Editor's note: This interview with Bill Gates was conducted in 2014.
With an endowment of $40 billion (give or take), the Bill & Melinda Gates Foundation has the financial heft to make dramatic changes in hundreds of millions
Editor's note: This interview with Bill Gates was conducted in 2014.
With an endowment of $40 billion (give or take), the Bill & Melinda Gates Foundation has the financial heft to make dramatic changes in hundreds of millions of people’s lives around the world. But how does the organization decide which causes and institutions to fund? Bill Gates, its co-founder and co-chair, has a well-established knack for sifting through complex data sets to find the right pathways for making progress around the globe in health, education and economic development. Scientific American contributing editor W. Wayt Gibbs sat down with Gates to learn more about how he views the world. A shorter excerpt of the interview appeared in the August 2016 article “Health Check for Humanity.” An edited transcript of the full-length interview follows.
In 1993 the World Bank published a World Development Report that you have said was instrumental in your early thinking about how to direct your charitable giving to be most effective in improving global health.
That was a very important document for me. Melinda and I went to Africa in 1993, and that trip got me thinking about how much nutrition people there have, how people live—sometimes not even being able to afford shoes—why so many children die and the different tiers of social development. We had already been doing some things to improve women’s access to contraception because when women can plan their families, they’re healthier and their kids are healthier. But then I saw that World Development Report. We were giving money to PATH [an international charity based in Seattle], which was working both on infectious diseases and contraception. I was having dinner with their board and someone pointed out that, although it may seem counterintuitive, improving the health of children actually works in the long-term to reduce population growth—when fewer kids die, parents choose to have smaller families.
And then I saw in that World Development Report that 12 million children are dying every year. Wow! It was mind-blowing to me that these preventable diseases—pneumonia, diarrhea, malaria and some other infections that infants get—had such a huge impact. That was the first time it dawned on me that it’s not hundreds of different diseases causing most of the problem—it’s a pretty finite number. And I was surprised by the huge disparity between poor countries, where 20 percent of children were dying before the age of five, and rich countries where that number is more like half a percent.
You were an early backer of Christopher Murray and his push to create an independent organization, the Institute of Health Metrics and Evaluation [IHME], to pull together rigorous statistics on human health worldwide largely independently of the WHO [World Health Organization]. How did you two meet and decide on this course?
I met Chris in 2001 when he was working for the WHO and was doing the first-ever ranking of national health systems. Some countries were pushing back because they didn’t like how he ranked things. This idea that somebody should try to pull together the best understanding of health, particularly for poor countries—Chris is an ambitious guy, so from the beginning he wanted to do it for all countries—was an attractive one. So we gave money to the University of Washington to create IHME.
Chris’s theories are always provocative. The one that has received the most attention recently is his belief that there are a lot of adult malaria deaths both inside and outside of Africa. Ninety percent of the field thinks he’s wrong. Within the next five years, that controversy should be brought to ground.
But just the fact that somebody is trying to publish these numbers and put error bars on them focuses the discussion. We want to get the trend lines on these things, and now that IHME has created a central repository, you no longer have to read hundreds of articles and try to assemble the big picture yourself. People can argue over specific numbers but if the right process is in place, the error bars will either get bigger or some study will be done and the state of knowledge will get better.
Chris did the first version, and a lot of people disagreed with the results. So now IHME has set up a governance committee and a formal process [for conducting outside expert peer review]. Chris is supergood but he likes controversy—and he doesn’t back down. He’s been right about a lot of the opinions he has. But for the job of administering the normative database, he’s not absolutely the perfect person. It just happens that he and the team he has built are so good at the technical stuff that he’s the best choice. We’ve added these other structures to make sure that everybody views this as the definitive source of information.
But in a few cases, mainly malaria, there are stil