Illumination and Innovation: What Philanthropic Foundations Bring to Global Health Governance

Abstract

This article argues that because much of the scholarship examining the influence of private foundations in global health governance is either neo-Gramscian or reflexively critical in orientation, undue attention has been paid to foundations' origins, affiliations and perceived biases towards bringing technological solutions to bear on problems with deep socio-political determinants, obscuring their chief functions as global governors while downplaying their agency. Such concerns are by no means new as private philanthropic influence in the governance of global health is not a new phenomenon. Drawing on examples from the Ford, Rockefeller and Bill and Melinda Gates Foundations' efforts to strengthen public health across the Global South, we argue that for over a century private foundations have been instrumental in the governance of collective action problems for two important reasons. Firstly, their stark illumination of state and market failures disproportionately affecting the world's marginalised and the potential of science-enabled innovation to address longstanding challenges has repeatedly generated the requisite political will to address, however imperfectly, global disparities. Secondly, foundations have ensured that functional governance mechanisms exist to provide public goods to the poor when changes to the structural fabric of the world order constrain the ability of other institutions mandated to perform this function.

Notes

* The authors wish to acknowledge Jennifer Clapp and Andrew Cooper for commenting on earlier versions of this article as well as the two anonymous reviewers for their helpful comments and feedback.

1. Jon Cohen, “Gates Foundation Rearranges Public Health Universe”, Science, Vol. 295, No. 5562 (2002), pp. 2000–2001; Kent Buse and Sonja Tanaka, “Global Public–Private Health Partnerships: Lessons Learned from Ten Years of Experience and Evaluation”, International Dental Journal, Vol. 61, No. 2 (2011), pp. 3 and 4.

2. Anne-Emanuelle Birn, “Gates's Grandest Challenge: Transcending Technology as Public Health Ideology”, The Lancet, Vol. 366, No. 9484 (2005), pp. 514–519.

3. David McCoy et al., “The Bill & Melinda Gates Foundation's Grant-Making Programme for Global Health”, The Lancet, Vol. 373, No. 9675 (2009), pp. 1645–1653.

4. Donald G. McNeil, “WHO Official Criticizes Gates Foundation ‘Cartel’ on Malaria Research”, The New York Times, 18 February 2008, available: <http://www.nytimes.com/2008/02/18/health/18iht-gates.1.10134837.html> (accessed 6 March 2008).

5. Charles Piller et al., “Dark Cloud over Good Works of Gates Foundation”, The Los Angeles Times, 7 January 2007, available: <http://www.latimes.com/news/la-na-gatesx07jan07,0,2533850.story> (accessed 8 January 2007).

6. McNeil, op. cit.

7. McCoy et al., op cit.; S. Rushton and O. Williams, “Private Actors in Global Health”, in S. Rushton and O. Williams (eds.), Partnerships and Foundations in Global Health Governance (Basingstoke: Palgrave Macmillan, 2011), pp. 18–19; D. McCoy and L. McGoey, “Global Health and the Gates Foundation—In Perspective”, in Rushton and Williams, Partnerships and Foundations, op cit., pp. 152 and 156.

8. McCoy and McGoey, op cit., p. 161.

9. Tanya Börzel and Thomas Risse, “Public–Private Partnerships: Effective and Legitimate Tools of Transnational Governance”, in E. Grande and L. Pauly (eds.), Complex Sovereignty: Reconstituting Political Authority in the Twenty-First Century (Toronto: Toronto University Press, 2005), p. 204.

10. Robert W. Herdt, “People, Institutions, and Technology: A Personal View of the Role of Foundations in International Agricultural Research and Development 1960–2010”, Food Policy, Vol. 37, No. 2 (2012), p. 185.

11. Ibid., p. 185.

12. Foundation Center, International Grantmaking Update: A Snapshot of US Foundations Trends (New York: Foundation Center, 2010), p. 5.

13. See, for instance, Anne-Emanuelle Birn, Marriage of Convenience: Rockefeller International Health and Revolutionary Mexico (Rochester, NY: University of Rochester Press, 2006); M. Ceuto, “Visions of Science and Development: The Rockefeller Foundation's Latin American Surveys of the 1920s”, in M. Ceuto (ed.), Missionaries of Science: The Rockefeller Foundation and Latin America (Bloomington: Indiana University Press, 1994); M.B. Ogilvie, “The Rockefeller Foundation, China, Western Medicine, and PUMC”, in S. Hewa and P. Hove (eds.), Philanthropy and Cultural Context: Western Philanthropy in South, East, and Southeast Asia in the 20th Century (New York: University Press of America Inc., 1997).

14. E. Richard Brown, “Public Health Imperialism: Early Rockefeller Programs at Home and Abroad”, American Journal of Public Health, Vol. 66, No. 9 (1976), p. 897.

15. Birn, Marriage of Convenience, op. cit.

16. Anne-Emanuelle Birn and Armando Solórzano, “Public Health Policy Paradoxes: Science and Politics in the Rockefeller Foundation's Hookworm Campaign in Mexico in the 1920s”, Social Science & Medicine, Vol. 49, No. 9 (1999), p. 1198.

17. John Baick, “Cracks in the Foundation: Frederick T. Gates, the Rockefeller Foundation, and the China Medical Board”, The Journal of the Gilded Age and Progressive Era, Vol. 3, No. 1 (2004), pp. 59–89.

18. Birn and Solórzano, op. cit., p. 1198.

19. Birn, Marriage of Convenience, op. cit.

20. Birn and Solórzano, op. cit., p. 1204.

21. Brown, op cit., p. 897.

22. Ibid., p. 897.

23. See, for instance, edited volume by Robert F. Arnove (ed.), Philanthropy and Cultural Imperialism: The Foundations at Home and Abroad (Boston, M: G.K. Hall & Co., 1980).

24. Robert Arnove and Nadine Pinede, “Revisiting the ‘Big Three’ Foundations”, Critical Sociology, Vol. 33, No. 3 (2007), pp. 389–425.

25. Ann Vogel, “Who's Making Global Civil Society: Philanthropy and US Empire in World Society”, The British Journal of Sociology, Vol. 57, No. 4 (2006), pp. 635–655.

26. Robert W. Cox, Approaches to World Order (Cambridge: Cambridge University Press, 1996).

27. Benedicte Bull et al., “Private Sector Influence in the Multilateral System: A Changing Structure of World Governance?”, Global Governance, Vol. 10, No. 4 (2004), p. 490.

28. Ibid., p. 490.

29. Peter Utting, “Corporate Responsibility and the Movement of Business”, Development in Practice, Vol. 15, Nos. 3/4 (2005), p. 378.

30. Benedicte Bull and Desmond McNeill, Development Issues in Global Governance: Public–Private Partnerships and Market Multilateralism (New York: Routledge, 2007), pp. 6–7.

31. Anne Zammit, Development at Risk: Rethinking UN-Business Partnerships (Geneva: The South Centre/United Nations Research Institute for Social Development, 2003).

32. Ibid., p. 29.

33. M. Moran, “Philanthropic Foundations and Global Health Partnership Formation: The Rockefeller Foundation and IAVI”, in S.J. MacLean et al., Health for Some: The Political Economy of Global Health Governance (Basingstoke: Palgrave Macmillan, 2009), p. 129; see also volume edited by Rushton and Williams, Partnerships and Foundations, op. cit., pp. 123–205.

34. McCoy and McGoey, op. cit., pp. 144–149.

35. Ibid., p. 152.

36. T. Faubion et al., “Co-Opting the Global Health Agenda: The Problematic Role of Partnerships and Foundations”, in Rushton and Williams, Partnerships and Foundations, op. cit., pp. 212–214.

37. Ibid., pp. 215–218.

38. Ibid., p. 215.

39. Rushton and Williams, “Private Actors in Global Health”, op. cit., p. 18.

40. See, for instance, Arnove, op. cit.

41. M. Moran, “Private Foundations and Global Health Partnerships: Philanthropists and ‘Partnership Brokerage’”, in Rushton and Williams, Partnerships and Foundations, op. cit., pp. 137–140.

42. Moran, “Philanthropic Foundations and Global Health Partnership Formation”, op. cit., p. 129.

43. Richard T. Mahoney and James Maynard, “The Introduction of New Vaccines into Developing Countries”, Vaccine, Vol. 17, No. 7–8 (1999), p. 647; see also Klaus Schwab, “Global Corporate Citizenship: Working with Governments and Civil Society”, Foreign Affairs, Vol. 87, No. 1 (2008), pp. 107–118.

44. Rushton and Williams, “Private Actors in Global Health Governance” op. cit.; Anonymous Interviewee No. 1 (30 June 2011).

45. Anonymous Interviewee No. 2 (23 June 2011).

46. Michael Reich (ed.), Public–Private Partnerships for Health (Cambridge, MA: Harvard University Press, 2002), p. 10.

47. K. Buse and C. Naylor, “Commercial Health Governance”, in K. Buse et al. (eds.), Making Sense of Global Health Governance: A Policy Perspective (Basingstoke: Palgrave Macmillan), pp. 199–201.

48. Anonymous Interviewee No. 3 (19 November 2010).

49. The IHC was renamed the International Health Board in 1915, and finally the IHD in 1927.

50. M. Ceuto, “The Cycles of Eradication: The Rockefeller Foundation and Latin American Public Health, 1918–1940”, in P. Weindling (ed.), International Health Organizations and Movements (Cambridge: Cambridge University Press, 1995), p. 223.

51. Educator Abraham Flexner's highly influential 1910 report, commissioned by the Carnegie Foundation, called for systematic reforms to how medicine and public health were taught in American universities and associated research conducted, leading to standardised admission criteria, duration of studies, salaried professional instructors and schools of medicine becoming part of established universities.

52. Anonymous Interviewee No. 4 (18 January 2011).

53. Established in 1901, The Rockefeller Institute for Medical Research (renamed the Rockefeller University in 1953) is widely seen as a paragon of the eventual establishment of the United States National Institutes of Health (NIH).

54. Anonymous Interviewee No. 3, op. cit.

55. Anonymous Interviewee No. 4, op. cit.; see also Craig Murphy, International Organization and Industrial Change: Global Governance since 1850 (New York: Oxford University Press, 1994), p. 183.

56. Anonymous Interviewee No. 4, op. cit.

57. Anonymous Interviewee No. 5 (23 February 2011).

58. Anonymous Interviewee No. 6 (9 June 2011).

59. Anonymous Interviewee No. 4, op. cit.

60. William Muraskin, The Politics of International Health: The Children's Vaccine Initiative and the Struggle to Develop Vaccines for the Third World (Albany: State University of New York Press, 1998), pp. 27–28.

61. Anonymous Interviewee No. 5, op. cit.

62. Anonymous Interviewee No. 7 (18 August 2011).

63. Anonymous Interviewee No. 8 (12 July 2011).

64. Anonymous Interviewee No. 7, op. cit.

65. William Muraskin, The Politics of International Health, op. cit., pp. viii–ix.

66. Anonymous Interviewee No. 7, op. cit.

67. Anonymous Interviewee No. 8, op. cit.

68. William Muraskin, Crusade to Immunize the World's Children: The Origin of the Bill and Melinda Gates Children's Vaccine Program and the Birth of the Global Alliance for Vaccines and Immunization (Los Angeles: USC Marshall Global BioBusines Intitiative, 2005), pp. 158 and 206.

69. Anonymous Interviewee No. 8, op. cit.

70. William Muraskin, “The Global Alliance for Vaccines and Immunization: Is It a New Model for Effective Public–Private Cooperation in International Public Health?”, American Journal of Public Health, Vol. 94, No. 11 (2004), pp. 1922–1925.

71. Muraskin, Crusade to Immunize the World's Children, op. cit., pp. 158 and 206.

72. Anonymous Interviewee No. 9 (16 August 2011).

73. Duncan Green, From Poverty to Power: How Active Citizens and Effective States Can Change the World (Oxford: Oxfam International, 2008).

74. McCoy et al., op. cit.

75. Lily Kay, The Molecular Vision of Life: Caltech, the Rockefeller Foundation, and the Rise of the New Biology (New York: Oxford University Press, 1993), pp. 8–17; also see K. Prewitt, “American Foundations: What Justifies their Unique Privileges and Powers', in K. Prewitt et al. (eds.), The Legitimacy of Philanthropic Foundations: United States and European Perspectives (New York: Russell Sage Foundation, 2006), pp. 27–46.

76. Mary Moran, “A Breakthrough in R&D for Neglected Diseases: New Ways to Get the Drugs We Need”, PLOS Medicine, Vol. 2, No. 9 (2005), p. e302.

77. Anonymous Interviewee No. 9, op. cit.

78. Anonymous Interviewee No. 8, op. cit.

79. Anonymous Interviewee No. 9, op. cit.

80. M. Moran and M. Stevenson, “Partnerships and the MDGs: The Challenge of Reforming Global Health Governance”, in G. Brown et al. (eds.), The Handbook of Global Health Policy (Hoboken, NJ: Wiley-Blackwell forthcoming 2013).

81. Kent Buse and Gill Walt, “Global Public–Private Partnerships. Part I: What Are the Health Issues for Global Governance”, The Bulletin of the World Health Organization, Vol. 78, No. 5 (2000), pp. 704–705; see also McCoy et al., op. cit.

82. “What Has the Gates Foundation Done for Global Health?”, The Lancet, Vol. 373, No. 9675 (2009), p. 1577.

83. Ibid., p. 1577.

84. Anonymous Interviewee No. 9, op. cit.

85. Rushton and Williams, “Private Actors in Global Health”, op. cit., p. 19.

86. Ibid., p. 19.

87. Ibid., p. 18.

88. David Fidler, “Architecture amidst Anarchy: Global Health's Quest for Governance”, Global Health Governance, Vol. 1, No. 1 (2007), p. 3.

89. Judith Richter, “Public–Private Partnerships for Health: A Trend with No Alternatives?”, Development, Vol. 47, No. 2 (2004), p. 46.

90. Kent Buse and Andrew Harmer, “Seven Habits of Highly Effective Global Public–Private Health Partnerships: Practice and Potential”, Social Science & Medicine, Vol. 64 (2007), p. 267.

91. Ann Danaiya Usher, “GAVI Enters its Second Decade with Massive Funding Gap”, The Lancet, Vol. 375, No. 9717 (2010), p. 791.

92. Ann Danaiya Usher, “GAVI Takes Steps to Address Funding Woes”, The Lancet, Vol. 377, No. 9764 (2011), p. 453.

93. S. Osberg, “Wayfinding without a Compass: Philanthropy's Changing Landscape and its Implications for Social Entrepreneurs”, in A. Nicholls (ed.), Social Entrepreneurship: New Models for Sustainable Social Change (Oxford: Oxford University Press, 2006).