PHA-Exchange> op-ed on Gates-Buffett "merger"

[Claudio]

From: "Anne-Emanuelle Birn" <ae.birn at utoronto.ca>
to <spiritof1848 at yahoogroups.com>
FYI:  This editorial was rejected by over 30 U.S. newspapers across the 
country before being published by the Toronto Star today.

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.

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