Global Philanthropy and Health Disparities Research: The

Opportunities and Challenges of Approaches and Results

Anne C Petersen, PhDResearch Professor, CHGD, UM

Founder & President, Global Philanthropy Alliance

Presentation for UM MHIRTMarch 22, 2011

Outline of Presentation

Brief review of global philanthropy

Brief review of health disparities, especially global

Using philanthropy to address global health disparities

Conclusions

Global Philanthropy Foundation growth in global giving

outstripped domestic giving over last two decades; now 24% of $ given

Background:• Foundation assets increased four-fold since

1990• Foundation giving increased more than

five-fold over same period• Number of foundations more than doubled

over same period; new foundations more likely to give internationally

Global Philanthropy (cont)

Half of international giving consistent with Millennium Development Goals

Health received the largest share of foundation funding with intended beneficiaries outside the US (43% in 2006, 39% in 2008)

Gates gave almost all the global health funding

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Recession Effects

Foundation Center estimates that • US Foundations lost 17% of assets in

2008• Giving down 8% in 2009• International giving down only 4% in

2009• Without Gates in data, both domestic

and international giving down 9% in 2009

Broader Global Philanthropy

Foundation giving only a small part of global giving (but are good data for US, not for rest)

Other donors include:• Individuals• NGOs• Religious organizations – by far the

largest generally; globally too?• Corporations

Individual Giving Internationally Data from PSID 2007 (2006 giving) 6.3% giving rate $100/272 median/average giving per

donor household Factors influencing giving:

• Age (rate linear, highest gifts 10-64 yr)• Income/Wealth (linear for rate, amount)• Education (rate linear, $ lowest some coll)• Region (NE highest rate, Mtn highest $)• Marital Status (married highest rate, $)

Global Philanthropy Modes

Grants Loans Time/effort

(volunteering)

Impact of Global Philanthropy

Foreign aid not so effective Is philanthropy better? Few good studies yet despite greater

impact orientation of global donors Critique (Garrett)

• donors too narrow • no one looking at the whole system• doing as much damage as good?

Health Disparities

Dramatic differences among countries in health indicators

Maps that follow show death and disability-adjusted life year (DALY) rates by WHO regions

HIV/AIDS is the leading cause of adult mortality in Africa

Two leading causes of DALY rates: lower respiratory infections and diarrheal diseases

Health-related MDGs Fewer children dying – deaths of

children <5 down 30% since 1990 Fewer children < 5 years

underweight - % underweight-25% More skilled help during childbirth

but <50% births in Africa & SE Asia New HIV infections -16% from 01-08 TB Rx more effective More safe drinking water but not safe

toilets

Laurie Garrett Critique

The Challenge of Global Health (Foreign Affairs, 2007)

More money for global health but significant problems• Narrowly focused on single problems• Must refocus on public health• Brain drain of health workers getting

worse

Need Systemic Approach

Recent report from FSG (Kania & Kramer, 2010) on Collective Impact found that 90% of non-profit efforts are suboptimal

Efforts that are effective engage all stakeholders over multiple years

Is this possible in global arena? Or even focusing on country health?

Current scattershot efforts unlikely to have sustainable effectiveness

L Garrett (cont) Situation since 2007? Talk on 2/7/11 Currently at plateau Most of global funding from the US –

“two Washingtons” Huge funding risk now with budget

cuts in the US (as in Western Europe) No likely support for global health in

Congress

Will US Philanthropy Fill the Gap Left by US Funds

Recent report (KFF 2010) shows global health funding flat in 2009

Funders Concerned about AIDS reported that funding for that disease was down in 2009 compared with 2008

US foundations not known for collaboration

But Gates together with partners could make a difference

Future of Global Health

Could current efforts be sustained – possible IF Gates + UN + key countries partner

Will current efforts be sustained – unlikely• Regions of significant instability• Most “developed” countries focused on

cutting budgets not increasing or even sustaining commitments

BUT

Being an eternal optimist I believe that leadership could

emerge to lead the world through our current crises

Stranger things have happened