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Attacking Gates

A chapter dedicated to the Gates Foundation’s work on tackling diseases in the developing world, in a new report called Global Health Watch 2, brings together most of the main criticisms of the foundation. It provides a useful checklist of what some in the global health community have against the world’s leading philanthrocapitalist. So here goes, with a bit of commentary from us, which draws in part on our discussion of some of these criticisms in the book:

1) Philanthropy in general may be tainted by where the money comes from. Our reply: Yes, the way that wealth has been earned is pertinent to the social contract between the rich and the rest.  But Gates has a good case that he has earned his money through merit rather than rent-seeking and that he has already paid the price for any anti-competitive practices by Microsoft by due process of the antitrust courts.
2) Philanthropy is not always well motivated. Our reply: True, vanity and other lesser emotions may play a part in giving.  But does that matter if that philanthropy is doing good? Surely impact is more important than motivation? Anyway, Gates does appear to be driven by a strong ethic that all lives are of equal value, and that he has been fortunate and thus has a responsibility to give back, which seems a pretty good motivation.
3) Philanthropy concedes power to the wealthy. Our reply: Yes, the wealthy do have power in society but philanthropy can be a way to use that power to good ends. Having effective systems to manage the political and philanthropic power of the rich is what matters, rather than wishing philanthropy away.
4) Philanthropy can steer social movements towards “more conservative positions” and creates division and competition within civil society. Our reply: These charges are unsubstantiated and seem to be based on a romantic notion that all of civil society is good.  As we have argued before, one of philanthrocapitalism’s greatest achievements would be to help the nonprofit sector to become more effective by helping the good in civil society to grow at the expense of the bad and the ugly.
5) Gates invests in unethical companies. We look at this criticism in some detail in the book. The problem is defining unethical (are all investments in energy and pharmaceutical companies necessarily unethical?).  Rather than putting his money only into ethically copper-bottomed investments, Gates thinks he does more good by going for maximum returns so that he has more to give away. This is a logically defensible position, though there is certainly a case to be made for trying to find ways of investing more ethically.
6) The Gates Foundation is not accountable to developing governments or the World Health Organisation. Our reply: That may be the point – it gives Gates the freedom to do risky things that global consensus policy-making would not permit (as Peter Piot, the outgoing head of the UN agency leading the fight against HIV/AIDS has argued).
7) Gates uses research, lobbying and the media to set the global health agenda. Our reply: Er, that’s the point isn’t it?
8) Gates is tied narrowly to pursuing technological solutions to diseases. Our reply: This has been a fair criticism in the past and one that the Foundation has taken on board as it increasingly takes an interest in health systems issues – it’s a signatory to a compact between donors and recipients called the Global Health Partnership that is all about health systems, as the author acknowledges.
9) Gates’ position on intellectual property is uncertain. Our reply: Gates is using private sector expertise to find ways to lever in the pharmaceutical companies to do more on global health, which may do more good than bemoaning the status quo.

 The (anonymous) author of this chapter says that its purpose is “to stimulate a more critical discussion about this important global health actor and about philanthropy in general.”  This is a worthwhile exercise and we would certainly support the author’s call for as much transparency as possible, from Gates and all the other philanthrocapitalists (and from critics too, we would add).

A part of the global health profession is reacting against the entry of a new and disruptive force into their business.  The author would, it seems, like to see the Gates Foundation acting like everyone else, at one point questioning why Gates isn’t getting involved in providing direct grants to developing country governments (known as ‘budget support’ in the aid business) as government donors are doing.  But to do that would be to squander the best of what the philanthrocapitalists can offer. Philanthropy, even Gates-scale philanthropy, will always be small relative to governments (as we quote him saying in the book).  To be effective, philanthropists need to use their business skills and ability to take risks to find new and different ways of tackling problems that governments and international institutions cannot.

That is what Gates is trying to do, even if it upsets the establishment. Indeed, even the author of this critical chapter concedes he is having an impact: “If ‘global health’ ten years ago was a moribund patient, the Gates Foundation today could be described as a transfusion of fresh blood that has helped revive the patient”. Amen.

0 replies on “Attacking Gates”

Matthew Bishop and Michael Green state: 1) Philanthropy in general may be tainted by where the money comes from. Our reply: Yes, the way that wealth has been earned is pertinent to the social contract between the rich and the rest. But Gates has a good case that he has earned his money through merit rather than rent-seeking and that he has already paid the price for any anti-competitive practices by Microsoft by due process of the antitrust courts.

GHW: Well, this is partly a matter of proportion. There is nothing wrong with rewarding people for hard work and enterprise, and Bill Gates is undoubtedly gifted, hard working and enterprising. But a system that allows reward to be accumulated by people to such an excessive degree has something wrong with it. Grossly excessive material profits are socially harmful and divisive, never mind distasteful. A society that accepts, condones and even exalts such concentrations of wealth side by side with entrenched and growing poverty is a society that is morbid and unhealthy. The excessive size of many current rewards, driven by market failures of various sorts, far exceeds the utility that rewards play in incentivising enterprise.

Matthew Bishop and Michael Green state: 2) Philanthropy is not always well motivated. Our reply: True, vanity and other lesser emotions may play a part in giving. But does that matter if that philanthropy is doing good? Surely impact is more important than motivation? Anyway, Gates does appear to be driven by a strong ethic that all lives are of equal value, and that he has been fortunate and thus has a responsibility to give back, which seems a pretty good motivation.

GHW: Impact is important – of course. But so is motivation. Poorly motivated philanthropy can lead to inappropriate, ineffective and even harmful acts of charity. ‘Doing good’ is not as simple as it may sound. Put another way, there are good ways of ‘doing good’ and there are bad ways of ‘doing good’. Vanity and ego-centricity frequently underlie bad (or false) philanthropy, and there seems to be a streak of that in the way the Foundation’s charity is so tightly wound around the personality and cult of one man. However, vanity and ego are minor issues raised in the GHW chapter.

As for believing that ‘all lives are of equal value’, I would suggest that people read beyond the lines of the Foundation’s strapline. A true and real belief in equality would see a much more politically conscious approach to ‘doing good’ – rather than one that is so centred on the idea of top-down technological help (charity) for poor people who are generally treated as if they are simply unlucky with life. The reality is that many people with poor health are denied even the most basic elements of development, freedom and health for social and political reasons. If the Foundation believes that all lives are of equal value, then it should work on a social and political agenda that gives people more equal economic, social and cultural rights.

Matthew Bishop and Michael Green state: 3) Philanthropy concedes power to the wealthy. Our reply: Yes, the wealthy do have power in society but philanthropy can be a way to use that power to good ends. Having effective systems to manage the political and philanthropic power of the rich is what matters, rather than wishing philanthropy away.

GHW: Thankyou for helping make our case. Your argument doesn’t sound like someone who believes that ‘all lives are of equal value’? The problem with the huge economic and political power wielded by Bill Gates is that it condones and even exalts the concentration of that power and wealth – which by implication, condones inequality and and perpetuates the disempowerment of many others.

There seem to be two instincts that guide a person’s response to philanthrocapitalism – one is to be attracted to the apparent benevolence of people with wealth and power; the other is to challenge and question the concentration of power as an underlying cause of inequality and poverty. We appear to share different instincts, even if we might share the same social objectives.

Matthew Bishop and Michael Green state: 4) Philanthropy can steer social movements towards “more conservative positions” and creates division and competition within civil society. Our reply: These charges are unsubstantiated and seem to be based on a romantic notion that all of civil society is good. As we have argued before, one of philanthrocapitalism’s greatest achievements would be to help the nonprofit sector to become more effective by helping the good in civil society to grow at the expense of the bad and the ugly.

GHW: You have quoted the book out of context. Global Health Watch raises an argument made by many scholars who have studied philanthropy. Philanthropy can be wielded in a way that attenuates social movements and used to ‘divide and rule’ in favour of the interests of elites. It is not an unsubstantiated argument, and hardly a far-fetched or radical idea.

Furthermore, nowhere does the chapter suggest that all civil society is good. There are many examples of ‘bad civil society’. But the mere fact that gross levels of health inequality, child deaths and premature mortality are treated largely as apolitical phenomena by the Gates Foundation in itself has a debilitating effect on society’s understanding of the social determinants of health.

Matthew Bishop and Michael Green state: 5) Gates invests in unethical companies. We look at this criticism in some detail in the book. The problem is defining unethical (are all investments in energy and pharmaceutical companies necessarily unethical?). Rather than putting his money only into ethically copper-bottomed investments, Gates thinks he does more good by going for maximum returns so that he has more to give away. This is a logically defensible position, though there is certainly a case to be made for trying to find ways of investing more ethically.

GHW: We are glad you concede a small point here. It’s not very good being a ‘philanthocapitalist’ if at the same time you’re supporting and making money from our present day robber barrons and unregulated merchants of disease and death. Large segments of global capitalism today are brutal, harmful and criminal. The decision by the Gates Foundation not to invest its endowment ethically is bizarre at best.

Matthew Bishop and Michael Green state: 6) The Gates Foundation is not accountable to developing governments or the World Health Organisation. Our reply: That may be the point – it gives Gates the freedom to do risky things that global consensus policy-making would not permit (as Peter Piot, the outgoing head of the UN agency leading the fight against HIV/AIDS has argued – see previous blog entry).

GHW: No – you miss the point. It’s not a case of Gates simply doing ‘risky things’. The Foundation, by virtue of its grant-making programme and its policy influence on governments, civil society and UN agencies, may be ‘doing things that are harmful’. It has effects on a wide range of other actors and some of these are destablising and inappropriate. Why don’t you accompany us on a field trip to Africa and we’ll show exactly what we mean and why the Foundation needs to be more accountable?

Finally, you forget the point that a large amount of the Foundation’s funds are tax-exempt dollars. Society has some claim over this money and should expect to see that it is spent well. This doesn’t even take into account the grossly inadequate systems of financial regulation that have allowed multinationals in general to escape their social duties by engaging in massive amounts of tax avoidance.

Matthew Bishop and Michael Green state: 7) Gates uses research, lobbying and the media to set the global health agenda. Our reply: Er, that’s the point isn’t it?

GHW: Yes, but who says it is setting the right global health agenda?!

Matthew Bishop and Michael Green state: 8) Gates is tied narrowly to pursuing technological solutions to diseases. Our reply: This has been a fair criticism in the past and one that the Foundation has taken on board as it increasingly takes an interest in health systems issues – it’s a signatory to a compact between donors and recipients called the Global Health Partnership that is all about health systems, as the author acknowledges.

GHW: Well, there is certainly more rhetoric thrown in the direction of strengthening health systems. And there may be a few more grants thrown in that direction as well. But have you done a thorough analysis of the Foundation’s pattern of grant-making? And do you know what effect its funding is having on health systems? Let’s take that trip together.

It’s fine to say that governments should be responsible for health systems. But the problem is that the Foundation’ funding of, for example, vertical and selective health care programmes and its support for the expansion of private for-profit private health care in Africa, is actually weakening health systems.

Matthew Bishop and Michael Green state: 9) Gates’ position on intellectual property is uncertain. Our reply: Gates is using private sector expertise to find ways to lever in the pharmaceutical companies to do more on global health, which may do more good than bemoaning the status quo.

GHW: Yes – absolutely. But there is an alternative option to merely bemoaning the status quo. We can change TRIPS (the Agreement on trade-related aspects of intellectual property) and reverse the TRIPS-plus effects of bilateral and regional trade agreements. Let’s reform the current intellectual property rights regime so that we make the scientific discovery more efficient and less fraudulent; so that the benefits of such discovery are harnessed more effectively to meet the needs of society; and so that such excessive profits (also publicly-subsidised) are not made by a Big Pharma.

Matthew Bishop and Michael Green state: The (anonymous) author of this chapter says that its purpose is “to stimulate a more critical discussion about this important global health actor and about philanthropy in general.” This is a worthwhile exercise and we would certainly support the author’s call for as much transparency as possible, from Gates and all the other philanthrocapitalists (and from critics too, we would add).

GHW: The Global Health Watch is designed to represent a collective view. All authors have foregone the benefits of intellectual attribution in favour of representing a larger viewpoint. The Economist promotes a particular corporate-friendly viewpoint through articles that are not attributed to individual authors. Contributions to the Global Health Watch have been made in a spirit of solidarity – not one which seeks to place the names of people in lights.

Matthew Bishop and Michael Green state: A part of the global health profession is reacting against the entry of a new and disruptive force into their business. The author would, it seems, like to see the Gates Foundation acting like everyone else, at one point questioning why Gates isn’t getting involved in providing direct grants to developing country governments (known as ‘budget support’ in the aid business) as government donors are doing. But to do that would be to squander the best of what the philanthrocapitalists can offer. Philanthropy, even Gates-scale philanthropy, will always be small relative to governments (as we quote him saying in the book). To be effective, philanthropists need to use their business skills and ability to take risks to find new and different ways of tackling problems that governments and international institutions cannot.

GHW: We agree that many benefits that can be accrued from private money being harnessed to serve society. But these benefits do not excuse the problems that can accompany philanthropy. As for the point about the Foundation’s relatively small amount of funding – yes, that’s true in nominal terms. But because a variety of factors, Gates money has enormous leverage power within the health sector. Although its budget is small relative to government budgets, it goes a very long way. We would be happy to explain this further, and to show you first hand.

Matthew Bishop and Michael Green state: That is what Gates is trying to do, even if it upsets the establishment. Indeed, even the author of this critical chapter concedes he is having an impact: “If ‘global health’ ten years ago was a moribund patient, the Gates Foundation today could be described as a transfusion of fresh blood that has helped revive the patient”. Amen.

GHW: Amen indeed. As you imply, the GHW chapter is not a gratuitous and thoughtless attack on Gates as you wrongly and unfairly accuse it of being.

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