Abstract

"Health and the Chronology of Global Governance"

Heidi Tworek, University of British Columbia (heidi.tworek@ubc.ca)

The influence of philanthropy on global health is often portrayed as a recent development, particularly spurred by the Gates Foundation. Yet business interests, especially American philanthropic organizations, are one of the key drivers of global health. This paper explores the longer history of American funding in global health to show how its sources changed over the twentieth and twenty-first centuries, with patterns that look somewhat different from other cycles of globalization, as described by scholars like Geoffrey Jones.

Starting with the Rockefeller Foundation in the early twentieth century, spending ramped up in the interwar period, as the Foundation provided the crucial funding for the League of Nations Health Organization. This stood in stark contrast to other economic deglobalization/shifts in trade patterns. And it occurred despite the United States not being a member of the League of Nations. Public/private distinctions in funding and governing global health were blurred.

In the post-World War II period, the creation of the World Health Organization meant that the United States government became a key funder of international health organizations. American philanthropies turned to other projects of development, such as modernization and the Green Revolution.

Only from the 1990s onwards did American philanthropies become crucial for governing global public health. The Gates Foundation often has greater funds at its disposal than the WHO and its business-driven modes of assessment (e.g. value for money for treatments) have shaped how global health operates in the twenty-first century. It also advocates on behalf of pharmaceutical companies to retain intellectual property rights in medicine and vaccines.

The presentation will trace this chronology, where global health finds itself back to the future, with American philanthropies dictating much of global health's priorities. The history of global health at the League and WHO is also very much a business history.