3 MYTHS
THAT BLOCK PROGRESS FOR THE POOR
By almost any measure, the world is better than it has ever been. People are living longer, healthier lives. Many nations that were aid recipients are now self-sufficient. You might think that such striking progress would be widely celebrated, but in fact, Melinda and I are struck by how many people think the world is getting worse. The belief that the world can’t solve extreme poverty and disease isn’t just mistaken. It is harmful. That’s why in this year’s letter we take apart some of the myths that slow down the work. The next time you hear these myths, we hope you will do the same.
- Bill Gates
MYTH ONE
POOR COUNTRIES ARE DOOMED TO STAY POOR
by Bill Gates
I’ve heard this myth stated about lots of places, but most often about Africa. A quick Web search will turn up dozens of headlines and book titles such as 'How Rich Countries Got Rich and Why Poor Countries Stay Poor.'
Thankfully these books are not bestsellers, because the basic premise is false. The fact is, incomes and other measures of human welfare are rising almost everywhere, including in Africa.
So why is this myth so deeply ingrained?
I’ll get to Africa in a moment, but first let’s look at the broader trend around the world, going back a half-century. Fifty years ago, the world was divided in three: the United States and our Western allies; the Soviet Union and its allies; and everyone else. I was born in 1955 and grew up learning that the so-called First World was well off or “developed.” Most everyone in the First World went to school, and we lived long lives. We weren't sure what life was like behind the Iron Curtain, but it sounded like a scary place. Then there was the so-called Third World—basically everyone else. As far as we knew, it was filled with people who were poor, didn't go to school much, and died young. Worse, they were trapped in poverty, with no hope of moving up.
The statistics bear out these impressions. In 1960, almost all of the global economy was in the West. Per capita income in the United States was about $15,000 a year.1 (That’s income per person, so $60,000 a year for a family of four.) Across Asia, Africa, and Latin America, incomes per person were far lower. Brazil: $1,982. China: $928. Botswana: $383. And so on.
Years later, I would see this disparity myself when I traveled. Melinda and I visited Mexico City in 1987 and were surprised by the poverty we witnessed. There was no running water in most homes, so we saw people trekking long distances by bike or on foot to fill up water jugs. It reminded us of scenes we had seen in rural Africa. The guy who ran Microsoft’s Mexico City office would send his kids back to the United States for checkups to make sure the smog wasn’t making them sick.
Today, the city is mind-blowingly different. Its air is as clean as Los Angeles’ (which isn’t great, but certainly an improvement from 1987). There are high-rise buildings, new roads, and modern bridges. There are still slums and pockets of poverty, but by and large when I visit there now I think, “Wow, most people who live here are middle-class. What a miracle.”
FOREIGN AID IS A BIG WASTE
by Bill Gates
You may have read news articles about foreign aid that are filled with big generalizations based on small examples. They tend to cite anecdotes about waste in some program and suggest that foreign aid is a waste. If you hear enough of these stories, it’s easy to get the impression that aid just doesn’t work. It’s no wonder that one British newspaper claimed last year that more than half of voters want cuts in overseas aid.
These articles give you a distorted picture of what is happening in countries that get aid. Since Melinda and I started the foundation 14 years ago, we’ve been lucky enough to go see the impact of programs funded by the foundation and donor governments. What we see over time is people living longer, getting healthier, and escaping poverty, partly because of services that aid helped develop and deliver.
I worry about the myth that aid doesn’t work. It gives political leaders an excuse to try to cut back on it—and that would mean fewer lives are saved, and more time before countries can become self-sufficient.
So I want to take on a few of the criticisms you may have read.3 I should acknowledge up front that no program is perfect, and there are ways that aid can be made more effective. And aid is only one of the tools for fighting poverty and disease: Wealthy countries also need to make policy changes, like opening their markets and cutting agricultural subsidies, and poor countries need to spend more on health and development for their own people.
But broadly speaking, aid is a fantastic investment, and we should be doing more. It saves and improves lives very effectively, laying the groundwork for the kind of long-term economic progress I described in myth #1 (which in turn helps countries stop depending on aid). It is ironic that the foundation has a reputation for a hard-nosed focus on results, and yet many people are cynical about the government aid programs we partner with. The foundation does a lot to help these programs be more efficient and measure their progress.
The U.S. government spends more than twice as much on farm subsidies as on health aid. It spends more than 60 times as much on the military. The next time someone tells you we can trim the budget by cutting aid, I hope you will ask whether it will come at the cost of more people dying.
Corruption
One of the most common stories about aid is that some of it gets wasted on corruption. It is true that when health aid is stolen or wasted, it costs lives. We need to root out fraud and squeeze more out of every dollar.
But we should also remember the relative size of the problem. Small-scale corruption, such as a government official who puts in for phony travel expenses, is an inefficiency that amounts to a tax on aid. While we should try to reduce it, there’s no way to eliminate it, any more than we could eliminate waste from every government program—or from every business, for that matter. Suppose small-scale corruption amounts to a 2 percent tax on the cost of saving a life. We should try to reduce that. But if we can’t, should we stop trying to save lives?
You may have heard about a scandal in Cambodia last year involving a bed net program run by The Global Fund to Fight AIDS, Tuberculosis and Malaria. Cambodian officials were caught taking six-figure kickbacks from contractors. Editorial writers trotted out headlines like “How to waste foreign aid money.” One article mentioned me as someone whose money was being wasted.
I appreciate the concern, and it’s a good thing when the press holds institutions accountable. But the press didn’t uncover this scheme. The Global Fund did, during an internal audit. In finding and fixing the problem, The Global Fund did exactly what it should be doing. It would be odd to demand that they root out corruption and then punish them for tracking down the small percentage that gets misused.
There is a double standard at work here. I’ve heard people calling on the government to shut down some aid program if one dollar of corruption is found. On the other hand, four of the past seven governors of Illinois have gone to prison for corruption, and to my knowledge no one has demanded that Illinois schools be shut down or its highways closed.
Melinda and I would not be supporting The Global Fund, or any other program, if the money were being misused in a large-scale way. Malaria deaths have dropped 80 percent in Cambodia since The Global Fund started working there in 2003. The horror stories you hear about—where aid just helps a dictator build a new palace—mostly come from a time when a lot of aid was designed to win allies for the Cold War rather than to improve people’s lives. Since that time, all of the actors have gotten much better at measurement. Particularly in health and agriculture, we can validate the outcomes and know the value we’re getting per dollar spent.
SAVING LIVES LEADS TO OVERPOPULATION
by Melinda Gates
We see comments like this all the time on the Gates Foundation’s blog, Facebook page, and Twitter feed. It makes sense that people are concerned about whether the planet can continue to sustain the human race, especially in the age of climate change. But this kind of thinking has gotten the world into a lot of trouble. Anxiety about the size of the world population has a dangerous tendency to override concern for the human beings who make up that population.
Going back at least to Thomas Malthus, who published his An Essay on the Principle of Population in 1798, people have worried about doomsday scenarios in which food supply can’t keep up with population growth. As recently as the Cold War, American foreign policy experts theorized that famine would make poor countries susceptible to Communism. Controlling the population of the poor countries labeled the Third World became an official policy in the so-called First World. In the worst cases, this meant trying to force women not to get pregnant. Gradually, the global family planning community moved away from this single-minded focus on limiting reproduction and started thinking about how to help women seize control of their own lives. This was a welcome change. We make the future sustainable when we invest in the poor, not when we insist on their suffering.
The fact is that a laissez faire approach to development—letting children die now so they don’t starve later—doesn’t actually work, thank goodness. It may be counterintuitive, but the countries with the most deaths have among the fastest-growing populations in the world. This is because the women in these countries tend to have the most births, too. Scholars debate the precise reasons why, but the correlation between child death and birth rates is strong.
Take Afghanistan, where child mortality—the number of children who die before turning five years old—is very high. Afghan women have an average of 6.2 children.7 As a result, even though more than 10 percent of Afghan children don’t survive, the country’s population is projected to grow from 30 million today to 55 million by 2050. Clearly, high death rates don’t prevent population growth (not to mention the fact that Afghanistan is nobody’s idea of a model for a prosperous future).
When children survive in greater numbers, parents decide to have smaller families. Consider Thailand. Around 1960, child mortality started going down. Then, around 1970, after the government invested in a strong family planning program, birth rates started to drop. In the course of just two decades, Thai women went from having an average of six children to an average of two. Today, child mortality in Thailand is almost as low as it is in the United States, and Thai women have an average of 1.6 children.
If you look at the graph below of Brazil, you’ll see the same thing: As the child mortality rate declined, so did the birth rate. I’ve also charted the population growth rate, to show that the country’s population grew more slowly as more children survived. If you graphed most South American countries, the lines would look similar.
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