1. Global Philanthropy and Health Disparities Research: The Opportunities and Challenges of Approaches and Results Anne C Petersen, PhD Research Professor, CHGD, UM Founder & President, Global Philanthropy Alliance Presentation for UM MHIRT March 22, 2011

2. Outline of Presentation Brief review of global philanthropy Brief review of global philanthropy Brief review of health disparities, especially global Brief review of health disparities, especially global Using philanthropy to address global health disparities Using philanthropy to address global health disparities Conclusions Conclusions

4. Global Philanthropy Foundation growth in global giving outstripped domestic giving over last two decades; now 24% of $ given Foundation growth in global giving outstripped domestic giving over last two decades; now 24% of $ given Background: Background: Foundation assets increased four-fold since 1990Foundation assets increased four-fold since 1990 Foundation giving increased more than five-fold over same periodFoundation giving increased more than five-fold over same period Number of foundations more than doubled over same period; new foundations more likely to give internationallyNumber of foundations more than doubled over same period; new foundations more likely to give internationally

5. Global Philanthropy (cont) Half of international giving consistent with Millennium Development Goals 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) 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 Gates gave almost all the global health funding

8. Recession Effects Foundation Center estimates that Foundation Center estimates that US Foundations lost 17% of assets in 2008US Foundations lost 17% of assets in 2008 Giving down 8% in 2009Giving down 8% in 2009 International giving down only 4% in 2009International giving down only 4% in 2009 Without Gates in data, both domestic and international giving down 9% in 2009Without Gates in data, both domestic and international giving down 9% in 2009

9. Broader Global Philanthropy Foundation giving only a small part of global giving (but are good data for US, not for rest) Foundation giving only a small part of global giving (but are good data for US, not for rest) Other donors include: Other donors include: IndividualsIndividuals NGOsNGOs Religious organizations – by far the largest generally; globally too?Religious organizations – by far the largest generally; globally too? CorporationsCorporations

10. Individual Giving Internationally Data from PSID 2007 (2006 giving) Data from PSID 2007 (2006 giving) 6.3% giving rate 6.3% giving rate $100/272 median/average giving per donor household $100/272 median/average giving per donor household Factors influencing giving: Factors influencing giving: Age (rate linear, highest gifts 10-64 yr)Age (rate linear, highest gifts 10-64 yr) Income/Wealth (linear for rate, amount)Income/Wealth (linear for rate, amount) Education (rate linear, $ lowest some coll)Education (rate linear, $ lowest some coll) Region (NE highest rate, Mtn highest $)Region (NE highest rate, Mtn highest $) Marital Status (married highest rate, $)Marital Status (married highest rate, $)

11. Global Philanthropy Modes Grants Grants Loans Loans Time/effort (volunteering ) Time/effort (volunteering )

12. Impact of Global Philanthropy Foreign aid not so effective Foreign aid not so effective Is philanthropy better? Is philanthropy better? Few good studies yet despite greater impact orientation of global donors Few good studies yet despite greater impact orientation of global donors Critique (Garrett) Critique (Garrett) donors too narrowdonors too narrow no one looking at the whole systemno one looking at the whole system doing as much damage as good?doing as much damage as good?

14. Health Disparities Dramatic differences among countries in health indicators Dramatic differences among countries in health indicators Maps that follow show death and disability-adjusted life year (DALY) rates by WHO regions 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 HIV/AIDS is the leading cause of adult mortality in Africa Two leading causes of DALY rates: lower respiratory infections and diarrheal diseases Two leading causes of DALY rates: lower respiratory infections and diarrheal diseases

18. Health-related MDGs Fewer children dying – deaths of children <5 down 30% since 1990 Fewer children dying – deaths of children <5 down 30% since 1990 Fewer children < 5 years underweight - % underweight-25% Fewer children < 5 years underweight - % underweight-25% More skilled help during childbirth but <50% births in Africa & SE Asia More skilled help during childbirth but <50% births in Africa & SE Asia New HIV infections -16% from 01-08 New HIV infections -16% from 01-08 TB Rx more effective TB Rx more effective More safe drinking water but not safe toilets More safe drinking water but not safe toilets

19. Laurie Garrett Critique The Challenge of Global Health (Foreign Affairs, 2007) The Challenge of Global Health (Foreign Affairs, 2007) More money for global health but significant problems More money for global health but significant problems Narrowly focused on single problemsNarrowly focused on single problems Must refocus on public healthMust refocus on public health Brain drain of health workers getting worseBrain drain of health workers getting worse

20. Need Systemic Approach Recent report from FSG (Kania & Kramer, 2010) on Collective Impact found that 90% of non-profit efforts are suboptimal 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 Efforts that are effective engage all stakeholders over multiple years Is this possible in global arena? Or even focusing on country health? Is this possible in global arena? Or even focusing on country health? Current scattershot efforts unlikely to have sustainable effectiveness Current scattershot efforts unlikely to have sustainable effectiveness

21. L Garrett (cont) Situation since 2007? Situation since 2007? Talk on 2/7/11 Talk on 2/7/11 Currently at plateau Currently at plateau Most of global funding from the US – “two Washingtons” Most of global funding from the US – “two Washingtons” Huge funding risk now with budget cuts in the US (as in Western Europe) Huge funding risk now with budget cuts in the US (as in Western Europe) No likely support for global health in Congress No likely support for global health in Congress

22. Will US Philanthropy Fill the Gap Left by US Funds Recent report (KFF 2010) shows global health funding flat in 2009 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 Funders Concerned about AIDS reported that funding for that disease was down in 2009 compared with 2008 US foundations not known for collaboration US foundations not known for collaboration But Gates together with partners could make a difference But Gates together with partners could make a difference

23. Future of Global Health Could current efforts be sustained – possible IF Could current efforts be sustained – possible IF Gates + UN + key countries partner Gates + UN + key countries partner Will current efforts be sustained – unlikely Will current efforts be sustained – unlikely Regions of significant instabilityRegions of significant instability Most “developed” countries focused on cutting budgets not increasing or even sustaining commitmentsMost “developed” countries focused on cutting budgets not increasing or even sustaining commitments

24. BUT Being an eternal optimist Being an eternal optimist I believe that leadership could emerge to lead the world through our current crises I believe that leadership could emerge to lead the world through our current crises Stranger things have happened Stranger things have happened