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The 2018 Annual Letter by Bill and Melinda Gates, which is also their 10th, starts with the optimism shared in The Bill and Melinda Gates Foundation’s new annual report, Goalkeepers: The Stories Behind the Data. This edition of the letter looks to answer 10 tough questions that people often ask the philanthropist couple.

The letter kicks off by acknowledging that “despite the headlines, we see a world that’s getting better". It clarifies that “being an optimist isn’t about knowing that life used to be worse. It’s about knowing how life can get better."

Marked with handwritten notes, the letter talks about headlines being full of news about political division, violence, natural disasters and sexual harassment (written in red in the margin) and then contrasts them with the brilliant work done by scientists who are inventing cutting-edge tools to cure disease, dedicated government leaders who are being creative about prioritizing health, and acknowledges the work of brave and brilliant individuals across the world who are imagining new ways to transform their communities. Edited extracts from the letter:

Why don’t you give more in the United States?

Melinda: Our foundation spends about $500 million a year in the United States, most of it on education. That’s a lot, but it is less than the roughly $4 billion we spend to help developing countries. (Handwritten note: Plus on homelessness in Washington State where we live).

We’ve spent $15.3 billion on vaccines over the past 18 years. And it’s been a terrific investment. Better immunization is one reason why the number of children who die has gone down by so much, from almost 10 million in 2000 to 5 million last year. (Handwritten note: This is our favourite anti-pessimistic statistic).

Bill: We’ve been looking at how we might expand our work in the US beyond education. (Handwritten note: We are still thinking this through).

What do you have to show for the billions you’ve spent on US education?

Bill: A lot, but not as much as either of us would like.

We made education the focus of our work in the US because it is the key to a prosperous future, for individuals and the country. Unfortunately, although there’s been some progress over the past decade, America’s public schools are still falling short on important metrics, especially college completion. And the statistics are even worse for disadvantaged students.

Melinda: We recently announced some changes in our education work that take these lessons into account. Everything we do in education begins as an idea that educators bring to us. They’re the ones who live and breathe this work, who have dedicated their careers to improving systems that are failing many students today, especially minority students. (Handwritten note: We are constantly learning from principals and teachers across the country).

Why don’t you give money to fight climate change?

Bill: We do! Some of it involves our foundation, and some of it involves our own personal investments.

Melinda: Even breakthrough technology can’t stop the weather from changing. So the world needs to adapt to what’s happening now and what we know is coming. That’s why our foundation’s work, especially in global agriculture, is increasingly focused on climate issues.

Hundreds of millions of people in developing countries depend on farming for their livelihoods. They had almost nothing to do with causing climate change, but they will suffer the most from it. When extreme weather ruins their harvest, they won’t have food to eat that year. They won’t have income to spend on basic necessities like health care and school fees. For smallholder farmers, climate change is not just an ominous global trend. It is a daily emergency. (Handwritten note: Including the women who tend to grow the food their families eat.)

Are you imposing your values on other cultures?

Bill: On one level, I think the answer is obviously no. The idea that children shouldn’t die of malaria or be malnourished is not just our value. It’s a human value. Parents in every culture want their children to survive and thrive.

Melinda: We’re acutely aware that some development programmes in the past were led by people who assumed they knew better than the people they were trying to help. We’ve learned over the years that listening to and understanding people’s needs from their perspective is not only more respectful—it’s also more effective.

Does saving kids’ lives lead to overpopulation?

Melinda: When more children live past the age of 5, and when mothers can decide if and when to have children, population sizes don’t go up. They go down. Parents have fewer children when they’re confident those children will survive into adulthood. Big families are in some ways an insurance policy against the tragic likelihood of losing a son or a daughter.

Bill: Fortunately, the number of child deaths is likely to keep going down. The rate of innovation in child health is extraordinary, and the world is starting to make progress on some of the most stubborn challenges in the field. One promising area is the study of the microbiome—all the bacteria in the human gut—and the role it plays in kids’ ability to absorb nutrients. We’re also working with a partner on a device that’s the thickness of a piece of string that can go down infants’ noses and take 360-degree microscopic pictures of the gut. Soon, we’ll be able to see how a child is developing, instead of having to guess. (Handwritten note: Sounds crazy but it could save lives).

How are President Trump’s policies affecting your foundation’s work?

Bill: In the past year, I’ve been asked about President Trump and his policies more often than all the other topics in this letter combined. The administration’s policies affect our foundation’s work in a number of areas. The most concrete example is foreign aid. For decades the US has been a leader in the fight against disease and poverty abroad. These efforts save lives. They also create US jobs. And they make Americans more secure by making poor countries more stable and stopping disease outbreaks before they become pandemics. The world is not a safer place when more people are sick or hungry.

President Trump proposed severe cuts to foreign aid. To its credit, Congress has moved to put the money back in the budget. It’s better for the US when it leads, through both hard power and soft power. More broadly, the America First world view concerns me.

Why do you work with corporations?

Bill: We think poor people should benefit from the same kind of innovation in health and agriculture that has improved life in the richest parts of the world. Much of that innovation comes out of the private sector. But companies have to make a return on their investments, which means they have little incentive to work on problems that mainly affect the world’s poorest people. We’re trying to change that—to encourage companies to focus a bit of their expertise on the problems of the poor without asking them to lose money along the way.

Is it fair that you have so much influence?

Melinda: No. It’s not fair that we have so much wealth when billions of others have so little. And it’s not fair that our wealth opens doors that are closed to most people. World leaders tend to take our phone calls and seriously consider what we have to say.

Bill: As much as we try to encourage feedback, we know that some of our critics don’t speak up because they don’t want to risk losing money. That means we need to hire well, consult experts, learn constantly, and seek out different viewpoints.

Even though our foundation is the biggest in the world, the money we have is very small compared to what businesses and governments spend. For example, California spends more than our entire endowment just to run its public school system for one year. So we use our resources in a very specific way: to test out promising innovations, collect and analyse the data, and let businesses and governments scale up and sustain what works. We’re like an incubator in that way.

What happens when the two of you disagree?

Melinda: We never disagree. Just kidding. Bill and I have two things going in our favour.

First, we agree on basic values. Second, Bill is very open-minded, which isn’t necessarily how people perceive him.

Bill: I agree with all of this! Though I have to admit that Melinda is more comfortable with—and better at—talking in public about personal subjects than I am.

Some people see Melinda as the heart of our foundation, the emotional core. But just as she knows I’m more emotional than people realize, I know she’s more analytical than people realize.

Why are you really giving your money away—what’s in it for you?

Bill: It’s not because we think about how we’ll be remembered. There are two reasons to do something like this. One is that it’s meaningful work. The other reason is that we have fun doing it. Both of us love digging into the science behind our work.

Melinda: We both come from families that believed in leaving the world better than you found it.

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