Innovating to Improve the Human Condition with Bill and Melinda Gates | National Geographic
Well, Melinda and Bill Gates, thank you so much for joining me to talk about this Goalkeepers report with National Geographic. We really appreciate your time. Why did you decide to start doing this report in the first place?
Well, we decided to start doing it because we think that the news that the world has made this incredible progress, that news isn't really out there. And yet the UN set these amazing goals for the future to help us really continue to reduce poverty, and we want to make sure that we hold people accountable for that progress. We let them know what's happened and really inspire the next generation of leaders who are going to take these tasks on. We want them to know how tough the work is. We want them to feel great about what's going on. We don't want to just wait till the end of the period and see that things were off track.
One of the things that I saw was how much progress has been made in Rwanda. I was recently in Rwanda, and it just astonishes me that just a generation after this terrible genocide, there is so much progress going on. You talked about Rwanda having the steepest drop in child mortality of any place, and I guess the question then is: how do you get these kids not just to survive but to thrive? What are you seeing in some of the different countries? Who's doing a great job and where does more progress need to be made?
Well, the idea that even a very poor country can do a good job on health, can do a good job on agriculture, even on education, provides a lot of hope because you can copy what's being done there. Rwanda has been a big outlier in the quality of those health services, but it's when you get those three things together—health, education, agriculture—that eventually these countries can become self-sufficient. And so, you know, when people think of poverty, they think, "Oh, it's just a binary thing; there's the poor and then there's the not poor." Understanding there are a lot of milestones along the way, including getting to what we call middle income, that is within reach for a lot of these countries.
People should have that clearly in mind. What are the steps that are helping to get countries there faster? I think one of the things that's also encouraging, if you take a country like Rwanda or you take a country like Ethiopia, Rwanda's a very small country; Ethiopia is quite a large country, the second-largest on the continent of Africa. But they have learned the lessons of what has made people make progress from around the world, and that makes us optimistic when you see it actually being implemented in the way those countries are.
If there was just one thing you could fix, what would it be? And I’d want to ask each of you just one, the magic wand here.
Well, I would say certainly contraceptives, giving a woman access to a basket of contraceptives that she can choose which one she wants to use at which point in her life or points in her life so that she can space the births of her children. It changes everything for her and for her children. So if I could wave a magic wand, 200 million women who are asking us for contraceptives today would have them.
Bill, what would yours be?
Well, the development of these children because of malnutrition means that in Africa today, over half the kids never develop physically or mentally, and that has to do with things going on with their diet and the diseases they face. I'm super excited that it looks like we'll understand that and be able to have cheap interventions that mean that those kids will fully develop. And that means all the investments you make in their education wanting to benefit from their productivity will work far better. And so, you know, we're not just failing the kids who die—that 5%—we're also failing the fifty percent who are held back nutritionally.
You don’t hear—I mean wrongly, perhaps—you don't hear that much about HIV anymore because both prevention and treatment have really improved so much. I know in other countries that is not so much the case, but there is such a disparity. So in South Africa, there's still a huge HIV problem. A country like Zimbabwe, you know, here on the African continent seems to really have conquered that. What are you seeing in the differences with how those countries are handling that problem?
Well, the southern part and the eastern part of Africa bore the brunt of the epidemic, where 80% of the cases are. There, a girl by the time she finishes her 20s, the majority are infected. It’s made a huge difference to get the drugs in and save these lives, and so the death rate has gone down a lot. We have to look at every country and say, “Okay, are they doing a good job with the different communities?” Mother-to-child, a lot of countries have done well to reduce that. You have some stigmatized communities, like drug-using communities or sex workers or men who have sex with men, now diving in and saying, "Okay, what are the tactics, the prevention tactics that are working in each of those?"
I mean, even in the United States, you have to bring down stigma so that people can talk about it and know where to go for treatment, know where to go for testing. And I think when we first were traveling in Africa, and AIDS was being discussed, there was an enormous amount of stigma, especially in South Africa. One of the biggest concerns, as Bill said, is for young women in particular; there's so much AIDS in the community, and their chance of acquiring it is very high. So, continuing to get the messages out about what can you do to protect yourself, getting yourself tested, and also the other message that really needs to be out there, and is widely getting out in Africa, is really about family planning tools.
And that’s even separate from HIV/AIDS—it’s important for many reasons. When you think about learning from one another, I was struck by this example from Vietnam, which is not a rich country, but there you’ve got those fifteen-year-olds who are doing as well on these international tests and school as people from the UK or from the US. What, you know, what are the lessons from Vietnam that can perhaps translate across other countries? Bill talks about his education; I talk about my own; we all care about our kids getting educated.
It's this universal truth. When we go out and talk to parents in the developing world, we might be there to talk about health or agriculture, but if you ever ask a parent anywhere in the world what their hopes and dreams are, they talk about their kids. They know education is the thing that will lift their kids up and give them a different opportunity. The agenda for poor countries, up until now, it's largely been, "Get the kids into school," which is fantastic. The biggest missing piece still is how much knowledge they’re gaining.
A few countries, by training the teachers the right way, bringing the right material into the classroom, have really achieved way beyond what you might expect. And, of course, that human capital—the healthiness and the education of a young generation—predicts their future as much as their current income level does. When you look back, the UN Millennium Goals that were set, one of the goals was to get kids into school, and that has essentially been achieved. But now, with this next set of goals, it's about the fidelity of how do you get the depth of learning and education right? And I think that's what a set of goals can do when it's set by nations around the world.
Family planning is crucial anywhere, in any community you’re in around the world because if a woman can decide if and when to have a child, she’s going to be healthier and her child’s going to be healthier. It's one of the longest-standing pieces of global health research we have that there are 200 million who are asking us for family planning; they want contraceptives, and the world hasn't delivered that to them. And so we are finally making more progress as a world. It had been taken off the global health agenda for a while; it's back on as of 2012.
Can I ask why was it taken off the global health agenda? Was it just too hard to talk about?
Yes, it became too hard to talk about and too politicized, and quite a few negative things had happened. I did want to turn that around, which is—that's the completely wrong approach. You need to talk to women and let them decide whether they want to have children. What struck me the most when I would travel in Africa, and still travel a lot, is women know about contraceptives and they want access. They’re asking us, and they're just not being delivered in the ways or the places that they go. But when you do that, then a woman and a man in their family have the chance to lift their family out of poverty. Because if they can space the births of those children, they can then feed them, they can educate them, the woman can work and contribute her income to the family.
It changes everything in the family dynamic, and it changes the community. Ultimately, you get these country-level effects where it’s good for everybody. So, on the continent of Africa today, the most popular type of family planning, of contraceptives, is an injectable shot. You get, actually, pretty painful—you get it once a quarter, but it means you have to walk to a health clinic. It has to be in stock at the clinic; you stand in line, and then you go home. So, it can be, you know, five, six hours by the time you get it.
One of the things that's coming along that we've been involved in is a very small—it’s a little tiny needle, a little tiny blister pack—that a healthcare worker with her kit in a village can give to them. Ultimately, women will be able to self-inject. So you can give them a supply; they take it at home, they squeeze it—it’s a tiny little needle—they squeeze it into the arm, and they're done. It’s a, you know, three-week, three-month supply of a family planning contraceptive.
And the whole notion of family planning is really tied up with education, is it not? You know, the more educated some of these women are, young women are, the later they delay having children.
Yeah, that's hugely correlated. You know, as women get educated, as income goes up, child death rates go down—all these things both sort of cause one another and help reinforce those. So that you get out of this poverty trap in a country becomes self-sufficient. And if you think about reproductive health tools, if you think about contraceptives, if a woman has access to contraceptives, she can further her education. So even in the United States, what allowed women to go into the workforce in droves? It was the birth control pill.
So if we want women to be able to get not only a high school education but a university education and have their families later, we need to give them access to these tools. It will change everything in terms of their empowerment and their role in society. We know that.