Source: www.thelancet.com
Author: Simon Chapman

On June 14, the world’s two richest men, Mexico’s Carlos Slim Helú and the USA’s Bill Gates, jointly announced that they would each contribute US$50 million to the Latam health project to increase vaccinations and improve child nutrition and natal health in central America.1 Slim already contributes reputedly $2·5 billion annually to his Instituto Carlos Slim de la Salud, which runs a large variety of health programmes in Latin America.2 The latest announcement will naturally attract widespread acclaim as an outstanding example of philanthropy. But it also invites important questions about consistency and competing interests.

Any assessment of Slim’s net contribution to public health must balance the impact of his philanthropic contributions as well as the indirect health consequences that flow from his wealth generation with a less appreciated source of his wealth. Descriptions of Slim’s vast fortune generally concentrate on his telecommunications empire.3 Relatively little is mentioned about his long-standing majority ownership of the Mexican tobacco company Cigatam,3 which has since 2007 been 80% owned by Philip Morris.4 Slim’s website acknowledges that Cigatam “turned out to be the first and most important because of its cash flow, providing the Group with sufficient liquidity to capitalize on available opportunities and thereby increase its acquisitions of big companies”.5 Nor is it as widely publicised that he has a continuing role as a non-executive director6 of the world’s largest tobacco company, Philip Morris International (PMI).

The company’s shareholders doubtless expect him—like all directors—to make a major contribution to maximise investment returns and the company’s bottom line. PMI’s website6 notes that Slim serves on its finance, product innovation, and regulatory affairs committees. The purposes of these committees include to “monitor the financial condition of the Company, oversee the sources and use of cash flow, capital structure and resulting financial needs”,7 to “monitor and review the development of new product strategies, key legislative, regulatory and public policy issues and trends affecting the Company”, and to “anticipate, respond to, and challenge where appropriate, regulatory and fiscal proposals”.8 This must include responding to international efforts at tobacco control. It is inconceivable that Slim would not have known of the action Philip Morris is currently taking against Uruguay in the International Centre for the Settlement of Industrial Disputes objecting (among other things) to that nation’s new requirement for large graphic health-warnings on cigarette packs.9

The tobacco industry has long suffered ethical bottom-feeder status with both the public and the corporate world. The Reputation Institute’s 2010 report,10 which involved over 80 000 respondents in 32 countries, saw the tobacco industry ranked a distant last of 25 industries on “reputation”. Why? This is an industry whose products kill over 5·5 million people each year, on average 15 years earlier than normal life expectancy.11 It is an industry which has engineered the chemistry and design of its products to, as one infamous 1984 Philip Morris internal memorandum put it, “make it harder for existing smokers to leave the product”.12 It is an industry whose product is responsible for the inexorable rise of lung cancer, the world’s leading cause of cancer death and a disease that was very uncommon before the mass production and marketing of cigarettes.13

Slim’s massive contributions to Latin American health undoubtedly do much good. But the consequences of his continuing history of high-level regional and global involvement in the tobacco industry are hardly trivial in any assessment of his public health footprint.

Gates’ philanthropy is unmatched this century. His commitment to reducing some of the world’s worst infectious diseases has poured unprecedented capital into health projects in many of the world’s poorest and unhealthiest nations. His contributions will have already saved uncounted lives.

Gates has recently begun to fund tobacco-control projects in low-income and middle-income nations, joining New York’s mayor Michael Bloomberg in injecting an estimated $500 million to try and curb tobacco use in the world’s poorest nations.14 In April this year,15 the Bill & Melinda Gates Foundation withdrew a grant of $5·2 million to Canada’s International Development Research Centre (IDRC), after it emerged that the IDRC’s chair, Barbara McDougall, was a very recent board member of Imperial Tobacco Canada.16 The Gates Foundation statement17 said: “The foundation was recently informed that the chair of the board of our partner, the International Development Research Centre (IDRC), has until recently also been a Director of Imperial Tobacco Canada, Ltd. We are deeply disappointed by this revelation and feel this conflict is unacceptable as we work to support meaningful tobacco control programs in Africa. Therefore, we are terminating our tobacco control grant to IDRC, effective immediately. We remain committed to tobacco control work and look forward to continuing to partner with the anti-tobacco community to reduce tobacco use in Africa.”

Gates’ decision just 2 months later to partner with Slim is plainly inconsistent. He apparently did not know of McDougall’s appointment when he funded the IDRC. He might well not have known about Slim’s tobacco connections when he joined with him in the Latam project. He must know now. His subsequent actions with IDRC were an outstanding example of principled philanthropy. Let us hope he makes the same call again.

Author: I declare that I have no conflicts of interest.

References
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