Bill Gates has been a philanthropist for over a quarter of a century, but there’s still a substantial question about him: what are his political views? I’ve watched and read about Gates’s philanthropy ever since he became a major giver, and five years ago once spent a lunch with him (and 300 other people) at the American Enterprise Institute. But although I can say with confidence, “the Gates Foundation is a liberal foundation,” I can’t tell you whether Bill Gates is a liberal. I’ve never heard him express a political opinion.
But I can speak with confidence about the way that Bill Gates views the world. He likes numbers and statistics. He was a great admirer of Dr. Hans Rosling, the Swedish epidemiologist whose writings and TED talks conveyed a good deal of valuable, clear-headed information about poverty. (I wrote about Dr. Rosling here). Gates was such a fan of Dr. Rosling’s work that he donated an electronic copy of Dr. Rosling’s book Factfulness to anyone in the U.S. getting a bachelor’s, master’s, or doctoral degree in 2018. (Gates reviews Factfulness here.)
So it’s little wonder that when Bill Gates was invited to deliver a lecture at Cambridge University in October 2019 in honor of Stephen Hawking, he gave a talk which Dr. Rosling would have approved of. Gates’s thoughtful comments should be of interest to any global poverty fighter.
He begins his lecture with three key statements:
“Global health has seen dramatic improvements in recent decades.” Between 1990 and 2017, the number of children under age 5 dying each year has fallen in half, from around 12 million deaths annually to under 6 million. There are also far more people living in their seventies and eighties in 2017 than there were in 1990.
“Improvements are made possible by innovation.” The oral polio vaccine was invented in 1961, but not until 1988, when the Global Polio Eradication Initiative was launched, did the vaccine become available worldwide. In the past three decades, polio deaths have fallen by 99.9 percent, thanks to a “massive volunteer effort” from Rotary International.
Data about preventable diseases has also dramatically improved. In 1990, one could look at a chart and discover diarrhea rates for regions of the world and get vague statements about diarrhea rates. But in 2017, a chart from the Global Burden of Disease breaks down diarrhea rates by country and gives far more details about what causes diarrhea than existed in 1990. You can learn, for example, that in Chad a lot of diarrhea is caused by rotavirus, so disease fighters can order more rotavirus vaccine for that nation.
“Innovation is a long game.” Gates believes that many of the innovations he sees happening in public health in the next 20 years are taking place now. What he foresees is that preventable deaths in lower-income countries will decline. Malnutrition will fall because people in the Third World will be able to get better food—including better probiotics.
Gates foresees general practitioners in Africa doing what they do in the U.S.: helping patients deal with preventable diseases so they can live longer, happier lives. He believes, for example, that malaria can be conquered, in part because we have far better information about where disease-bearing mosquitos are concentrated, so that preventative measures, such as bed nets, can be concentrated in a particular region as needed. Genetic engineering can also play a role, as genes can be introduced that can prevent mosquitos from carrying parasites.
These changes may mean that children in the Third World can do better in school, because they won’t have to worry about childhood diseases that are currently commonplace. With a better-educated labor force, the incomes of workers in developing countries will slowly rise, ensuring that their lives will be better.
Other donors can learn from Gates’s optimism. I’m reminded of arguments Nobel Laureate Sir Angus Deaton made in his book The Great Escape (which I reviewed here), that the best way to help the Third World is to give them knowledge. The Gates Foundation specializes in medical research, and the Howard G. Buffett Foundation funds efforts to improve Third World agriculture. These are far better ways to help the developing world than giving surplus food that reduces the demand for products from local farmers, or sending people such as nurses and teachers who will increase unemployment among local nurses and teachers.
The Gates Foundation may be large, but I’m sure there are plenty of other medical projects, which would make the lives of people in developing countries better. So medical research on diseases that afflict the poor might well be a good place to steer your resources.
“Innovation is shrinking the gap between perfect and not perfect health for everyone,” Gates writes. “And the smaller it gets, the better the world becomes.”