PAPER: Who decides on our health?

The World Health Organization's involvement with private actors has increased over the years. Is more private involvement something we should applaud when it comes down to our right to health?

Charitable organizations are regarded as good-doers but often have a hidden agenda that stands in contradiction with public interest

Philanthropists and their foundations like the Bill and Melinda Gates Foundation are making a presence on the international stage. Governments and institutions are applauding them for pledging their wealth, fame, and entrepreneurial talents to solve the world's problems. In the field of health, the World Health Organization's (WHO) involvement with private actors, both politically and financially, has increased over the years. To date, philanthropic foundations are amongst the WHO primary funding partners. But there is quite some controversy as harmful effects and conflicts of interest have been identified.

In this paper, we go deeper into this problematic.

Read the paper: 'Who decides on our health?'

Below, we offer you a summary.

Voluntary donations, obligatory results

A significant amount of WHO budget is from voluntary donations from philanthropic foundations. These are very unpredictable. Even more, they are 'earmarked': which means the donor decides for which particular program the money is used. This puts these charitable organizations in an influential position to decide on global health decisions and policy. But the intentions of these organizations are not always clear, and there is always the danger of a 'conflict of interest.'

The increasing need for private donor funding in the WHO stems from the decision of high-income countries to freeze their assessed financial contributions to the organization in the early 1980s. Governments are now embracing donor’s involvement as a way of easing pressure on their budget and funding responsibilities towards the WHO. Inevitably, the WHO can not fully implement its projects. An example is the budget cut for emergency preparedness which led to the late response of the WHO during the Ebola crisis.[1]

But the WHO's growing independence on private-for-profit entities also jeopardizes its position as the global health decision maker. By consequence, it is losing sight of its original mission.

Conflicting interests

Charitable organizations are regarded as good-doers with good intentions but often have a hidden agenda of private interest that stands in contradiction with public interest. Their partnership with multinational enterprises does often pursue economic and commercial opportunities.

The most known example is the Bill and Melinda Gates Foundation. In 2016 only, the Foundation granted over 71 million dollar to the WHO, making it the largest non-state funder and the second largest donor after the United States of America. From their side, the organization obtains earnings from investments made in the forms of stocks, mutual funds and corporate bonds managed by a different legal entity known as the Bill and Melinda Gates Foundation Trust.

The Foundation is one of the driving force behind public-private partnerships. Their primary focus goes to biomedical solutions such as vaccines by which representing a vertical approach as a quick-win solution to global health challenges. Since 1960, the international health community employed similar programs in less developed countries targeting specific diseases such as eradicating malaria. Afterwards, it became apparent that disease-specific interventions work well only if they are backed up by the widest provision of public primary health care by strengthening the overall health system. We refer to this as the horizontal approach. Population health does not improve through parallel programs that are isolated one from another.

The Bill and Melinda Gates Foundation's strong involvement with the pharmaceutical sector may explain their funding choices. Investing in prevention such as healthy environments and strong health systems is less profitable from a commercial point of view, it would make vaccines and medication for preventable diseases less needful. But the contradictory interests go much further. The Bill and Melinda Gates Foundation Trust has investments in the unhealthy food and beverage industry, such as in companies like Coca-Cola and Walmart. The massive consumption of these products play a mayor role the current crisis of preventable heart disease, stroke, cancer, and diabetes.

Who should decide on our health?

We are thus seeing a privatization of global health governance. To date, more than 80% of WHO budget is from voluntary donations of which 93% is earmarked for targeted interventions. This funding strategy prevents the implementation of programs that are not supported by wealthy member states or donors.

The commercial interests of powerful corporations pose risks and barriers to affordable health care. These companies have more interest in profit for them and their shareholders than providing affordable and efficient solutions. An uncritical rush into these partnerships erodes member’s states decision-making powers.

The public investment in the development of well-trained workforce facilities appropriates prevention, detection, and control of disease outbreak. Decision making within the WHO should be based on the democratic mandate a state is given, not on the funding you can provide as an actor. In the WHO counts: one state, one vote, and not one dollar, one vote. Development, poverty eradication, social protection, and health is not a favor. It is a right. It is not the philanthropist, but the collective responsibility of member states to make a change to ensure these rights.

We keep a close watch

However, rules and control are important but they do not guarantee changes. It is only through strong and massive social movements, where the most oppressed have a powerful voice, that people defend their rights. In the end, it is the best guarantee for our right to health to be respected.

This is why TWHA supports the People's Health Movement, an international movement that unites grassroots organizations, health activists and academics from more than 70 countries. They are present at every big meeting of the WHO to raise a critical voice and demand strong protection against these private influences.


1. An interesting background on the Ebola crisis can be found here.