.
IV. A Broader Agenda
Behind BMGF’s coordinated interventions in pharmaceuticals, agriculture, population control, and other putatively philanthropic concerns lies a broader agenda. In a recent interview Bill Gates briefly strayed off-message to warn of “huge population growth in places where we don’t want it, like Yemen and Pakistan and parts of Africa.”77 His use of the majestic plural here is revealing: in spite of much rhetoric about “empowering poor people,” the Foundation is fundamentally concerned with reshaping societies in the context of ruling-class imperatives.
The central thrust of current imperialist strategy involves increasingly direct intervention in the developing countries/Third World, ranging from internal destabilization to regime change to outright military occupation. This is evidenced by recent wars of conquest in Iraq and Libya, multiple programs of destabilization and proxy warfare throughout the Middle East and North Africa, and the integration of African Union military forces into the framework of AFRICOM. Military aggression undergirds a redoubled effort to seize control of raw materials in developing countries, in particular oil and strategic mineral resources in the African continent. Big Philanthropy’s more aggressive interventions in the public health systems of the Third World reflect and complement this strategy.
Meanwhile, the capitalist core is pursuing an energetic program of what David Harvey has called “accumulation by dispossession,” leading to “a rapid and large movement of foreign capital taking control over huge tracts of land—mainly in Africa, Southeast Asia, and Latin America—by either outright purchase or by long-term leases and removal of peasant farmers from the land.”78 This process is facilitated in multiple ways by the activities of the Gates Foundation. What follows is an attempt to summarize the Gates agenda in a few broad strokes.
“Land mobility” not land reform
Hunger, claims the Gates Foundation website, is rooted in “population growth, rising incomes, dwindling natural resources, and a changing climate,” and is best addressed by enhancing agricultural productivity.79 Unmentioned is the fact that per capita food production has been trending upward for decades and remains at historic highs,80 meaning that hunger is an issue of unequal distribution rather than inadequate productivity. Extensive scholarship shows also that food insecurity has been greatly exacerbated over recent decades by massive dispossession of small farmers, depriving millions of their livelihoods.81 Contra Gates, the food crisis is not one of “rising incomes” but of vanishing incomes.
Although Foundation publicity pays lip service to the idea of sustainable smallholder agriculture, in fact its initiatives are uniformly directed toward high-tech, high-yield farming methods – much like the “Green Revolution” technologies that proved ultimately ruinous for rural peasantries beginning in the 1960s.82 Gates works closely with agribusiness giant Monsanto through organizations like the Alliance for a Green Revolution in Africa (AGRA), which steers billions in grant money primarily to biotech and GMO research.83 The Foundation has also thrown its weight behind a revival of Grameen-style microbanking schemes, which transpired during the 2000s to be a debt trap leading to dispossession of rural families.84
Far from empowering small farmers, BMGF’s efforts envision the exit of “inefficient” small farmers from their land – a process euphemistically termed “land mobility” – as revealed by an internal memo leaked to the press in 2008:
In order to transition agriculture from the current situation of low investment, low productivity and low returns to a market-oriented, highly-productive system, it is essential that supply (productivity) and demand (market access) expand together… [this] involves market-oriented farmers operating profitable farms that generate enough income to sustain their rise out of poverty. Over time, this will require some degree of land mobility and a lower percentage of total employment involved in direct agricultural production.85
The impact of these policies on small farmers and their families is disastrous. As Fred Magdoff recently explained, “the world capitalist economy is [no longer] able to provide productive employment for the huge numbers of people losing their lands. Thus the fate of those migrating to cities or other countries is commonly to live in slums and to exist precariously within the ‘informal’ economy.86
Indeed, the Foundation's agricultural policy strikingly resembles what Samir Amin describes as the logical outcome of subjecting agriculture to the same market principles as any other branch of production: 20 million industrial farmers producing the world's food supply in place of today’s three billion peasants.87 As Amin observes:
The conditions for the success of such an alternative would include: (1) the transfer of important pieces of good land to the new capitalist farmers (and these lands would have to be taken out of the hands of present peasant populations); (2) capital (to buy supplies and equipment); and (3) access to the consumer markets. Such farmers would indeed compete successfully with the billions of present peasants. But what would happen to those billions of people?88
Amin’s analysis chimes with the Gates Foundation memo quoted above, and there is reason to believe that BMGF is already contemplating strategies for coping with the “surplus” population that the processes of accumulation and dispossession are generating.
Population control not redistribution
In a 2012 Newsweek profile, Melinda Gates announced her intention to get “family planning” back on the global agenda and made the dubious claim that African women were literally clamoring for Depo-Provera as a way of hiding contraceptive use from “unsupportive husbands.”89 Boasting that a decision “likely to change lives all over the world” had been hers alone, she announced that the Foundation would invest $4 billion in an effort to supply injectable contraceptives to 120 million women – presumably women of color – by 2020. It was a program so ambitious that some critics warned of a return to the era of eugenics and coercive sterilization.90
Bill Gates, at one time an avowed Malthusian “at least in the developing countries”91 is now careful to repudiate Malthus in public. Yet it is striking that Foundation publicity justifies not only contraception, but every major initiative in the language of population control, from vaccination (“When children survive in greater numbers, parents decide to have smaller families”92) to primary education (“[G]irls who complete seven years of schooling will marry four years later and have 2.2 fewer children than girls who do not complete primary school.”)93
In a 2010 public lecture, Bill Gates attributed global warming to “overpopulation” and touted zero population growth as a solution achievable “[i]f we do a really great job on new vaccines, health care, and reproductive health services.”94 The argument is disingenuous: As Gates certainly knows, the poor people who are the targets of his campaigns are responsible for no more than a tiny percentage of the environmental damage that underlies climate change. The economist Utsa Patnaik has demonstrated that when population figures are adjusted to account for actual per capita demand on resources, e.g., fossil fuels and food, the greatest “real population pressure” emanates not from India or Africa, but from the advanced countries.95 The Gates Foundation is well aware of this imbalance and works not to redress it but to preserve it – by blaming poverty not on imperialism but on unrestrained sexual reproduction “in places where we don’t want it.”
From Malthus to the present day, the myth of overpopulation has supplied reliable ideological cover for the ruling class as it appropriates ever greater shares of the people's labor and the planet's wealth. As argued in Aspects No. 55, “Malthus’s heirs continue to wish us to believe that people are responsible for their own misery; that there is simply not enough to go around; and to ameliorate that state of wretchedness we must not attempt to alter the ownership of social wealth and redistribute the social product, but instead focus on reducing the number of people.”96 In recent years BMGF's publicity apparatus, exploiting Western alarm about “climate change,” has helped create a resurgence of the overpopulation hysteria last experienced during the 1970s in the wake of Paul Erlich’s bestseller The Population Bomb.97
Yet the sheer scale of BMGF's investment in “family planning”" suggests that its ambitions reach beyond mere propaganda. In addition to the multibillion dollar contraception distribution program discussed previously, BMGF provides research support for the development of new high-tech, long-lasting contraceptives (e.g., an ultrasound sterilization procedure for men as well as “non-surgical female sterilization”). Meanwhile the Foundation aggressively lobbies Third World governments to spend more on birth control and supporting infrastructure.98 while subsidizing steep cuts in the price of subcutaneous contraceptives.99
These initiatives lie squarely within the traditions of Big Philanthropy. The Rockefeller Foundation organized the Population Council in 1953, predicting a “Malthusian crisis” in the developing world and financing extensive experiments in population control. These interventions were enthusiastically embraced by US government policymakers, who agreed that “the demographic problems of the developing countries, especially in areas of non-Western culture, make these nations more vulnerable to Communism.”100 Foundation research culminated in an era of “unrestrained enthusiasm for government-sponsored family planning” by the 1970s.101 Less discussed but amply documented is the consistent support for eugenics research by US-based foundations, dating from the 1920s, when Rockefeller helped found the German eugenics program that undergirded Nazi racial theories,102 through the 1970s, when Ford Foundation research helped prepare the intellectual ground for a brutal forced sterilization campaign in India.103
Why have foundations invested so persistently in actual technologies and campaigns for population reduction? In the absence of a definitive explanation, two possibilities are worth pondering:
Gates and his billionaire associates may well share Dean Acheson's view – famously ridiculed by Mao Zedong – that population growth engenders revolutions by “creating unbearable pressure on the land.”104 A more recent expression of this idea, contained in the report of the US Vice President’s Task Force on Combatting Terrorism, is that “population pressures create a volatile mixture of youthful aspirations that when coupled with economic and political frustrations help form a large pool of potential terrorists.”105 Thus BMGF likely sees population control as a security imperative, in keeping with its fear of a “less stable” world and reflecting the philosophy of global health governance.106
Population control is, in another sense, one of the instruments of social control. It extends ruling-class jurisdiction more directly to the personal sphere, aiming at “full-spectrum dominance” of the developing world. Like laws regulating marriage and sexual behavior, such interventions in the reproduction of labor power are not essential to capitalists but remain desirable as a means of exercising ruling class hegemony over every aspect of the lives of the working people. Whereas the ideology of population control is intended to turn attention away from the existing distribution of wealth and income that causes widespread want, population control as such directly targets the bodies and dignity of poor people, conditioning them to believe that life’s most intimate decisions are outside of their competence and control.107
The relationship between bourgeois ideology and imperialist practice is dynamic and mutually supportive. As David Harvey has observed: “Whenever a theory of overpopulation seizes hold in a society dominated by an elite, then the non-elite invariably experience some form of political, economic, and social repression.”108 Seen in this light, BMGF's promotion of population control is doubly pernicious because it is cloaked in the language of environmentalism, popular empowerment, and feminism. Melinda Gates may evoke “choice” in support of her family planning initiatives, but in reality it is not poor women, but a handful of the world’s wealthiest people who have presumed to choose which methods of contraception will be delivered, and to whom.
Dependency not democracy
Speaking off the record, public health officials are scathing about the imperiousness of the Gates Foundation. It is said to be “domineering” and “controlling,” contemptuous of advice from experts, seeking to “divide and conquer” the institutions of global health via “stealth-like monopolisation of communications and advocacy.109 But the high-handedness of the Foundation goes far beyond office politics in Geneva. In general it “has not been interested in health systems strengthening and has rather competed with existing health services.”110 It routinely subverts the health ministries of sovereign nations, either coercing their cooperation or outmanoeuvring them via NGO-sponsored field operations that bypass existing infrastructure and personnel.
In particular, the Foundation’s emphasis on single-issue, vertically organized interventions tends to undermine community-based primary care, endorsed by the Alma Ata Declaration of 1978 as the model for Third World public health programs. Based implicitly on the “barefoot doctor” program that revolutionized public health in the People’s Republic of China, the philosophy of primary care proposed that the people “have a right and duty to participate individually and collectively in the planning and implementation of their health care.”111 In theory, the goal was not only improvement of health as such, but also popular empowerment and genuine democracy at the local level. People would be encouraged to believe that health care was not a gift from Western benefactors, but belonged to them as of right.
Although the Chinese model could never be properly implemented in non-socialist countries, Alma Ata inspired various community-based health initiatives in developing countries, achieving some success in lowering infant mortality and raising life expectancy.112 Today, however, primary care programs worldwide are on the decline due both to the imperatives of structural adjustment programs and to the meddling of US-based foundations.113 The Gates Foundation, for its part, invariably acts to steer resources away from community-based holistic doctoring and toward single-disease crash programs, controlled by Western NGOs in collaboration with health-related MNCs. Its approach to diarrhea, which kills upwards of one million infants annually, is a case in point.
The procedures necessary to control diarrhea are not mysterious: clean water and adequate sanitation are essential to prevention, while treatment consists of administering oral rehydration salts (ORS) and zinc supplements to afflicted infants. Chinese “barefoot doctors” achieved steep declines in diarrhea mortality from the 1950s through the 1980s by distributing ORS supplies at the village level and educating families on their importance and proper use.114 Yet while shepherding governments away from investing in the sanitation infrastructure and primary care that have been proven to save lives, BMGF funds and promotes vaccine research, marketing programs administered by NGOs, and “work[ing] with manufacturers and distributors to make ORS and zinc products more attractive to consumers—by improving flavors and repackaging products.”115
Perhaps Bill Gates, who became rich through the expert marketing of inferior software, really believes that poor mothers can’t be relied upon to take an interest in saving their children’s lives unless medicines are advertised like Coca-Cola. But BMGF’s overall stance toward diarrhea, as toward public health in general, reminds us that the attenuation of Third World democracy is far from unwelcome to the rulers. As the educational theorist Robert Arnove has observed, foundations are at bottom
a corrosive influence on a democratic society; they represent relatively unregulated and unaccountable concentrations of power and wealth which buy talent, promote causes, and in effect, establish an agenda of what merits society’s attention. They serve as ‘cooling-out’ agencies, delaying and preventing more radical, structural change. They help maintain an economic and political order, international in scope, which benefits the ruling-class interests of philanthropists.116
Charitable activities that undermine democracy and state sovereignty are immensely useful to the ruling class. Robust, effective social programs in developing countries are an impediment to the current imperial agenda of worldwide expropriation; healthy people, in control of their own destinies and invested in the social well-being of their communities, are better equipped to defend their claim to the wealth they possess and produce. Far better, from the point of view of the Good Club philanthrocapitalists, if the world’s poorest billions remain wholly dependent on a largesse that may be granted or withdrawn at pleasure.
A facelift for the rulers
In the wake of the 2007-08 financial crisis and the subsequent implementation of "austerity" programs worldwide, the super-rich experienced popular anger more directly than at any time since the Great Depression. The masses took to the streets worldwide; the avowedly anti-capitalist Occupy Wall Street movement received extensive and largely favorable press coverage; newspaper columnists openly wondered whether reforms might be needed to save capitalism from itself; Capital and The Communist Manifesto returned to bestseller lists. Particularly worrisome to the mega-rich was the extent to which they themselves, rather than vague complaints about “the system,” became the focus of discontent. Even relatively well-to-do Americans questioned the power and disproportionate wealth controlled by elites, now commonly identified as “the 1 per cent” or the “1 per cent of the 1 per cent.” Confronting widespread hostile scrutiny, the ruling class was in need of a facelift.
BMGF’s publicity operation was quick to respond. The Foundation exploited “multiple messaging avenues for influencing the public narrative” including the creation of “strategic media partners” – ostensibly independent news organizations whose cooperation was ensured via the distribution of $25 million in annual grant money.117 Bill Gates, said to be socially awkward and formerly shy of media attention, was suddenly ubiquitous in the mainstream press. In every interview Gates worked from the same talking points: he had resolved to dedicate “the rest of his life” to assisting the world’s poor; to that end he intended to give away his entire fortune; his uncompromising intelligence and business acumen made him uniquely qualified to wring “more bang for the buck” from philanthropic endeavors; he is nevertheless kindhearted and deeply moved by personal encounters with sick and impoverished children; etc. Invariably he told the suspiciously apposite story of his mother’s deathbed adjuration: “From those to whom much is given, much is expected.”118 At the same time BMGF expanded its online operations, using Twitter and Facebook to disseminate pseudoscientific aperçus and heartwarming images to millions of “followers” worldwide.119
Gates’ willingness to carry the torch for the world’s billionaires reflected an understanding that his Foundation plays an important ideological role within the global capitalist system. Apart from the promotion of specific corporate interests and imperialist strategic aims, BMGF’s expertly publicized activities have the effect of laundering the enormous concentration of wealth in the hands of a few supremely powerful oligarchs. Through stories of Gates’ philanthropy we are assured that our rulers are benevolent, compassionate, and eager to “give back” to the less fortunate; moreover, by leveraging their superior intelligence and technocratic expertise, they are able to transcend the bureaucratic fumblings of state institutions, finding “strategic, market-based solutions” to problems that confound mere democracies. This apotheosis of Western wealth and knowhow works hand-in-hand with an implicit contempt for the sovereignty and competence of poor nations, justifying ever more aggressive imperialist interventions. 120
Thus the Gates Foundation, like the MNCs it so closely resembles, seeks to manufacture consent for its activities through the manipulation of public opinion. Happily, not everyone is fooled: popular resistance to the designs of Big Philanthropy is mounting. The struggle is broad-based, ranging from the women activists who exposed the criminal activities of PATH in India, to the anti-sterilization activities of African-American groups like The Rebecca Project, to the anti-vaccine agitations in Pakistan following the revelation that the CIA had used immunization programs as cover for DNA collection.121 Surely a worldwide campaign to eradicate the toxic philanthropy and infectious propaganda of the Gates Foundation would be in the best traditions of public health.
