Following the class discussion on Friday, I found an article in the NY Times Saturday morning that seems to illustrate the ease with which a philanthropic health initiative can cause perverse incentives. Bill Gates is donating over $10 billion to a vaccination program for children throughout the world over the next 10 years. Included in his funding projections is a currently being developed malaria vaccine which will save the lives of approximately 1,000,000 children in Africa. My concern is that without the growth and development of the corresponding political, social and agricultural infrastructure, this increased population will further degrade the agricultural land causing more malnutrition, starvation, deaths and other socio-economic problems. An increased population, without an accompanying economic development policy, can cause more governmental instability problems furthering that condition on the African continent. Individual philanthropic endeavors are important contributions to world poverty problems, but without a concerted and well thought out program, the goals may be undermined by unperceived consequences. A public health initiative needs to also consider, and build into its plan, the increased health and population growth which will be the result with increased educational opportunities, economic initiatives and the environmental (in all forms from energy consumption to land sustainability) consequences.