The WHO Foundation in global health governance: Depoliticizing corporate philanthropy

The creation of the WHO Foundation during the COVID-19 pandemic represents a significant institutional development in the politics of financing the World Health Organization (WHO). In the context of longstanding acute financial pressures, the objective of the WHO Foundation is to widen WHO's resource base by attracting philanthropic donations from the commercial sector. In placing funding decisions 'at one remove' from WHO, the stated expectation is that the WHO Foundation will act as an intermediary, insulating the WHO from potential conflicts of interest and reputational risk through a combination of strategic distance from WHO and proximity with its norms and rules of engagement with non-state actors. Yet, whether this model has translated into practice remains understudied. In this article, we focus on emerging institutional practices within the WHO Foundation, highlighting a drift from its stated governance model. Based on analysis of WHO Foundation documents, we demonstrate how due diligence and transparency practices within the Foundation have been redesigned in ways that contradict or subvert its claims to applying alignment with WHO's governance norms, notably relating to its engagement with health harming industries such as alcohol and petrochemical companies. While this situation may seem paradoxical, we argue that, in placing funding decisions 'at one remove' from the formal institutions and structures of WHO, the creation of the Foundation has served to displace this issue to a more secluded arena where drifts in practice are less exposed to political oversight and scrutiny. Focusing on the discursive aspects of this process of depoliticisation, we contend that the Foundation has strategically managed 'fictional expectations' of accountable and transparent governance in order to mitigate concerns about its mandate and functions. This assessment provides new and important insights into the depoliticizing functions of the WHO Foundation and the significant implications this may have for global health governance.

Integrating Advocacy into Your Practice

In the last 60 years, health care has evolved due to many trends including the introduction of third-party payers, a progressively aging society, advancing technology, emerging recognition of social issues of race/gender/poverty, the relative decline in the physician workforce, rising health care costs, ongoing consolidation of health care entities, and the corporatization of health care delivery. This has led to problems in health care delivery with respect to cost, quality, and access. Many medical leaders feel it is now the duty of the physician to go beyond the classic patient-doctor clinical responsibility and work to advocate for their patients and society regarding economic, financial, educational, and social issues.

A preliminary characterization of and call for benchmarking pharmacy alumni engagement

INTRODUCTION

Alumni are essential but often overlooked stakeholders for pharmacy programs, and engaging alumni in philanthropy, volunteerism, events, and communication may have important implications for the growth and success of pharmacy programs. This research aims to preliminarily characterize pharmacy alumni engagement across four metrics and provide a call to action for standardized tracking and reporting of alumni engagement efforts across the Academy.

METHODS

A cross-sectional survey was sent to alumni relations and advancement personnel at United States schools and colleges of pharmacy. The survey gathered information on the accuracy of pharmacy alumni records, alumni engagement within four categories (philanthropy, communication, events, and volunteering), alumni relations personnel, and barriers to alumni engagement efforts.

RESULTS

Respondents reported using various database systems to track and measure alumni engagement, and 41% noted having accurate pharmacy alumni records. Opportunities for alumni engagement within the four categories varied across institutions. Fifty percent of respondents indicated that one full-time equivalent position is allocated to pharmacy alumni engagement efforts at their institution. Barriers to alumni engagement efforts included limited budgets, and staff, engaging alumni via in-person events, and maintaining accurate alumni records.

CONCLUSIONS

The Academy may benefit from expanding the annual alumni survey and developing a consistent tracking mechanism to capture and report alumni engagement activities. Additionally, education on alumni engagement metrics and potential collaborative efforts with institutional alumni relations personnel would be of value. This is vital in developing and optimizing alumni relations efforts and engaging pharmacy alumni bases.

Guidance for Pharmacy Curricula to Incorporate Health, Wellness, and Health Inequities Stemming From Climate Change: The Report of the 2022-2023 AACP Argus Commission

The 2022-2023 American Association of College of Pharmacy Argus Commission was charged to provide guidance to schools, curriculum committees, and faculty on how to incorporate health, wellness, and health inequities stemming from climate change into pharmacy curricula. The Argus Commission does not advocate for major changes in the curriculum or standards but suggests a concerted effort across the Academy to enhance the awareness of graduating students of the potential impact of climate change on health both now and in the future. Various examples, along with recommendations and suggestions, are provided of how the impact of climate change on health is currently being integrated into curricula in member schools, as well as a list of resources faculty can use to enhance their awareness of issues related to climate change and health. The Commission was also charged to provide guidance to the American Association of College of Pharmacy regarding future fundraising and business development opportunities. Recommendations in that regard are also included in this report.

Reducing Fear to Help Build Healthy Families: Investing in Non-Punitive Approaches to Helping People with Substance Use Disorder

BACKGROUND

Many pregnant and parenting people with substance use disorders (SUD) refrain from seeking perinatal care or treatment for their SUD for fear of being treated poorly by health care providers and/or triggering a child welfare investigation. For those who do seek treatment, there are relatively few clinicians willing and able to prescribe medications for opioid use disorder (MOUD) to pregnant people. Both stigma and lack of access to treatment put many pregnant and parenting people at risk. Drug-related deaths contribute significantly to U.S. maternal mortality rates, with people at especially high risk of drug overdose in the months following delivery.

METHODS

The Foundation for Opioid Response Efforts (FORE) is a national philanthropy focused on finding and fostering solutions to the opioid crisis. We draw lessons from our grantees' efforts to expand access to substance use treatment and recovery supports for pregnant and parenting people.

RESULTS

To build systems of care that ensure more pregnant people get timely perinatal care, we need to expand training for perinatal providers on how to provide OUD treatment, clarify child welfare reporting rules, and engage and support trusted organizations and community-based services.

CONCLUSIONS

In addition to changes to our systems of SUD treatment and recovery, we need greater philanthropic investment in efforts to combat the public health crisis of substance use and overdose among pregnant and parenting people. Private funders have the leeway to act quickly, take risks, and demonstrate the effectiveness of new approaches, building the case for investment of public resources in such initiatives.

The Luck of the Draw: Wellcome's Institutional Fund for Research Culture

Wellcome's Institutional Fund for Research Culture (IFRC) closed call is an invite-only grant call in 2023. It is a departure from Wellcome's previous methods of institutional funding, providing institutions with up to £1m of grant funding to take on ambitious projects that advance research cultures and research environments that are equitable, diverse and supportive. Recognising the broad range of topics and ideas for advancing positive research cultures, IFRC is the first ever Wellcome-funding scheme to use partial randomisation to allocate funding. Applications were grouped by a funding committee into three categories (Gold, Silver and Bronze), with the applications selected for Gold being directly recommended for funding and all applications in the Silver group being set for funding by the randomiser. Applications grouped into Bronze were not funded. To ensure that this activity Wellcome's principles for openness and transparency, we have included the Python script for the call here. IFRC comes when efforts to fund positive and inclusive research cultures are mainstream. Similar efforts to support research culture activities at scale have come from the Research England Development (RED) Fund, and the next iteration of the Research Excellence Framework (REF 2028) will also mark 25% of the assessment criteria for people, culture and environment. IFRC was not designed with the national picture in mind but is a testament to Wellcome's values as an inclusive funder. The range of projects and geographies that IFRC will fund is exciting.Still, it also threw up several interesting social and philanthropic research questions we want to explore in future community-facing activities following the call. We hope that findings from IFRC projects become a valuable resource for institutions wishing to improve their research cultures and a catalyst for future change and discussion within the sector that makes academic careers more inclusive.

The intent and influence of evaluation policies and strategies in the philanthropic sector

Evaluation policies are being written across the philanthropic sector. These policies offer rules and principles that are intended to guide evaluation practice. However, it is unclear what has motivated the development of evaluation policies and what impact, if any, they have on evaluation practice. Through interviews with 10 evaluation directors at foundations that have written evaluation policies, we identify the intent of these policies and their perceived influence in the philanthropic sector. We conclude with suggestions for future research on evaluation policy.

Six Key Approaches in Open Society Foundations' Support for Global Palliative Care Development

CONTEXT

Between 1998 and 2021, the Open Society Foundations (OSF) network invested around US$50 million in supporting the emerging field of palliative care worldwide, funding different approaches and interventions to advance its objective of putting palliative care on the global public health agenda.

OBJECTIVE

To describe six approaches that were instrumental to the successes of Open Society Foundations' support in building the global field of palliative care. A robust discussion of lessons learnt is unfortunately not possible because Open Society Foundations did not commission a rigorous evaluation of the impacts of its investments.

METHODS

This article describes these six approaches: Investing in versatile palliative care leaders at national and regional level; investing in palliative care champions within the OSF network; proactively engaging the World Health Organization (WHO) in efforts to promote palliative care; developing tools and skills to improve palliative care financing; using a human rights-based approach; and supporting self-advocacy by people with palliative care needs.

RESULTS

Deep, long-term investments in national and regional champions from the palliative care community and OSF's own network built palliative care leaders with well-rounded skills, knowledge and opportunities to develop their own networks. The active engagement and involvement of the WHO in efforts to advance palliative care enhanced the credibility of palliative care as a discipline as well its champions, whereas the human rights approach resulted in more diverse strategies to overcome barriers to palliative care. The focus on palliative care financing and self-advocacy showed significant promise for impact.

DISCUSSION

The approaches and strategies described helped a nascent palliative care field develop into a health service that is increasingly integrated into public health systems. Other funders and national governments can build on OSF's long term support for the palliative care field and support further integration of palliative care within public health to increase access.

Inequality in Chile's Philanthropic Ecosystem: Evidence and Implications

Philanthropy seeks to address deep-rooted social issues and assume responsibility for the creation of public goods not provided by the public sector-and in this way help reduce inequality. Yet philanthropy has also been criticized for bypassing democratic mechanisms for the public determination of how to invest in society-and thus may perpetuate other inequities. In both cases, inequality, defined as asymmetries of resources and power, plays a critical role in public goods creation and in the legitimacy of a country's philanthropic ecosystem. However, little empirical research examines the existence and role of inequality in country-level donation systems. To fill this gap, this study provides evidence of growing donation concentration in Chile's philanthropic ecosystem, with a focus on the culture sector, characterizes it by mapping systematic differences in ecosystem perceptions by actor type, and identifies and tests statistically structural and organizational factors associated with these perceptions. Inequality in Chile's donation system operates at multiple geographical, legal, and organizational levels, all of which are reflected in objective donation amounts and subjective ecosystem perceptions. We conclude that in Chile resource asymmetries and power imbalances hinder the fulfillment of philanthropy's promise and call for further research to identify policies that address inequities in emerging philanthropic ecosystems in Chile, Latin America, and beyond.

Wealth Without Limits: in Defense of Billionaires

In this essay we argue against preventing people from amassing extreme wealth via increased taxation. The first argument in favor of such a proposal, recently advanced by Ingrid Robeyns (2018), states that billionaires' resources would be better spent addressing morally important goals such as meeting disadvantaged people's needs and solving collective action problems. In response to this claim, we argue that billionaires are typically in a better position to benefit the poor and to solve collective action problems than public officials. The second argument in favor of preventing extreme wealth accumulation, advanced by Robeyns and Robert Reich (2018), states that billionaires have an inappropriate amount of influence in public life, which undermines political equality. We argue that corporate leaders tend to be more accountable to their fellow citizens than public officials. We then consider and criticize the objection that billionaires' success is typically a result of public investment, which entitles public officials to enforce taxes that demand a return on the public investment.

Philanthropic donor perspectives about providing harm reduction services for people living with HIV/AIDS in a hospital setting

BACKGROUND

Hospital-based harm reduction services are needed to reduce drug-related harms, facilitate retention in care, and increase medical treatment adherence for people who use drugs. Philanthropic donor support plays a key role in delivering such innovative services which might fall outside current funding streams. However, little is known about how the principles, implementation, and practice of harm reduction services, which are often highly stigmatized, may impact donor behaviours. We explored this issue within Casey House, a speciality hospital in Toronto, Canada.

METHODS

Our mixed methods study utilized an explanatory sequential design. A convenience sample of n = 106 philanthropic individual donors, recruited via email, completed an anonymous web-based survey, between July and October 2020, which assessed their knowledge of harm reduction services and the potential impact of implementing new hospital-based harm reduction services on donors' future support. Following this, we conducted semi-structured qualitative interviews with n = 12 of the donors who completed a survey and volunteered to be interviewed. Interviews examined donors' perspectives about harm reduction and their hopes/concerns for such programming at Casey House. Data were analysed using descriptive statistics and participatory-based thematic analysis.

RESULTS

Survey data show a high level of support for hospital-based harm reduction services, with participants reporting that they "strongly agree/agree" with providing harm reduction equipment (85%), supervised consumption services (82%), and prescription opioid treatment (76%) at Casey House. A majority of participants (66%) claimed that implementing new harm reduction services at the hospital would not impact their future donation, while 6% said they would be less inclined to donate. Interview participants were supportive of harm reduction services at Casey House, recognizing the benefits of providing such services for hospital clients and the wider community. However, some spoke of the potential impact that implementing hospital-based harm reduction services may have on "other" donors who might be opposed. Although some believed harm reduction services should be fully funded by the government, most saw a role for donors in supporting such services.

CONCLUSIONS

Our findings show support of hospital-based harm reduction services among philanthropic donors and provide insight into how donor support may be affected when such services are introduced.

Moral Elites and the De-Paradoxification of Danish Social Policy Between Civil Society and State (1849-2022)

The article argues that in Denmark during the past 150 years, moral elites have been central in settling paradoxes within social policy by developing 'classifications' of citizens and sectors: who are deserving of help and what sector (public or third) should provide care. Contrary to widely held beliefs, historically, there is no logical or practical connection between 'more deserving' and 'state support'. Theoretically, the article integrates elite scholarship and cultural sociology in developing a concept of moral elites' power from-their sources of moral authority-and power to, the way that they have used their power to classify citizens and sectors. Empirically, the Danish moral elite and its involvement in social policy are analyzed based on secondary as well as primary historical sources. Findings: The development of the Danish moral elite has roots in the administrators of the nineteenth-century absolutist state: the clergy, medical doctors, and lawyers. Educational resources and state affiliation continue to be central to moral elite status. Economists have ascended to the top of the moral elite, while clergymen have dropped out. Three major classifications were developed during the period. 'Help to self-help' (late nineteenth century): deserving poor should receive help from private charity, while the public system should deter and discipline. 'Rights' (mid-twentieth century): the state should care for all, philanthropy mostly considered stigmatizing. 'Workfare' (late twentieth century to present): citizens are considered deserving as long as they are 'active', and sectors are considered equal in providing for citizens as long as they reach the economistic goal of activation.

Containing Hunger, Contesting Injustice? Exploring the Transnational Growth of Foodbanking- and Counter-responses- Before and During the COVID-19 Pandemic

COVID-19 caused levels of household food insecurity to spike, but the precarity of so many people in wealthy countries is an outgrowth of decades of eroding public provisions and labour protections that once protected people from hunger, setting the stage for the virus' unevenly-distributed harms. The prominence of corporate-sponsored foodbanking as a containment response to pandemic-aggravated food insecurity follows decades of replacing rights with charity. We review structural drivers of charity's growth to prominence as a hunger solution in North America, and of its spread to countries including the UK. By highlighting pre-pandemic pressures shaping foodbanking, including charities' efforts to retool themselves as health providers, we ask whether anti-hunger efforts during the pandemic serve to contain ongoing socioeconomic crises and the unjust living conditions they cause, or contest them through transformative pathways to a just food system. We suggest that pandemic-driven philanthropic and state funding flows have bolstered foodbanking and the food system logics that support it. By contextualising the complex and variegated politics of foodbanking in broader movements, from community food security to food sovereignty, we reframe simplistic narratives of charity and highlight the need for justice-oriented structural changes in wealth redistribution and food system organisation if we are to prevent the kinds of emergency-within-emergency that we witnessed as COVID-19 revealed the proximity of many to hunger.

Ethical Pain and Terminal Chaperonage

Terminal chaperonage embedded in palliative care deeply resonates with human needs and has undergone significant advances in the past decades. At the same time, it is in jeopardy due to austerity measures in healthcare. Its comprehensive translation in philanthropic end-of-life practice necessitates reflection on underlying ethical issues. This chapter addresses ethical aspects arising in pain and terminal chaperonage and deduces important ethical imperatives in the wake of the palliative mandate. The imperatives affect the deployment of resources necessary for a humane pain and terminal chaperonage, one that is to be comprehensive and flexible in design and implementation at the same time. Furthermore, they are concerned with critical implications for dying clients emerging from the idiosyncratic properties of opioids with respect to their potential to induce mental status alterations. Given that living and dying are profoundly mental by nature, the human mind plays a fundamental role in the command of both. Based on this, this chapter also outlines the essentials of terminal thought plasticity and affect catharsis en route to a mindful, decent death. It identifies and advocates eight most fundamental affective, respectively cognitive fields of the human mind, the "Ensemble of the essential eight iridescent fields of relinquishment", whose adaptable, culturally sensitive facilitation in mental management prior to death may have to be considered the core ethical imperative in terminal chaperonage - in true congruence with philanthropic end-of-life care.

Billionaires in Global Philanthropy: a Decade of the Giving Pledge

Billionaire philanthropists claim to play a key role in advancing well-being and public goods across the world. One of the most prominent recent expressions of these efforts is the Giving Pledge, created in 2010 by Bill and Melinda Gates in collaboration with Warren Buffett. After a decade of its existence, this analysis of the Giving Pledge population and its commitment letters shows an overall dominance of white, male, and US-based billionaires among the signatories. Tech billionaires are a wealthier and younger subgroup of pledgers than their counterparts in other industries. The pledge letters reveal an emphasis on education and health as dominant philanthropic causes. Among explanations for giving, the four most frequent reasons mentioned are a desire to make a difference, a wish to give back, a sense of personal fulfillment resulting from giving, and references to being socialized into philanthropic giving early in life. While the Giving Pledge is the most prominent global effort to increase philanthropic giving among the wealthy, the voluntary nature and relatively modest commitment goal make it difficult to assess its significance and impact.

Looking Back on Philanthropy in a Pandemic Foundation Colleagues Share Common Perspectives from Across the Pond

Over the past year, the pandemic caused havoc globally touching the lives of most people. This included emerging challenges for nonprofits on the front lines of escalating need while at the same time limiting fundraising. Scaling up to meet needs in an extreme resource constrained environment pushed many nonprofits to the brink of insolvency. Many foundations have responded effectively to this circumstance by increasing grant making, reducing red tape, and extending greater flexibility for nonprofits. In doing so, foundations have exercised unusual humility in how they positioned themselves relative to nonprofits in protecting capacity to serve intended beneficiaries. This op-ed explores the relaxing of traditional tensions between foundations and grant seekers in ways that enabled more adequate and timely responses to pressing human needs in the face of the pandemic.

Contemporary Philanthropy in the Spotlight: Pushing the Boundaries of Research on a Global and Contested Social Practice

This article is intended as the leading article in a special issue devoted to the achievements, limitations, opportunities and risks entailed in the research and practice of contemporary philanthropy. The article first characterizes philanthropy as a highly diverse and dynamic set of social practices that has only recently been subject to the systematic scrutiny of an emerging field of research, parallel to its rapid transformation and increased societal visibility. The main debates that emerged during the last two decades while researching the complexities of contemporary philanthropy are contextualized from the perspective of multiple disciplines; and the main foci for contentious conceptualizations and societal expectations explored. In this context, contributions of the special issues are summarized. Further avenues for pushing the boundaries of philanthropy research in ways inclusive of the dynamism, diversity, multi-disciplinarity and controversy that characterize the field, while at the same time providing meaningful answers to societal concerns about the potential and shortcomings of new philanthropic practices, are drawn.

Will philanthropy save us all? Rethinking urban philanthropy in a time of crisis

In the wake of the COVID-19 pandemic, philanthropy has been quick to react to the call for help from Governments and International Organisations. And yet, despite the overwhelming response, increasing attention has been brought to the intricate ways in which philanthropists and billionaires have been asserting their presence through their actions and influence in different spheres of power. In this commentary, I challenge the idea that philanthropy can be the solution to all of our problems, and highlight some of the problematic issues that emerge when philanthropy is put at the forefront of the discussion. Also, I point out to other elements that have been left out, including the wave of collective solidarity that has been channelled through mutual aid groups and organisations.

A systematic review of the barriers to and facilitators of the use of evidence by philanthropists when determining which charities (including health charities or programmes) to fund

BACKGROUND

Philanthropists, charity leaders and policy-makers have increasingly recognised that the process of giving resources needs to be grounded in evidence-sometimes referred to as 'evidence-based' or 'data-driven' philanthropy. Yet few philanthropists practise evidence-based philanthropy, and some contend that there is insufficient evidence on which to base their funding decisions. This review aims to identify factors that promote or limit the use of evidence by philanthropists and to rigorously evaluate all existing research on this issue.

OBJECTIVES

To identify, synthesise, and evaluate appropriate and rigorous research, examining factors which act as barriers to or facilitators of the use of evidence by philanthropists.

METHODS

This review was conducted according to Cochrane standards and reported following PRISMA guidelines. The review protocol was pre-registered ( dx.doi.org/10.17504/protocols.io.wbsfane ). We searched 10 interdisciplinary databases using a highly sensitive search strategy, developed in consultation with an information scientist. We also contacted experts and searched a range of websites. Studies were included if they comprised primary research into or systematic reviews of the barriers to and facilitators of the use of evidence by philanthropists or funders when determining which charities (including health charities or programmes) to fund. All studies were appraised for quality, and the results synthesised using thematic analysis.

RESULTS

Of 686 studies identified through database and hand searching, nine met inclusion criteria. The thematic summary identified three main barriers to philanthropists or funders using evidence: (1) inadequate knowledge transfer and difficulties accessing evidence, (2) challenges in understanding the evidence and (3) insufficient resources. The three key factors that expedite the use of evidence are (1) improved knowledge transfer and more accessible/relevant high-quality information, (2) access to professional advisors and networks and (3) broadening the definition of what counts as credible evidence along with standardisation of reporting.

CONCLUSIONS

The authors of this review found several compelling arguments for promoting the use of evidence by philanthropists to inform their philanthropy. If evidence-based philanthropy is to flourish, then they recommed the following actions: Firstly, philanthropy should be underpinned by a commitment to 'do no harm'. Secondly, the definition of evidence should be expanded and funding decisions based upon consideration of 'all available evidence'. Finally, there should be more investment in synthesizing evidence and in the infrastructure for knowledge transfer.

Translating big data to better treatment in bipolar disorder - a manifesto for coordinated action

Bipolar disorder (BD) is a major healthcare and socio-economic challenge. Despite its substantial burden on society, the research activity in BD is much smaller than its economic impact appears to demand. There is a consensus that the accurate identification of the underlying pathophysiology for BD is fundamental to realize major health benefits through better treatment and preventive regimens. However, to achieve these goals requires coordinated action and innovative approaches to boost the discovery of the neurobiological underpinnings of BD, and rapid translation of research findings into development and testing of better and more specific treatments. To this end, we here propose that only a large-scale coordinated action can be successful in integrating international big-data approaches with real-world clinical interventions. This could be achieved through the creation of a Global Bipolar Disorder Foundation, which could bring government, industry and philanthropy together in common cause. A global initiative for BD research would come at a highly opportune time given the seminal advances promised for our understanding of the genetic and brain basis of the disease and the obvious areas of unmet clinical need. Such an endeavour would embrace the principles of open science and see the strong involvement of user groups and integration of dissemination and public involvement with the research programs. We believe the time is right for a step change in our approach to understanding, treating and even preventing BD effectively.

Invisibility and the extractive-pandemic nexus

The Covid-19 pandemic is reshaping the world economy. Headline news stories depict mining companies as a stabilising force: supporting the flow of resources to keep the economy moving, and contributing to local welfare initiatives for communities in crisis. We argue that this narrative masks important details about the local conditions where mining companies operate. The issues at the company-community interface are typically invisible to distant audiences. While travel restrictions are necessary to limit community-spread, these constraints push interfaces in mining communities further into the unknown. The effects of the global pandemic will be far reaching. Scholarship is needed to understand the dynamics of mining in the time of Covid-19 and to place present impacts, actions, and decisions in their proper historical context.

The Karolinska Institutet Prize for Research in Medical Education: A history

Purpose: This article presents a history of the Karolinska Institutet Prize for Medical Education (KIPRIME), highlighting the history of, and influences on, its funders Drs. Gunnar Höglund and Anna-Stina Malmborg.Methods: Historic analysis of an archive of documents developed by the authors in a prior study exploring philanthropy in medical education research. Documents in the archive were drawn from publicly available Internet sources, media reports about the KIPRIME and its winners and an interview with Drs. Höglund's and Malmborg. The latter interview was conducted with Ethics Board approval in non-anonymous fashion and with the explicit permission of the interviewees to present their personal information and to cite their words. Finally, observations were shaped iteratively by the authors on multiple trips to the Karolinska Institutet with input from the KIPRIME prize committee leaders.Findings: The results of this analysis present a history of the prize situating it in the personal histories of, and influences acting upon, Drs. Höglund and Malmborg. Special attention is given to the potential influence of the Nobel Prizes and the culture of philanthropy in Sweden.

The Jonas Scholars Program-Evaluation of a decade-long program to advance doctoral-prepared nurses

BACKGROUND

The Jonas Scholars Program of Jonas Nursing & Veterans Healthcare aims to advance the pipeline of doctoral-prepared, research-focused, and practice-focused faculty via student financial support and leadership training.

PURPOSE

Program evaluation of the Jonas Scholars Program. We describe the reach of the program over time, scholar characteristics, and report on graduated scholars that are currently employed in faculty and clinical positions.

METHOD

Retrospective analysis of administrative records from the Jonas Scholars Program spanning 2008 to 2016.

FINDINGS

The Jonas Scholars Program has grown substantially since its inception. From 2008 to 2016, a total of 1,032 doctoral students at 174 universities across the United States have received financial support through the program. Scholars have a mean age of 38 and nearly two-thirds are enrolled in a research-focused PhD program. Most graduated scholars for which data are available are primarily faculty in nursing schools 185 (30.7%), providing direct patient care 171 (28.4%), or conducting research 118 (19.8%).

DISCUSSION

The Jonas Scholars Program supports the pipeline of a younger generation of doctoral-prepared nurses that are faculty in schools of nursing, providing direct patient care and conducting research.

Impacts of an Alumni Association-Institutional Partnership to Invest in Educational Innovation

An 8-year small grants program funded by an alumni association has awarded $814,356 to 50 principal investigators for educational research. The 63 projects principally concerned simulation, educational tools and techniques, interprofessional education, and pilot projects for curricular reform. Awardees identify career growth and institutional advancement of education as major outcomes. Four publications, 63 posters/presentations, nationally disseminated educational materials, and external grants have been generated. Other outcomes include a second small grants program and travel funding for educational scholarship. The alumni association has made additional investment of over $1.8 million in educational development and has been nationally recognized for its collaborative philanthropy.

'Tolerable Intolerance': Protestantism, Sectarianism and Voluntary Hospitals in Late-nineteenth-century London

This article interrogates the complicated understanding of sectarianism in institutional cultures in late-nineteenth-century England through an examination of the practice of religion in the daily life of hospital wards in voluntary hospitals. Voluntary hospitals prided themselves on their identity as philanthropic institutions free from sectarian practices. The public accusation of sectarianism against University College Hospital triggered a series of responses that suggests that hospital practices reflected and reinforced an acceptable degree of 'tolerable intolerance'. The debates this incident prompted help us to interrogate the meaning of sectarianism in late nineteenth-century England. How was sectarianism understood? Why was it so important for voluntary institutions to appear free from sectarian influences? How did the responses to claims of sectarian attitudes influence the actions of the male governors, administrators and medical staff of voluntary hospitals? The contradictory meanings of sectarianism are examined in three interrelated themes: the patient, daily life on the wards and hospital funding. The broader debates that arose from the threat of 'sectarianism in hospital' uncovers the extent to which religious practices were ingrained in hospital spaces throughout England and remained so long afterwards. Despite the increasing medicalisation and secularisation of hospital spaces, religious practices and symbols were embedded in the daily life of voluntary hospitals.

The price of progress: Funding and financing Alzheimer's disease drug development

INTRODUCTION

Advancing research and treatment for Alzheimer's disease (AD) and the search for effective treatments depend on a complex financial ecosystem involving federal, state, industry, advocacy, venture capital, and philanthropy funding approaches.

METHODS

We conducted an expert review of the literature pertaining to funding and financing of translational research and drug development for AD.

RESULTS

The federal government is the largest public funder of research in AD. The National Institute on Aging, National Institute of Mental Health, National Institute of General Medical Sciences, and National Center for Advancing Translational Science all fund aspects of research in AD drug development. Non-National Institutes of Health federal funding comes from the National Science Foundation, Veterans Administration, Food and Drug Administration, and the Center for Medicare and Medicaid Services. Academic Medical Centers host much of the federally funded basic science research and are increasingly involved in drug development. Funding of the "Valley of Death" involves philanthropy and federal funding through small business programs and private equity from seed capital, angel investors, and venture capital companies. Advocacy groups fund both basic science and clinical trials. The Alzheimer Association is the advocacy organization with the largest research support portfolio relevant to AD drug development. Pharmaceutical companies are the largest supporters of biomedical research worldwide; companies are most interested in late stage de-risked drugs. Drugs progressing into phase II and III are candidates for pharmaceutical industry support through licensing, mergers and acquisitions, and co-development collaborations.

DISCUSSION

Together, the funding and financing entities involved in supporting AD drug development comprise a complex, interactive, dynamic financial ecosystem. Funding source interaction is largely unstructured and available funding is insufficient to meet all demands for new therapies. Novel approaches to funding such as mega-funds have been proposed and more integration of component parts would assist in accelerating drug development.

Philanthropy and the nation-state in global health: The Gates Foundation in India

In recent years, philanthropic actors such as the Gates Foundation have been understood as commanding sweeping influence in global health. They have been associated with the outsourcing of public health services, shifting of policy priorities, and the eventual sidelining of national governments. This article makes a different argument about the impact of global philanthropic actors. It focuses on the work of the Gates Foundation in India over the last decade and a half, tracing how the foundation initially circumvented the national government but then moved on to a discourse of partnership. Ironically, after an early discounting of the role of the government, the foundation later sought to transition its programmes to the state. The foundation's evolving trajectory reflects its experiences on the ground and also the difficulties of realising its original ambitions. While the foundation's work in India is marked by ebbs and flows, the state's institutions remain constant. The article argues that there is not always a straightforward marginalisation of the government vis-à-vis global philanthropic actors. Actors such as the Gates Foundation, perceived as enormously powerful in global health institutions in Geneva and New York, may have a far more qualified impact in large developing countries such as India.

Estimated effects of implementing an open access policy for grantees at a private foundation

Background

The Gordon and Betty Moore Foundation (GBMF) was interested in understanding the potential effects of requiring that grantees publish their peer-reviewed research in open access journals.

Methods

We collected data on more than 2,000 publications in over 500 journals that were generated by GBMF grantees since 2001. We then examined the journal policies to establish how two possible open access policies might have affected grantee publishing habits.

Results

We found that 99.3% of the articles published by grantees would have complied with a policy that requires open access within 12 months of publication. We also estimated the maximum annual costs to GBMF for covering fees associated with “gold open access” to be between $400,000 and $2,600,000 annually.

Discussion

Based in part on this study, GBMF has implemented a new open access policy that requires grantees make peer-reviewed publications fully available within 12 months.

Policy entrepreneurship in the reform of pediatric dentistry

In a recently published IJHPR article, Cohen and Horev ask whether an individual who holds rightful governmental power is able to effectively “challenge the equilibrium” in ways that might “clash with the goals” of an influential group”. This question is raised within the context of a shift in governmental policy that imposed the potential for cost management by HMOs acting as financial intermediaries for pediatric dental care in an effort to provide Israeli children better access to affordable dental care. The influential group referred to consists of Israel’s private dentists and the individual seeking to challenge the equilibrium was an Israeli Minister of Health whom the authors consider to be a policy entrepreneur.

The Israeli health care system is similar to that of the United States in that private benefit plans and self-pay financing dominate in dental care. This is in contrast to the substantial role of government in the financing and regulation of medical care in both countries (with Israel having universal coverage financed by government and the US having government financing the care of the elderly and the poor as well as providing subsidies through the tax system for the care of most other Americans).

Efforts to expand governmental involvement in dental care in both countries have either been opposed by organized dentistry or have suffered from ineffective advocacy for increased public investment in dental care.

In the U.S., philanthropic foundations have acted as or have supported health policy entrepreneurs. The recent movement to introduce the dental therapist, a type of allied dental professional trained to provide a narrow set of commonly-needed procedures, to the U.S. is discussed as an example of a successful challenge to the equilibrium by groups supported by these foundations. This is a somewhat different, and complementary, model of policy entrepreneurship from the individual policy entrepreneur highlighted in the Cohen-Horev paper.

The political traction gained to change the equilibrium favored by organized dentistry – in both Israel and the U.S. - may reflect aspirations for care that is more accessible, patient-centered, accountable and equitable. Evolving aspirations may lead to policy changes to systematize the disparate, disaggregated dental care delivery system in both counties. A change in payment incentives to provide more value is being explored for medical care, and its expansion to dental care can be anticipated to be among the policies considered in the future.

Opportunities for epilepsy: Outcomes of the Milken Institute State of the Science Retreat

The Milken Institute Center for Strategic Philanthropy has launched a Giving Smarter Program in Epilepsy to inform philanthropists on the state of the science for the epilepsy field, key challenges, and solutions to address them. As part of the program, the Milken Institute Center for Strategic Philanthropy hosted a retreat to identify strategic investments that would accelerate epilepsy research to ultimately improve care. The top three prioritized opportunities from the retreat were to 1) invest in data standards and analytical tool development, 2) support young investigators, and 3) promote cross-sector collaborations especially between basic scientists, preclinical researchers, clinicians, and patients.

The New Careers in Nursing Program: A Strong Investment in the Future of Nursing

In 2008, faced with the challenges of a looming nursing shortage and a nursing workforce that did not mirror the diversity of the population of the United States, the Robert Wood Johnson Foundation considered how to contribute to a solution. A key challenge was how to rapidly and effectively build a cadre of diverse nurses who were ready to take on the leadership challenges of an evolving health care system. From that challenge, the New Careers in Nursing program was developed. A collaboration between the Robert Wood Johnson Foundation and the American Association of Colleges of Nursing, the program set about to change the face of nursing. After investing in over 3,500 scholars and as the program winds down, the program's impact can be seen in the scholars, the schools, the nursing profession, and the future investments of the Robert Wood Johnson Foundation.

Empty rituals? A qualitative study of users' experience of monitoring & evaluation systems in HIV interventions in western India

In global health initiatives, particularly in the context of private philanthropy and its 'business minded' approach, detailed programme data plays an increasing role in informing assessments, improvements, evaluations, and ultimately continuation or discontinuation of funds for individual programmes. The HIV/AIDS literature predominantly treats monitoring as unproblematic. However, the social science of audit and indicators emphasises the constitutive power of indicators, noting that their effects at a grassroots level are often at odds with the goals specified in policy. This paper investigates users' experiences of Monitoring and Evaluation (M&E) systems in the context of HIV interventions in western India. Six focus groups (totalling 51 participants) were held with employees of 6 different NGOs working for government or philanthropy-funded HIV interventions for sex workers in western India. Ten donor employees were interviewed. Thematic analysis was conducted. NGO employees described a major gap between what they considered their "real work" and the indicators used to monitor it. They could explain the official purposes of M&E systems in terms of programme improvement and financial accountability. More cynically, they valued M&E experience on their CVs and the rhetorical role of data in demonstrating their achievements. They believed that inappropriate and unethical means were being used to meet targets, including incentives and coercion, and criticised indicators for being misleading and inflexible. Donor employees valued the role of M&E in programme improvement, financial accountability, and professionalising NGO-donor relationships. However, they were suspicious that NGOs might be falsifying data, criticised the insensitivity of indicators, and complained that data were under-used. For its users, M& E appears an 'empty ritual', enacted because donors require it, but not put to local use. In this context, monitoring is constituted as an instrument of performance management rather than as a means of rational programme improvement.

Advancing Cancer Survivorship in a Country with 1.35 Billion People: The China Lymphoma Project

Rates of lymphoma are rising rapidly and lymphoma is now the ninth most common cancer among Chinese males. The China Lymphoma Project was founded to increase awareness of lymphoma in China, including the survivability of the disease and the availability of potentially life-saving treatments, and to provide social support for men, women, and children in China who are living with the disease. The project is working with China government officials, several of the top cancer hospitals in China and the U.S., internationally known oncologists and cancer researchers, pharmaceutical and biotech companies in China and the U.S., healthcare and environmental companies, the Confucius Institute at San Diego State University, and the Asian Heritage Society. Advances in e-Health are being utilized to provide patient education and social support. The project will provide free e-books that profile lymphoma survivors (e.g., Kai-Fu Lee, creator of Google China), new videos, websites, pamphlets, blogs, video logs (vlogs), peer-to-peer counseling and support, and information about the latest treatments and oncology clinical trials.

Neural valuation of environmental resources

How do people value environmental resources? To estimate public valuation of natural resources, researchers often conduct surveys that ask people how much they would be willing to pay to preserve or restore threatened natural resources. However, these survey responses often elicit complex affective responses, including negative reactions toward proposed destructive land uses of those resources. To better characterize processes that underlie the valuation of environmental resources, we conducted behavioral and neuroimaging experiments in which subjects chose whether or not to donate money to protect natural park lands (iconic versus non-iconic) from proposed land uses (destructive versus non-destructive). In both studies, land use destructiveness motivated subjects' donations more powerfully than did the iconic qualities of the parks themselves. Consistent with an anticipatory affect account, nucleus accumbens (NAcc) activity increased in response to more iconic parks, while anterior insula activity increased in response to more destructive uses, and the interaction of these considerations altered activity in the medial prefrontal cortex (MPFC). Further, anterior insula activity predicted increased donations to preserve parks threatened by destructive uses, but MPFC activity predicted reduced donations. Finally, individuals with stronger pro-environmental attitudes showed greater anterior insula activity in response to proposed destructive uses. These results imply that negative responses to destructive land uses may play a prominent role in environmental valuation, potentially overshadowing positive responses to the environmental resources themselves. The findings also suggest that neuroimaging methods might eventually complement traditional survey methods by allowing researchers to disentangle distinct affective responses that influence environmental valuation.

Henry Solomon Wellcome: A philanthropist and a pioneer sponsor of medical research in the Sudan

Henry Solomon Wellcome, the famous drug manufacturer had a fascinating association with the Sudan. Besides supporting tropical medicine research in this country, he established an extensive project in the Sudan that aimed at combining archeological excavations, philanthropy and social reform. This article is an archives-based account on this side of Wellcome's association with the Sudan. The article starts with Wellcome's early years in the American Midwest and the evolution of his career and his rise as a world-renowned drug manufacturer. After the battle of Omdurman, Wellcome visited Sudan in 1900 - 1901 where he offered to support the establishment of the research laboratories which later came to be known as the Wellcome Tropical Research Laboratories in Khartoum. He then became directly involved in the planning and running of extensive archeological excavations in the central Sudan. This project served as a field in which Wellcome found an outlet for his philanthropy. More than 4000 labourers were employed in Jebel Moya. Professional archeologists and anatomists were recruited by Wellcome to supervise the work, and all the requirements in terms of equipment were catered for. Wellcome devised a Savings Bank System whereby part of the earnings of each labourer were saved to him till the end of the season. He also introduced one of his innovations: aerial photography using box kite which was used for the first time in archeology. Wellcome made it a rule that no applicant should be turned away. The Camp Commandant had to find suitable work for each applicant, including the handicapped who were assigned to appropriate jobs like mending baskets or cutting grass for building huts. Wellcome's welfare work had a significant impact on the local inhabitants of Jebel Moya. Henry Solomon Wellcome, 1906. Oil painting by Hugh Goldwin Riviere. Credit: Wellcome Library.