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It is true that the Bill & Melinda Gates Foundation works on almost every issue, from poverty alleviation to primary school enrolment. But nowhere is this contradiction more acute or tragic than in health.
The world witnessed a global health boom between 2000 and 2020. Child mortality declined by 50%. In 2000 more than 10 million children died each year, and now the number is less than 5 million. The spread of the world’s deadliest infectious diseases also halved. The best part is that progress is being made in areas where the burden of disease is highest. The greatest improvements were seen in Sub-Saharan Africa and South Asia.
Then COVID-19 came and progress suddenly stopped.
Today, the world faces more challenges than at any time in my adult life: inflation, debt, new wars. It also grapples with the worst child-health crisis: malnutrition. Unfortunately, aid is not matching these needs, especially where it is needed most.
More than half the time when a child dies, the root cause is malnutrition. Climate change is making the situation worse. Between 2024 and 2050, nearly 40 million additional children will be stunted and 28 million will suffer from malnutrition as a result of climate change, according to new data from the Institute for Health Metrics and Evaluation. These conditions, the most severe forms of malnutrition, mean that children do not develop to their full potential, mentally or physically.
The health and economic impacts are devastating. A child who suffers severe malnutrition before the age of three will complete five fewer years of schooling than well-nourished children, and studies show that those who went hungry in childhood are less likely to die in their lifetime. Earn 10% less and are 33% less likely to run away. poverty.
We must invest in global health to protect children from the worst effects of hunger, mitigate the effects of climate change, and drive economic growth. And looking to the past can provide inspiration to rekindle progress.
There were many reasons for the global health boom. A new generation of political leaders embraced humanism. Hundreds of thousands of health workers around the world brought the latest medicines to places where doctors rarely visited. But an often overlooked factor was the small but significant increase in funding.
Starting in 2000, the world’s wealthiest countries began to steadily increase their funding to supplement low-income countries as they increased their investments in health. During the first 20 years of the century OECD countries increased foreign aid from an average of 0.22% to 0.33% of their gross national income – with the most generous countries giving around 1%. Low-income countries received an average of $10.47 per capita in 2020. It doesn’t seem like much, but that $10.47 made a noticeable difference. It promoted the work of organizations such as Gavi, the Vaccine Alliance, and the Global Fund to fight AIDS, tuberculosis, and malaria, giving poor countries access to life-saving vaccines, medicines, and other medical breakthroughs.
The effect of this generosity was amazing. Still the work is incomplete. Even today, more than half of child deaths occur in sub-Saharan Africa. Since 2010 the percentage of the world’s poor living in this region has increased by more than 20 points to almost 60%. Yet, over the same period, the share of total foreign aid to Africa has declined from nearly 40% to just 25% – the lowest percentage in 20 years. Fewer resources mean more children will die from preventable causes.
The global health boom is over. But for how long? This is the question I have been struggling with for the last five years. Will we see this period as the end of the Golden Age? Or is it just a brief pause before another surge begins?
I am still optimistic. I think we can put global health second – even in a world where competing challenges require governments to increase their budgets. To do this, we will need a two-pronged approach.
First, the world must recommit itself to the work that led to progress in the early 2000s, especially investing in critical vaccines and medicines. They are still saving millions of lives every year.
We also need to look ahead. The research and development pipeline is full of powerful and surprisingly cost-effective breakthroughs. We need to put them to work to fight the most widespread health crises. And it starts with good nutrition.
One of the few failures of the global health boom was that we did not understand the importance of nutrition. But in the last 15 years, doctors have begun to explore how the gut affects every aspect of human health. If we solve malnutrition, we make it easier to solve many other problems. We solve extreme poverty. Vaccines are more effective. And deadly diseases like malaria and pneumonia become much less lethal.
This knowledge is now translating into surprisingly cost-efficient innovations, like super-fortified bouillon and more effective prenatal vitamins. The impact of scaling these innovations will be amazing. In Nigeria, modeling suggests that fortifying bouillon cubes would not only prevent anemia; It would also prevent more than 11,000 deaths from birth defects of the central nervous system, known as neural tube defects. And if low- and middle-income countries adopted the most complete form of prenatal vitamins, called multiple micronutrient supplements, nearly half a million lives could be saved by 2040.
The initial global health boom is over. “But for how long?” is a question which is still within the power of humanity to determine. I believe we can usher in a second global health boom by providing children with the nutrients they need to thrive.
Bill Gates is the co-founder of Microsoft and co-chairman of the Bill & Melinda Gates Foundation. A longer version of this article appears in Foundation 2024.
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