The Impact of Philanthropy on Medicine and Health

THE IMPACT OF PHILANTHROPY ON MEDICINE AND HEALTH ROBERTJ. GLASER* Philanthropic foundations, as we know them today, are a relatively new entity, and to a considerable extent an American phenomenon. In all likelihood, the first private foundation in this country was established in 1867 by George Peabody, with an endowment of $2 million—by current standards a very modest sum. Its purpose was to improve education in the southern United States. The concept was apparently well received , so that by the end of the nineteenth century there were over 300 private foundations in the United States, only one of which, however , had a corpus of more than $10 million. In this century, establishment of new foundations moved at a rapid rate, and the rate accelerated after World War II. In the 10-year period from 1950 to 1959, over 1,200 new foundations were formed, and today the total in this country exceeds 25,000. Although many are relatively small, 94 have assets over $200 million. In addition, there are a number of corporate as well as community foundations. Some of the latter have grown impressively, especially those in major cities, and support a variety of worthwhile local and regional activities. The impact of foundations on medicine in general and health in particular was rather limited until this century, when a number of wealthy and public-spirited individuals, notably Andrew Carnegie, John D. Rockefeller, Julius Rosenwald, Edward Harkness, and James B. Duke, created foundations with resources of a size that enabled them to influence in a major way various fields of human endeavor, particularly general education, medical education, and medical research. Health care Based on the first David L. Everhart Lecture, Northwestern Memorial Hospital, Chicago , Illinois, January 7, 1991. ""Trustee and Director for Medical Science, The Lucille P. Markey Charitable Trust, and Consulting Professor of Medicine, Stanford University. Address: 525 Middlefield Road, Suite 130, Menlo Park, California 94025.© 1992 by The University of Chicago. AU rights reserved. 0031-5982/93/3601-0795$01.00 46 RobertJ. Glaser ¦ The Impact ofPhilanthropy delivery, in more recent times a major focus of foundation programs, was not emphasized in the early part of the century because growth in medical knowledge had not yet created the demand for care that we are now facing. Given the large number of foundations that have developed in our time, and taking into account that many of them have done good works on an admirable but relatively small scale, I would like to focus on the impact that a number of large foundations have had over the greater part of the twentieth century, both directly through grants and indirectly by virtue of their having made possible the development of replicable models that could be widely adapted. I also want to indicate how private donors on the one hand and private foundations on the other have often been collaborators, albeit not necessarily by original intent. Because the state of medicine reflects in a significant way the quality of the educational process that produces physicians, nurses, and other health care professionals, it is appropriate to look first at the contributions of philanthropy to medical education and to a major related activity , medical research. It is fair to say that in the nineteenth century, medicine in this country was hardly a showpiece. Although there were dedicated individuals who recognized the importance of medical education and worked to establish creditable schools of medicine, the truth is that the medical schools of the nineteenth century were in large measure proprietary and, with few exceptions, of very low quality in terms of academic standards. Medical research was for all intents and purposes still awaiting development. Although in some degree it is an oversimplification, by and large the first stirrings in the effort to upgrade medical education beganjust after the midpoint of the nineteenth century, when Charles William Eliot, president of Harvard, recognized the need to make the study of medicine a truly academic discipline. At that time, and in the latter half of the nineteenth century, medical education and medical research were more advanced in Western Europe than in this country, and those who hoped to improve their skills as physicians or aspired to engage...