Kristof on Gates

By Nicholas Kristof

My Sunday column is about Bill Gates and his first annual letter, which will be released Monday. You can sign up for it or read it on the Gates Foundation site, and by all means also take a look at the video of parts of my conversation with Gates.
It’s well worth reading in full for what it says about health, development and education. It’s largely aimed at elites — that’s you — and I do hope the Gates Foundation will figure out more ways to market its issues to the general public so as to help build more of a social movement for these causes.
On the whole, I am so impressed with what the Gates Foundation is doing, particularly in global health. It has managed to focus scientific research on the diseases of poverty and galvanize an effort that will probably culminate in life-saving vaccines. If some of these big bets pay off — say, a malaria vaccine — then the impact on Africa will be incalculable, and the benefit will be seen in economic growth as well as lives. My hunch is that Bill Gates is going to be remembered more for what he did in health than what he did in software.
Discussions about Gates always tend to migrate into discussions of aid effectiveness, and there are serious questions about how well aid works. But I should also note that the two areas that have the best track record in aid are health and education, and perhaps the two single most cost-effective interventions ever were the campaign that eradicated smallpox and the battle against childhood mortality led by James P. Grant of Unicef beginning in 1980. So, sure, I grant that aid often doesn’t work as well as is hoped — but sometimes its successes are simply spectacular.
In the letter, Gates notes that he and Melinda started off focusing on reproductive health, apparently thinking that family planning was the crucial barrier. That is indeed a problem for hundreds of millions of women (and one reason I’m delighted that Obama has restored funding to the U.N. Population Fund). But Bill and Melinda realized that it’s more complicated than a technical matter of providing contraception: when families expect several children to die of diarrhea, measles or malaria, then they want more children, and throughout history the first step has been to reduce childhood mortality and then fertility soon drops as well. If poor people can be assured that their children will survive, they will have fewer children. That’s one reason Bill and Melinda Gates moved their focus from reproductive health to global disease — and the results may be truly historic.