Richard Smith asks: Can the rich save the world?
29 May, 09 | by BMJ Group
Mathew Bishop, one of the authors of Philanthrocapitalism , last night told the audience of a Lancet debate packed into the grandeur of the Royal Society of Arts in London, that the rich—like Bill Gates, Warren Buffet, and Carlos Slim—could save the world.
Many in the audience were palpably horrified, believing exactly the opposite—that these rich bastards had made their fortunes on the backs of the poor and were now busy corrupting public bodies like the United Nations.
It was a wonderfully polarised debate entirely lacking nuance, and Richard Horton, editor of the Lancet, was right in his rollicking summing up to describe it as simply a beginning. It was, however, a debate that everybody there agreed was important and wasn’t really happening. Bishop was dismissed by his opponent, Dave McCoy, managing editor of the Global Health Watch, as a “neoliberal,” while Bishop accused McCoy of being a Marxist. Yet both complimented each other on contributing to the debate over the role of “philanthrocapitalists” in the modern world.
The title of the debate, which soon flowered into a clash of ideologies, was “What has the Gates Foundation done for global health?”which is also the title of a Lancet editorial. Bishop compared this to the famous Monty Python sketch “What have the Romans ever done for us?”
Apart from roads, medicine, education, wine, public health, peace, and public order it’s nothing, which is why the revolution must go ahead. Similarly Gates, according to the Lancet editorial, has given billions to global health, “challenged the world to think big and be more ambitious about what can be done to save lives in low income settings…added renewed dynamism, credibility, and attractiveness to global health…inaugurated an important new era of scientific commitment to global health…[and fostered] deep political commitment to health.”
So what’s the problem? McCoy acknowledged the importance of philanthropy and the contribution of Gates and aimed his attack less against Gates and more against “philanthrocapitalism” in general, recognising that Gates is the “poster child” of philanthrocapitalism.
But what is philanthrocapitalism? Is it anything new? There have since ancient times been rich people who gave to the poor, probably hoping to buy their way into heaven after a life of misdemeanours.
The difference, argued McCoy, is partly scale (although didn’t Rockefeller own a larger part of the US economy a hundred years ago than Gates has ever owned?) but more that these philanthrocapitalists are not simply giving money but are unaccountably pursuing their own agendas, insisting on the methods of business and markets, buying influence at the highest levels, corrupting public discourse, and pouring scorn on the flabbiness, slowness, and bureaucracy of more traditional organisations.
Further, they have achieved their wealth through dubious behaviour and through global markets that are increasing inequalities and leading to massive environmental damage. In other words, they are playing a prominent part in creating huge problems that worsen global health and then amusing themselves spending their money to ameliorate those problems.
The specific charges against the Gates Foundation are that it is undemocratic, unaccountable, and non-transparent, concentrating its resources on a few conditions rather than relating its spend to the global burden of disease, obsessed with technological fixes, and undermining health systems in many poor countries by attracting health workers and researchers into specific projects. Horton told the audience in summing up how Gates when he moved full time to the foundation had cancelled grants made with the intention of developing health systems.
The debate had an unhelpful tendency to roam into broad questions about capitalism generally, but there was agreement that the debate was a good thing and that philanthocapitalists must be made more accountable. McCoy and some members of the audience described the Gates Foundation as “wholly unaccountable,” but they were ignoring the power of accountability of the press.
As the Daily Telegraph has shown in the past few weeks with its exposure of corrupt practices in Britain’s parliament, accountability through the press can be very powerful. The Lancet is to be applauded both for the material it has published and holding the debate, but much more is needed.
In a day or two you will be able to listen to the whole debate by visiting the RSA website.
Competing interest: RS might be described as a crypto and small time philanthrocapitalist as he is director of the UnitedHealth Chronic Disease Initiative, which is funding centres in low and middle income countries to counter chronic disease. The Gates foundation has famously ignored chronic disease—perhaps in part because it is not amenable to technological fixes but needs wholesale change.
Thank you for relaying the events of what sounds like an exciting and essential event to those of us who are fighting on the front lines in the war on poverty and disease. You discription makes the tension palpable even from Bangladesh.
The potential further fracturing of already weak health systems is a risk that is taken any time a new intervention or new focus is introduced to the sector, particularly on a large scale.
Some of the greatest minds in public health and demography now work in Seattle–and scan the world seeking innovative solutions to the problems of the poor and offering support to those who will deal with those issues face-to-face, every day. The Foundation has the resources and the supra-governmental ability to be a unifying force on specific big ticket issues in public health, such as coordinating the global effort to scale up zinc as a treatment for childhood diarrhea. The national scale up of zinc in Bangladesh was visionary in aim and scope–and without the contributions of the Gates Foundation and the tireless leadership on the ground of Dr. Charles Larson would NEVER have been possible. It represents the best of trasnlating basic science into action on the grand scale. Such efforts are expensive and the Foundation has been a fantastic partner.
Richard Horton is right that a shift away from health systems strengthening activities in favor of investment in technological innovation is worrisome. The development of a new treatment or a new device–even the greatest innovation is nothing if the thirsty man cannot get a drink or if the baby is sick because existing technologies are not being properly deployed or utilized. Strengthening health systems must be a consideration in all public health related programmes or projects, it must be a tenet of corporate or donor social responsibility.
Thank you Richard for the event coverage. I do not know if the Internet will be fast enough in Dhaka to listen first hand to the RSA transmission–so thank you for keeping the rest of us informed. Are you a crypto? Hmmm…
Tracey Perez Koehlmoos
May 29th, 2009 at 1:52 pm
Not sure I was at the debate described above: I found it rudimentary, flabby and unfocussed. The time might have been better spent quizzing the audience of interested parties, as clearly it was, for quotable accounts of their experiences of TGF. One late contribution on cronyism was particularly telling. But did this event start a ball rolling? Maybe, just.
Gary Rimmer
May 29th, 2009 at 3:23 pm
I have just returned from Delhi, which as most realise is a stark example of a wealth divide and how an sudden influx of wealth and the ability to gain wealth, brings out the worst in people. The majority of the Indian new money does not care if his fellow man lives in abject poverty and dies in the same street he was born. To quote, “that’s just the way it is”. We British would seem just as heartless to a man whose country would not allow anyone to suffer living homeless because he has a mental illness which nobody cares to acknowledge.
I cannot help but think that people like Bill Gates (BG) do not actively go out to rape and pillage the world, but just go about their daily routine being extremely good at what they do. To some this seems ruthless and autocratic to meet the end goal which BG sees as paramount. But I think it’s all relative. We could all do much more for the world, starting at the street level where we actively avoid chuggers (charity-muggers) and beggars alike. At least at the end of the day BG and his corporation have some kind of positive impact which would not be there if his billions stayed put in his account.
So should the question be more focussed on what we can all do rather than pointing out the inadequacies of those few who, when scrutinised, fail to meet the standards which we, the relatively poor set for them. In the same way, we should expect the average `man of the street` may point a similarly shabby finger at us as well.
How much of this issue has been escalated due to the world financial crisis? Was it bubbling under the surface and brought to the fore by the discontent of those with dwindling shares, looking for the highest flying scapegoat? We have all known BG was accumulating a vast and wealthy empire for years, but for those who rode the wave of gain and prosperity it was accepted mainly applauded. Could this be the same reaction as the large scale blame which was seen in the Great Depression?
My feeling is that if the masses kept their own philantropic houses in check there would be no need to have this kind of debate. The enormous lump sum, headline donations of BG and the like would be unwarranted. The majority of the wealth is with the majority of the people no matter how rich the ones at the top of the pile are.
Matt James
May 30th, 2009 at 12:59 am
I must agree with Professor Rimmer that the debate was in many ways a poor one, and I suspect that Richard Horton thought so too–which is why he referred to the debate as simply a beginning. Both of the speakers went over their time (always a bad thing), and both are probably better writers than speakers. Then the comments from the audience were random and often uninformed and ideologically driven.
I chose to play down the deficiencies of the debate and concentrate on the energy in the room, which was considerable. The challenge to Professor Rimmer is to raise the quality of the debate. He should also read the material in the Lancet where he will find much of what he found missing in the debate.
Richard Smith
May 30th, 2009 at 12:42 pm
I am not a professor. My comments are just my personal opinion.
Gary Rimmer
May 31st, 2009 at 11:46 pm