Illumination and Innovation: What Philanthropic Foundations Bring to Global Health Governance

This article argues that because much of the scholarship examining the influence of private foundations in global health governance is either neo-Gramscian or reflexively critical in orientation, undue attention has been paid to foundations' origins, affiliations and perceived biases towards bringing technological solutions to bear on problems with deep socio-political determinants, obscuring their chief functions as global governors while downplaying their agency. Such concerns are by no means new as private philanthropic influence in the governance of global health is not a new phenomenon. Drawing on examples from the Ford, Rockefeller and Bill and Melinda Gates Foundations' efforts to strengthen public health across the Global South, we argue that for over a century private foundations have been instrumental in the governance of collective action problems for two important reasons. Firstly, their stark illumination of state and market failures disproportionately affecting the world's marginalised and the potential of science-enabled innovation to address longstanding challenges has repeatedly generated the requisite political will to address, however imperfectly, global disparities. Secondly, foundations have ensured that functional governance mechanisms exist to provide public goods to the poor when changes to the structural fabric of the world order constrain the ability of other institutions mandated to perform this function.