what you
want.ââ Bishop and Green, 2008:69.
46 Bishop and Green, 2008:65.
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Devi Sridhar has referred to the foundation as the âGates Empireâ, explaining that almost every
university, think-tank, civil society organisation and partnership receives foundation funding
directly or indirectly.47 An analysis of the foundationâs Global Challenge programme between
1998-2007 shows that only US and UK universities received grants, cementing discursive power
relations, and weakening the voices of developing world academics. Moreover, the vast majority
of university grants were to just four universities : Washington, Johns Hopkins, Harvard and
Columbia.48 As Birn points out, might not some of the most valuable lessons in global health be
taught by Cuban health authorities?49
The danger of monopolistic thinking was raised by the former WHO Head of Malaria who
warned of the unintended consequences of being involved in the funding of all relevant
research. He argued that independent reviews were hard to find because everybody is being
funded by the foundation. He also suggests that WHO came under pressure from the foundation
to approve an anti-malarial drug for babies, which was not obviously worth approving, saying
WHO met with âintense and aggressive oppositionâ.50
The philanthrocapitalist model can result in odd health outcomes, such as in a mass vaccination
campaign for which people may be expected to walk miles to attend the mobile clinic or lab and
form long line-ups for a single shot, but are forbidden to ask other health questions because
they would slow down the line and introduce inefficiency. Yet these people might very rarely
see a trained nurse, or be in the vicinity of a doctor.51 This approach might fail to treat people
with dignity and respect. In focusing on âefficiencyâ, projects may fail to recognise the human
element of the problem.
Furthermore, in seeking technological solutions to global health, or what Paul Farmer called the
âmagic bullet,â the foundation ignores the vital societal, cultural and infrastructural elements of
health systems for improving global health.52 Accounting for these elements renders decisions
on prioritisation far harder, and outside the realm of economic modelling. When the foundation
ignores societal contexts, or the social determinants of health, it ends up merely âsqueezing the
mortality balloonâ at one end.53 Similarly, the foundationâs focus on vaccines âdetracts from the
focus on the social determinants of health and undermines coherent and long term development
of health systemsâ.54 Birn provides estimates that two-thirds of child deaths and four-fifths of all
adult 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 after
public health has already improved due to nutrition, habitation and sanitation improvements.55
The hunt for âmagicâ solutions, as anything more than a part of the approach could weaken
global health efforts. Michael Edwards perhaps puts it best:
ânew loans, seeds and vaccines are certainly important, but there is no vaccine
against the racism that denies land to âdalitsâ...no technology that can deliver the
47 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.
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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.â56
One final result of the groupthink may be the foundationâs inability to think laterally, given its
intense focus on âgetting resultsâ. This is manifest in the foundationâs endowment policy, which
only excludes investment in Sudan and tobacco. When journalists questioned its investment in
oil, gas and chemical companies, the foundation responded that its role was simply to maximise
money for its programs â seemingly unaware of the fact that some of its programmes will be
negatively affected by the companies its endowment supports.57 One critique of charitable
foundations suggested that they âmaintain the economic and social systems that generate the
very inequality and injustice they wish to correct.â58
In sum, there is a danger that the foundationâs power distorts approaches to global health,
encourages a myopic focus, and even leads to internal contradictions.
5. Conclusion
This essay demonstrated that the Gates Foundation projects extensive instrumental, structural
and especially discursive power. In its relations with WHO, national governments and the field
of global public health more generally it risks being seen as unaccountable, ignorant of the
importance of the social determinants of health and a homogeniser of opinion, despite its desire
to encourage innovation.
The foundation is just one effect of globalisation, which has led to extreme levels of inequality
evidenced by the rise of the âsuperrichâ. A globalised political response trails behind this reality,
allowing the superrich to snap up football teams, or more positively, to found charitable
foundations. The structural argument against foundations is that any system that allows such
huge wealth inequalities is broken, and that this wealth should instead be spent by governments
pursuing democratic policies. Bishop and Greenâs historical review predicts that philanthropy
eventually leads to state provision, but given the lack of a global state, this prediction might not
be realised soon enough for the worldâs poor, even though a global tax and spend regime may be
the only way to truly ameliorate poverty and guarantee minimum standards in global public
health.
Meanwhile, the Bill and Melinda Gates Foundation is leading a growing philanthropic
movement. This essay has shown that there is a clear public interest in scrutinising their
projections of power. Further research should focus on moving beyond anecdotal, journalistic
accounts towards deeper qualitative study, such as process-tracing. Examples could include the
foundationâs involvement in the establishment of the Global Fund, the impact of their funding of
WHO or a review across the field of global health to determine whether policy has shifted
towards idealising technological solutions. Further, the historical argument is exciting. Research
should examine the exact processes by which philanthropy is supplanted by the social state. It
56 Edwards 2008:14. The foundationâs response is that health systems are a governmentâs responsibility,
but given that the foundation is probably responsible for brain drain from national health ministries, and
that it is funding private health schemes, this is a weak argument. Pillar and Smith, 2007; Peoples Health
Movement et al, 2008:254.
57 Heim, 2007.
58 Arnove and Pinede, 2007:389.
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should suggest how to pursue a more equitable, accountable and diverse distribution of power
in global health.
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6. Bibliography and works cited
Arnove, Robert and Pinede, Nadine, 2007. Revisiting the "Big Three" Foundations. Critical Sociology.
Vol. 33, pp. 389â425.
Barnett, Michael, and Duvall, Raymond. 2005. Power in Global Governance. In Power in Global
Governance, edited by Michael Barnett and Raymond Duvall, pp. 1â32. 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. Gates's grandest challenge: transcending technology as public health
ideology. The Lancet, August 6, Vol. 366, No. 9484, pp. 514-519.
Birnbaum, Jeffrey, 2007. Why the Nation's 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. âNGO Power in Global Social and
Environmental Standard-Settingâ, Global Environmental Politics, Vol. 10, No. 4, pp. 36-59.
Bozorgmehr, Kayvan, 2010. "Rethinking the âglobalâ 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, âForget about the Gates Foundation. The world's biggest charity owns IKEAâ
and is devoted to interior designâ. 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), Billâs Annual Letter, published on gatesfoundation.org.
11
12. Joseph Mitchell GGOV643 Health Term Paper
Garrett, 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 Gatesâ, 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. 1â40.
McCoy, David et al, 2009. The Bill & Melinda Gates Foundation's grant-making programme for global
health, The Lancet, May 9, Vol. 373, Issue 9675, pp. 1645-1653.
McNeil, Donald, 2008. Gates Foundationâs 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, 2008
Piller, 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.
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