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The Emergence of Private, Mega Philanthropy Foundations and The Implications For Global Public Health

202x Trends and Perspectives- May 2, 2011, University Of Pennsylvania - CVEP

The Nature of the Issue

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The Gates Foundation is one of the largest donors to the WHO, giving sums (approximately $150MM) that amount to about 4% of WHO’s overall budget in 2008 [*]

* WHO’s Budgetary Allocations and Burden of Disease: A Comparative Analysis, David Stuckler, Lawrence King, Helen Robinson, Martin McKee; Lancet 372: 1563-1569

The Gates Foundation - Example

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The Gates Foundation - Example

Bill and Melinda Gates Pledge $10 Billion in Call for Decade of Vaccines - Increased vaccination could save more than 8 million children by 2020; significant funding gaps remain, others must join effort

DAVOS, Switzerland -- Bill and Melinda Gates announced today that their foundation will commit $10 billion over the next 10 years to help research, develop and deliver vaccines for the world’s poorest countries.

The Gates said that increased investment in vaccines by governments and the private sector could help developing countries dramatically reduce child mortality by the end of the decade, and they called for others to help fill critical financing gaps in both research funding and childhood immunization programs.

January 29, 2010, Gates Foundation Press Release 

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The Gates Foundation - Example

BERLIN -- German Development Minister, Dirk Niebel, met today with Bill Gates, Co-chair of the Bill & Melinda Gates Foundation, in Berlin. During this meeting, they signed an agreement for close cooperation between the Federal Ministry for Economic Cooperation and Development, BMZ, and the Gates Foundation. This agreement encompasses the areas of global health policy, agriculture and rural development, water and sanitation, urban development, as well as microfinance.

The Partnership will commence with a joint increase to the vaccine initiative, the GAVI alliance with the commitment of the BMZ to increase its contribution through innovative bilateral contributions. The ministry will increase its funding by €14m in 2011 for childhood immunization. In turn, the Gates Foundation will match this amount through multilateral contributions to GAVI; the foundation will also match any further increase in funds for 2012 and 2013 should Germany announce these contributions ahead of the June GAVI Pledging Conference.

Bill Gates said: “We are very happy to sign this agreement that will make it easier to cooperate on our common priorities of investing in smart aid, which can save lives, improve living conditions and build a prosperous and stable society.

April 6, 2011, Gates Foundation, Press Release

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The Gates Foundation - Example

Smart Aid Works : The numbers are impressive:

•In the last 50 years, child deaths in the developing world have been cut by more than 50 percent, despite the birth rate increasing;•Polio cases have been reduced by 99 percent since 1988, and we are now on the threshold of eradicating only the second disease in history;•Measles deaths in Africa dropped by 92 percent between 2000 and 2008;•Malaria cases have been reduced by 50 percent in 38 countries between 2000 and 2008;•Ghana’s agriculture sector is growing at more than 5 percent a year and the country cut hunger levels by 75 percent from 1990 to 2004.

“I come to Germany with the simple message that smart aid works,” Bill Gates said. “And while we have facts and figures as evidence, it’s the lives saved and the futures restored that are the real living proof that our investments in aid are working.”

April 6, 2011, Press Release, Gates Foundation

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Top Five US Foundations-By Asset Size

Rank Name/(state) Assets

As ofFiscal YearEnd Date

1.Bill & Melinda Gates Foundation (WA) $33,912,320,600 12/31/20092.Ford Foundation (NY) 10,742,611,000 09/30/20103.J. Paul Getty Trust (CA) 9,339,172,138 06/30/20094.The Robert Wood Johnson Foundation (NJ) 8,490,415,783 12/31/20095.W. K. Kellogg Foundation (MI) 7,238,160,845 08/31/2010

The list below includes the five largest U.S. grant making foundations ranked by the market value of their assets, based on the most current audited financial data in the Foundation Center's database as of February 22, 2011. Fiscal records will be updated when more recent audited financial information is obtained.

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More to Come… To Date, 69 Billionaires

My Philanthropic Pledge - Warren Buffett

In 2006, I made a commitment to gradually give all of my Berkshire Hathaway stock to philanthropic foundations. I couldn't be happier with that decision. Now, Bill and Melinda Gates and I are asking hundreds of rich Americans to pledge at least 50% of their wealth to charity. So I think it is fitting that I reiterate my intentions and explain the thinking that lies behind them. First, my pledge: More than 99% of my wealth will go to philanthropy during my lifetime or at death. Measured by dollars, this commitment is large. …

My family and I will give up nothing we need or want by fulfilling this 99% pledge. Moreover, this pledge does not leave me contributing the most precious asset, which is time. what I call the ovarian lottery. (For starters, the odds against my 1930 birth taking place in the U.S. were at least 30 to 1. My being male and white also removed huge obstacles that a majority of Americans then faced.) …

Were we to use more than 1% of my claim checks on ourselves, neither our happiness nor our well-being would be enhanced. In contrast, that remaining 99% can have a huge effect on the health and welfare of others. That reality sets an obvious course for me and my family: Keep all we can conceivably need and distribute the rest to society, for its needs…

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Private foundations

Data on the contribution made by private foundations towards international development are relatively limited. The World Bank stated that in 2005 private donors gave roughly US$4–4.5 billion to international development, but noted that philanthropic giving ‘is significantly under-researched due to the lack of a world-wide data collection procedure’ (Sulla 2006).

The entry of the Bill & Melinda Gates Foundation into the global health landscape (bringing with it also the donation of US$30 billion by Warren Buffett) has taken private, philanthropic funding for international development, especially for health, to new and unprecedented heights. One estimate of the amount of private foundation spending on global health in 2005 was US$1.6 billion, much of it coming from the Gates Foundation (MacArthur 2006).

In 2006, the Gates Foundation awarded 195 global health grants amounting to US$2.25bn in total (McCoy et al. 2009). In terms of money paid out to global health grants, US$916 million and US$1.22 billion were disbursed in 2006 and 2007, respectively. The Foundation is now a bigger international health donor than all governments bar the United States and the United Kingdom.

Global Health Funding: How Much, Where It Comes From And Where It Goes, Health Policy Plan 24: 407-417, 2009

The Issues – Power & Influence Re: Public Policy

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The Rockefeller Foundation grew out of the Standard Oil Company and was criticised for becoming a leading funder of the eugenics movement[1], and subsequently for population control programmes linked to President Nixon’s declaration that population growth in developing countries reduced access to key raw materials and was therefore a “national security threat”[2].

[1] Black E (2003) Eugenics and the Nazis -- the California connection. San Francisco Chronicle. http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2003/11/09/ING9C2QSKB1.DTL.

[2] Engdhal W (2005) Seeds of destruction: The geopolitics of GM food: connection between Monsanto and The Rockefeller Foundation. http://www.politicalfriendster.com/showConnection.php?id1=238&id2=2472

The Issues – Power & Influence Re: Public Policy

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Money which ought to be in the hands of the public is being retained by aristocrats for purposes beyond the control of democratic institutions; the academic freedom of universities is being subverted by control of academic budgets by the foundations; public policy is being determined by private groups; the scientific and scholarly research and the artistic creativity of individuals are being stifled by the emphasis of foundations on group-research; smallness and individual effort are thwarted by materialistic and business-oriented demands of foundation management; foundations are bastions of an elite of white, Anglo-Saxon, Protestant managers holding out against the normal development of a pluralistic and ethnic society. Karl B, Katz, SN (1981) The American Private Philanthropic Foundation And The Public Sphere, 1890-1930. Minerva 19: 236-270.

The Issues – Power & Influence Re: Public Policy

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The Rockefeller Foundation was criticised for having advanced the entry of genetically-modified crops into new markets against popular opposition, while having financial investments in genetically-modified-seed-producing companies [3].

[3] Maessen J (2009) Beyond golden rice: The Rockefeller Foundation's long-term agenda behind Genetically Modified Food. http://www.globalresearch.ca/index.php?context=va&aid=13944

The Issues – Real and/or Perceived Conflict of Interest

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The Issues – Real and/or Perceived Conflict of Interest

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The Flip Side of The Issues Country Comparison :: Life expectancy at birth

This entry contains the average number of years to be lived by a group of people born in the same year, if mortality at each age remains constant in the future. The entry includes total population as well as the male and female components. Life expectancy at birth is also a measure of overall quality of life in a country and summarizes the mortality at all ages. It can also be thought of as indicating the potential return on investment in human capital and is necessary for the calculation of various actuarial measures. – CIA Handbook-2011

Rank country (years) Date of Information

1 Monaco 89.73 2011 est.

5 Japan 82.25 2011 est.

9 Australia 81.81 2011 est.

12 Canada 81.38 2011 est.

27 Germany 80.07 2011 est.

28 United Kingdom 80.05 2011 est.

50 United States 78.37 2011 est.

57 Cuba 77.70 2011 est.

95 China 74.68 2011 est.

160 World 67.07 2011 est.

186 Ghana 61.00 2011 est.

192 Botswana 58.05 2011 est.

193 Rwanda 58.02 2011 est.

195 Cote d'Ivoire 56.78 2011 est.

196 Ethiopia 56.19 2011 est.

197 Sierra Leone 56.13 2011 est.

201 Cameroon 54.39 2011 est.

215 Zimbabwe 49.64 2011 est.

216 South Africa 49.33 2011 est.

220 Nigeria 47.56 2011 est.

221 Afghanistan 45.02 2011 est.

222 Angola 38.76 2011 est.

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The Flip Side of The Issues

Country Comparison :: HIV/AIDS - adult prevalence rate

This entry gives an estimate of the percentage of adults (aged 15-49) living with HIV/AIDS. The adult prevalence rate is calculated by dividing the estimated number of adults living with HIV/AIDS at yearend by the total adult population at yearend. CIA World Fact Book, 2011-

Rank country (%) Date of Information

1 Swaziland 25.90 2009 est.

2 Botswana 24.80 2009 est.

3 Lesotho 23.60 2009 est.

4 South Africa 17.80 2009 est.

5 Zimbabwe 14.30 2009 est.

6 Zambia 13.50 2009 est.

7 Namibia 13.10 2009 est.

8 Mozambique 11.50 2009 est.

9 Malawi 11.00 2009 est.

10 Uganda 6.50 2009 est.

11 Kenya 6.30 2009 est.

12 Tanzania 5.60 2009 est.

13 Cameroon 5.30 2009 est.

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The Flip Side of The Issues

Country Year

Per Per capita government expenditure on health at average exchange rate (US$)

Monaco 2008 2,5596,667Germany 2008 3,6923,556

United States of America 2008 7,5363,506United Kingdom 2008 3,2303,248Canada 2008 4,0953,234Australia 2008 3,4482,923Japan 2008 2,7512,510Cuba 2008 1,132642Botswana 2008 779291South Africa 2008 826187Angola 2008 161103China 2008 25966Zimbabwe 2007 2036

Ghana 2008 11328

Rwanda 2008 10723

Nigeria 2008 13422Cameroon 2008 12119Côte d'Ivoire 2008 6811Afghanistan 2008 8410Ethiopia 2008 306Sierra Leone 2008 324

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Reflections

Private, Mega Foundations are major players in International Public Health

These Foundations are and will continue to form, shape and direct International Public Health issues and policy

A major reason for the relevance of these Foundations is the failure and/or inability of governments in multiple countries to care for the health of their citizens

These Foundations are here to stay

There are important policy issues that this phenomenon raise and that need to be reflected on and further discussed

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