Foundations as International Organizations

American foundations have been powerhouses of international health reform. They supported a broad spectrum of policies, encompassing laboratory research, public health training, and sanitary fieldwork. Infectious and parasitic diseases, mental health, and drug therapy have at various times appeared on foundation agendas. These programs have involved strategic evaluation of some fundamental problems: how to measure health and disease and their economic costs, how most efficiently to turn discoveries in the laboratory into preventive policies, and how to calculate the prospects for wholesale eradication of infectious diseases. Foundations have had greater freedom than state agencies to support experimental projects and to disseminate standards based on best practice derived through international training programs.

The foundations' varied activities have given rise to conflicting interpretations of their role as social agencies. Some scholars have taken the medical programs at face value as promoting disinterested advancement of medicine for human benefit. According to these accounts, in their visionary support for cultural and medical projects, donors such as John D. Rockefeller, Jr. assume an almost saintly quality. Since the mid-1970s, a wave of critical studies examined foundations as agencies of imperialism, including cultural imperialism, disseminating American cultural and political values in expert-led public health programs. These studies claimed that the foundations expressed the class interests of trustees, who were generally recruited from elites in industry and banking, leavened by professional leaders in law and medicine.