Our 2017 annual letter is addressed to our dear friend Warren Buffett, who in 2006 donated the bulk of his fortune to our foundation to fight disease and reduce inequity. A few months ago, Warren asked us to reflect on what impact his gift has had on the world.
What follows is our answer to him.
It’s a story about the stunning gains the poorest people in the world have made over the last 25 years. This incredible progress has been made possible not only by the generosity of Warren and other philanthropists, the charitable giving of individuals across the world, and the efforts of the poor on their own behalf—but also by the huge contributions made by donor nations, which account for the vast majority of global health and development funding.
Our letter is being released amid dramatic political transitions in these countries, including new leadership in the United States and the United Kingdom. We hope this story will remind everyone why foreign aid should remain a priority—because by lifting up the poorest, we express the highest values of our nations.
One of the greatest of those values is the belief that the best investment any of us can ever make is in the lives of others. As we explain to Warren in our letter, the returns are tremendous.
Your gift a decade ago left us speechless. It was the biggest single gift anyone ever gave anybody for anything, and we knew we owed you a fantastic return on your investment.
In this letter, we’ll share some highlights with you, and we’ll focus on global health—because that was the starting point of our philanthropy, and it’s the majority of what we do.
We don’t have sales and profits to show you. But there are numbers we watch closely to guide our work and measure our progress.
Let’s start with the most important one.
Our Favorite Number
Melinda: Every September, the UN announces the number of children under five who died the previous year. Every year, this number breaks my heart and gives me hope. It’s tragic that so many children are dying, but every year more children live.
Bill: If you add up each year’s gains, 122 million children under age five have been saved over the past 25 years. These are children who would have died if mortality rates had stayed where they were in 1990.
Melinda: Saving children’s lives is an end in itself. But it has other benefits as well. If parents believe their children will survive—and they have access to contraceptives that let them time and space their pregnancies—they’re able to choose how many children to have.
Bill: When a mother can choose how many children to have, her children are healthier, they’re better nourished, their mental capacities are higher—and parents have more time and money to spend on each child’s health and schooling. That’s how families and countries get out of poverty.
The Best Deal Is Vaccines
Melinda: Coverage for the basic package of childhood vaccines is the highest it’s ever been, at 86 percent. And the coverage gap between rich countries and developing countries is the lowest it’s ever been. This explains a lot of the gains in childhood survival—vaccines are the single biggest reason for the drop in under-five deaths.
Reducing Newborn Mortality
Bill: The first day of life is especially dangerous for babies, and more than 2.5 million newborns die in their first month. The world hasn’t made as much progress in this area as we have in others. Newborn deaths now represent 45 percent of all childhood deaths, up from 40 percent in 1990.
Melinda: But some very poor countries have improved their survival rates by encouraging breastfeeding and increasing the number of trained health workers attending births. And health centers we’re funding in Africa are now doing autopsies so pathologists can learn more about the causes of newborn deaths. Bill had the opportunity to observe one of these autopsies last year in South Africa.
Melinda: Malnutrition makes kids more likely to die from childhood diseases. It also stunts their growth and hurts their cognitive development.
Bill: Malnutrition destroys the most human potential on the planet. We’re funding research to identify key nutrients and find ways of getting them into the diets of kids in poor countries. When researchers make these discoveries, the rise in the number of children who achieve their potential will change the world.
The Power of Family Planning
Melinda: In the developing world, 300 million women have access to modern contraceptives. This number is an all-time high, but there are still 225 million women in developing countries who want to use modern contraceptives and can’t get them. That’s tragic. Contraceptives save lives and reduce poverty. When women in developing countries space their births by at least three years, their children are almost twice as likely to reach their first birthday. When women can time and space their pregnancies, they are more likely to advance their education, earn an income, and have healthy children. This leads to greater prosperity—and it starts with women who have the power to choose how many children to have.
Poverty Is Sexist
Bill: Poverty is sexist. The poorer the society, the less power women have. Men decide if a woman is allowed to go outside, talk to other women, earn an income. The male dominance in poorer societies is mind-blowing.
Melinda: Fortunately, as a society becomes better off, a woman’s position in that society improves. But how do women in poor societies get more power now? Actually, women get more power from other women. About 75 million women are involved in self-help groups in India alone. The groups might form to help women get loans or share health practices, but once things get started, the women take it in the direction they want to go. That is empowerment.
More Optimistic Than Ever
Bill: In a recent survey, just 1 percent knew that the world had cut extreme poverty in half, and 99 percent underestimated the progress. The survey wasn’t just testing knowledge, it was testing optimism, and the world didn’t score so well.
Melinda: Optimism isn’t just a belief that things will automatically get better; it’s a belief that we can make things better. And in many ways we are making the world better—global poverty is going down, childhood deaths are dropping, literacy is rising, the status of women and minorities around the world is improving.
Bill: Warren, it won’t surprise you to know we’re more optimistic than ever.
Melinda: And more impatient too.
Bill: Especially for this:
Bill: This is the number we’re striving toward every day at the foundation. Zero malaria. Zero HIV. Zero TB. Polio is closest to reaching that magic number. In 1988, there were 350,000 new cases of polio worldwide. Last year, there were 37.
Melinda: Those cases were confined to Northern Nigeria and parts of Afghanistan and Pakistan. Immunizing children in conflict areas is hard—and dangerous. We’re in awe of the vaccinators who are taking risks to reach each child.
Bill: If things stay stable enough in the conflict areas, humanity could see its last case of polio sometime this year.
Warren, these numbers help capture the successes and struggles in global health. The problems are still here because they’re so hard to solve. But we have confidence in the world’s talent, energy, and empathy—and that lets us end our letter with a bright look ahead.
Polio will soon be history. In our lifetimes, malaria will end. No one will die from AIDS. Few people will get TB. Children everywhere will be well nourished. And the death of a child in the developing world will be just as rare as the death of a child in the rich world.
We can’t put a date on these events, and we don’t know the sequence, but we’re confident of one thing: The future will surprise the pessimists.
Thank you for putting your trust in us, Warren. We won’t let you down.
—Bill and Melinda
The authors are co-chairs of the Bill & Melinda Gates Foundation. Their 2017 Annual Letter, from which this article was adapted, is available at www.gatesletter.com.