07/01/2018 - Beatriz Nascimento & Luana Bermudez

Mark Zuckerberg, Bill Gates, Carlos Slim, Warren Buffett, Jeff Bezos, Michael Bloomberg. Everyone knows these names. But could anyone tell what these and other mega-billionaires have to do with global health? How do the world’s richest men interfere with public health decisions in the most important multilateral fora? The answer to these questions lies in philanthrocapitalism: the combination – controversial and sometimes dangerous – between their interests in philanthropy and their mega-capitalist roles in a highly unequal society that frequently focuses in generating wealth and income.

An example of the combination of public health interests and commercial interests is seen in many initiatives led by the Bill & Melinda Gates Foundation (BMGF). This past January 8th, in a speech given during the 36th Annual Healthcare Conference hosted by the major financial corporation J.P. Morgan, Bill Gates encouraged entrepreneurs present to support public health promotion initiatives, “not only because it is the right thing to do, but because it can be lucrative too”[i].

In this sense, the profits of the world’s biggest entrepreneurs are becoming greater and greater. In January 2017, the Oxfam Report, “An Economy for the 99%,”[ii] pointed out that the world’s 8 richest men have incomes equivalent to 3.6 billion people – half of the world’s population. These 8 men are considered mega-philanthropists, allocating millions of dollars of their fortunes in public health, scientific research, education and humanitarian causes.

The term philanthrocapitalism was created in 2008 by Matthew Bishop, editor of The Economist magazine. According to Bishop[iii], philanthrocapitalists are not traditional donors; they are social investors who direct resources to the causes they choose as priorities. Philanthrocapitalism has a twofold effect: it demonstrates the philanthropic potential of the capitalist system itself and, at the same time, infiltrates philanthropy with principles and practices of for-profit enterprises[iv]. As was mentioned by Trevor Mundel, President of the Bill & Melinda Gates Foundation Global Health Program at the 36th Annual JP Morgan Health Conference, “there is a certain business rationale for involvement with global health”[v].

Philanthrocapitalism and public health

The relationship between philanthrocapitalism and public health began in the late nineteenth century. The Rockefeller Foundation was the first to promote philanthropic activities directly in the health field, both within the United States and in other countries in the Latin American region. Throughout its history, it has operated public health programs in 93 countries and was responsible for establishing more than 20 important public health schools, such as USP in Brazil and the School of Public Health in Toronto, Canada.

Nowadays, the main example of this modality is the Bill & Melinda Gates Foundation (FBMG), which influences much of the international agenda not only in global health, but also in  development, education, among other subjects.

What, then, are the implications of philanthrocapitalism for global health and governance? Do the issues defined as priorities by these foundations really reflect the world’s greatest problems and the need of the people?

Allegedly, philanthrocapitalism would allow capitalism to benefit everyone: those who buy the goods produced by the system, those who have jobs also generated by the system, and those who are the target of the philanthropic actions carried out by these companies. The logic is based on the belief that business approaches can solve social problems more efficiently than government or civil society approaches, thus creating a system in which decisions are made by those who hold wealth. A wealth that, by the way, has become extremely concentrated because of the inherent inequalities of the capitalist system, since much of the profits accumulated by these mega-billionaires come from tax exemptions, financial speculation, monopoly prices, and even, by some accounts, exploitation of workers and destruction of natural resources.

It is clear that philanthropy is often subsidized with public resources, since a considerable amount of resources destined to it, in fact, should be destined to the States through taxes paid by the companies that finance these philanthropic actions.

In other words, philanthrocapitalism is enshrined by its practitioners as a way of saving the world, but the people who invest in these resources are responsible for exacerbating the inequalities of the system. Philanthropy is used to preserve capitalism as a system and, at the same time, appease its contradictions, legitimizing the wealth that generates inequality.

Anne-Emanuelle Birn, a renowned scholar in the field of global health, points out that one of the major differences between the Rockefeller Foundation and the Bill & Melinda Gates Foundation is that the former supported the creation of a global public health coordination agency – the World Health Organization – while the latter has privatizing approaches, which end up hampering WHO’s mandate to promote health as a fundamental human right.

Philanthrocapitalism allows crucial decisions for society to be made by private initiatives, whose main objective is not to guarantee the well-being of the population, but rather to maximize its profits. In addition, these private companies are accountable only to their own boards of directors, unlike governmental entities that have a social responsibility. This could lead to a number of conflicts of interest, such as the close links between the BMGF and Big Pharma, or the fact that the last two chairmen of the Global Health Program and other senior BMGF executives have already worked – many in high-level positions – at pharmaceutical companies such as Novartis and GSK[vi].

Philanthrocapitalists tend to focus their view on technological and cost-effective (sometimes simpler) solutions to structural and complex problems. An example of this is Bill Gates’ speech at the World Health Assembly (WHA) in 2005: “Some point to better health in the developed world and say that we can only improve health when we eliminate poverty. And eliminating poverty is an important goal. But the world did not have to eliminate poverty to eliminate smallpox – and we do not need to eliminate poverty before reducing malaria. We need to produce and deliver a vaccine – and the vaccine will save lives, improve health and reduce poverty”[vii].

The importance of vaccines as instruments of public health cannot be denied, but this disease-centered view ultimately ignores the social determinants of health. There is great evidence that mortality and morbidity rates tend to decrease with improved living conditions, such as access to education, food, clean water, housing, primary health care, basic sanitation, employment, among others, in addition to environmental conditions.

Within WHO, one of the strategies to deal with this issue is the Framework of Engagement with Non-State Actors (FENSA). Approved at the 69th edition of the WHA (2016), FENSA establishes the rationale, principles, benefits and risks inherent to collaboration with these actors, and encompasses all modes of relationship at all WHO levels. The document is a milestone for the countries, as it emphasizes the importance of adequate and transparent regulation with these bodies.

This can be a good instrument for States to reinforce their central role in setting the global agenda, and prevent these philanthropic elites from guiding public policies on the basis of capital accumulation, while ignoring social justice. In addition, a collective advocacy effort is required to obtain social responsibility from these actors. As Birn argues, “it may well still be a rich man’s world, but we need not settle for a rich man’s agenda for global health”[viii].

[ii] Oxfam. An economy to the 99%. January, 2017. Available at
[iii] Bishop, Matthew. The birth of philanthrocapitalism. The Economist, February, 2006. Available at
[iv] Bishop, Mathew; Green, Michael.
[vi] Birn, Anne Emanuelle. Philanthrocapitalism, past and present: The Rockefeller Foundation, the Gates Foundation, and the setting(s) of the international/global health agenda. Available at:
[vii] Presentation by Mr Bill Gates, Co-founder of the Bill and Melinda Gates Foundation at the Fifty-eighth World Health Assembly, Monday, 16 May 2005. Available at
[viii] Birn, Anne Emanuelle. Philanthrocapitalism, past and present: The Rockefeller Foundation, the Gates Foundation, and the setting(s) of the international/global health agenda. Available at: