Do they have an equivalent of 'Bill Chill' south of the border? Something like 'Frio Frenk'?

Though this article shows that it is not impossible to develop an analysis of and criticise Frenk's ideas. His use of tobacco money is an example.

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Healthy interests
Andrew Jack
September 18 2008

When Carlos Slim bought Condumex, the Mexican cable company, in the early 1990s, he evicted senior managers from its luxurious headquarters and sent them to their factories to be closer to the business. The new tenants seem unlikely to face a similar fate.

The Carso Health Institute – Latin America’s answer to the Bill & Melinda Gates Foundation – operates from calm and stylish offices set in gardens facing a colonial-era mansion. But it has plenty of work even just outside its walls in Mexico City’s historic San Angel district, where the poor live among the rich and both are affected by troubling levels of obesity.

“A third of Mexican children, and 70 per cent of women of reproductive age, are overweight,” says Julio Frenk, the Institute’s slender, silver-haired director. “That’s second in the world after the US among countries that measure it. It’s not a silver medal we aspire to. It’s about genetics, lack of exercise, diet. We have the second highest consumption of soft drinks in the world.”

The Gates Foundation, founded by the creator of Microsoft who was until recently the world’s richest man, has focused primarily on tackling infectious diseases in the developing world. Slim – who by some accounts is now wealthier than his US counterpart – has instead concentrated his health interests on handling the growing epidemic of chronic disease both in Mexico and globally.

By recently expanding the extent and profile of his public philanthropy, Slim has also set an example for other billionaires from emerging markets who are beginning to show interest in the field, notably in Latin America, a region better known for sharp inequalities in wealth than for private initiatives to help bridge the gap.

In late 2006, Frenk – a doctor, public health specialist and former Mexican health minister – took a job as a senior adviser to the Gates Foundation after losing out in the highly political election to be director-general of the World Health Organisation. Soon after, he received the call that led to his current job. Slim explained that he wanted to expand his activities in health, as well as education and sport, and needed a strategy within three months.

The principal areas of action Frenk identified were to address the challenges of non-communicable diseases including heart disease and diabetes linked to obesity; to close the social gaps in Latin America in meeting the United Nations’ Millennium Development Goals to boost child health and cut maternal mortality; and to respond to the health risks of globalisation.

Frenk stresses the style as well as the substance. “We have called it an institute and not a foundation because of the idea that it is more proactive,” Frenk says. “We do very rigorous analysis, set an agenda, find partners and implement. Everything is subject to evaluation. It’s like a sandwich. The two pieces of bread are highly analytical, and the meat is the foundation which gives grants.”

The Carso Institute programmes are only just getting under way, alongside scholarships and academic support, work to quantify progress on health in Latin America, and specialist analysis about the future of vaccines and the health impact of global warming.

But Frenk stresses that Slim, the son of Lebanese immigrants to Mexico, had long been active in philanthropy. A charity bearing his name was created more than two decades ago “to serve Mexican society by contributing to the development and training of human capital”. His Telmex Foundation, established in 1995, focused on nutrition, justice and environmental conservation.

Like many philanthropists, Slim became particularly active and focused because of personal experience, notably the death of his wife Soumaya from severe kidney complications. That helped expand his support for work on organ donation, as well as health activities more broadly, including operations for cataracts and cleft palates. Ever since, his corporate and charitable works have carried a new brand: Carso is a combination of the start of the couple’s first names.

As in business, so Slim’s philanthropy is designed to deliver results by handpicking executives, establishing projects that can be self-sustaining and fixing firm deadlines for results. There has been a fresh urgency of late, with Slim setting the objective of seeing the first meaningful benefits of his giving by the time he reaches his 70th birthday at the start of 2010.

As he told the Spanish newspaper El Pais earlier this year: “Businessmen ... should participate in solving problems; doing more than giving ... I believe that what is absurd is to bequeath in your will that when you die, a big museum should be built or a foundation should be created, and these things will be managed by people who do not have the slightest idea of how to solve problems.”

There are some intriguing parallels between Slim and Gates. The men know each other, and in 2000 jointly unveiled what became Mexico’s largest internet portal. They have each shown a particular interest in health and education philanthropy. Both have been accused of being monopolists – Gates deriving his wealth from dominance in the commercial software market and Slim from telecommunications.

Both have also faced criticism that they have used their foundations to further their business interests. Gates was initially attacked for putting computers into libraries as a way to boost Microsoft’s influence. Now, several Carso Health Institute programmes are developing services provided via his mobile phone company, including a project in Panama to help reduce complications for pregnant mothers and one launched at the International Aids Conference in Mexico City in August to provide information to HIV patients.

But Frenk – an advocate of employing business methods in philanthropy – says he recommended the use of mobiles, a technology also being applied in health projects in many other countries. “We need a new model for the 21st century that can draw on the business idea of franchises,” he says. “We should homogenise quality and control systems; introduce simple medical records and training; and reduce unit costs with bulk purchasing.”

Victoria Marquez-Mees, the Institute’s director of social investment, adds that mobiles are an increasingly powerful way to reach the poor, and rejects suggestions of any possible conflict of interest. She says she will publish information on any systems that are developed so they can be copied and offered by other mobile operators if they so chose. And the poorest will not be charged for the services provided. “Those people who can’t pay will never have to,” she says.

As an entity focused on disease prevention, the Institute has also been criticised for something still more sensitive: its very funding by Slim, much of whose wealth came from tobacco, one of the major chronic “killers” through respiratory and circulatory problems and cancers. The billionaire continues to hold a significant stake in Cigatam, Mexico’s largest manufacturer, and sold his majority share to his partner, conglomerate Philip Morris, only last year.

Frenk already faced attacks as a minister at the start of the decade when he negotiated an arrangement by which tobacco companies, including Slim’s, helped fund Mexico’s health insurance system. Critics said the deal risked holding the government hostage to industry, limiting its independence and diluting its anti-smoking policies. Frenk retorted that the result was world-leading health and tobacco control programmes.

Anti-smoking initiatives are not an explicit priority for the Institute, though smoking is banned in the building (along with biscuits, in a nod to the fight against obesity). But Frenk calls suggestions that Slim’s business interests distort its public health work “insulting”. “We presented the blueprint, and have been given complete freedom to carry out the agenda,” he says. “We are fully committed to tobacco reduction as a strategy.”

He adds that Slim has been reducing his tobacco investments, none of which contributed to the Institute’s endowment, which is instead derived entirely from shares in America Movil, his telecoms business, and Ideal, which specialises in social development programmes.

The Gates Foundation, too, has been criticised for the companies in which its managers have invested their funds – tobacco is a rare sector in which they will not buy shares. But Frenk stresses one other important difference between the two philanthropists: scale. Gates’s annual spending on health alone is several times the value of the Carso Institute’s entire $500m endowment. That will limit its disbursements to about $25m a year – at least until a reassessment in 2010.

“I have learnt a lot from the Gates Foundation,” says Frenk, who will remain an adviser to both entities. In January, he also takes up a full-time position as Dean of the Harvard School of Public Health. “The US has a very rich philanthropy tradition. Quite sadly, Latin America spends less per head than anywhere else, even sub-Saharan Africa. Part of the agenda is to stimulate philanthropy and put it back on the agenda.”

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