Gates Report Shows 'Mind-Blowing' Progress—and Work to Do

In 2015 at the United Nations, world leaders adopted 17 goals aimed at reducing poverty, inequality, and other global ills by 2030. Such goals have long been championed by philanthropists Bill and Melinda Gates. So in 2017 the Gates Foundation launched Goalkeepers, an initiative to spur action and track progress toward the goals. Its 2018 status report says there have been “mind-blowing improvements in the human condition”—but it also calls for more investment and innovation in fighting poverty lest progress against it stall. I recently sat down with the Gateses for a rare joint interview on the new report, which was released to the public September 18.

Susan Goldberg: I’ve just read the Goalkeepers report. Why did you decide to start doing this?
Melinda Gates: Because we think that the news—that the world has made this incredible progress, this increase in lives saved, the reduction in poverty—that news isn’t really out there. The UN set these amazing goals for the future to help us continue to reduce poverty, and we want to make sure that we hold people accountable for that progress and really inspire the next generation of leaders who are going to take these tasks on.

One of the things I liked about the report is that the audience is treated as adults—you’re saying there are some areas where it’s really tough and we’re not making as much progress as we’d like. You talk specifically about how while poverty is going down everywhere, it’s not going down quite as fast in Africa.
MG: When we travel on the continent, we see this unbelievable potential, particularly with the young people coming up who have so much energy and ingenuity. But the reality is there’s also poverty. And so how do you make sure that the progress that we’re seeing that’s moving forward in places like Rwanda or Ethiopia, that it reaches everybody? And that the lessons that are being learned in certain countries are spread?

What are you seeing in different countries? Who’s doing a great job?
Bill Gates: Even a very poor country can do a good job on health, can do a good job on agriculture, on education. That 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. Ethiopia, on agriculture, is growing over 5 percent a year. In education Vietnam is one we talk about, because they’re so far ahead of where you’d expect given their wealth. But it’s when you get those three things together—health, education, agriculture—that eventually these countries can become self-sufficient.

MG: One of the things that’s also encouraging: [In population] Rwanda is a very small country, Ethiopia is the second largest on the continent of Africa—but they have learned the lessons of what has helped people make progress from around the world. So they’re looking at what happened in Asia in agriculture, how did Brazil decrease the stunting rate [among malnourished children] so phenomenally across a very large country with lots of poverty.

When you think about learning from one another, I was struck by the example from Vietnam, where you’ve got 15-year-olds who are doing as well on international tests in school as people from the United Kingdom or from the United States. What are the lessons from Vietnam that can translate across other countries?
BG: It’s a really new thing to try and get into the amount of learning. The agenda for poor countries up until now has largely been to get the kids into school—and attendance rates have gone up a lot, for girls and boys. The biggest missing piece still is how much knowledge they’re gaining. A few countries, by training the teachers the right way and bringing the right material into the classroom, have really achieved learning way beyond what you might expect.

MG: When you look back at the UN millennium goals that were set [in 2000], one of the goals was to get kids into school. And that has essentially been achieved, particularly at the primary level and quite a bit at the secondary level. So it’s neat to see a goal achieved, but now with this next set of goals, it’s about how to get the depth of learning and the education right.

Thinking about the African continent: How young it is, how many young people there are, is both a huge challenge and a great opportunity. Can you talk a little bit about that?
BG: The African continent today is about a billion people out of the some seven billion on Earth. As this century goes forward, over half the young people in the entire world will be there. With those people moving into the job market, if the right investments are made—stability, education, health—Africa will have growth and innovation, far more than lots of other places. If, on the other hand, we don’t take care of the HIV crisis, then you’ll just have more people who will get infected. If you don’t have the right conditions, then the young people, particularly the men, can add to that instability. So Africa definitely hangs in the balance.

You mentioned the HIV crisis. What are the differences in how African countries are handling it?
BG: The southern and eastern parts of Africa bore the brunt of the epidemic: 80 percent of the cases are there, and so the prevalence is very high. In lots of places a majority of women are infected by the end of their 20s. It’s made a huge difference to get [antiretroviral] drugs into countries; the death rate has gone down a lot. Mother-to-child transmission of the virus—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 we have to look at every country and say, OK, are they doing a good job with the different communities? What are the prevention tactics that are working?

MG: One of the biggest concerns, as Bill said, is for young women; there’s so much AIDS in the community, and their chance of acquiring it is very high. So it’s important to continue to get the messages out about what you can do to protect yourself, getting yourself tested. And the other message that really needs to be out there is about family planning tools, and that’s even separate from HIV/AIDS. It’s important for many reasons.

Melinda, this has been one of the issues that you’re most involved in. Can you talk to me a little about that?
MG: Family planning is crucial anywhere, in any community 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 is going to be healthier. That’s one of the longest-standing pieces of global health research we have. What struck me the most when traveling in Africa is that women know about contraceptives and want access, but contraceptives just aren’t being delivered in the ways or the places that these women need. Since 2012 we now have 40 million additional women on contraceptives. That’s progress, but not enough progress; we need to get 200 million women access to contraceptives.

When you do that, people have the chance to lift their families 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, and ultimately you get these country-level effects where it’s good for everybody.

You’ve both gone all over the world and seen the problems up close. If you could wave a magic wand and fix just one thing, what would it be?
MG: I would say certainly contraceptives: giving a woman access to contraceptives so she can choose which one she wants to use at which points, so that she can space the births of her children. It changes everything for her and 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?
BG: The development of children. Today more than half the kids in Africa never fully develop physically or mentally because of malnutrition, their diet, and the diseases they face. With research on the human gut microbiome, we’re gaining an understanding of stunting, why they don’t grow. [Editor’s note: See the facts—and the faces—of malnutrition, in the downloadable PDF below.] I’m superexcited that by the end of the decade we expect to have cheap interventions so those kids will fully develop. That means all the investments you make in their education, wanting to benefit from their productivity, will work far better. So if there was just one thing, it’s the intervention to stop malnutrition.

As we close, I wanted to ask about this notion of optimism that is threaded through your report.
BG: The constant increased visibility of negative things gives people a misimpression. You might even conclude that it’s kind of hopeless—but that’s a mistake. You really need to learn from what’s gone so well. As we’ve gotten vaccines out, miraculous things are happening. Literacy levels all over the world, including in Africa, have gone up very dramatically. A few of the problems are daunting. But maybe there’s a new innovation; maybe there’s a group of young people coming up with a new way of doing it—that’s an attitude that you really want to get engaged, not discouraged.

MG: Optimism is important because it’s a form of seeing what’s possible and then helping make that a reality. With the earlier goals that were set, we can measure what has happened over the last 20 years, and we see the progress. We see it in the numbers, we see it in the reports, but we also see it with the people on the ground. We see this amazing ingenuity, and if we can tap that as a world—wow, will things change!

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