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.