The Gates Foundation, Global Health, and Domination

The turn of the twenty-first century witnessed a revival of interest in the role of philanthropy in the international system, especially in the fields of global poverty and health. Yet, despite an emergent critical literature in development studies and international studies, philanthropy has barely featured in the debate on global distributive justice. This article uses the republican conception of domination as an analytical framework to precisely articulate concerns of justice raised by transnational philanthropy. Using the Bill and Melinda Gates Foundation and its role in global health as a test case, it argues that transnational philanthropy is characterized by an asymmetric distribution of power, which is sufficient to produce dependence, and that is uncontrolled insofar as its use either rests on the will of powerful agents or on terms of social cooperation beyond contestation. This arbitrary character is particularly relevant to philanthropy because of its use of epistemic power to produce and legitimize knowledge. In short, transnational philanthropy is dominating. If individuals have the right to exercise control over the social institutions that profoundly affect their basic interests, then philanthropy has a problem of justice that cannot be dismissed.