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Seattle talk: Philanthro-capitalism and the politics behind the global health agenda

On Friday, 3:30-6 pm, UW Health Sciences Hogness Auditorium, historian Anne-Emanuelle Birn gave the Stephen Stewart Gloyd endowed lecture, “Philanthrocapitalism, Cooption and the Politics of Global Health Agenda-Setting.”


The words “global health” usually conjure images of health workers vaccinating children in Africa, major initiatives aimed at getting anti-HIV drugs or anti-malaria bed nets out to people in poor communities across the globe or any number of other noble efforts aimed at fighting diseases of poverty.

Most don’t think of global health as a means to also advance corporate or political agendas.

Anne-Emanuelle Birn

But Anne-Emanuelle Birn does and on Friday, at a UW symposium, she explained why.

Birn’s a historian who literally wrote the book on global health! (Well, okay, she’s first author on the 3rd edition of it … known as the Textbook of International Health). The popular narrative of global health, she says, is too often a simplistic portrayal of the field as a charitable enterprise largely devoid of political and economic power or social conflict.

“There’s an incredible amount of naivete and lack of knowledge about all this,” said Birn. “To begin with, it’s important to recognize that philanthropy emerged in the United States in the early 20th century as an alternative to the welfare state.”

That’s important, she explained, because it provides a lens through which to evaluate the strategies and choices made by philanthropists to advance their goals.

The Rockefeller Foundation, created from the wealth of Standard Oil, did great things to expand the field of public health internationally. But this was done in part, Birn says, to counter some of the social justice and political reform movements in Latin America and elsewhere in the early 20th century that were perceived as a threat to the interests of the corporate founders of the philanthropy.

Birn is a historian at the University of Toronto, the Canada Research Chair in International Health, who has focused on the interplay between philanthropy and international health. She believes the practice of furthering political and economic agendas along with the humanitarian mission carries on with the Bill & Melinda Gates Foundation’s strategy in the field now known as global health.

A careful academician, Birn nevertheless doesn’t mince words. In a much-cited 2005 Lancet article, she criticized the Gates Foundation for its Grand Challenges project that she contends has helped define global health today as largely a technological and scientific challenge:

“In calling on the world’s researchers to develop innovative solutions targeted to “the most critical scientific challenges in global health”, the Gates Foundation has turned to a narrowly conceived understanding of health as the product of technical interventions divorced from economic, social, and political contexts.”

On Friday, Birn compared the efforts of the Rockefeller Foundation to largely fund and direct the creation of the field of international health, which contributed to improvements in public health worldwide and eventually the creation of what would become the World Health Organization, to the Gates Foundation’s current efforts to achieve similarly grand results.

Philanthro-capitalism is included in the lecture title, she said, because this appears to be the philosophical belief that governs much of the Seattle philanthropy’s approach and has gained popularity within the global health narrative. Put simply, Birn defined it as an approach which holds that private and business solutions are preferable to government solutions.

By ‘co-option,’ Birn gave as an example the way the Gates Foundation uses the word ‘equity.’

“They don’t use the word in a social or political context,” she said. “It’s a narrowing of the meaning of the word.”

Birn acknowledged that the Gates Foundation does appear, rhetorically at least, to have become less single-minded in its’ techno-fix’ approach and more willing to expand its efforts into some of the messier, more politically charged arenas such as women’s reproductive health. She doesn’t mean to only target the Gates Foundation, she said. But they do represent perhaps the biggest single influence in global health and so must be held to account.

“I still think they’re fairly narrow, largely market-oriented and technological in focus,” Birn said. But more importantly, the Seattle philanthropy is at the leading edge of a trend to diminish public accountability and transparency by increasing private control over this most fundamental of human needs, health.

“What I want to get across is that we need a new form of global health governance leading to true social equity,” said Birn, adding that the agenda for global health needs to be set more by the people of the “global south” — low- and middle-income countries — and much less by even the most benevolent of rich corporate philanthropists.



About Author

Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at] or follow him on Twitter @tompaulson.