Bill Gates tells us what we know now that we didn't know a year ago

Bill Gates reads a lot, knows a lot, travels a lot, and thinks a lot. And so when you ask him what he knows now that he didn’t a year ago, there’s plenty of material for him to work with.

Quartz put that question to Gates during a phone interview organized in advance of an annual Bill & Melinda Gates Foundation report on progress against global health and poverty goals.

It was the first question of the interview. Gates spent nearly seven minutes answering, a sweeping response stretching to about 900 words.

The question: “What do we know now that we didn’t know a year ago?”

Here’s how Gates answered:

Bill Gates: The understanding of how important nutrition is, has been rising. But I’d say in the last year, the breadth of that recognition has gone up quite a bit, and that’s at several levels.

We’ve done a lot of looking at the data and see that the kids that are the most vulnerable to dying are kids who are not on their growth path. So we built this incredible database that’s completely open and available to researchers about healthy birth and growth. And what we see is that as a kid falters in their growth path—that is height for age—that their risk of dying is like four times higher when they’re off that growth path as opposed to when they’re on that growth path.

A lot of what we’ve done in global health is what you call acute intervention or avoiding acute episodes. You know when you get the rotavirus vaccine, you don’t have acute episodes, rotavirus diarrhea because you don’t get rotavirus. Or you get the pneumococcus vaccine, then you don’t have an acute episode of pneumonia. But there’s always been this question, why do some kids die when they get those acute episodes and why do some kids survive? And the understanding that it is very connected to them being on their growth path—that’s really come out through this. We took all these studies that were done on various questions and pulled them together to create literally millions of growth records and connect those two health events. So that’s understanding, “OK, nutrition and growth are important.”

On the science side, there’s the understanding that the so-called microbiome, the bacteria that are growing in your gut, that there are the issues really driving whether you have two kids having the same diet, one of whom stays on the growth path and is healthy and they have full mental and physical development, and the other kid somehow develops inflammation in their gut and they are not able to absorb, even the nutrition that they’re eating. Our understanding of that pathology—which has always had names like enteric enteropathy or tropical enteropathy—we’ve understood that was there because we saw with oral vaccines, a lot of kids’ vaccines wouldn’t work. So we understood that there’s something going on in the gut where you have enough inflammation that the oral polio vaccine doesn’t work, or the rotavirus vaccine. Those are the two main oral vaccines. They don’t work. So, at any rate, I’d highlight our understanding about nutrition.

In the area of education, I’d say there’s something that the development world should have been more focused on but really only is happening now is the quality of education. So a lot of the metrics that go back to the [Millennium Development Goals] were pretty straightforward, which is are the kids in school, particularly are the girls in the school, and looking at that, at both the primary and secondary level. With these experts who were fantastic that the World Bank had write this year’s world development report, [we see] the understanding that most countries are not taking advantage of that time [in schools] to really get the math and reading skills that you need a for a lot of the jobs and the economic growth. They’ve really shone a strong light on that.

And, just like in health, if you plot per GDP, you have kind of an expectation curve where most countries fall on—as GDP goes up, the quality of education goes up. Just like in health, that’s a plot we look at all the time, the childhood-survival-rates versus GDP, the vaccine-coverage-rate versus GDP. Here, with years-of-learning versus GDP they found a few outliers, positive outliers. The one that we highlight in the report that they talk a lot about is Vietnam, where the actual quality of education taking place there is comparable with a so-called high-income country. Even though Vietnam just recently achieved middle-income status. And so they go and look at the personnel system and it’s actually not that they’re putting huge amounts of money in. They’re putting a reasonable amount of money, but they’re not an outlier in terms of their investment level. What they are is they are an outlier in terms of how they manage it.

I can take malaria or HIV and say that we’re smarter today about those. It’s sort of my job to sit in meetings and talk about malaria and HIV and where we’re doing well and where we’re not doing well. You know in the HIV piece, I’d say it’s daunting, the kind of getting the behavior change to achieve goals. You probably heard of this idea of 90, 90, 90, which is 90% know their status, 90% are on treatment and 90% are virally suppressed. And so you take the third and that’s the percentage that are in great shape anyway, that’s proven to be difficult. There was just a big AIDS conference that talked about that.

So, we get smarter and, and we get innovation. And the whole idea of Goalkeepers [the annual report and event] is to talk about places where people are ahead and where there are positive outliers and how we should adopt their best practices and be frank about places that have fallen behind, goals that are proving to be very difficult to get on track to.