the Gates money
Prof. Howard Berliner on the Buffett Donation and the Gates Foundation
I asked Howard Berliner, Professor of Health Services Management and
Policy at the New School in New York City, if he could write a brief
comment on the Buffett donation and the ideology of the Gates
Foundation, and he graciously agreed to do so. Berliner is a polymath
� an expert on urban health care systems today and an accomplished
medical historian. He also frequently collaboratored with the late,
legendary Columbia University medical economist and urban health
expert Eli Ginzberg on a series of works, the last of which was The
Health Marketplace: New York City, 1990-2010 (New Brunswick:
Transaction Publishers, 2001). You should visit his website to read
his lastest work.
I asked Berliner to comment because he authored another important
book on the role of big philanthropy in shaping medical education and
the medical research agenda. A System of Scientific Medicine:
Philanthropic Foundations in the Flexner Era (New York: Tavistock,
1985) came out six years after Richard Brown�s controversial
Rockefeller Medicine Men, which I wrote about a little last week, and
which Berliner reviewed favorably (along with two others) at the time
for the Bulletin of the History of Medicine. (The reaction to his
review from the Bulletin�s editor review is a fascinating story for a
forthcoming post and will answer a few questions I�ve received about
the reaction to Brown�s book.)
And if you missed it last week, here�s Anne-Emmanuelle Birn�s Lancet
commentary on the Gates Foundation�s health programs, discussed by
Berliner below.
Here is Prof. Berliner�s commentary:
The Gates Billions
The recent announcement that Bill Gates is stepping down from his
Microsoft position to play a greater role in his foundation and the
subsequent announcement that Warren Buffet is giving $31 billion to
the foundation (of which he is a board member) has certainly set the
philanthropic world aflutter. The largest foundation ever, with more
money to distribute than the United Nations and largely focused on
areas of public health (both topical and geographic) that get little
other support.
In the early 1900�s, the gifts of John D. Rockefeller to
international public health not only created the initial schools of
public health ( e.g., Johns Hopkins), but also brought new medical
discoveries to large segments of the world that had no other way of
obtaining them. The initial analysis of the Rockefeller gifts was
explained in terms of religious obligations and the needs of the
wealthy to help the poor, if only to further their entrance into
heaven. Later analyses, by myself and E. Richard Brown, among others,
looked to the way that the philanthropy eased the inroads of western
business into hostile areas and how the gifts ultimately led to the
expansion of markets.
At the time of the Rockefeller philanthropies, much of the criticism
was based on the notion of �blood money�� the Rockefeller money had
been expropriated from workers, many of whom died in the struggle to
achieve better and safer working conditions and a living wage. Anyone
who used the money had the blood of those workers on them. While this
argument never really went away, it never stopped anyone from
accepting the money either.
The best arguments against the Gates Foundation money have been laid
out by Anne-Emanuelle Birn in her piece in the Lancet. But critiques
from the left seldom have much weight when contrasted with the clear
and vast needs of the populations that will receive the largesse.
One could argue that the Gates money is going to areas that western
philanthropy has long ignored, that the United Nations, IMF and World
Bank have little interest in, and for which the governments of the
countries affected have few resources to spend. Therefore, the Gates
money should be welcomed. But the existence of the Gates money has
the paradoxical effect of keeping other potential funding away from
the problem. Why should a government waste scarce resources on
Malaria if the Gates Foundation is willing to step in?
It is hard to ignore the role of such funds in a neoliberal universe
where NGO�s are the rule, yet the consequences of the Gates
Foundations could be quite dramatic. As Birn notes in her piece, the
Gates approach is to use high technology� find cures for diseases,
vaccines, pharmaceutical solutions, as well as less high tech
approaches � mosquito netting, for example. Yet, the focus on health
care issues belies the needs for essential infrastructural
development in third world countries. Without a better base in
agriculture, the impact of success by the Gates Foundation (and
others working in the same fields) will be to increase the numbers of
people subject to starvation. Without better primary health care
systems, success in any one disease will be mitigated or negated by
the inability to deal with more common health problems. In his recent
book Planet of Slums (Verso, 2006) Mike Davis presents a horrendous
picture of the growth of cities without access to basic services and
the absence of any systems to provide either jobs or nutrition for
residents. The growth of automobile traffic, high levels of air and
water pollution from manufacturing industries, substandard housing
and inadequate nutrition will all create public health problems that
will take greater resources than the Gates Foundation to solve. But
who will take on that role?