Global health philanthropy and institutional relationships: How should conflicts of interest be addressed?

Background: The increasing role of private philanthropy in development assistance for health has raised two issues: the scope for major donors to shape the distribution of resources among different health problems and the potential for conflict of interest, especially when philanthropic bodies have ties to for-profit corporations. There is widespread agreement that transparency is important to alleviate concerns, yet this is often confined to visibility of the processes of decision-making and fails to draw on the literature on corporate relationships that has helped researchers in other fields understand factors that may exert a more subtle influence on how decisions are made. We describe a method to identify such relationships, illustrating it with a case study of five large U.S. private foundations which contribute to global health.

Methods: Data from the Securities and Exchange Commission were used to map the relationships between foundation investments, board members, for-profit corporations, universities, and political organizations.

Findings: Links between Foundation investments, Foundation board members and private for-profit corporations have been concentrated in the private food and pharmaceutical sectors. These firms are, in some instances, directly impacted by the Foundation's philanthropy, and in many cases Foundation board members also are or were on the boards of the corporations.

Interpretation: While private foundations adopt standard disclosure protocols to mitigate potential conflicts of interests, the extent and range of relationships between tax-exempt foundations and for-profit corporations suggests that transparency or grant-making recusal alone may not be preventing conflicts of interests from affecting global health financing.