Introduction and Context:

The Cambridge Union’s Professor Hawking Fellowship Lecture of 2019 serves as the platform for the segment. The fellowship, established in 2017 in collaboration with Professor Stephen Hawking, aims to honor extraordinary contributions to STEM and social discourse. Bill Gates is presented with this prestigious accolade in the 2019 ceremony.

Bill Gates’ Relation with Hawking:

Bill Gates expresses deep gratitude for receiving the honor, and he reflects on his personal interactions with Professor Hawking. He first met Hawking in 1997 during an announcement of a Microsoft research lab collaboration with Cambridge. They met multiple times in both Cambridge and Seattle and mainly discussed physics.

Importance of Physics:

Gates emphasizes his fascination with physics, stating that conversations with Professor Hawking were an exceptional opportunity for someone as interested in the field as he is. He suggests that talking about physics with a mind like Hawking’s is a rare and valuable experience.

Stephen Hawking as a Communicator:

Gates lauds Hawking not just for his contributions to physics but also for his ability to communicate complex scientific ideas to the general public. According to Gates, Hawking was committed to making science accessible and urged people to be curious and ask questions.

Commitment to Public Understanding:

Bill Gates highlights that Hawking devoted his career to making science both accessible and interesting to the general public. Hawking encouraged people to engage with science, urging them to be curious, learn facts, and ask questions.

Introduction:

Bill Gates addresses the potential to predict the future, specifically focusing on global health. He argues that we can indeed predict the future of health, guided by three critical facts about the development and distribution of healthcare technologies and resources.

Health Improvements Over Time:

Gates starts by detailing the dramatic improvements in global health over the years. Using data charts, he shows that child mortality rates have significantly decreased from 1990 to 2017. In 1990, over 12 million kids under five died, compared to under 6 million in 2017. Gates highlights that despite these improvements, there are still significant disparities, especially in Africa where child mortality rates can be higher than 10% or even 15%.

Role of Innovation:

Gates emphasizes that innovation is not just about medical breakthroughs but also includes system improvements. He uses the example of the Global Polio Eradication Initiative (GPEI) to illustrate how innovative strategies in distribution and surveillance can drastically reduce disease incidence. GPEI has brought down polio cases by 99.9% globally since its inception in 1988.

Advanced Understanding and Tools:

Gates explains how our understanding of diseases and healthcare needs has drastically improved, thanks to resources like the Global Burden of Disease database. This information allows for targeted interventions, such as identifying that Chad needs rotavirus vaccines, while Bangladesh might need focus on typhoid or cholera.

Long-term Innovation Pipeline:

Gates points out that innovation is a long-term game and can often take decades to reach fruition. He is optimistic about the future because of recent scientific breakthroughs and a robust pipeline of new technologies, which he believes will lead to vaccines for diseases like HIV and TB.

Predictions for the Future:

Gates ends his talk by making two significant predictions for the next 20 years: solving malnutrition and significantly reducing the number of nutrition-related deaths. He describes malnutrition as the most significant health inequity worldwide, affecting both mortality rates and life quality.

Malnutrition: Wasting and Stunting:

Gates elaborates on two forms of malnutrition: wasting and stunting. Wasting represents extreme thinness and is the most severe form. Stunting, however, is more pervasive and happens when a child doesn’t get enough nutrition during their first three years of life, affecting both physical and mental development permanently.

In summary, Bill Gates is optimistic about the future of global health, supported by a history of progress, the power of innovation, and detailed understanding of health conditions. He believes that targeted interventions and long-term innovations will continue to improve global health, particularly in solving malnutrition.

Stunting as a Global Issue:

Bill Gates discusses the problem of stunting, emphasizing that despite advancements in health, over one in five children globally are stunted. Stunting isn’t simply an issue of not having enough food but is a complex issue involving the type and quality of food consumed.

Energy Distribution in Children:

He explains that when children eat, the energy they gain goes into brain activity, physical motion, and immune system function. In the early years of life, any leftover energy is used for growth. Failure to provide the right kinds of nutrients can lead to stunting.

Nutritional Complexities:

Gates details multiple causes of stunting, beyond just a lack of food. It could also be due to a lack of micronutrients, inflammation caused by infections, and imbalances in the body’s microbiome. Maternal health and nutrition are also contributing factors.

Existing Solutions and Challenges:

While solutions exist for some of these issues, such as fortified foods for micronutrient imbalances and medicines for infections, Gates identifies the role of the microbiome as a previously unexplored frontier.

Role of the Microbiome:

Thanks to advances in sequencing technologies, researchers have begun to understand the microbiome’s critical role in malnutrition. It’s comprised of microbial cells that outnumber human cells in our body and is essential for digestion and immunity.

Landmark Research:

Bill Gates highlights a 2013 study by biologist Jeff Gordon that focused on infant twins in Malawi. The study showed that the microbiome isn’t merely a byproduct of health; it is a key component in nutritional health. When the microbiome of a stunted child was transferred to mice, they also showed signs of malnutrition, indicating that the microbiome plays a direct role in health.

Implications and Future Directions:

Gates concludes that the deeper understanding we are gaining into the microbiome should eventually allow us to solve the problem of malnutrition. Understanding and altering the microbiome may be a key factor in combating stunting on a global scale.

Stunting and Nutrition:

Bill Gates discusses the global health issue of stunting in children, emphasizing that one in five children is stunted due to malnutrition. Stunting affects not just growth but also cognitive development and immune function. Providing the right calories, not just more calories, is crucial. Micronutrients and vitamins are also essential for balanced growth.

The Role of the Microbiome:

The microbiome, the community of bacteria living in our bodies, has emerged as a key area of interest in addressing malnutrition. Advances in sequencing technology have made it possible to study the microbiome in detail. Gates refers to a landmark study that showed that an imbalance in the microbiome could directly lead to malnutrition.

Interventions and Future Directions:

Gates is optimistic about the potential of engineering interventions to correct imbalances in the microbiome, such as scientifically refined probiotics and microbiome-targeted therapies. These interventions are still in the early stages of development but are promising in addressing malnutrition and reducing stunting in children.

Global Health Implications:

Gates suggests that understanding the microbiome will benefit both the developed and developing worlds, tackling issues like malnutrition and obesity. The discoveries could also affect other health conditions, such as asthma and allergies, that are linked to imbalances in the microbiome.

Shifting Healthcare Focus:

Over the next two decades, Gates predicts a global shift from merely keeping people alive to improving their quality of life. He highlights the inequities between healthcare in developed and developing countries, emphasizing the need for a more preventative and holistic approach to health.

Long-term Global Outlook:

Gates sees a global transition where preventable diseases will decrease, particularly in developing countries. He notes that as our ability to provide health advice improves, the focus will increasingly move towards enhancing the quality of life, setting the stage for a more equitable global health landscape.

Nutritional Advancements:

Bill Gates discusses the importance of the gut microbiome and its impact on both malnutrition and obesity. He is optimistic that in the next 20 years, engineered interventions will be designed to balance the microbiome. Trials are underway for foods that promote healthy gut bacteria. These interventions could have global impacts, particularly in reducing stunting in children.

Malaria Eradication:

Malaria continues to be a significant cause of death in sub-Saharan Africa. Gates is hopeful that by 2040, malaria will be virtually eliminated. Advanced mapping technologies can identify where mosquitoes, the primary vectors of malaria, are most concentrated. Gene editing technologies such as gene drives are in the testing phase and could either eliminate malaria-carrying mosquito species or dramatically reduce their populations.

HIV Treatment:

On the topic of HIV, Gates expresses optimism about long-acting drugs. Currently, people with HIV must take daily therapy for their entire lives, with the risk of developing drug resistance if adherence is not consistent. Research is underway to develop treatments that require only monthly or yearly administration, possibly in the form of an implant. This would be a significant advance in managing the disease and would benefit from global funding initiatives.

Shift in Global Health Focus:

Gates predicts that healthcare will transition from merely saving lives to improving lives. As medical advances continue, including solving nutritional problems and eradicating preventable diseases like malaria and HIV, global healthcare can focus on long-term wellness, closing the healthcare quality gap between rich and poor countries.

Funding and Collaboration:

The British government and the Global Fund play significant roles in financing healthcare advancements, particularly in HIV treatment. Gates mentions an upcoming meeting hosted by President Macron in Lyon, France, emphasizing the international collaborative efforts required for these healthcare advancements.

Medical Advances:

Bill Gates discusses his optimism for the future of medical science, predicting significant progress in eradicating diseases like malaria and HIV within the next 10 to 20 years. New tools are being developed, including long-acting drugs for HIV that could simplify treatment protocols.

Shift in Health Priorities:

As acute diseases get controlled, Gates suggests that the focus of healthcare will shift towards chronic and mental illnesses. Conditions like Alzheimer’s, diabetes, and depression are seen as the next frontiers in medical research.

Global Benefits of Health:

Improving global health has wide-reaching implications, including economic growth and poverty reduction. Gates notes that countries with the highest percentage of preventable diseases also have the lowest GDP per capita. Improved health could lead to reduced population growth as child mortality decreases, thereby fueling a “demographic dividend” and economic growth.

Challenges and Politics:

Although there is significant opportunity, Gates emphasizes that the speed of these advancements is uncertain and subject to political will. The need for focus and funding, especially from rich countries, is crucial to maintain momentum in global health initiatives.

Inspiration and Call to Action:

Referencing Stephen Hawking, Gates advocates for a focused investment in global health as a way to shape a better future. He encourages a collective commitment to harness the “magic of science and research” to expand possibilities and make progress.

This summary captures the major points of Bill Gates’ lecture on the future of global health, emphasizing both the promising advances in the field and the challenges that remain.

Motivation for Philanthropy:

Bill Gates discusses his transition from a successful tech career to addressing global health challenges. His faith in long-term investments in innovation and science, honed during his time at Microsoft, informed his approach to philanthropy. As Microsoft thrived, he considered how he could effectively give back to society. Research, including data on global health conditions, heavily influenced his philanthropic focus.

Importance of Targeted Investment:

Gates notes how limited the funding for significant issues like malaria was, describing it as an opportunity for targeted impact. Despite being a newcomer in the domain of global health, he applied his team-building and long-term investment experience from Microsoft to create solutions. With even modest initial investments in malaria, Gates became one of the largest funders in that area.

Challenges and Awareness:

Gates expresses concern about the general public’s low awareness of progress in global health, attributing this lack to prevalent cynicism. The belief that issues like poverty in Africa are unchangeable, or the lack of focus on international aid, can hinder progress.

External Threats:

Aside from internal funding and awareness issues, Gates identifies external headwinds like climate change as significant challenges, especially for vulnerable populations in Africa. These factors could negatively impact efforts to combat issues such as malnutrition.

Optimism and Realism:

While he remains optimistic about what focused effort and investment can achieve, Gates acknowledges that progress is “possible but not inevitable.” He warns against a lack of focus or waning international support as significant risks that could stall or reverse gains in global health.

Tech’s Role in Global Health:

Though the discussion hints at how technological advancements can be both an opportunity and a challenge, Gates does not explicitly comment on the potential negative impact tech might have on global health. The emphasis remains on the importance of continuous, dedicated effort to make significant strides.

Gender Awareness in Development:

Bill Gates acknowledges the existence of gender bias in data and development strategies. He mentions that women and men often focus on different crops in agriculture, and existing farmer education systems tend to favor men. To counteract this, interventions like distributing chickens can be pro-woman, as the income generated usually benefits the family more directly.

Digital Tools and Access:

Gates points out the gender disparity in access to digital tools like cell phones, which impacts women’s ability to save money. Such disparities can perpetuate economic instability for women, thus amplifying the gender gap in economic opportunities.

Women’s Groups:

Creating women’s groups at the village level has been an effective strategy for female empowerment. These groups serve as platforms for women to give feedback on local services like schools and healthcare. They also provide education on healthcare best practices, including vaccinations for children. The groups often revolve around microfinance activities, serving as a vital tactic for uplifting women’s economic and social status.

Educational Disparities:

While Asia has made strides in balancing gender representation in education, Sub-Saharan Africa still lags. Gates acknowledges that more work is required to address this imbalance, particularly in secondary education.

Role of Melinda Gates:

Gates gives credit to his wife, Melinda, for her focus on examining all their philanthropic activities through a gender lens. From maternal health to agriculture, efforts are being made to ensure that the interventions are effective for women as well as men. The emphasis is on understanding how each project impacts women and figuring out strategies, such as creating self-help groups, that allow women to voice their needs effectively.

Conclusion:

The conversation highlights the importance of acknowledging and addressing gender biases in data and development work. Specific strategies like digital inclusion, creation of women’s groups, and gender-specific development initiatives are discussed as ways to mitigate these biases and promote gender equity.

Favorite Animal:

When asked about his favorite animal, Gates turns the conversation towards utility, mentioning that chickens and cows can be highly beneficial for impoverished people. He personally owns a dog, acknowledging it doesn’t have the same utilitarian value but brings joy.

Advice to Younger Self:

Gates reflects on his youth, admitting that he struggled with social skills. The insecurities he faced, however, fueled his ambition in academics, especially in math and science. He mentions that when he arrived at Harvard, he had to reposition himself, as he was no longer uniquely skilled in these subjects among his peers.

Importance of Emotional Intelligence:

Gates notes that high IQ is not the sole determining factor for success in management roles. This realization came later in his career, contrasting his earlier belief that IQ was “fungible,” or easily transferable, across different tasks and roles.

Working with the U.S. Government:

He admits that not collaborating effectively with the U.S. government led to complications, notably the Department of Justice lawsuit against Microsoft. Gates suggests that better anticipation and communication could have mitigated these issues.

Life Reflection:

While discussing what he might change if he could relive his youth, Gates hesitates, indicating that any change could alter the positive aspects of his life, which includes a fulfilling family life and rewarding work.

Conclusion:

The Q&A session reveals Gates as a reflective individual who considers both practical and emotional dimensions of life decisions. His answers span from the utilitarian benefits of animals for impoverished people to the complexities of navigating social dynamics and professional pitfalls. Despite past challenges, Gates concludes that he would be cautious about changing anything, given how well his life has turned out.

Boarding Schools and Cultural Impact:

Bill Gates was asked about the trend of children being sent to boarding schools, often far away from their home cultures, as a cost-effective measure. Gates questioned the assertion, arguing that it is generally more expensive to send a child to a boarding school than to educate them in their village. He acknowledged the tragic disappearance of languages but mentioned that there are digital efforts to document and preserve them.

Quality of Rural Education:

Gates stressed that the quality of education in rural settings is far below that in urban centers. He stated that there are few positive outliers among poor countries that provide good education, unlike in healthcare where some poor countries excel in primary care. The Gates Foundation focuses on agricultural health and education and is interested in spreading best practices to improve learning quality.

Focused vs. Broad Philanthropy:

When asked whether it’s better to focus on eradicating one problem in one country or to fund preliminary research in multiple areas, Gates elaborated on the approach of his foundation. He mentioned that as countries become wealthier, they graduate from being aid recipients, freeing resources to be allocated elsewhere. He gave examples related to malaria, explaining that efforts are both targeted and broad, aimed at reducing cases as well as eradicating malaria in specific regions.

Drug Resistance in Malaria:

Gates highlighted the importance of eradicating malaria in Southeast Asia due to drug resistance that originated from that region. The current preferred treatment, artemisinin combination therapy, could become ineffective if resistance spreads, making it a priority to control malaria in Southeast Asia before drug resistance can spread to Africa.

These points offer a comprehensive view into Bill Gates’ thoughts on issues ranging from education to global health.

Early Life Influence:

Bill Gates talked about the impact of his upbringing on his philanthropic pursuits. His parents were active in volunteering and were involved in various community organizations, which laid the groundwork for his later philanthropic interests.

Focus in 20s:

During his 20s, Gates was highly focused on Microsoft and did not prioritize philanthropy. Though Microsoft did engage in some community service activities, they were more for team building and not driven by Gates’ personal interest in philanthropy.

Shift in Focus:

It was not until his 40s, after Microsoft had achieved significant success and under the influence of his wife Melinda, that Gates began to take a serious look at global issues like death rates and inequities.

Learning Curve:

Gates acknowledges the importance of starting philanthropic efforts early. He compared himself to Mark Zuckerberg, who began philanthropic initiatives much earlier in life through the Chan Zuckerberg Initiative. Gates mentioned that starting early allows for a better understanding and effectiveness in philanthropic pursuits.

Recommendations for Young People:

Gates advocates for young people to be aware and active in causes from an early age, even if they can’t contribute financially. Volunteering time or being politically active are ways to make a difference, according to him.

Role of Companies:

Gates also notes that individuals can leverage the capabilities of their companies to address inequities. Whether working in pharmaceuticals or food, one can advocate for the company’s resources and skills to be used in service of the community.

Evolution in Philanthropy:

Gates shifted to being full-time at his foundation in 2008, after about 10 years of prior experience in philanthropy. This transition was facilitated by the learning and resources acquired over those years, including a significant boost from Warren Buffett’s contributions.

The conversation provides a detailed perspective on how Gates views the integration of philanthropy and business, advocating for an early and parallel focus on both.