By THE EDITORS
Ms. Gates, of the Bill & Melinda Gates Foundation, recently returned from a three-day trip to Bangladesh. She, along with Nick, agreed to answerreaders’ questions about development issues focusing on that part of the world. Here is the first installment of the Q&A session.
Q.
How can a “small” person without a lot of financial resources help the women of the world? What can each of us do to reach out to the women in Africa, Haiti, South America and the Far East? I feel so helpless and it really hurts. –JEANIE, New York City
A.
MELINDA: That’s a great question, Jeanie. I believe that each of us can do important and meaningful work to make the world a better place. It’s not about the money. It’s about using whatever resources you have at your fingertips to try to improve the world.
I think that real giving starts with caring about others and wanting to learn more. I encourage everyone to become a student of the causes they care about. And if you are interested in learning about what you can do to help women in developing countries lead healthy and productive lives, you can go to the websites of organizations such as UNICEF, UN Women, CARE, andSave the Children that support programs focused on women. At Nothing But Nets you can purchase a bed net for just $10 to protect a mother and her children from getting malaria.
One thing that touches me the most when I travel is the fact that so many of the women I meet don’t have a voice—not in their government, often not even in their own household. They want to be able to deliver their babies in a clinic or get their children immunized, but there is no place for them to be heard. They go to incredible lengths to take care of their children, like the group of women I met with today who were at the clinic learning about health and nutrition. This is something they will do for five days a week for five months, to make sure their children are properly fed, thanks to a program put together by the Foundation.
By supporting programs like this, we in the developed world can use our voices to demand that those women have the same basic health services we do.
This is the reason why I’ve started using Twitter and Facebook to share stories and communicate with people who are making a difference—as well as those who are eager to make a difference. I’m a big believer in the power of social networks, whether they are local networks of women working together to improve newborn health in rural Bangladesh, or online networks. Use your own network to spread the word about challenges that these women face or successful organizations that you learn about so others can also become engaged.
A.
NICK: Two suggestions for Jeanie’s good question. First, you don’t have to be wealthy to make a difference. Even modest donations do make a difference. For less than $1 a day, for example, you can sponsor a child through PLAN USA (I have a PLAN child in Dominican Republic, whom I visited a few years ago). Or you can browse Kiva.org or GlobalGiving.org and probably find a better use for $25 than you could find at the mall.
But even if you don’t have $25 to spare, there are other steps you can take – such as lobbying for good programs, or for change in bad ones. The CARE action network, for example, suggests who to send emails or letters to on humanitarian causes. Many other organizations have similar online campaigns. You can even introduce your child to freerice.com and, through educational game play there, support food donations. So sure it helps to be a billionaire, and Jeanie is unlikely to affect as many people as Melinda. But I’ll bet that Jeanie or anyone else can affect one or two people or more in ways that are transformative. If you see a girl who can go to school, for example, because someone has paid her school fees through Camfed, and who as a result now has an entirely different future – well, that’s the most gratifying feeling in the world.
Q.
I’d like to thank the Gates, and I would like to ask how they factor in the unintended consequences which may result from their work. For example, earlier efforts to use vaccinations and other means to reduce child mortality were extremely successful in the Third World, but the consequence was very rapid and substantial population growth. I’m not suggesting that saving lives is bad; it is the most noble act a person can perform. My question is how does the Gates Foundation estimate the results of their programs, and do you plan additional efforts to ensure that the results of your work, such as population growth, are effectively managed as well? Thank you. –MARSHALL GOLDBERG
A.
MELINDA: This is a question that we think a lot about. The foundation is data-driven in everything we do, from making grants to estimating and evaluating their impact. For example, here in Bangladesh, we are funding several research studies to better understand which viruses and bacteria cause the most cases of pneumonia. Only by generating solid data will we be able to make well-informed decisions. And, of course, we need to know if our work ishaving impact. Measurement and evaluation is built into every single grant so we can analyze the results of programs that we fund.
I want to share with you something that surprised Bill and me when we first started learning about global health. Like many people, we thought that if you made advancements in global health, rapid population growth would result. But, in fact, the opposite is true. When the health of a population improves, family size starts to decrease and population goes down. If a mother knows that her children are going to make it through to adulthood, she will have fewer children. She will have an easier time feeding those children and sending them to school. Life for her family starts to get better by every measure.
But in order for this to happen, family planning is critical. More than 215 million women want to use modern contraceptives but don’t have access. That’s a crime. We need to make sure that every woman is able to choose how many children she wants to have and when she wants to have them.
A.
NICK: People often push back at me when I talk about saving lives and say, in effect: There’s no point. Those people who are saved will just have more children until everyone is starving again. That’s a canard. In fact, it’s increasingly understood that one reason people have large families is because they expect some children to die. If they can be assured that their children will live, they’ll have fewer kids (after a lag). That’s why birth rates are already dropping in poor countries. Indians, for example, now have just 2.6 babies – down from almost 6 in 1950. Bangladeshis average just 2.3 babies.
The bottom line is this: the way to deal with population pressures is to support family planning, not to let children die of disease.
Q.
I attended a talk once with the British economist Benny Dembitzer. He thinks that too much money is spent on the fight against malaria and other diseases, believing that a child may be saved from malaria today but could die from diptheria tomorrow. Instead, he’d rather see that money spend on primary education. As a molecular biologist, I think that the fight against insect transmitted diseases can be won, but I can understand the argument. Do you think that a point might be reached at which we have to say: Enough’s enough. Let’s give everyone bed nets and we can fight malaria through bringing people out of poverty? –ROBERT JONES
A.
MELINDA: I hear that question a lot, and I don’t think it is either or. We have to do both. It is incredibly important not only to invest in health, but also to invest in efforts that stimulate economic growth, expand access to opportunity, and help the poor raise themselves out of poverty. Take agriculture, for example. We invest in agriculture because we believe that if smallholder farmers, the majority of whom are women, had access to better information and higher yielding and more resilient crops, they could better feed their families, earn higher incomes, and become self-sufficient.
On the health front, we’ve learned that in addition to causing some children to die, infectious diseases take a massive toll on those who get sick but survive. For instance, some studies have shown that children who suffer from cerebral malaria have more trouble paying attention and remembering information. The same holds for children suffering from diarrhea and for those who are undernourished, especially newborns and infants. Over 80 percent of calories in the first year of a baby’s life goes towards brain development. If that energy is used instead to fight malaria or diarrhea, the brain may not develop properly. And then children can’t live up to their full potential, no matter how good a primary education they receive. Good health is fundamental to breaking the cycle of poverty.
Just this morning, I met a beautiful little girl named Shrabonti in Mirpur, a slum in the Northwest of Dhaka, while visiting a study site exploring the link between intestinal infections, nutrition, and cognitive development. Shrabonti, who shares her name with the rainy season, looked fairly normal, until I realized that she was already 20 months old.
She only weighed 19lbs, the size and weight of a healthy nine-month-old. Shrabonti had already been sick 27 times in her short life, including seven bouts of diarrhea. I was left thinking—life shouldn’t be so hard for her. How do we make sure that all children like Shrabonti have the greatest chance of living up to their full potential?
A.
NICK: Should American presidents focus on the economy or on national security? Obviously, the answer is both. We have many priorities and we’re fated to juggle them all. In the same way, combating malaria is important not only to save lives but also to promote economic development – but education is also critically important to build skills and transform economies and societies. So I agree with Melinda that we don’t have the luxury of picking and choosing a single target; to make a difference, we have to be jugglers.
That said, I think Robert is right that we have to scrutinize the challenges and figure out where we can be more cost-effective. One of the things that the development community has gotten better at doing is introducing metrics and rigor to see what kinds of interventions get the most bang for the buck. I do think that the evidence is pretty good that work in both education and public health tend to be highly cost-effective, and also are mutually supportive. Deworm kids and give them bed nets, and they’ll miss less school. And as they become better educated, they’ll become more concerned with their own health and will have fewer children whose health they’ll take better care of. We’re already seeing this virtuous cycle in action right now, which is why Africa is economically the fastest growing part of the world today.
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