Bill Gates on how feeding children well can change global health care

This applies to almost every issue the Bill & Melinda Gates Foundation works on, from poverty alleviation to primary school enrollment. But nowhere is the contrast greater or more tragic than in the field of health.

Between 2000 and 2020, the world witnessed a global healthcare boom. Infant mortality fell by 50%. In 2000, more than 10 million children died annually, and now that number is less than 5 million. The prevalence of the world’s deadliest infectious diseases also fell by half. Best of all, the progress happened in regions where the burden of disease was highest. The greatest improvement was seen in sub-Saharan Africa and South Asia.

Then Covid-19 struck and progress came to an abrupt halt.

Today the world faces more challenges than ever in my adult life: inflation, debt, new wars. It also faces the worst child health crisis: malnutrition. Unfortunately, aid is not keeping pace with these needs, especially where they are needed most.

When a child dies, the underlying cause is malnutrition in half of the cases. Climate change worsens the situation. According to new data from the Institute for Health Metrics and Evaluation, approximately 40 million additional children will be stunted and 28 million children will suffer from wasting due to climate change between 2024 and 2050. These conditions, the most acute forms of malnutrition, ensure that children cannot grow optimally mentally and physically.

The health and economic consequences are catastrophic. A child who has suffered from severe malnutrition before the age of three will spend five years less in school than well-nourished children. Research shows that people who went hungry as children earn 10% less throughout their lives and are 33% less likely to escape. poverty.

We must invest in global health to protect children from the worst effects of hunger, mitigate the effects of climate change and boost economic growth. And looking to the past can provide inspiration for how we can reignite progress.

The global health boom had many causes. A new generation of political leaders embraced humanism. Hundreds of thousands of healthcare workers spread across the world, bringing the latest medicines to places where doctors had rarely gone. But an often overlooked factor was a small – but crucial – increase in funding.

Beginning in 2000, the world’s richest countries began steadily increasing their financing to supplement low-income countries while increasing their own investments in health care. Over the first two decades of this century, OECD countries steadily increased foreign aid from an average of 0.22% of their gross national income to 0.33% – with the most generous countries giving around 1%. In 2020, low-income countries received an average of $10.47 per person. It doesn’t sound like much, but that $10.47 made a remarkable difference. It fueled the work of organizations like Gavi, the Vaccine Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria, giving poorer countries access to life-saving vaccines, medicines and other medical breakthroughs.

The impact of this generosity was astonishing. Yet the work is not yet finished. Today, more than half of all child deaths still occur in sub-Saharan Africa. Since 2010, the percentage of the world’s poor living in the region has increased by more than 20 percentage points to almost 60%. Despite this, over the same period the share of total foreign aid going to Africa has fallen from almost 40% to just 25% – the lowest percentage in twenty years. Fewer resources mean more children will die from preventable causes.

The global health boom is over. But for how long? That’s the question I’ve been wrestling with for the past five years. Will we look back on this period as the end of a golden era? Or is it just a short pause before a new bloom begins?

I’m still an optimist. I think we can give global health a second leg – even in a world where competing challenges require governments to stretch their budgets. To do this we need a two-pronged approach.

First, the world must recommit to the work that fueled progress in the early 2000s, especially investments in critical vaccines and medicines. They still save millions of lives every year.

We also have to look ahead. The research and development pipeline is packed with powerful – and surprisingly cost-effective – breakthroughs. We must use these in the fight against the most profound health crises. And it starts with good nutrition.

One of the few failures of the global health boom was that we failed to understand the importance of nutrition. But over the past fifteen years, doctors have begun to discover the ways in which the stomach affects every aspect of human health. When we solve malnutrition, we make it easier to solve many other problems. We solve extreme poverty. Vaccines are more effective. And deadly diseases such as malaria and pneumonia are becoming much less deadly.

This knowledge is now being turned into surprisingly cost-efficient innovations, such as super-fortified broths and more effective prenatal vitamins. The impact of scaling these innovations would be staggering. Modeling in Nigeria shows that fortifying stock cubes would not only prevent anemia; it could 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 were to adopt the most complete form of prenatal vitamins, called Multiple Micronutrient Supplements, nearly half a million lives could be saved by 2040.

The early global healthcare boom is over. “But for how long?” is a question that humanity can still decide for itself. I believe we can start a second global health boom by giving children the nutrients they need to thrive.

Bill Gates is co-founder of Microsoft and co-chairman of the Bill & Melinda Gates Foundation. A longer version of this article will appear in the foundation’s 2024 reports.