Philanthropy historically means the love of humanity; a philanthropist is a person who seeks to promote the welfare of others, especially by the generous donation of money to good causes. Some significant contributors to global health are philanthropists: the very well-known Bill and Melinda Gates are the founders of their self-named Foundation. In their 2016 annual letter they wrote about their role in reducing childhood mortality, fighting the battle towards ending malnutrition, increasing vaccination and reducing newborn mortality. Over the years, the Gates have done a huge amount for global health efforts, but what was the main lesson that they learnt in 2016? The answer to this is the link between lower birth rate and ending poverty. Lowering the birth rate in developing countries has huge benefits for families living in poverty. When the number of children in a household is high, access to resources (which are already limited in number) becomes even more restricted. This can lead to malnourishment and suffering on behalf of whole families. Reduction in the birth rate can lead to families being uplifted out of poverty, due to having a better share of limited resources. Moreover, with lower birth rate comes increased emancipation of women: they have more power to choose their fates. Women are empowered to further their education and earn more money to support themselves and their families. Moreover, further education for women can lead to future benefits, as they pass on their knowledge to their children… as goes Brigham Young’s well-known quote: if you educate a woman, you educate a generation. These facts lead to the Gates’ conviction that ‘contraceptives are one of the greatest anti poverty innovations in history’.
However, despite their grand role in global health, are their any flaws in the work of the Gates foundation, and other philanthropy efforts? Perhaps one could fault their focus on absolute poverty. Anne Emmanuelle Birn points out the importance of only paying attention to absolute poverty whilst ignoring poverty in its relative form. But what is the difference? Absolute poverty refers to a standard which would be the same in every country: it refers to unfortunate circumstances such as starvation, homelessness, and complete lack of access to basic resources. We know absolute poverty when we see it. Some countries around the world will be victims of a far higher prevalence of absolute poverty than others. However, relative poverty is more subtle; it is completely dependent on the individual society in question. Relative poverty refers to your circumstance, in terms of income and access to resources for example, in relation to the rest of society. Michael Marmot talks about the social gradient present in all countries across the world: the higher up the social ladder you are, and the better your social standing, the longer your life expectancy. This inequity is present wherever you are in the world; this injustice affects all of us. Relative poverty involves economics, politics and social attitudes; the Gates are more focused on technical solutions to isolated problems reflecting absolute poverty. The question is: how sustainable is it to address the problems of poverty without looking at he underlying structures that perpetuate such poor living standards and health. Birn highlights the fact that, in the absence of redistribution of power and resources, health systems alone cannot undo the economic and political underpinnings of poor health’.
UCL MedSoc Global Medicine Subsection Chair
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