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Development Assistance for Health  – Hope for a Next Big Thing?

With each new year and each new year’s annual report, it’s clear that the first decade of the 21st century was a golden age for Development Assistance for Health (DAH). There’s an emphasis on the ‘was’ because it’s over – a beginning and end points are pretty well-defined at this point and the field has settled into what is only a modest upslope of annual growth. The Institute for Health Metrics and Evaluation’s (IHME) comprehensive annual report on DAH, Financing Global Health 2016, contains a very optimistic graph (below) implying that the exponential annual increases from 2000-2010 could have continued indefinitely. Unfortunately the only growth that can sustain that rate takes place on an agar plate.

Screen Shot 2017-08-17 at 12.49.55 PM

Source: Financing Global Health 2016 (

So what happened in the 2000s? In extremely simplistic terms, the US under George W Bush (and to a lesser degree, Great Britain) started giving a lot more, largely to tackle the AIDS epidemic, and separately, Bill and Melinda Gates entered the arena. In 2016, the Gates Foundation’s contribution to DAH was $2.9 billion (plus the foundation has other initiatives outside the realm of DAH), making it the third biggest contributor of any variety – larger than 193 out of 195 nations of the world. Only the governments of the United States and the United Kingdom donated more [5].

In reviewing the 2016 IHME report, none of these major players was new or particularly different in its contribution compared to the prior year. The overall ODA for 2016 was only marginally higher than 2015’s. Another year of the new norm. An essentially flat field, overall. What grabbed my attention in the IHME report, however, was a detail that I had never noted or really wondered about before: the second- and third-largest private donors to DAH. They get less attention because they’re much smaller than Gates. Number two was Bloomberg Philanthropies, established by Michael Bloomberg (you probably remember him as the former mayor of New York City). The next was the Parker Foundation, established by tech entrepreneur Sean Parker (you probably remember him as Justin Timberlake).

In considering whether there was any hope for a new DAH boost and a return to the 2000s heyday sometime in the near or intermediate term, I was intrigued by this top three. I wondered whether their personal backgrounds and their route to wealth might herald a trend of other similarly wealthy individuals jumping into the DAH arena on a scale that would rival nations. Indeed, there appears to be something of a profile of the private DAH donor: new, self-made wealth (ie, not inherited) based on something in the sector of technology. Gates was a computer designer. Parker was a computer programmer. Bloomberg’s major achievement was more niche – he developed a news and information network widely used in the financial sector – but he still fits the mold of the other two, in being tech-centric [6].

Reviewing Forbes’ 2017 list of the world’s billionaires, there are plenty more who fit this profile. Overall, there is an ever-increasing number of billionaires in the world – 2,043 in 2016, a 13% increase from 2015 [2]. One hundred eithy-three (8.9% of all billionaires) were tech based [11]. Fifty-six were under 40 years of age. The upper echelon of this upper echelon – those with dozens of billions of dollars of net worth – is rich in techies, including #3 Jeff Bezos and #5 Mark Zuckerberg [10]. Somewhat arbitrarily looking at those with $30 billion or greater, 8 of 21 are distinctly products of the tech sector (some others blur the lines). Of course, also represented are plenty of other ways to get rich – retail, finance, and the good, old-fashioned Luck of having fantastically wealthy parents.

Aside from the potentially arbitrary fact that the top three private DAH donors have tech-based wealth, I looked a little further into the idea that something about this new breed of wealth brings a tendency towards philanthropy. There is no shortage of opinion pieces touting this notion. More concretely, there have been several notable initiatives from within the ranks of the ultra-wealthy. Gates in 2010 started the Giver’s Pledge, in which signatories promise within their lifetimes to donate half of their wealth to philanthropic causes [1]. To date 168 billionaires have signed on. More specifically within the tech realm, The Founder’s Pledge seeks a commitment from founders of tech startups to make a pledge of 2% of their personal fortunes towards philanthropies at the time of selling their businesses. Zuckerberg and his wife, Priscilla Chan, have committed to donating 99% of their Facebook shares to philanthropy by the end of their lives, an amount that could ultimately value at as much as $100 billion [3]. Parker wrote a manifesto for the Wall Street Journal – “Philanthropy  for Hackers” – to accompany the debut in 2015 of his foundation, arguing in pretty fascinating fashion that there’s a mix of altruism and anti-establishment sentiment that informs the inclination of many in the tech generation towards philanthropy [7].

Throughout all of these documents and in other interviews and editorials, there is a difficult-to-interpret sense of hubris, and at times outright disdain, in defining the new generation of philanthropists relative to the old. There’s a central idea that some rational design was missing from the philanthropy of previous era. An odd word that pops up over and over and over again to describe the approach is “disruption”, which sounds more like a pet term for a Christopher Nolan villain than a philanthropic movement. “They see poverty and inequality as an engineering problem,” as one pundit puts it, “and the solution is their brain power, not a tithe” [9]. This sentiment feels like a close cousin to social capitalist concepts that infuse the west coast bloodstream (if that’s a new term, you can read up here). Ultimately it seems that the emphasis on philanthropy among the enfants terribles of the tech generation is sincere. That’s an overwhelming positive, even if the catch is a bit of annoyingly chirpy language as well as some tendency to micromanage. Gates catches flak for what some perceive as his heavy-handedness with the WHO, and as a true sign of the times, guys like Parker already seem to lump him in with an old guard who are insufficiently analytic in their interventions.

While that’s the evidence that philanthropy is being taken seriously among this new generation of wealth, whether DAH, specifically, will catch a substantial portion of that philanthropy is more speculative. In some instances, the fact that institutions like the Gates Foundation are at this point so well-established can allow it to route into its causes the donations from those who don’t already have their own organizational groundwork. For instance, Warren Buffet was so impressed by Gates work in 2006 that he chipped in $30 billion to the foundation [3]. This principle cuts both ways, though, as funds such as The Silicon Valley Community Foundation, which has been most active with education projects, seems to have an inside track in some respects in courting tech money [8]. Some of Zuckerberg’s largest donations, for example, have gone to this foundation.

What may be the biggest factor, then, for a new influx of DAH funding is pure chance: whether the attention of the right person happens to be hooked by a specific need or a specific opportunity. Gates has said often that his decision to place such emphasis on DAH was influenced by reading the 1993 Global Burden of Disease report [4]. It’s silly to try to guess whether or not the Gates Foundation would have become the global health force that we know today were it not for that report, but it does underscore some element of unpredictability. Getting back to the beginning – and to what was ultimately a non-exponential graph – the big DAH gains of the future may be unlikely to be resemble that steep 2000-2010 upslope. But there is legitimate hope for that decade to begin to look like the first step in a flight of stairs, with new, lump infusions as the opportunities for gains in global health settle in with what appears to be a receptive generation of philanthropists.



*Bloomberg’s and Parker’s contributions to DAH are not given in actual amounts. Their foundations’ overall worth is established, and they are noted to have DAH as core components of their missions.

Works Cited:

1. Clifford, Catherine. “These 14 billionaires just promised to give away more than half of their money like Bill Gates and Warren Buffet”. CNBC. Published 31 May 2017. Accessed 17 August 2017.

2. Dolan, Kerry. “Forbes 2017 BIllionaire’s List: Meet The Richest People On The Planet”. Forbes. Published 20 March 2017. Accessed 17 August 2017.

3. George, Bill. “America is in the Middle of a Philanthropic Revolution”. Fortune. Published 17 January 2017. Accessed 17 August 2017.

4. Gibbs, W Wyat. “Bill Gates View Good Data as Key to Global Health”. Scientific American. Published 1 August 2016. Accessed 17 August 2017.

5. Institute for Health Metrics and Evaluation (IHME). Financing Global Health 2016: Development Assistance, Public and Private Health Spending for the Pursuit of Universal Health Coverage. Seattle, WA: IHME, 2017.

6. McCracken, Harry. “How the Bloomberg Terminal Made History – And Stays Ever Relevant”. Fast Company. Published 6 October 2015. Accessed 17 August 2017.

7. Parker, Sean. “Philanthropy for Hackers”. The Wall Street Journal. Published 26 June 2015. Accessed 17 August 2017.

8. Shinal, John. “When Silicon Valley execs suddenly make billions, they turnt to this man to help them give it away”. CNBC. Published 10 June 2017. Accessed 17 August 2017.

9. Stanley, Alessandra. “Silicon Valley’s New Philanthropy”. The New York Times. Published 31 October 2015. Accessed 17 August 2017.

10. “The World’s Billionaire’s”. Forbes. Updated 16 August 2017. Accessed 17 August 2017.

11. Vinton, Kate. “Meet The 183 Tech Billionaires Who Own $1 Trillion Of The World’s Wealth”. Forbes. Published 20 March 2017. Accessed 17 August 2017.

This entry was posted in BMC.
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