Bill and Melinda Gates Are Spending Their Money the Wrong Way, Critics Say | Hacker News Reader

Bill and Melinda Gates Are Spending Their Money the Wrong Way, Critics Say

bloomberg.com

39 pointspetethomas52 comments

“But they should move away from disease-specific funding into health-system strengthening.”

Disease-specific funding goes to research organisations. Health-strengthening funding goes to politicians. Given the history and current state of corruption in many of these client countries, giving them money to strengthen the health system is a very bad idea.

"corruption in many of these client countries"

You say that as if governments in donor countries like the US were responsible with public funds.

Very funny

There's a tendency of people think their problems are as bad as everybody else's

They are a lot more responsible it's not even funny (also because of more stringent controls)

So Gates shouldn't give his money to USG either, is what you're saying?

Irrelevant, the gates foundation doesn't donate to the US.

"many officials say spending billions of dollars to fight ailments such as AIDS, malaria, and polio rather than supporting basic health services has left nations unprepared for epidemics like Ebola."

So, these people are actually criticizing Gates for not strengthening the overall system? He is not God, you can't just say "Hey, great that you improved W,X, and Y, but we think you should've improved Z instead, then we'd be free of all our problems!"

So sure, the critics are right: Gates should instead be an omnipotent god with knowledge of the future and the ability to improve basic healthcare services with the stroke of a pen. Maybe he thought putting his money in places with clearly defined goals was a better idea.

What they are saying is that instead of spending that money on say buying malaria meds which are then distributed by western volunteers spending that money on say grants for med and nursing schools for the local population might be a better cause for the long run even tho i might not directly save anyone for a decade or two. I actually agree with the general premise of this criticism and have had similar thoughts about how the west had been dealing with the situation in Africa for quite some time. It seems that pretty much all the west does it to make Africa more and more dependent on external "help" than developing local resources. You can see this across the board from cutting direct investment to undesirable governments to blocking the formation of pan-African military alliances that could provide assistance for conflicts without needed to call in 15,000 Chinese peace keepers. On other projects especially in agriculture it seems that the West(and China too in this case) are insisting on tying African countries to life time mortgages in forms of super advanced engineered crops which African countries can't self sustain without global corporations instead of local traditional farming and homesteading which has been proven to improve communities much faster than Monsanto donating some seeds in a hope of building another captive market.

My point is that they are criticizing him for his good deeds which are already done, because he did not instead do a good deed which only in their hindsight appears to be a better alternative. It's purely ridiculous to criticize someone in this manner.

The appropriate thing to do would be to write an open letter to Gates encouraging him to instead invest in basic services now, since what he's already done cannot be changed, nor is it worthy of such criticism.

This is a news article, I haven't seen any indication in the article that they actually covered a specific case of criticism. As it seems to me this is more of a case of reporters conducing research on the effects of donation and the direct intervention medical industry in Africa and presenting the negative effects it might have. The Bill and Melinda Gates tag is a "click bate" which has nothing to do with it being an internet article. Virtually every news article these days and for as long as i can remember needs a hook and this is a fairly easy one to boot. Is it completely fair? probably not, is it grossly wrong? not really...

"money on say grants for med and nursing schools for the local population might be a better cause for the long run even tho i might not directly save anyone for a decade or two"

Building out general healthcare infrastructure could have a lot of problems. For example, the government might reduce its own funding of the infrastructure by an equal amount, effectively making the foundation a giant taxpayer.

I am pleased with the progress the Gates foundation is making. If they actually eradicate polio, that will be a real step forward for all of humanity. Also, it seems like there's a lot of merit in focusing resources when dealing with contagious diseases.

Give a man a fish... As it currently stands it's much less about funding and more about the fact that they have no infrastructure, no doctors, no nurses, nothing. Doctors are actually in very high demand in Africa the funny thing is that you would probably get paid much more there than in the west atm (in the countries that at least some what hold it together). A class mate(from high school) of mine actually went to work in Nairobi he's getting paid about 300K US a year working a vascular surgeon(i think). On the polio thing.. sure eradicating polio might sound like a great cause (and a spiffy headline), but global polio cases in the 21st century are below 500 per year, and considering that polio causes muscle damage in less than 1% of infections, and the mortality rates of that percentage are about 10% i would dare to say that now there might be better things to spend money on. Especially considering that good sanitary conditions (clean water, sewage systems, and heck toilers) prevent the spread of polio almost as well as vaccination.

I disagree with you on polio eradication. Eradication is a risky bet, but it is also one time investment that yields benefits year after year. It is risky because most of benefits are realized only if you reach zero: below 500 per year is very different from zero. In other words, it is a risky bet in part because people think like you.

Talking about fostering independence instead of fighting Malaria is absurd. Malaria is a chronic diseased devastating to the productivity of affected individuals, and jeopardises their ability to make a living. Farming and homesteading sounds nice, but is hard when you're regularly unable to work because of yet another a Malaria relaplse.

You've taken 2 completely unrelated issues and mixed them into a straw man. That said the fight against malaria is proving to be counter productive, all we got so far is that every strain of malaria is now resistant to all malaria medications but one. Malaria is also not a chronic disease(although we made it now due to drug resistant strains). The only relapse you can have is either due to poor treatment(which again goes back to having limited to no healthcare infrastructure) to reinfection which again is a sanitary issue. Turning marshes into fields, stable water and sewage infrastructure, sanitary life stock control all help fight Malaria, and are probably more important in the eradication of it than just dumping more and more meds which are not properly distributed in the first place.

>You've taken 2 completely unrelated issues and mixed them into a straw man

You are the one that put these issues together in the grandparent thread in the first place.

Please read it again the fact that i had apples and oranges in a thread doesn't mean you should compare them. It was 2 examples of how western intervention builds reliance rather than self sufficiency in Africa. By no means i said we should fund local homesteads instead of malaria drugs. I said that funding local farming might be better than funding high tech crop projects, and improving local medical services and sanitary conditions might be better than just throwing more doctors without borders at it with out thinking of the bigger pictures...

Countries like the US focus power in the hands of elites, who act benevolent or not as they wish. To influence their allocation decisions, you have various methods at your disposal. In a dictatorship, you'd similarly try to influence the king; in a Soviet state, you'd influence the Party; etc. In the US, you influence capitalists and the state which serves them.

If you look closer at the critiques than some news article, the Gates Foundation has been reported to give money to big pharma and strengthen intellectual property rights. Rather than more fundamental changes to the system. Feel free to look closer at the real, serious critiques.

These critics overestimate the impact of Ebola. Even with this current weak system, the recent Ebola outbreak has had a death toll of 7,645 as of Dec 23. A million people die every year from Malaria, and some (optimistic) estimates say that the Gates' efforts could save 5 million lives.

This seems like a classic example of our tendency to overestimate the importance of singular, cataclysmic impacts, as opposed to predictable, systemic ones.

The whole point of the article is that Gates' efforts focus on singular diseases, as opposed to investing in healthcare infrastructure that can support predictable, systemic outbreaks of new diseases.

Then again, it's much easier for Gates to elevate his status as a philanthropist by investing in projects that can come up with sexy headlines like "we saved X million people from AIDS!"

Based on how he talks and goes about doing his philanthrophy, it doesnt seem like Gates is doing it or for that matter, need it, to elevate his status. It is best to assume positive intent in such things.

You're right, definitely best to give the benefit of the doubt.

You just missed the point. It's better to do something about millions of buildings currently on fire rather than spending more resources training emergency responders to deal with abstract events.

I don't think this is a helpful article.

Given this amount of money, it is pretty much impossible to spend it and be able to answer the question "is this the absolute best way to spend the money?" with an honest & confident "yes."

It's good to try and think of more efficient or better uses of the money, but solving the problems around some of the world's most persistent ailments is quite a good use, in my opinion.

This is an inflammatory headline that does justice neither to the NGOs nor to the people commenting about the NGOs.

A better headline would be "Health experts believe Bill and Melinda Gates could save more lives by modifying resource allocation" or something like that.

I'm not a writer so it could probably be stated better but you get the idea. The guy isn't saying what they are doing is bad, which the headline implies, but rather that resource spending could be further optimized.

> The guy isn't saying what they are doing is bad

But he kinda is...

> Such groups “are doing more damage than good; I want the world to hear it,”

Ah I missed that line while I was reading. But in that vase he is just being inflammatory as well. A more measured statement would be more accurate.

It's a sad day when choosing to donate billions of dollars to charity makes you a target for critics.

Everyone's a target for critics. Especially anyone with an ounce of success. The critic is jealous of the success and wants to validate himself by arguing against the actions or views of the successful person.

Anyone visible is subject to criticism. Many critics are just doing critique, they aren't jealous or have some dishonest motive.

Very few are critiquing just for the sake of it. Most do it in some feeble attempt to put themselves on the same level of the person they are critiquing. It's much easier to form an argument about why some high profile person is wrong about something to get some attention rather than actually doing something better.

The Chinese communist party (high profile persons) has basically said this about the dissidents (aka social critics) it throws in jail.

It is probably better to focus on the specific failings of the critique rather than the perceived mental state of the criticizer.

Spending money on charity is good, and people should be free to spend it as they please, but if the aim is to help as many people as possible, perhaps consulting experts so that the money can be spent fro maximal effectiveness would be better.

Agreed. In fact, that's actually one of the things these critics are attacking: that the Gates foundation employs extensive effectiveness analysis and channels the majority of funds towards treatments which save the largest number of lives.

The Gates certainly have done their homework, and I believe that this is an understood issue, but they only have so many resources, and want to work on a particular set of goals.

I used to really dislike Bill Gates, Microsoft, and all that he stood for. I heard of his charity, thought "hey that's nice" but that was about it. Then, I saw him on Charlie Rose, and everything changed. He answers a lot of questions about the health care issue of impoverished nations, and shows a great deal of understanding of the problems they're dealing with, and what will happen when they do what they can. http://charlierose.com/watch/60331104

"Many officials say spending billions of dollars to fight ailments such as AIDS, malaria, and polio rather than supporting basic health services has left nations unprepared for epidemics like Ebola."

This is nonsense. Does anyone disagree AIDS, malaria, polio are higher priority than Ebola?

"You get treatment if you're a woman with malaria or if you're a woman with HIV, but if you've got cervical cancer or cardiovascular disease, you're not covered, Evans said."

Cancers and cardiovascular diseases are not infectious. Does anyone disagree infectious diseases are higher priority?

"You'd get more for your money if you supported a broad range of health system strengthening activities, Daulaire said by phone from Oslo, where he's a visiting scholar at the Norwegian Institute for Public Health. That's a much more difficult message."

This may well be true but very unobvious. While I understand difficulty of analysis and presentation, burden of proof of "You'd get more for your money" lies on health system strengthening proponents. You can't argue as if it is given.

I remember reading Bill Gates's own writings on how he chooses where to put those money. He has a very clear and developed strategy; it's basically investment except that the profits come back not directly to to Gates, but to the society as a whole. He doesn't just spend the money, he tries to find the spots where applying money would give the greatest and most lasting effect.

For example, his donations to malaria researches nearly doubled the overall money that went to these researches over the world and it's not that his donations were so huge, it's just that these researches did not get much funding (compared to the effect of malaria). Similarly, he wanted to fund a program in education of teachers, but he specifically picked a program that looked it could make the greatest profit/expense ratio: filming great teachers as they work and distributing these films to other teachers.

That said, I'm sure Mr Gates will be very interested in hearing any sound businesslike proposition in regard to where to invest his money :)

I am happy with the Gates foundation and the strengthening of basic scientific research that has come about from their grants particularly in resource poor countries. Respective governments have a role to play in improving the health systems research and I am not sure that is the mandate of the Gates foundation or any other charity. Furthermore, it may mean meddling with political forces in their respective areas of support and I am not sure if that would really ease the situation.

After all what has the Brenton Woods institutions gained or improved in resource poor countries? Have they not poured billion of dollars in loans and grants and even given conditions (some very painful) on how to administer the monies? What has improved? I think Gates foundation is doing a commendable job in supporting and raising awareness for neglected infectious diseases for example and supporting grass root solutions to common problems. I am no expert in these areas and I stand to be corrected.

WTF is it the responsibility for private organizations to fund basic health care in other countries?

That is the responsibility of nation states like the USA to help other countries with basic health care like preventing Ebola so it doesn't arrive on their shores.

Except since all single single digit people stopped having Ebola in the USA, the news decides that people in other countries dying like flies didn't matter so all pressure on Congress to do anything stopped entirely and they went home for their many weeks of vacation.

The 2015 Congress most certainly won't fund a damn thing. It's just not as sexy to them as dropping million dollar bombs on people.

When is it the responsibility of the United States? Isn't it the responsibility of the affected countries to mind their own store? After seeing what happened to rice shipments in Somalia, something could be said for the value of a bomb. Personally, I prefer Bono's approach -- develop markets so countries can afford to help themselves.

"Politicians in wealthy countries are more interested in supporting groups that produce measurable results such as the number of lives saved by vaccinations than in less-quantifiable goals such as building health infrastructure."

I don't get that at all. Building 14 clinics, adding 700 hospital beds, training a thousand nurses... all infrastructure, all far more quantifiable than measuring lived saved by vaccinations.

In any case I agree with those who find the whole thing a false dichotomy.

Czech Army had mobile hospital in Afganistan for locals. There was a huge queue of people, some family would carry their relative for a week, just to get to hospital. We simply have no idea what is it there like.

Money could be probably spend more efficient way (exterminate mosquitoes rather than fight malaria). But running hospital in country without basic infrastructure is always very expensive.

The mosquito problem is one of the aspects the Gates Foundation is working on to eradicate Malaria.

A friend of mine worked as a volunteer nurse at a make shift hospital in a remote part of Ethiopia. There was a group that carried a dead person for more than a day to the hospital to see if they could save her. I have no idea what it is like to provide health care services in an area like this.

When the critics make their billions then perhaps they can criticize how others spend theirs. I'm not the biggest fan of Gates, but he certainly puts his money where his mouth is and is certainly leaving a positive mark on humanity. The world is a better place because of Bill Gates. Windows ME aside.

Well, I have some fantastic news for these critics. They are completely free to make their own billion dollars and then spend it on whatever aid they think would be better.

Critics are welcome to spend their money the 'right' way, I say. I certainly feel the world is a better place with Bill and Melinda 'in the arena'.

These critics simply want a share of the pie which they dont own. That is why they criticize. These peopel should be ignored.

Some good done through a suboptimal approach is better than no good done as a result of seeking the perfect solution.

How is funding new and efficient ways of fighting disease not part of "health-system strengthening"?

I'd love to hear Peter Thiel's thoughts on his efforts.

I think this is an interesting data point in the story of an over-arching shifting of philosophies. That philosophical shift has been brought on by the historically unmatched availability of data. The old way tasked experts with figuring out where to spend money and resources to do the most good; the best of those experts found their way to the top spots of the UN, WHO, the world bank, etc. These folks are the best in the world at what they do. The problem, for them, is that Bill Gates isn't interested in doing it the way it's always been done. He doesn't want a bunch of experts in a room deciding how resources are used.

He's talked about this a lot over the years, and the people who handle the nitty gritty details of his organization have talked about it some too. Data comes first for the foundation. Certainly, that data is filtered through a particular, somewhat pro-capitalist, and competitive, lens. But, the data is driving the decisions...it has much less room for experts in the decision-making process.

I honestly don't know enough about the person making these assertions, or the problems of improving world health; they may very well be right. But, I remember reading about the early days of the foundation, and thinking, "Hmm...this might actually do some amazing stuff." And, I think they really have. Solving malaria with a cheap, safe, vaccine, would be a miracle on the order of achieving world peace (more people have died from malaria, mostly young children, than in all the wars ever fought).

Further, I question anyone who asserts that responding to Ebola would be a more valuable use of resources than saving the lives of as many as 1 million children per year who would have died of malaria. As someone else mentioned, it sounds like someone thinking like a human, and making the mistake of valuing catastrophic events higher in terms of their importance over the data-driven approach of attacking the biggest problems. It's like the difference between the old school hacker who micro-optimizes a program by inlining functions or converting the whole thing from an interpreted to compiled language, vs. someone who profiles the code and finds the bottlenecks and knocks those out by using more efficient algorithms with less time/effort and better results than the micro-optimization strategy.

This may be that, despite my general dislike of Bill Gates, I simply think more like Gates. I guess a lot of us here do, and that may be why the general consensus in this thread is to dismiss the article and side with Gates. That may be an indicator that we should all do a bit more research and thinking on the subject. I may make myself a homework project of coming up with an equally compelling argument for why this article is right, and Bill Gates is still an asshole after all these years.

Everyone's a critic

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