Over the past two decades, global health has undergone a transformation. As public funding has become increasingly unpredictable, private philanthropy has largely stepped in to fund global programmes. It is well-known that large foundations such as the Gates Foundation and Bloomberg Philanthropies now largely contribute to the budgets of the WHO and of public-private partnerships, or initiate their own initiatives. What is less visible though is how philanthropists increasingly produce the knowledge infrastructures through which health problems are known, prioritised, and eventually governed.
Philanthropic foundations have widely invested in the production of metrics on the “burden” of specific health conditions, as well as on the “costs” and “returns” of health interventions. In 2007, the Gates Foundation created the Institute of Health Metrics and Evaluation (IHME) to provide “timely, relevant, and scientifically valid evidence” for policymakers. The IHME calculates the Global Burden of Disease (GBD) metrics, the largest-scale project ever set up aimed at measuring morbidity and mortality rates worldwide. With generous funding from the Gates Foundation, the IHME produces profuse estimates and projections that largely surpass those of the WHO, which now increasingly relies on those numbers for its own sense-making and agenda-setting exercises. Other “data” initiatives have further stabilised the presence of philanthropists in global health. In 2015, Bloomberg Philanthropies, in partnership with the Australian government and the Gates Foundation, launched its own Data for Health initiative. Philanthropists’ data centres have come to sit at the core of global infrastructures of quantification. On the basis of those estimates, health actors produce calculations to identify which health interventions could “save the most lives” and be most “cost-effective”.
This calculative logic sustains an approach in which “results” must be continuously and quantitatively evidenced. This implies that problems are seen mainly in terms of their magnitude and that interventions need to have “scalability” and “reach population impact”. This also favours highly technical interventions, as it is easier to produce evidence on their impact and the economic returns they generate. The distribution of hundreds of millions of insecticide-treated nets has for instance become a flagship intervention to solve malaria, with quantifiable impact, supported by the Gates Foundation. “Quick fixes” are favoured, while factors relating to socioeconomic and environmental conditions are too often ignored.
Understanding this shift is crucial. As private resources fill funding gaps, such a move is not neutral but deeply political. Although improving public health is in itself a laudable objective, it is necessary to interrogate the role philanthropic actors — largely rooted in for-profit logics as they are — play in knowledge governance around public health research, data, and public health conditions.
Read the full article in The Conversation.
This article was published in Globe #38, the Graduate Institute Review.
Photo Credit: STOCKHOLM, Sweden. Host Jenny Strömstedt greets Microsoft co-founder Bill Gates during the Gates Foundation’s first global Goalkeepers event in the Nordics. 22 January 2026. Stefan JERREVANG / TT News Agency / AFP