Transcript: Bill & Melinda Gates on The Takeaway

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Melinda Gates, winner of the Public Service Award, Lasker Board Member Alfred Sommer, and Bill Gates, winner of the Public Service Award, are seen during the 2013 Lasker Awards. Sept. 20, 2013
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John Hockenberry: Bill and Melinda Gates, welcome to The Takeaway.

Bill Gates: Great to be here.

Melinda Gates: Hi. Thanks.

John Hockenberry: So what really is the message that you really want people to get from the annual message, which really is less about the foundation and much more about a certain exasperation with the way the conditions you’re trying to change in the world are actually getting better? Bill?

Bill Gates: Well, there are some key beliefs that underlie the work we do. These are things we wouldn’t even know ourselves unless we were deeply engaged. In fact, the way the news talks about set backs, it’d be easy to be confused. So, we focus the letter on what the myths are and why they’re wrong.

John Hockenberry: Can we take the last one first? Melinda, it’s scientifically interesting as to why improving health conditions actually has a positive impact on birth rate. What have you discovered?

Melinda Gates: Well what we discovered is that as more children survive in a family around the world, people naturally want to bring down their birth rate. They want to be able to feed and educate those children and they see the future for their children. It happened in France in the late 1700s, Germany in the mid 1800s. Then it happened Argentina, Brazil. Lately, Bangladesh, Syria. So, you see the trend across the world, and you start to see where people have been left behind. And that is Africa, where 200 million women say they’d like to have access to contraceptives but still don’t.

John Hockenberry: Do people actually tell you, “What are you talking about here? Saving lives increases the population and makes things worse?”

Melinda Gates: Well, people do believe that, and I think even before we got involved in this work we started to say, “My goodness, if all these children survive, what is going to happen to the planet?” Because I think a lot of things that were written in the late 1960s about the population explosion, those myths have held. And so as we’ve learned more about this and realized my goodness, actually the opposite is true, we want to make sure the word gets out there.

John Hockenberry: Let’s take the second myth you talk about. Bill, there’s always criticism of foreign aid, particularly in the United States. It’s not a huge expenditure on the part of U.S. government and you try to explode this idea that aid produces dependence. There are certain forms of aid that do create dependence by developing nations, yes?

Bill Gates: Well, every intervention, you do you have to make sure it’s got positive effects. Giving people better seeds raises their agricultural productivity. Making sure their kids are healthy allows them to have economic output themselves. If you went in and ran businesses yourself or distorted prices, yes that could mix things up. And you do want to work with them to make sure you don’t bring in too many experts, that you’re educating their people. So, aid is something we have to be a lot smarter about. We’re learning all the time on how you accelerate that self sufficiency; but help is aimed in that direction, and we see so many examples where that’s worked.

John Hockenberry: In terms of sustainable development and problems that emerge when you run into cultural surprises in trying to help poor countries, what sorts of lessons have you learned in making sure that aid is customized to the individual recipients and the communities that are going to need to use it?

Melinda Gates: Well, I think that’s a really important issue which is when you’re on the ground you have to be very culturally sensitive because you’re coming into people’s lives as they already exist. And I’ll give you a great example in the area of population. In Niger, it really is the men that have control over the women. There’s a very high desired number of children by men and women, but it’s really the man that decides if his wife gets to use contraceptives unless he’s away, and she can go do it covertly. So the way that the work is being done in that country is to do a husband school, which is to first educate husbands about the fact that if you have fewer children and they stay alive you have a better chance of keeping them nourished and keeping them educated. So by going to the husbands first, they begin to open up and say, “Wow that might be acceptable for me to choose to do it in my family.” In India, you go to mother-in-law first because she’s often more in control of the household. So you design programs based on what’s right in a particular country.

John Hockenberry: Let’s take the Ethiopia example for a moment. What worked there? Can you describe to me the chain of communication? Who did you go to first to try to get change filtered into various institutions that would really carry things forward? Because it’s important to get the sequence right.

Bill Gates: Yeah, in Ethiopia’s case they have a great health minister—Tedros [Adhanom]—who got the donors working together and built measurement systems. In the case of their agriculture work, it was really Meles [Zenawi]—the leader—who realized he was unhappy with what was going on and in a meeting with Melinda encouraged us to come in and do an assessment and actually build a whole new agency called the Agricultural Transformation Agency that oversaw the new policies. He actually took one of the Foundation’s best people to run that activity, and it was done tops down to create it. He’s gone now, but fortunately that institution has been strong enough that it’s continuing to grow and do great work.

Melinda Gates: And when you’re on the ground travelling in these countries. You know, Bill and I have been going to Tanzania for over a decade now. Ethiopia, over a decade. Where we go multiple times on trips, and when you go out in the rural areas and talk to farmers in Tanzania who are starting to get new seeds and they’re getting three times the yield on their farm, life for them is getting better. They’ll show you the corrugated roof they have. They’ll show where their kids are now able to go to school. They’ll show you how they can pay the school fees. So, in tangible ways, those families are actually seeing progress. And when you go into Tanzania, into even a place like Arusha, you can see the economic progress that’s happening there.

John Hockenberry: Alright, final question. To get what you need done in these places, do you sometimes have to work with unsavory characters? Do you have to look the other way on human rights issues in certain governments and just allow things to proceed domestically and focus on the ground level success that you want to achieve?

Bill Gates: Well certainly we’re working with all kinds of governments. And if you had to agree with all their policies you wouldn’t be in Africa. Who knows if you could even work in the United States if you had that kind of view. We do know that as you get health and education, the issues of equity—how women are treated, how gays are treated—those improve quite a bit. So, things that the U.S. has just come around on the past twenty years you can’t expect Africa to have come around in all those things as of today. But I think in the same way their health is going up, they’ll proceed in the direction that fortunately this country has become more enlightened on.

John Hockenberry: Melinda, final thought?

Melinda Gates: Yes, I would just say that, you know again, that as we have travelled around Africa you see families coming together, you see communities coming together to demand health services of their government. So I saw this recently when I was in Senegal. The community, these three villages had banded together and said, “We need a health post in our community.” And in their collective power, they go to government and they get a health post built. You see the change that has happened around the world when you get a growing, prosperous middle class in a country, and I think you’ll start to get these rights for women and other people that are so needed.

John Hockenberry: Bill and Melinda Gates, thanks so much for being with us.

Melinda Gates: Thank you.

Bill Gates: Thank you.