What Should a Billionaire Give—and What Should You?

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With Christmas approaching, and Americans writing checks to their favorite charities, it’s a good time to ask how these two beliefs—that a human life, if it can be priced at all, is worth millions, and that the factors I have mentioned do not alter the value of a human life—square with our actions. Perhaps this year such questions lurk beneath the surface of more family discussions than usual, for it has been an extraordinary year for philanthropy, especially philanthropy to fight global poverty. For Bill Gates, the founder of Microsoft, the ideal of valuing all human life equally began to jar against reality some years ago, when he read an article about diseases in the developing world and came across the statistic that half a million children die every year from rotavirus, the most common cause of severe diarrhea in children. He had never heard of rotavirus. “How could I never have heard of something that kills half a million children every year?” he asked himself. He then learned that in developing countries, millions of children die from diseases that have been eliminated, or virtually eliminated, in the United States. That shocked him because he assumed that, if there are vaccines and treatments that could save lives, governments would be doing everything possible to get them to the people who need them. As Gates told a meeting of the World Health Assembly in Geneva last year, he and his wife, Melinda, “couldn’t escape the brutal conclusion that—in our world today—some lives are seen as worth saving and others are not.” They said to themselves, “This can’t be true.” But they knew it was. Gates’s speech to the World Health Assembly concluded on an optimistic note, looking forward to the next decade when “people will finally accept that the death of a child in the developing world is just as tragic as the death of a child in the developed world.” That belief in the equal value of all human life is also prominent on the Web site of the Bill and Melinda Gates Foundation, where under Our Values we read: “All lives—no matter where they are being led—have equal value.” We are very far from acting in accordance with that belief. In the same world in which more than a billion people live at a level of affluence never previously known, roughly a billion other people struggle to survive on the purchasing power equivalent of less than one U.S. dollar per day. Most of the world’s poorest people are undernourished, lack access to safe drinking water or even the most basic health services and cannot send their children to school. According to Unicef, more than 10 million children die every year—about 30,000 per day—from avoidable, poverty-related causes. Last June the investor Warren Buffett took a significant step toward reducing those deaths when he pledged $31 billion to the Gates Foundation, and another $6 billion to other charitable foundations. Buffett’s pledge, set alongside the nearly $30 billion given by Bill and Melinda Gates to their foundation, has made it clear that the first decade of the 21st century is a new “golden age of philanthropy.” On an inflation-adjusted basis, Buffett has pledged to give more than double the lifetime total given away by two of the philanthropic giants of the past, Andrew Carnegie and John D. Rockefeller, put together. Bill and Melinda Gates’s gifts are not far behind. Gates’s and Buffett’s donations will now be put to work primarily to reduce poverty, disease and premature death in the developing world. According to the Global Forum for Health Research, less than 10 percent of the world’s health research budget is spent on combating conditions that account for 90 percent of the global burden of disease. In the past, diseases that affect only the poor have been of no commercial interest to pharmaceutical manufacturers, because the poor cannot afford to buy their products. The Global Alliance for Vaccines and Immunization (GAVI), heavily supported by the Gates Foundation, seeks to change this by guaranteeing to purchase millions of doses of vaccines, when they are developed, that can prevent diseases like malaria. GAVI has also assisted developing countries to immunize more people with existing vaccines: 99 million additional children have been reached to date. By doing this, GAVI claims to have already averted nearly 1.7 million future deaths. Philanthropy on this scale raises many ethical questions: Why are the people who are giving doing so? Does it do any good? Should we praise them for giving so much or criticize them for not giving still more? Is it troubling that such momentous decisions are made by a few extremely wealthy individuals? And how do our judgments about them reflect on our own way of living?