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?