Keeping Up With Philanthrocapitalism: The Perils, the Lies, and the Injustices
Practicing philanthropy and charity has been an increasingly common concept over the years, especially within the field of business marketing and retail. Defined as the social corporate responsibility of private corporations to address social and environmental challenges, philanthrocapitalism has steered many businesses towards incorporating charity giving within their business framework [1]. In 2016, such strategies amounted to approximately $18.55 billion worth of donations from across the USA, undeniably a trend on the rise [2].
Some examples of philanthrocapitalism include investments from the Chan Zuckerberg Initiative (CZI) towards initiatives that target education, justice, and science across the world [3]. The health and education grants of the Bill and Melinda Gates Foundation, and even the Rockefeller Foundation are similar projects, with money being raised for many causes, some of which target justice and equity in low-income nations [4]. The concept of compassionate consumerism is a branch of philanthrocapitalism. Product RED, a licensed brand owned by the international non-profit organization, ONE Campaign, is a classic example of compassionate consumerism.
By establishing partnerships with corporate giants such as Nike, American Express, and Apple, Product RED distributes a portion of its funds generated through (RED) trademarked products, such as Apple iPhones and Nike shoelaces, towards the Global Fund to Fight AIDS, Tuberculosis, and Malaria [5]. Compassionate consumerism has its benefits for consumers, stakeholders, and global communities. Credited with a form of creative capitalism, Product RED’s approach to increasing awareness about HIV/AIDS provides the modern-day market with a tangible connection to global health issues, allowing consumers to engage in philanthropy themselves at a low and affordable cost [6]. At the level of global communities, Product RED undoubtedly brings the issue of HIV/AIDS into people’s’ consciousness in a way which would otherwise not garner the necessary attention had the brand not existed. Its contributions to the Global Fund builds onto the $1.4 billion that is currently committed to HIV/AIDS programs in sub-Saharan Africa, specifically towards pre-existing grants in Rwanda which provides individuals with antiretroviral medications and tools to prevent HIV spread [6]. Product RED’s official documentary, The Lazarus Effect, highlights the importance of targeted aid in reducing the spread of HIV– referring to specialized antiretroviral pills as life saving medications for HIV positive patients [7]. In low-income nations, the social determinants of health, the set of economic, political, and cultural factors that influence health, such as income and employment, negatively impact individuals’ access to such medications [8]. As such, Product RED helps fill this gap through its monetary contributions towards the Global Fund [9]. Undoubtedly, philanthrocapitalism brings many important issues into the spotlight, drawing attention towards a growing need for social activism among the general public.
Needless to say, philanthrocapitalism has its benefits. However, given the complexity of the field of global health, it is imperative to strategize an intersectional plan which takes into consideration the social determinants of health. There exist many flaws within the model under which the ideology of philanthrocapitalism operates, some of which include corporations’ power to influence topics of discussion at international institutions, inaccurate focuses regarding solutions to global health issues, and corporations’ lack of accountability due to their role as non-state actors [19, 20]. As a result, one can argue that these factors are how philanthrocapitalism rather exacerbates negative health outcomes. It prevents communities from the enjoyment of human rights, instead of working towards the goal of achieving health equity.
How are decisions made at the big table?
One of the most affluent organizations that practices philanthrocapitalism in the world today is the Bill and Melinda Gates Foundation (BMGF). According to the 2017 Contribution Summary of the Global Fund, an international partnership between governments and the private sector dedicated to raising and investing approximately US $4 billion annually to support local programs that target HIV and AIDS, the BMGF contributed $202 million, the second largest contribution from a non-state organization [9]. Currently the world’s wealthiest charitable foundation, there is no doubt that BMGF has a profound effect on global health issues through its financial contributions. The term ‘agenda-setting powers’ describes the BMGF’s ability to influence the public agenda based on the organization’s mission and goals. Part of the reason for the BMGF’s current ability to set the global health agenda stems from the magnitude of its donations, its ability to quickly mobilize resources and allocate efforts towards innovation though the misconception that private corporations are more innovative public institutions [19, 21]. Take for example the BMGF’s personalized Lancet publication, which not only saw the Lancet abiding by their pre-existing guidelines and themes, but also promoted BMGF’s Global Health Division HIV Strategy about neonatal health and HIV [10].
The potential transformation of global health advocacy into a major enterprise is a common fear among many researchers, as it would compromise public health to the benefit of private interests [11]. Another example that demonstrates this type of philanthrocapitalism at its prime is the BMGF’s establishment of a public-private partnership in 2000. Alongside multiple governments, the partnership, called the Gavi Alliance, promotes vaccination campaigns across partnered nations under the funding capacities of the BMGF. Through Gavi, the BMGF was able to successfully position itself in the centre of discussions regarding the health of citizens, specifically the eradication of Polio. While Gavi increased immunization rates across the Globe, many critics argued that the eradication of Polio was, “solely the priority of wealthy nations, not developing ones- many of which were preoccupied with battling illnesses that created a far greater health burden in their nations, such as diarrheal diseases” [22]. The involvement of private enterprises with public health issues in the name of philanthrocapitalism obliges international bodies, like the WHO, to make room for individuals who many would argue do not belong at the table, but are simply accommodated for given their substantial monetary contributions. Not only do agenda-setting powers devalue the importance of public health issues, but it also leaves the world vulnerable to the prioritization of corporate gain [11].
The social determinants of health go ignored
Another challenge of involving corporations with health issues is the possibility of a lack of professional and community consultation during their philanthropic ventures, leading to out-of-touch goals and solutions that fail to meet a country’s actual needs [11]. The buzzwords, “social determinants of health,” are often ignored. Although philanthropic projects draw attention to many of these issues, they rarely take into consideration that most of the social determinants of health should be considered a function of the state’s responsibility and that a disease-centered view of public health will not attain the goals philanthrocapitalism sets to achieve [23].
The argument then follows that initiatives that focus on improving state infrastructure will eventually lead to better health outcomes when coupled with innovative biomedical solutions. This strategy, known as a bottom-up strategy, would have a more positive and sustainable impact on a population’s health [12].
Despite the efficacy of such an approach, it may not be in corporations’ best interests to pursue a bottom-up strategy as it may not align with their goals, and may not be reflective of their innovative capacity [11]. This issue is demonstrated by the research initiative Grand Challenges in Global Health (GCGH), in which the BMGF pushes for innovative technological solutions to tackle global health issues in low-income nations. From developing novel vaccines to technologies for quantitative assessment of population health, one can argue that GCGH attributes the problems of global health to a shortage of scientific knowledge that can be cured through technical interventions.
False-hope investing? Or marketing strategies?
Adding to this, Bill Gates himself has said that many of the Grand Challenges innovations are not expected to yield results for at least 15 years or more [13]. This introduces questions around how much countries’ health statuses would have improved had the BMGF invested in a universal health care system during the same time frame instead [11]. On top of this, studies have shown that a combination of poor nutrition, improper housing, financial insecurity, and the lack of attention to other social determinants of health can reduce the effectiveness of various biomedical treatments for disease, nullifying the gains from such technological solutions [14]. Given this information, one can make the argument that the true motives of philanthrocapitalism initiatives, regardless of how charitable they claim to be, are essentially just marketing strategies that are made to be appealing to consumers [11]. If scaled up, marketing costs are usually the first to rise, preceding research and development, and therefore, proving that corporations embark on philanthropic ventures at the expense of the social determinants of health [15].
What about human rights?
In addition to how corporations choose to function in terms of their projects, there lies substantial weight in the impacts of philanthrocapitalism on the communities they work in. One subtle detail is the fact that corporations are able to exert a large influence on communities while only being accountable to their own, self-selected boards instead of complying with human rights instruments ratified by states and public institutions [11]. These corporations, being classified as non-state actors, are not held accountable for the possible threats they pose to human rights violations within communities [11]. Take into consideration Article 25 of the Universal Declaration of Human Rights, which entitles individuals to the right to an adequate standard of living and most importantly, medical care [16]. As the BMGF’s Global Health HIV strategy provides specialized care to HIV-infected patients in Sub-Saharan Africa, they implicitly create a two-tiered health system through which only a subset of the population, those diagnosed with HIV, are able to receive medications. Furthermore, patients receiving HIV medications often have complex health conditions, and are diagnosed with multiple comorbidities such as cancer that also contribute to ill-health [17]. Treating patients solely with antiretroviral therapy can only win half the battle of “saving lives” as the BMGF aims to achieve. The underlying discriminatory criteria that exist to decide who should receive essential healthcare disregards Article 25 of the UDHR, but are the least of corporations’ worries most of the time as they are not legally bound to the UDHR in the first place. This poses as a loophole for many corporations as it allows them to exert influence over communities through the work they do as a part of philanthrocapitalism, while at the same time shutting a blind eye to sources of inequities that would otherwise be regulated by human rights instruments.
Reflections, morals, and recommendations
Philanthrocapitalism can be seen as a marketing approach to create a façade of humanitarianism for consumers, often foregoing bottom-up strategies in hopes of developing corporate credibility. While recommending alternatives is a follow-up question to this debate, consumers should question the ethics of allowing corporations to pursue capital gains even when these gains come at the cost of others’ suffering. The need to recognize the private sector’s affluence and resist its agenda-setting powers is a responsibility of national governments and the WHO in terms of prioritizing the health of communities. It is only after a holistic analysis of the interplay between politics, economics, and health can individuals, corporations, and states strive to create positive and sustainable social change.
References
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