In a recent conversation with Anand Giridharadas, author of the Department of Global Health (DGH) 2022-23 Common Book Winners Take All: The Elite Charade of Changing the World, the DGH community examined the increasingly powerful role billionaire philanthropists have assumed in setting the social change agenda, including in public health. His critiques speak to the challenges we face in our efforts to decolonize global health research and practice, center the priorities of the Global South, and promote equity in our work.  

Global Health Doctoral student and panelist for the conversation with Giridharadas, Hilma Nakambale, was excited to speak with Giridharadas. “[I] loved idea of bringing in people who can help us confront the issues in our institution and the big question of, 'How do we hold people accountable?'” 

The hour-long panel discussion and follow-up Q&A session have led to a few salient takeaways: the desire to have frank conversations that confront the truths about influence in global health, address the role of politics in global health, and explore accountability within the space of philanthropic giving. We spoke with two DGH professors about their takeaways from the conversation with  Giridharadas.  

Confronting the Truths About Influence in Global Health  

Part of the difficulty in having frank conversations in and about global health is that money controls the conversation. “A lot of what we see right now is corporate marketing masquerading as public change,” explained Giridharadas during the conversation with the DGH community. “We should understand that this kind of giving is very much in the interest of the giver.” In addition to controlling the conversation, Giridharadas made the point that the philanthropists have the power to edit the conversation and be “the editor of the terms of the common good.” 

The chance to edit the conversation isn’t just limited to wealthy philanthropists, it also applies to organizations. “Larger organizations that very often control both the discourse and the reality of funding for development work – and that conversation applies equally to the global health world,” shared Mary Anne Mercer, DrPH, MPH, Senior Lecturer Emeritus, Global Health during a follow-up discussion. “Reading his [Anand’s] book made it clear that he has important things to say that we don’t often hear from public health sources."  

Steve Gloyd, MD, MPH, Global Health Professor, also brought up phantom aid and the structural mismatch of aid distribution, which leads to a greatly reduced true value of the aid saying, “[aid] is often given with the best of intentions, but at the same time it tends to go back to us as opposed to going to the so-called recipients of the aid.”  

Palliative giving is another concern, executing strategies that address the symptoms of injustices while leaving their causes to languish. “There are constraints in our field,” noted Dr. Mercer. “Power is given to philanthropists who can set a research agenda when others who are much more in touch with what is needed are not able to speak.”  

Addressing the Role of Politics in Global Health 

“How often in a global public health conversation are we talking about wealth, taxation? How do we scale $2 malaria nets for a certain country?” said Giridharadas. “We may not talk about how that country is currently suing big western banks for debt relief, and what a difference it would make to the people in that country if their country was not sending back enormous interest payments to London or New York every month.”  

“Something that hasn’t been discussed enough in the world of global health and philanthropic giving is taxation,” shared Dr. Gloyd. “Anand’s focus on this and the explicit call-out was appreciated as it is a critical issue which needs to be discussed more.” Taxation not only applies to billionaires paying a lower tax rate than the average American, but also tax breaks for donor advised funds, money that may be sitting in a fund earmarked for charitable contributions but not actually being sent to any charity. 

The comments on taxation are a reminder that health problems do not exist in a vacuum, so solutions require a broader view. “I think that to be truly successful in our work, we need to be aware of and address the ‘larger' reasons for vast health disparities in the world, and not limit our studies to specific health problems or interventions,” explained Dr. Mercer. “If we want to truly ‘do good’ in global health we need to be far more cognizant of the political constraints on our efforts – and address those as well as the immediate issues.”  

Exploring Accountability Within the Space of Philanthropic Giving 

Giridharadas argues that billionaires and corporate leaders are using philanthropy and business approaches to offset the very problems that their business models have created. “Very wealthy plutocrats rig the system. [They] hoard resources, disfigure the common good, and then turn around as philanthropists.” Dr. Gloyd recognizes the complex relationship that public health has with billionaires, “people who essentially run the world of aid with their good intentions and get incredibly good vibes from around the world.”  

This leads to the question: should there be accountability in the space of philanthropic giving? Billionaire philanthropists may have the financial resources to put towards philanthropy, however they do not necessarily have the knowledge or expertise to know what really works in the field they are trying to solve. In some cases, they may even be contributing to the problem, such as development agronomy.  

Giridharadas ended the discussion with an encouragement not to blindly accept the status quo. “I think it becomes really important for your generation of young, up-and-coming scholars to articulate a public health world after plutocracy. I think we have to know what it looks like, and smells like, and tastes like, and imagine it, because it's a completely different world…maybe it’s time to step up and articulate the kind of public health you want and redefine it.”