[afro-nets] An editorial on the Gates-Buffett philanthropy

["Claudio Schuftan" <claudio@hcmc.netnam.vn>]

An editorial on the Gates-Buffett philanthropy
----------------------------------------------

Cross-posted from: spiritof1848@yahoogroups.com
By: "Anne-Emanuelle Birn" <ae.birn@utoronto.ca>

FYI:  This editorial was rejected by over 30 U.S. newspapers across the country before being published by the Toronto Star today.

http://www.thestar.com   The Toronto Star

The downside of $billions

Without taking social and political realities into account, the Gates Foundation patronage of even the most powerful medications cannot meet the goal of reducing global inequities, writes Anne-Emanuelle Birn

Aug. 16, 2006. 01:00 AM

In recent days, Warren Buffett has received near-universal praise for his $31 billion donation to the Bill and Melinda Gates Foundation. The foundation has likewise enjoyed wide acclaim for its global health and educational programs, with Buffett's gift the highest tribute of all.

Americans tend to be self-congratulatory philanthropists. After all, "scientific" philanthropy was invented by a pair of American magnates a century ago - Andrew Carnegie and John D. Rockefeller Sr. - who also focused on education and health.

In spite of the country's stingy foreign aid policy ? at 0.22 per cent of its gross national income, U.S. overseas development assistance trails that of almost every other industrialized nation, according to the Organization for Economic Co-operation and Development - Americans like to think of themselves as the most generous of peoples. The largesse of the world's top two billionaires helps Americans feel proud of the country's record, if not through official foreign aid, at least through private donations.

So what could possibly be wrong with Gates-Buffett philanthropy, aimed at improving global well-being? Five issues should give pause to the all-around backslapping:

Decision-making by a select few.

Unlike governments, which are subject to public scrutiny, philanthropies are accountable only to their self-selected boards. In the case of the Gates Foundation, decision-making is in the hands of a few executives and, ultimately, subject to approval only by the Gates family troika: Bill and Melinda Gates and Bill Gates Sr., the foundation's co-chairs.

Tax-free spending.

Some would argue that Buffett and Gates ought to be free to disburse their fortunes as they wish. But we must remember that every philanthropic dollar is untaxed and thus subsidized by taxpayers without the quid pro quo of public accountability.

Philanthropy cannot replace government responsibility for global well-being.

Although the Buffett donation will likely double annual Gates foundation spending to $3 billion U.S., with some 60 per cent going to global health, this amount does not substitute for what should be the U.S.'s peacetime foreign assistance responsibility. In 1969, Canadian Prime Minister Lester Pearson called for developed countries to commit 0.7 per cent of GDP to official development assistance, a target the U.S. has never been near reaching, with or without philanthropic participation.

Agenda-setting from above.

The Gates foundation typically operates through challenge grants, whereby it partially finances projects ? for example, drugs and vaccines to control diarrhea ? and other philanthropies, international organizations, developing country governments, and bilateral agencies follow the lead. Not only does this give tremendous agenda-setting power to the Gates foundation, it means locally defined needs - clean water and sanitation to control diarrhea - are given short shrift. The doubled size of the Gates foundation will give it an even greater role in determining global health priorities.

Narrowly conceived technical solutions.

Gates made his fortune in the technology arena, and the Gates foundation similarly favours technical approaches.

What's the problem?

The Gates foundation aims to "help reduce inequities" in the U.S. and globally but ignores the fundamental inequities that exist within and between countries: inequities of power and wealth. Ultimately, vaccine development or connecting schools to the Internet in the absence of better living and working conditions or democratic decision-making remain technological quick fixes, yielding no permanent or broadly shared improvements in human well-being.

Without taking social and political realities into account, Gates foundation patronage of even the most powerful medications cannot meet the goal of reducing inequities.

A philanthropic opportunity: integrating technical and social approaches.

The Buffett donation presents an ideal opportunity for the Gates foundation to multiply the effectiveness of its grants and democratize global health agenda-setting.

Historical experience shows that sustained global health progress has taken place in settings where technological tools have been integrated with redistribution of political power. In settings as diverse as early 20th century North America and 1950s-1970s Sri Lanka and Costa Rica - where maternal and child health-care measures were coupled with fair wage movements, universal education, equal rights for marginalized groups, progressive taxation, nutritional and housing protection, public health, democratic political movements, and extensive social safety nets - life expectancy went from 40 years to more than 65 years in the span of a few decades.

Medical care was but one element in this complex landscape of change.

Seductive as they are, sophisticated health technologies are unable to change the living conditions of the half of humanity living on less than $2 a day.

Even in industrialized countries, the skewed distribution of power and wealth means that the majority of the population faces preventable premature death. This is, in the words of Martin Luther King Jr., "Why we can't wait" for poverty and inequity to disappear on their own.

Celebrate Buffett's donation to the Gates foundation? Why not.

But let's make sure that philanthropy is accountable, democratic, and harnesses its technological know-how to social and political transformation that will truly improve global well-being.

******
Anne-Emanuelle Birn is Canada Research Chair in International Health at the University of Toronto 

--
Claudio Schuftan
mailto:claudio@hcmc.netnam.vn