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SPECIFICATIONS THAT YOU SHOULD FOLLOW:
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THESE SPECIFICATIONS APPLY TO REACTION PAPERS AND TAKE-HOME EXAMS:
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–THERE IS NO NEED TO INCLUDE A REFERENCE LIST AT THE END, AS THE PUBLICATION DETAILS SHOULD BE INTEGRATED INTO THE TEXT. IF YOU REFER TO ANOTHER COURSE READING, A SIMPLE IN-TEXT REFERENCE WILL SUFFICE.
–DONT USE CONTRACTIONS IN A FORMAL PAPER LIKE THIS ONE.
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Review
Philanthrocapitalism: Promoting Global Health but
Failing Planetary Health
Colin D Butler 1,2,3
1
2
3
National Centre for Epidemiology and Population Health, Australian National University, Canberra 0200,
Australia; colin.butler1955@gmail.com
Health Research Institute, University of Canberra, Bruce ACT 2617, Australia
College of Arts, Humanities & Social Sciences, Flinders University, Bedford Park, SA 5042, Australia
Received: 30 January 2019; Accepted: 19 March 2019; Published: 23 March 2019
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Get Help Now!Abstract: Focusing on the Bill and Melinda Gates Foundation (BMGF) as a case study, this paper
explores the relationship between philanthrocapitalism, economic history, and global and planetary
health. The Wellcome Trust is also briefly discussed, chiefly in the context of planetary health.
The paper argues that in the last 45 years there has been an increased preference for market-based
approaches, often called neoliberalism, particularly in the U.S. and its allies. This has generated
greater inequality in many high-income settings and weakened the norm of taxation. This has
provided a setting in which philanthrocapitalism has flourished, including the BMGF. The latter has
in turn become an important actor for global health, partially balancing the adverse consequences of
neoliberalism. Planetary health is here defined as the interaction between global health and global
environmental change, including to the climate and other elements of the Earth System. Although the
Wellcome Trust has recently made funds available for ecological health research, it continues to invest
in fossil fuels. The Gates Foundation provide no or minimal grants for ecological or planetary health
but appear to have recently substantially divested from fossil fuels, for unclear reasons. The paper
concludes that these large philanthrocapitalist organizations partly compensate for the decline in
attention to global health driven by market-preferring solutions, but remain insufficiently proactive
in the face of the great dangers associated with declining planetary health.
Keywords: Bill and Melinda Gates Foundation; capitalism; climate change; disinvestment;
economic history; effective altruism; global health; health systems; malaria; metrics; neoliberalism;
philanthrocapitalism; philanthropy, planetary health; vaccines; Wellcome Trust
1. Introduction
This introduction defines and discusses the three key terms most relevant to this article;
philanthrocapitalism, global health, and planetary health. Part two reviews economic history, seeking
to position the arising of philanthrocapitalism in the wider context of national and global inequality.
The third section describes several characteristics of the Bill and Melinda Gates Foundation (BMGF)
relevant to global and planetary health. These include its alleged authoritarianism, its preference for
technological rather than social interventions, its support for vertical (disease-focused) approaches
rather than the strengthening of national, horizontal health systems and its fondness for metrics.
Part four focuses on climate change, carbon divestment, and the role and responsibility of leadership
for planetary health that philanthrocapitalists should demonstrate. The conclusion argues that the
BGMF and other philanthrocapitalists have brought the trajectory for global health closer to the vision
that seemed possible to international health activists in the 1970s but which faded in following decades.
However, philanthrocapitalism is in general insufficiently aware of the great dangers associated with
declining planetary health.
Challenges 2019, 10, 24; doi:10.3390/challe10010024
www.mdpi.com/journal/challenges
Challenges 2019, 10, 24
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1.1. Examples of Philanthrocapitalism
The term philanthrocapitalism was coined only in 2006, but its existence is far older [1]. It is here
defined as the use of large sums of money and associated political and economic power, accumulated in
capitalist economies, for philanthropic purposes. The word philanthropy is derived from philo (Greek
for love) and anthro (Greek for human). Leading examples of philanthrocapitalist organizations include
the BMGF, the Wellcome Trust, the Open Foundations, and the United Nations (UN) Foundation (see
Table 1).
Table 1. Some of the most prominent examples of philanthrocapitalism in the English-speaking world.
Key: # My enquiry was unanswered.
Name
Founder(s)
Founded
Website
Assets (a)/
Endowment
(e) (US$ bn)
Annual
Budget US$
(bn)
Carbon
Investment
Policy
Bill and
Melinda Gates
Foundation
Bill and
Melinda
Gates
2000
https://www.gatesfoundation.org/
46 (a)
4.7
largely or
fully
divested
Wellcome
Trust
Henry
Wellcome
1936
https://wellcome.ac.uk/
27 (a)
1.4 (2017)
invest
The Open
Foundations
George
Soros
1979
https://www.opensocietyfoundatio
ns.org/about
18 (e)
Leverhulme
Trust
William
Lever
1925
https://www.leverhulme.ac.uk/
4.2(a)
Rockefeller
Foundation
John D
Rockefeller
1913
https://www.rockefellerfoundation.
org/about-us/our-history/
4.1 (a) (2016)
The UN
Foundation
Ted Turner
1998
https://unfoundation.org/
2 (a)
unsure
0.1 (2017)
unsure
fully
divested
0.115
unsure #
1.2. Global and Planetary Health
The terms global health and planetary health have a long and intertwined history [24].
Global health is viewed, by most, as the contemporary name for what was originally called tropical
medicine and then international health. Some scholars, however, have long argued that global
health also includes a focus on issues that directly or indirectly affect health but which transcend
national boundaries, including anthropogenic climate change and antibiotic resistance [5]. In this
conceptualization, global health (unlike international health) embraces some high-income populations
in the global North, i.e., developed countries, and overlaps with planetary health.
The term planetary health is at least 40 years old [6], but has recently attained prominence due
to the support of the Lancet, the Rockefeller Foundation, and the subsequent formation of the Planetary
Health Alliance. A key document of its recent formulation is a self-described manifesto, published
in The Lancet in 2014, led by Richard Horton, the journals long-standing editor [7]. This article (see
Box 1) stresses the importance of social justice, and explicitly warns that civilization is at risk, not only
from climate change, but from a constellation of other factors, including inequality [8]. It also explicitly
links what it perceives as a downward spiral to neoliberalism [9].
Box 1. Text about neoliberalism in From public to planetary health: a manifesto [7].
The idea of unconstrained progress is a dangerous human illusion: success brings new and potentially even more
dangerous threats. Our tolerance of neoliberalism and transnational forces dedicated to ends far removed from
the needs of the vast majority of people, and especially the most deprived and vulnerable, is only deepening the
crisis we face [7].
Some critics have argued that this encouraging acknowledgement of inequality and global
social injustice remains largely stillborn (see Table 2) [2,6]. A recent paper, written by the inaugural
director of the Planetary Health Alliance describes the rift between those who have largely caused the
environmental crisis and those most vulnerable to it as deeply unfair, and calls its solution a moral
Challenges 2019, 10, 24
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imperative [10]. However, the article is vague on practical ways to escape our planetary crisis and
does not otherwise analyze or criticize the global economic system.
Table 2. Prominent themes of ecohealth, international health, global health, One Health, planetary
health (two flavors) and public health. Key * most common definition; # less common definition; not
just total size but growth rate as a determinant of health outcomes; PHA = Planetary Health Alliance;
iV = inVIVO; dark green = strong, light green = moderate; orange = weak.
Health
Discipline
Multi-Disciplinary
Focus on
Poor
Global
Structural
Power
Eco-Climatic
Factors
Infectious
Diseases
Demographic
Factors
Conflict
Ecohealth
Global *
Global #
International
One Health
Planetary (PHA)
Planetary (iV)
Public
There is an alternative planetary health movement, associated with the Canmore Declaration [3],
the inVivo Planetary Health Network and this journal. It is premature to characterize this movement,
but a candidate distinction may be greater optimism [6,11]. However, at least one recent paper in this
tradition recognizes that the point of successful transition, if there is to be one, between the past (a time
of little appreciation of limits) and the future (where limits are apparent) will be a period of maximal
conflict and tension [11]. This explicit recognition of limits and the risk of conflict is, as yet, rare in
either of the contemporary planetary health fields [4].
Both versions of planetary health have a strong eco-climatic focus, as do the disciplines
ecohealth [4] and some forms of One Health [12]. There is agreement that global health shares with
public health and international health a priority on population-based and preventive foci, and a
concentration on poorer, vulnerable, and underserved populations. Table 2 compares and contrasts
some of the key similarities and differences between global health, planetary health, and some of their
companion disciplines that have evolved in the long struggle to improve world health. This table is
based on my involvement with these issues for over three decades (see Appendix A).
1.3. The Peril of Failing Planetary Health
As difficult as global health problems are, they are potentially dwarfed by the suite of issues
embraced by the term planetary health. Ecosystem change, climate change, and the social interactions,
including conflict and migration, from the human encounter with limits to growth present formidable
problems to sustainable population health [4,11]. Realization of these challenges is inhibited, including
by scientific reticence [13]. A disconnect exists between the level of risk and the declining appreciation
of it by most funders, researchers, reviewers and policy-makers who remain insufficiently aware of the
severity and intractability of the risks posed [8]. A supplementary appendix to the first main paper on
planetary health argues wealth can insulate powerful elites from the perceived risk of future threats,
but if civilizational collapse is imminent, the wealth of a few can mask the gravity of threats to all and
weaken incentives to act until it is too late [14]. This warning is not hyperbole.
2. Inequality, Revolts and Epidemics: The Seedbed for Health Philanthrocapitalism
This section seeks to position the evolution of philanthrocapitalism in the context of economic
history, evolution, and complexity theory. Humans, like other primates and many other social animals,
are a hierarchical species, but the scale of tolerable inequality is not infinite. Excessive inequality,
where visible, leads to resentment, and, at times organized revolt [15]. To reduce this risk, elites both
disguise their wealth and, at times, redistribute part of it. In the Roman Empire, elites, sometimes
Challenges 2019, 10, 24
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incredibly wealthy, had informal obligations to reduce hardship of the masses, if they were affected by
crisis [16]. Similar obligations also existed for Indian rulers.
2.1. Saving the British Class System
In the early 19th century, there was anxiety among the British ruling class that revolution would
cross the English Channel, following the 1789 French Revolution. Unrest and dissent in Britain
did occur, yet extreme, state-supported domestic violence to quell protest gradually abated, while
the 1832 Repeal Act ceded some power to workers, although the reform of the British Poor Law in
1834 halved national spending on welfare [17].
The easing of suppression was combined with growing economic opportunities to a rising
proportion of the British population, soothing unrest in Britain, apart from in Ireland. Opportunities
afforded by the industrial revolution and by the enormous, still expanding empire, itself founded
on coercion and violent state power [18,19], contributed to wealth that led to the emergence of a
large British middle class, widespread literacy, sewage systems in the major towns and even to
garden cities [20]. After an initial dip in the 1830s and 1840s, probably worsened by the temporary
cessation of organized smallpox vaccinations in Glasgow and perhaps elsewhere [17], British life
expectancy improved through the 19th century [20]. This was not only due to economic take-off [21]
based on ingenuity as well as distant pillage, but also to organized public health [22] and reformers
such as Charles Dickens, whose work was eagerly consumed by the increasingly literate masses.
These social factors interacted and reinforced each other, creating a snowball effect, leading to a social
phase change.
Physical resources were vital to this progress, but so too were education, idealism, religious fervor,
science, protest, redistribution, and reformers wary of the old corruptionthe ruling class [23].
The self-organization of these and other factors remains relevant to contemporary global and
planetary health.
2.2. Saving American Capitalism
In response to the Great Depression, itself a consequence of runaway capitalism, Franklin
Roosevelt, the patrician U.S. president, introduced the New Deal, and then the second New Deal. This,
with other policies, including incorporation by the government of many other Leftist ideas, weakened
support for the American Communist Party and, some say, saved American capitalism [24,25].
From about 1933 until about 1970, and especially in the 1940s, wages of workers rose in the U.S.,
while incomes of the rich fell as taxes were increased [26]. Greater equality, favored by the policies
of prominent economists such as J.M. Keynes and J.K. Galbraith snr, triumphed in the decades
immediately after World War II. Reduced domestic inequality, in both Britain and the US, was also
important to sustain morale during the war. The period of relative egalitarianism in the U.S. has been
called the Great Compression [26].
Thus, in both Britain and the U.S., in the 19th and 20th centuries, respectively, it can be argued
that inequality was lowered, at least temporarily, in order to avoid and to prevent an utter loss of elite
privilege, such as occurred in France and Russia. In some cases, aristocrats may also have sincerely
helped to support the cause of the common people (noblesse obligenobility obligates), motivated
either by compassion, a sensing of these risks, or perhaps more likely, a combination of the two [27].
Philanthrocapitalists also emerged in this category; people such as Peter Cooper, Andrew Carnegie,
John D. Rockefeller, Henry Wellcome, and, more recently, Bill Gates, George Soros, Warren Buffet and
others (see Table 1) [28,29]. The fortunes of these entrepreneurs who became philanthrocapitalists
accumulated due to the expansion in overall wealth that resulted from science, discovery and the
conversion of nature (such as oil, land, minerals, and forests) to manufactured and agricultural
goods. But these fortunes also accumulated, at least in Western countries, because of neoliberalism,
the reversal of the Great Compression and the introduction of new norms which spurned taxation, good
government, and public goods [9]. Few if any philanthrocapitalists accumulated their fortune during
Challenges 2019, 10, 24
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the Great Compression, a period of comparative self-restraint, as well as comparatively high taxation.
(The bequest of Sir Henry Wellcome, who died in 1936, created what, until recently, was the worlds
largest health foundation). Note, also, that few if any philanthrocapitalists inherited their fortunes;
they are not nobility or old money. Furthermore, many millionaires (more recently billionaires) dont
even pretend to be generous to the poor, although some take advantage of tax incentives to support the
arts, museums, or the environment, without claiming to promote any aspect of social justice. But some
others work to undermine both democracy and environmental protection [30].
2.3. Saving the World System
A hat-trick of global catastrophes (the Great War, the Depression, and World War II [WWII]) led,
in the mid-1940s, to the birth of the United Nations, the successor to the failed League of Nations.
Apart from the opinion of cynics and Cold War bulldogs such as George Kennan [31], the UN, at least in
its early decades, was widely regarded as a legitimate attempt to save the world system, or civilization
as we know it [32] (see Appendix B).
During the Great Compression some forms of global inequality eased. For example, many
nations were granted independence, although others, such as the former French colonies of Algeria
and IndoChina, were not willingly let go, triggering savage wars with long-lasting consequences.
The anticolonial war in Algeria also helped to inform and inspire the psychiatrist Franz Fanon, whose
book The Wretched of the Earth [33] helped to raise awareness of the plight of people in what was still
generally called the Third World [34].
The vindictiveness of Britain, France, and the U.S. that followed the Great War (World War I)
saw Germany burdened with enormous debt and helped trigger a short-lasting peace, immediately
foreseen as fragile by Keynes [35]. This mistake was not repeated after the second war. Instead,
the Marshall Plan can be seen as a form of self-interested generosity by the U.S. which is widely
credited as accelerating economic recovery in Western Europe, and which saw Germany emerge as
a strong and durable U.S. ally (until the presidency of Donald Trump), rather than the adversary it
became in the 1930s.
In Britain, the National Health Service (NHS) was introduced in 1948. Survivors of WWII voted
out the Conservatives, cementing a bipartisan compact protective of the NHS that still exists, despite
the sustained shift to the Right that occurred following the election of U.K. Prime Minister Margaret
Thatcher in 1979. In many countries, including in the U.S., executives showed voluntary self-restraint
with their salaries and bonuses, for about three decades after WWII, extending and consolidating the
Great Compression [36]. However, today, in Britain [37], France, and the U.S., inequality is again rising,
triggering major social reactions, including shifts towards nationalism and authoritarianism.
2.4. The Rise and Decline of WHO as a Promoter of Global Health
Adding to the trio of calamities that incubated the United Nations institutions, including the
World Health Organization (WHO), was the Spanish influenza pandemic, which killed as many as
50 million people in the final years of World War I and the period immediately following it (when global
population was fewer than 2 billion, compared to over 7.5 billion today) [38]. Some hypothesize that
the unusual virulence of the responsible virus evolved in the appalling conditions of undernutrition,
crowding, and mustard gas-damaged lungs that characterized the Great Wars closing years, and which
may have served inadvertently as a natural laboratory of biological warfare [39,40].
One aim of WHO (founded in 1948) was to prevent such pandemics. Another was to improve
health in developing countries, places today mostly called the Global South [34]. In 1955, for example,
WHO launched a highly ambitious, ultimately unsuccessful campaign to eradicate malaria [41].
Twelve years later, WHO launched another eradication campaign, against smallpox [42]. Within only
11 years, that campaign proved successful. In 1988, in a third major vertical health project, WHO
proposed to eradicate polio by the year 2…
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