Ask Bill Gates

Earlier this month NEWSWEEK invited readers to submit questions to Bill Gates about the work his foundation is doing on the problem of global health. We received more than 400 questions, and forwarded a selection of them to Gates. Here are his answers:

How did you start thinking about the Third World, when the whole world has been ignoring them?
—Kumud B.

Melinda and I first got involved in global health after reading an article about the huge impact of disease in poor countries. The article showed that every year millions of children die from diseases that are completely preventable with effective, affordable vaccines. We thought, "This can't be true. But if it is true, it should be the priority of our giving." Since then, Melinda and I have traveled extensively in the developing world, and those experiences have had a big impact too. When you have the opportunity to meet people in poor countries face to face, you quickly begin to see them as neighbors, not strangers. And when you see the devastation of diseases like malaria or AIDS, you want to do all you can to help.

I was born and raised in Mexico. I am now a Ph.D. student [in the U.S.]. I often struggle to find the right balance between working on new and exciting technology and the desire of helping those who need most. I am sure you are aware of several efforts that use high tech to try to solve the world's biggest problems. However, my impression is that, while helpful, they have a smaller impact on the world compared to the use of low-tech solutions, such as vaccination or boiling water to prevent disease. Do you think there are irreconcilable differences between high tech and social development? If not, what are the best approaches to tackle this?
—Andrés

We need both. Millions of lives can be saved if we do a better job of ensuring access to "low tech" health tools that already exist. For example, it's been estimated that 3 million newborn deaths could be prevented every year with greater access to relatively cheap, simple tools like vaccines and antibiotics. That's why some of the Gates Foundation's largest grants are helping to accelerate the delivery of existing solutions. For instance, we have provided $1.5 billion to the GAVI Alliance, which supports children's immunization in poor countries. We have also supported the Carter Center's efforts to distribute low-tech—but highly effective—tools to help eradicate Guinea worm, such as a special straw that filters out fleas from drinking water. But for many of the biggest health problems, the solutions we have today are not adequate. We need more effective and affordable vaccines, drugs, and diagnostic tests for many of the worst diseases, like AIDS, TB, and malaria. That's why we also invest significant resources into research and development.

I have nothing but respect for you and your wife for leading the way in helping to ease the suffering of so many people. [But the] planet is already overpopulated. Is it fair to save lives through advancements in medicine only to subject these people to abject poverty, more illness and the possibility of starvation?
—Judy B.

Melinda and I asked the same question when we got involved in global health, and the answer surprised us: there are good data to show that when health conditions improve, population growth actually goes down. Very quickly people realize that they can have fewer children because there's a much better chance they will grow up to be healthy adults. In countries where health improves, life improves on many levels: literacy rates go up, school attendance increases, economic opportunities grow, and so on.

Your foundation works on diseases caused by poverty. But what about diseases of affluence, like diabetes and obesity and heart disease? Will you work on them? Or do you think those diseases are the victims' own fault?
—Ben P.

All of those issues are important and need more attention. Melinda and I believe our foundation can have the greatest impact by focusing on a limited set of problems. That allows us to build up expertise in our focus areas, and to make long-term investments. Within health, we have decided to focus on about 20 diseases and health problems that disproportionately affect poor countries and receive inadequate attention and resources.

One of the elements that has hindered developmental efforts in the Third World, primarily Africa, has been the endemic culture of corruption that permeates many levels of government and society at large. How does your foundation circumvent this in its programs?
—James K.
This is an important issue—when a government sets the wrong incentives or undermines basic infrastructure and stability, there's a modest amount that outsiders can do. But it's also important not to overstate the problem. Many leaders in developing countries are seriously committed to improving the lives of their people, and they need support.
When our foundation supports projects in developing countries, we partner with organizations that have the expertise and capacity to deliver results on the ground. In many cases our partners have been doing work on these issues for many years, and our support enables them to move with greater urgency and help even more people. We're also committed to rigorously evaluating the results of our efforts, and changing course when we don't get the results we want.

What can young people do to make a difference in the world?
—Alex K.

I'd love to see more young people taking action to help the poor and disadvantaged—whether that's in your own backyard or anywhere in the world. If you decide to choose public service as a career, that's phenomenal—but you can also make a big difference by volunteering. Of course, the Internet has made it possible to learn about all kinds of causes and organizations, and to connect with others who have the same interests. Two places to get started are Network for Good and Global Volunteer Network.

What diseases do you think will be eradicated in your lifetime? Do you think AIDS will be?
—Sarah K.

Melinda and I are confident that in our lifetimes we will see major progress on many of the biggest infectious diseases, such as malaria and TB—maybe not complete eradication, but definitely major progress. On AIDS our dream is to see an HIV vaccine in our lifetime. This has proven to be an extremely tough scientific challenge, but we've got to keep pressing forward. Whether it takes 15, 20 or 25 years to get an HIV vaccine, it's our best long-term hope to break the back of the epidemic.

Have you given any thought to funding sustainable-agriculture education and methods in Third World countries, where deforestation is rampant and poverty levels are extreme? If so, which countries have you considered for this effort?
—Tomás H.

We have. Many of the world's poorest people live on small farms and rely on agriculture for their food and income. Melinda and I believe that making agriculture more productive and sustainable is a key to reducing poverty and hunger. It can also help preserve the environment. Last year our foundation launched an initiative that is working with partners to provide millions of small-scale farmers in Africa and South Asia with ways to boost their productivity, increase their incomes, and build better lives for themselves and their families. One of our major grantees, the Alliance for a Green Revolution in Africa, is funding programs at two universities in Ghana and South Africa that train African crop breeders to develop crops that are sustainable and suited to the needs of local farmers and environments.

In your philanthropic actions you focus on reducing the acute pain of poverty in developing countries. But there are also big problems on the horizon for the world. Specifically I mean the impending water crisis of the next half-century. Is it on the radar of the Gates Foundation? If not, should it be, and do you think it can be prevented?
—Leo B.

Water shortages are already a major problem in parts of the developing world, and, as you observe, they are only projected to get worse. Our foundation is addressing the issue through two of our grantmaking programs, although we are not focusing on the problem directly. Water is of course a crucial resource for farmers, and agriculture accounts for about 75 percent of all the water used by people worldwide. Some of our grants are specifically designed to promote more efficient ways to use water, such as drip irrigation. We also have an exploratory effort to understand more about water, sanitation and hygiene. Water for drinking, cooking and washing is a vital part of daily life, though it represents a fairly small share of overall water use. We are funding several pilot efforts to help more people get safe water, such as low-cost water treatment, and better ways to carry and store water.
 
In your honest opinion, what do you believe it will take to clean the world's water supply and ensure that all nations have access to clean, safe water? Is that even a true possibility? What can we—the small people—do to help?
—Karen H.

Everyone can do something to help. There are a number of groups doing good work that help people find safe solutions—and these groups need your support. You might look into organizations such as CARE or WaterAid, or find another group that's making a difference. At our foundation we've been studying this issue for the last two years. Unsafe water—and the contamination of water because of poor sanitation and hygiene—sickens and kills millions of people each year, hitting young children the hardest. It also forces people, particularly women and girls, to travel long distances every day to find safe water. There are ways to address this problem that have been demonstrated in Asia, Africa and other places during the last few decades, although usually on a small scale. We want to help these solutions reach many more people and ensure that they work over the long term. One thing we've learned is that approaches that strengthen and respond to people's demands for safer water, sanitation, and hygiene are more likely to be successful than those that focus only on giving people equipment like water taps and toilets.

Considering that you made most of your money in the United States, why are you spending so much time and money helping Third World countries? America seems to have quite a number of problems that someone like you could solve.
—Craig S.

Melinda and I started our foundation because we believe all lives have equal value. Today billions of people never even have the chance to live a healthy, productive life. We think all people—no matter where they live—deserve that opportunity. Around the world one of the worst inequities is health. In the U.S. it's the fact that millions of young people's choices in life are limited not because they aren't talented or motivated but because they don't have access to great schools and teachers. Every year, for the last 20 years, more than a million young people have dropped out of high school. Dropouts are more likely to be unemployed, end up in prison, slide into poverty, and need more assistance from the government. That's why our foundation has committed more than $3 billion in scholarships and grants aimed at ensuring that all students in the U.S. graduate from high school prepared to succeed in college, career and life.