全球卫生治理中的慈善资本主义：以盖茨基金为例

doi:10.3785/j.issn.1008-942X.CN33-6000/C.2024.12.021

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Abstract Philanthrocapitalism, a fusion of philanthropy and capitalism, has become an increasingly influential force in global health governance. By leveraging private capital and market-driven business principles, philanthrocapitalism seeks to create a win-win scenario between profit generation and the promotion of global health. The emergence of philanthrocapitalism in global health governance is rooted in the globalization of vertical health governance models, the growing influence of neoliberalism in global health, and the weakening of the global health governance financing system. While philanthrocapitalism significantly impacts the models and agenda-setting processes of global health governance, it also presents both challenges and opportunities due to the inherent tension between the altruistic nature of philanthropy and the profit-seeking nature of capitalism.With the increasing engagement of private philanthropic organizations such as the Gates Foundation, the Bloomberg Family Foundation and the Clinton Foundation in global health governance, philanthrocapitalism has become an indispensable force in global health governance. The Gates Foundation, as a quintessential example of philanthrocapitalism, has played such an important role in global health governance that it is almost omnipresent in any discussion on global health. It has been engaged in this domain through two primary mechanisms: first, by shaping the global health agenda using its epistemic and relational power; second, by expanding its decision-making influence through financial support to UN-affiliated organizations, public-private partnerships, non-governmental organizations, and research institutions. The “Gates Approach” is characterized by its expansion of institutional power, promotion of neoliberal policies, and emphasis on biotechnology. However, philanthrocapitalism is not a panacea for global health governance and poses several challenges. The Gates Foundation’s vertical governance model can distort global health priorities, exacerbate market failures, and widen the public health gap between the Global South and North. Additionally, its technology-centric approach may undermine global health equity.This paper employs qualitative and quantitative analysis to investigate the financing preferences of the Gates Foundation in global health governance. It argues that the primary motivation for private philanthrocapitalist foundations to be engaged in global health governance is not solely to promote philanthropy but also to expand capitalist interests. This study contributes to the field of global health governance research in multiple ways. On the one hand, it uses the concept of philanthrocapitalism as an analytical framework to comprehensively examine the role and impact of the Gates Foundation in global health governance, providing valuable insights into the strengths and weaknesses of private philanthrocapitalist organizations in global health governance. On the other hand, it critically analyzes the background, approaches, and motivations of such organizations, offering an objective evaluation of the role of the private sector in global health governance.

Key words： philanthrocapitalism global health governance Gates Foundation

Received: 02 December 2024

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	Jin Jiyong
	Lin Kexia

Cite this article:

Jin Jiyong,Lin Kexia. Philanthrocapitalism in Global Health Governance: A Case Study of Gates Foundation[J]. JOURNAL OF ZHEJIANG UNIVERSITY, 2025, 55(11): 43-60.

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https://www.zjujournals.com/soc/EN/10.3785/j.issn.1008-942X.CN33-6000/C.2024.12.021 OR https://www.zjujournals.com/soc/EN/Y2025/V55/I11/43

1 Khemka U.， “The birth of philanthrocapitalism，” 2006-02-25， https：//www.economist.com/special-report/2006/02/25/the-birth-of-philanthrocapitalism， 2025-06-25.
2 McGoey L.， “The philanthropic state： market-state hybrids in the philanthrocapitalist turn，” Third World Quarterly， Vol. 35， No. 1 （2014）， pp. 109-125.
3 Birn A. E.， “Philanthrocapitalism， past and present： the Rockefeller Foundation， the Gates Foundation， and the setting（s） of the international/global health agenda，” Hypothesis， Vol. 12， No. 1 （2014）， pp. 1-54.
4 The Lancet， “What has the Gates Foundation done for global health？” The Lancet， Vol. 373， No. 9675 （2009）， p. 1577.
5 Youde J.， “The role of philanthropy in international relations，” Review of International Studies， Vol. 45， No. 1 （2019）， pp. 39-56.
6 The Lancet， “The Wellcome Trust： an unsung hero in health research，” The Lancet， Vol. 371， No. 9612 （2008）， p. 531.
7 Bishop M. & Green M.， Philanthrocapitalism： How Giving Can Save the World， New York： Bloomsbury Publishing， 2010.
8 Haydon S.， Jung T. & Russell S.， “You’ve been framed： a critical review of academic discourse on philanthrocapitalism，” International Journal of Management Review， Vol. 23， No. 3 （2021）， pp. 353-375.
9 Butler C. D.， “Philanthrocapitalism： promoting global health but failing planetary health，” Challenges， Vol. 10， No. 1 （2019）， p. 24.
10 Edwards M.， Just Another Emperor？ The Myths and Realities of Philanthrocapitalism， Demos： Network for Ideas & Action and The Young Foundation， New York， 2008.
11 Gates B.， “Bill Gates’ three magical elements，” 2009-01-26， https：//www.forbes.com/2009/01/26/bill-gates-philanthropy-tech-enter-cx_wt_0126philanthropy.html， 2025-06-25.
12 Carnegie A.， The Gospel of Wealth， New York： Carnegie Corporation of New York， 2017.
13 Weindling P.， “American foundations and the internationalizing of public health，” in Solomon S.， Murard L. & Zylberman P. （eds.）， Shifting Boundaries of Public Health： Europe in the Twentieth Century， New York： University of Rochester Press， 2008， pp. 63-86.
14 Gaulkin T.， “Pandemic failure or convenient scapegoat： how did WHO get here？” 2020-07-09， https：//thebulletin.org/wp-content/uploads/2020/07/how-did-WHO-get-here-BulletinAtomic-Gaulkin.pdf， 2023-10-02.
15 Rogers R.， “Why philanthro-policymaking matters，” Society， Vol. 48， No. 5 （2011）， pp. 376-381.
16 Baltodano M. P.， “The power brokers of neoliberalism： philanthrocapitalists and public education，” Policy Futures in Education， Vol. 15， No. 2 （2017）， pp. 141-156.
17 Barnett M. & Finnemore M.， “The politics， power， and pathologies of international organizations，” International Organizations， Vol. 53， No. 4 （1999）， pp. 699-732.
18 Morton T. B.， “1955 Budget of the World Health Organization and the United States Assessment，” The Department of State Bulletin， Vol. 30， No. 782 （1954）， pp. 964-965.
19 Clinton C. & Sridhar D.， Governing Global Health： Who Runs the World and Why？ New York： Oxford University Press， 2017.
20 Bill & Melinda Gates Foundation， “2008 World Economic Forum，” 2008-01-24， https：//www.gatesfoundation.org/ideas/speeches/2008/01/bill-gates-2008-world-economic-forum， 2024-06-02.
21 Carbonaro G.， “How is the World Health Organization funded， and why does it rely so much on Bill Gates，” 2023-02-03， https：//www.euronews.com/next/2023/02/03/how-is-the-world-health-organization-funded-and-why-does-it-rely-so-much-on-bill-gates， 2023-12-26.
22 法］米歇尔·福柯：《安全、领土与人口》，钱翰、陈晓径译，上海：上海人民出版社，2010年。
23 Storeng K.T.， “The GAVI Alliance and the ‘Gates approach’ to health system strengthening，” Global Public Health， Vol. 9， No. 8 （2014）， pp. 865-879.
24 法］米歇尔·福柯：《生命政治的诞生》，莫伟民、赵伟译，上海：上海人民出版社，2011年。
25 Barnett M. & Duvall R.， “Power in global governance，” in Barnett M. & Duvall R. （eds.）， Power in Global Governance， Cambridge Studies in International Relations， New York： Cambridge University Press， 2004， pp. 1-32.
26 Garrett L.， “Money or die： a watershed moment for global public health，” 2012-03-06， https：//www.foreignaffairs.com/articles/2012-03-06/money-or-die， 2024-02-23.
27 Lynch C. & Schwarz T. B.， “Humanitarianism’s proselytism problem，” International Studies Quarterly， Vol. 60， No. 4 （2016）， pp. 636-646.
28 胡耀辉：《安全配置：福柯治理术的运转机制》，《社会科学研究》2021年第1期，第39-46页。
29 Curtis M.， “Gated development—is the Gates Foundation always a force for good？” 2016-01-20， https：//www.globaljustice.org.uk/resource/gated-development-gates-foundation-always-force-good/， 2024-12-22.
30 Anon.， “Grand Challenges，” https：//gcgh.grandchallenges.org/sites/default/files/files/grand_challenges_fact_sheet_2023.pdf， 2023-12-22.
31 Kilby P.， Philanthropic Foundations in International Development： Rockefeller， Ford and Gates， Oxford： Routledge， 2021.
32 Livingston S.G.， “The politics of international agenda-setting： Reagan and North-South relations，” International Studies Quarterly， Vol. 36， No. 3 （1992）， pp. 313-329.
33 Levich J.， “The Gates Foundation， Ebola， and global heath imperialism，” American Journal of Economics and Sociology， Vol. 74， No. 4 （2015）， pp. 704-742.
34 Foucault M.， Discipline and Punish： The Birth of Prison， London： Pantheon Books， 1977.
35 McCoy D. & McGoey L.， “Global health and the Gates Foundation—in perspective” in Rushton S. & Williams O. D. （eds.）， Partnerships and Foundations in Global Health Governance， London： Palgrave Macmillan， 2011， pp. 143-163.
36 Bill & Melinda Gates Foundation， “Vaccine development and surveillance，” https：//www.gatesfoundation.org/our-work/programs/global-health/vaccine-development-and-surveillance， 2024-05-12.
37 Gates B.， “Co-founder of the Bill and Melinda Gates Foundation at the Fifty-eighth World Health Assembly，” 2005-05-16， https：//apps.who.int/gb/archive/pdf_files/WHA58/A58_DIV8-en.pdf， 2025-01-20.
38 Enserink M.， “Gates call for decade of vaccine， pledges assault on child mortality，” 2010-01-29， https：//www.science.org/content/article/gates-call-decade-vaccines-pledges-assault-child-mortality， 2024-05-02.
39 Gates B.， “2005 world health assembly keynote address，” 2011-05-17， https：//www.gatesfoundation.org/media-center/speeches/2011/05/world-health-assembly， 2022-10-02.
40 Bill & Melinda Gates Foundation， “Developing successful Global Health Alliances，” https：//docs.gatesfoundation.org/documents/globalhealthalliances.pdf， 2024-05-22.
41 Belluz J. & Buissonniere M.， “How McKinsey infiltrated the World of Global Public Health，” 2019-12-17， https：//www.vox.com/science-and-health/2019/12/13/21004456/bill-gates-mckinsey-global-public-health-bcg， 2024-01-08.
42 Banco E. & Furlong A.， “How Bill Gates and partners used their clout to control the global Covid response—with little oversight，” 2022-12-14， https：//www.politico.com/news/2022/09/14/global-covid-pandemic-response-bill-gates-partners-00053969， 2024-05-22.
43 Bill & Melinda Gates Foundation， “Gates Foundation aims to increase payout by 50% to help meet urgent global needs，” 2022-07-12， https：//www.gatesfoundation.org/ideas/articles/gates-foundation-aims-payout-increase-us-9-billion-help-meet-global-needs， 2022-12-02.
44 Bill & Melinda Gates Foundation， “Global health agencies and funds，” https：//www.gatesfoundation.org/our-work/programs/global-development/global-health-agencies-and-funds， 2024-01-02.
45 Huet N. & Paun C.， “Meet the world’s most powerful doctor： Bill Gates，” 2017-05-04， https：//www.politico.eu/article/bill-gates-who-most-powerful-doctor， 2024-01-02.
46 Puyvallée A. de B.， “The rising authority and agency of public-private partnerships in global health governance，” Policy and Society， Vol. 43， No. 1 （2024）， pp. 25-40.
47 Morvaridi B.， “Does sub-Saharan Africa need capitalist philanthropy to reduce poverty and achieve food security？” Review of African Political Economy， Vol. 43， No. 147 （2016）， pp. 151-159.
48 丁梦丽、刘宏松：《制度化水平、参与深度与跨国公私伙伴关系的有效性》，《世界经济与政治》2018年第11期，第80-117页。
49 Rushton S. & Williams O. D. （eds.）， Partnerships and Foundations in Global Health Governance， Basingstoke： Palgrave Macmillan， 2011.
50 Barker R.， Political Legitimacy and the State， Oxford： Oxford University Press， 1990.
51 Moon S. & Omole O.， “Development assistance for health： critiques， proposals and prospects for change，” Health Economics， Policy and Law， Vol. 12， No. 2 （2017）， pp. 207-221.
52 Martens J. & Seitz K.， Philanthropic Power and Development： Who Shapes the Agenda？ Aachen： Bisch?fliches Hilfswerk Misereor， 2015.
53 WHO， “Noncommunicable diseases fact sheets，” 2023-09-25， https：//www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases， 2024-02-26.
54 Bowman A.， “The flip side to Bill Gates’ charity billions，” 2012-04-01， https：//newint.org/features/2012/04/01/bill-gates-charitable-giving-ethics， 2024-02-25.
55 Curtis M.， “Gated Development—is the Gates Foundation always a force for good？” 2016-01-20， https：//www.globaljustice.org.uk/resource/gated-development-gates-foundation-always-force-good/， 2024-02-25.
56 Ruckert A. & Labonté R.， “Public-private partnerships （PPPS） in global health： the good， the bad and the ugly，” Third World Quarterly， Vol. 35， No. 9 （2014）， pp. 1598-1614.
57 Hafner T. & Shiffman J.， “The emergence of global attention to health systems strengthening，” Health Policy and Planning， Vol. 28， No. 1 （2013）， pp. 41-50.
58 陈雪飞：《通过医学的治理：知识权威与健康政治》，《开放时代》2021年第3期，第140-150页。
59 Reddy S. K.， Mazhar S. & Lencucha R.， “The financial sustainability of the World Health Organization and the political economy of global health governance： a review of funding proposals，” Globalization and Health， Vol. 14， No. 1 （2018）， pp. 1-11.
60 Fink S.， “WHO leader describes the agency’s Ebola operations，” 2014-09-04， https：//www.nytimes.com/2014/09/04/world/africa/who-leader-describes-the-agencys-ebola-operations.html， 2025-09-04.
61 Brundtland G. H.， “Looking ahead for WHO after a year of change， summary of The world health report 1999，” 1999-03-30， https：//apps.who.int/gb/archive/pdf_files/WHA52/ew4.pdf， 2024-05-08.
62 Commission on Intellectual Property Rights， “Integrating intellectual property rights and development policy，” http：//www.iprcommission.org/papers/pdfs/final_report/ciprfullfinal.pdf， 2022-11-02.
63 Loffredo J. & Greenstein M.， “Why the Bill Gates global health empire promises more empire and less public health，” 2020-07-18， https：//grain.org/en/article/6511-why-the-bill-gates-global-health-empire-promises-more-empire-and-less-public-health， 2024-06-02.
64 Hancock J.， “Rather than give away its COVID-19 vaccine， Oxford makes a deal with drugmaker，” 2020-08-28， https：//www.inquirer.com/business/drugs/oxford-fauci-cdc-vaccines-astrazeneca-merck-pfizer-moderna-coronavirus-pandemic-who-harvard-20200828.html， 2024-06-02.
65 Smith R.， Mdee A. & Sallu S. M. et al.， “Neoliberal ideologies and philanthrocapitalist agendas： what does a ‘smart economics’ discourse empower？” Third World Quarterly， Vol. 44， No. 3 （2023）， pp. 574-594.
66 Breen E. & Kumar R.， Private Foundations and their Global Health Grant-making Patterns， Bonn： Global Policy Forum Europe e. V.， 2023.
67 Ruger P.， Global Health Justice and Governance， Oxford： Oxford University Press， 2018.
68 McGoey L.， No Such Thing as a Free Gift： The Gates Foundation and the Price of Philanthropy， London： Verso， 2015.
69 Birn A. E.， Pillay Y. & Holtz T.， Textbook of International Health： Global Health in a Dynamic World， New York： Oxford University Press， 2009.
70 McCoy D.， Kembhavi G. & Patel J. et al.， “The Bill & Melinda Gates Foundation’s grant-making programme for global health，” The Lancet， Vol. 373， No. 9675 （2009）， pp. 1645-1653.
71 Birn A. E.， “Gates’s grandest challenge： transcending technology as public health ideology，” The Lancet， Vol. 366， No. 9484 （2005）， pp. 514-519.
72 Blunt G. D.， “The Gates Foundation， global health and domination： a republican critique of transnational philanthropy，” International Affairs， Vol. 98， No. 6 （2022）， pp. 2039-2056.
73 Chuang J. A.， “Giving as governance？ philanthrocapitalism and modern-day slavery abolitionism，” UCLA Law Review， Vol. 62， No. 1516 （2015）， pp. 1518-1555.
74 Singer P.， The Most Good You Can Do： How Effective Altruism Is Changing Ideas about Living Ethically， New Haven： Yale University Press， 2015.
75 Twohey M. & Kulish N.， “Bill Gates， the virus and the quest to vaccinate the world，” 2020-11-23， https：//www.chicagotribune.com/2020/11/23/bill-gates-the-virus-and-the-quest-to-vaccinate-the-world-2/， 2024-12-02.