U.S. Philanthrocapitalism and the Global Health Agenda: The Rockefeller and Gates Foundations, Past and Present
by Anne-Emmanuelle Birn and Judith Richter
Advance preview of Chapter 10 from Health Care under the Knife: Moving Beyond Capitalism for Our Health, Howard Waitzkin and the Working Group for Health Beyond Capitalism, eds. Monthly Review Press (forthcoming 2018). Published under licence from the authors
A fiercely competitive and enormously successful U.S. businessman turns his attention mid-career to worldwide public health. Historic curiosity? Or the most powerful contemporary actor in this field? As it turns out, both. At the beginning of the twentieth century, the Rockefeller Foundation (RF) began to use John D. Rockefeller’s colossal oil profits to stake a preeminent role in international health (as well as medicine, education, social sciences, agriculture, and natural sciences). About a century later, the Bill and Melinda Gates Foundation (BMGF), named for the software magnate and his wife, had become the most influential agenda-setter in the global health and nutrition arena (and in agriculture, development, and education).
Each of these powerhouse foundations emerged at a decisive juncture in the history of international health. Each foundation was started by the richest, most driven capitalist of his day. Each businessman faced public condemnation for his unscrupulous, monopolistic business practices.1Both have been subject to adulation and skepticism regarding their philanthropic motives.2Sharing narrow, medicalized understandings of disease and its control, the RF sought to establish health cooperation as a legitimate sphere for intergovernmental action and shaped the principles, practices, and key institutions of the international health field,3while the BMGF appeared as global health governance was facing a crisis.
Both foundations and their founders were/are deeply political beings, recognizing the importance of public health to capitalism and of philanthropy to their reputations, while claiming the purportedly neutral technical and scientific basis of their efforts.
However, there is one critical difference between them: the RF supported public health as a public responsibility, while BMGF actions have challenged the leadership and purview of public, intergovernmental agencies, fragmenting health coordination and allotting a massive global role for corporate and philanthropic “partners.”4
Given the confluence of largesse and agenda setting at distinct historical moments, several questions emerge: How and why have U.S. mega-philanthropies played such an important role in producing and shaping knowledge, organizations, and strategies to address health issues worldwide? What are the implications for global health and its governance?
Such questions are particularly salient given that “philanthrocapitalism” is hailed as the means to “save the world” even as it depends on profits amassed from financial speculation, tax shelters, monopolistic pricing, exploitation of workers and subsistence agriculturalists, and destruction of natural resources—profits that are channeled, albeit indirectly, into yet more profiteering. The term philanthrocapitalism, coined by The Economist’s U.S. business editor, refers both to infusing philanthropy with the principles and practices of for-profit enterprise and to demonstrating capitalism’s benevolent potential through innovations that allegedly “benefit everyone, sooner or later, through new products, higher quality and lower prices.”5
Most government entities are subject to public scrutiny, but private philanthropies are accountable only to their own self-selected boards. Just a few executives make major decisions that affect millions of people. In North America (and various other jurisdictions), corporate and individual contributions to non-profit entities are tax deductible, removing an estimated $40 billion from U.S. public coffers each year.6 At least one-third (depending on the tax rate) of private philanthropies’ endowments thereby is subsidized by the tax-paying public, which has no say in how such organizations’ priorities are set or monies spent.
This chapter compares and contrasts the goals, modus operandi, and agenda setting roles of the RF and BMGF. We proposed that both the early twentieth century RF and the contemporary BMGF have significantly shaped the institutions, ideologies, and practices of the international/global health field, sharing a belief in narrow, technology-centered, disease-control approaches. The RF, however, favored creation of a singular, public, coordinating agency for global health (eventually, the World Health Organization, WHO), while the BMGF’s privatizing approaches undermine WHO’s constitutional mandate to promote health as a fundamental human right. Indeed, the BMGF’s venture-philanthropy approach—applying methods from the venture capital field to charitable giving7—underpins and is emblematic of the business models that now penetrate the global public health field. These conditions have resulted in extensive private, for-profit influence over global health activities and have blurred boundaries between public and private spheres, representing a grave threat to democratic global health governance and scientific independence.8
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- Ron Chernow, Titan: The Life of John D. Rockefeller, Sr. (New York: Random House, 1998); William H. Page and John E. Lopatka, The Microsoft Case: Antitrust, High Technology, and Consumer Welfare (Chicago: University of Chicago Press, 2009).
- William Wiist, Philanthropic Foundations and the Public Health Agenda (New York: Corporations and Health Watch, 2011), http://corporationsandhealth.org/2011/08/03/philanthropic-foundations-and-the-public- health-agenda/.
- Josep Lluís Barona, The Rockefeller Foundation, Public Health and International Diplomacy, 1920–1945 (New York: Routledge, 2015).
- Judith Richter, Public-Private Partnerships and International Health Policy Making: How Can Public Interests Be Safeguarded? (Helsinki: Ministry for Foreign Affairs of Finland, Development Policy Information Unit, 2004); Jens Martens and Karolin Seitz, Philanthropic Power and Development: Who Shapes the Agenda? (Aachen/Berlin/Bonn/New York: Brot für die Welt/Global Policy Forum/MISEREOR, 2015). https://www.globalpolicy.org/images/pdfs/Newsletter/newsletter_15_09_25.pdf.
- Matthew Bishop and Michael Green, Philanthrocapitalism: How Giving Can Save the World (New York: Bloomsbury Press, 2009). The original 2008 subtitle of Philanthrocapitalism volume, How the Rich Can Save the World, was changed in the wake of the 2008 global financial crisis when it became apparent that the rich were harming rather than saving the world. Website: http://philanthrocapitalism.net/about/faq/
- George Joseph, “Why Philanthropy Actually Hurts Rather Than Helps Some of the World’s Worst Problems,” In These Times, December 28, 2015, http://inthesetimes.com/article/18691/Philanthropy_Gates-Foundation_Capitalism.
- David Callahan, The Givers: Money, Power, and Philanthropy in a New Gilded Age (New York: Alfred A. Knopf, 2017).
- This is magnified by other actors, in particular the World Economic Forum’s Global Redesign Initiative (WEF GRI), a corporate-led campaign that set out in 2009 to restructure the architecture of global decision-making so that UN agencies become just one of many “stakeholders” in “multi-stakeholder governance.” See Judith Richter, “Time to Turn the Tide: WHO’s Engagement with Non-State Actors and the Politics of Stakeholder-Governance and Conflicts of Interest,” BMJ 348 (2014): g3351, http://www.bmj.com/content/348/bmj.g3351; Flavio Valente, “Nutrition and Food – How Government for and of the People Became Government for and by the TNCs,” Transnational Institute, January 19, 2016, https://https://www.tni.org/en/article/nutrition-and-food-how-government-for-and-of-the-people-became-government-for-and-by-the .