Students should learn to use digital technology wisely. They should be the master of technology and not let it control them.
Wired societies are currently struggling with the ill effects of
technology addiction among the youth. Let’s take three examples: South
Korea, Japan and the United States.
South Korea
As the
world’s most digitally connected society, nearly two-thirds of the
population of South Korea own a smartphone and 98 percent of households
have broadband Internet.
A government survey showed that about
2.55 million people are addicted to smartphones, using the device for
eight or more hours per day.
South Korea National Information
Agency reports that about 160,000 children aged 5 to 9 are addicted to
the Internet, accessed through smartphones, tablets or personal
computers.
Associated Press technology writer Youkyung Lee
describes how the digital lifestyle has taken its toll on kids. She
says a typical 11-year-old girl “sleeps with her android smartphone
instead of a teddy bear.”
The first thing that the youngster’s
eyes latch on when she wakes up is her smartphone. Her first task for
the day is managing messages from friends.
The gadget has
become a semipermanent appendage of her hand as it goes with her to the
streets, the school and even the bathroom. Catastrophe means not having
wireless Internet connection and a phone battery that is less than 20
percent full.
Kim Jun-hee, a kindergarten teacher for 10 years,
carried out an eight-month survey on Internet addiction among preschool
children. Early exposure to high-tech gadgets, she says, has made kids
as young as 4 and 5 indifferent, fidgety and impulsive.
Kim
teaches her students to take tech breaks such as resting the eyes and
stretching. She tells them stories about Internet addiction and
encourages them to play nondigital games.
According to Kim, parent cooperation is vital, and the best way to teach the kids is for adults to set a good example.
Treatment
Several South Korean medical practitioners have chosen to treat digital
addiction more as an illness rather than just a social problem. Lee
Hae-koo, a psychiatry professor at Catholic University of Korea’s
College of Medicine, says the country, along with Taiwan and China, is
actively researching whether
Internet addiction should truly be diagnosed as a mental illness.
In 2010, the unsettling story of a
3-month-old baby girl who died from neglect stirred the hearts of South
Koreans. The parents were avid gamers who were so engrossed with
marathon online gaming that they fed their baby only once a day.
Some teachers in Seoul require students to surrender their gadgets when
they get to school. The gadgets are returned to them at the end of
classes.
The South Korean government intends to take proactive
measures and now provides counselors for young people who are obsessed
with online gaming or Internet use.
The Ministry of Public
Administration and Security is studying the issue of compulsory
instruction on the dangers of Internet addiction starting from
preschool, with kids as young as 3.
Japan
Japan and
the United States are following suit. More than half a million kids aged
12 to 18 in Japan are believed to be Internet addicts, so Japan’s
Ministry of Education plans to create “fasting camps” where kids will
have no access to computers, smartphones, gaming devices or the
Internet.
“We want to get them out of the virtual world and to
encourage them to have real communication with other children and
adults,” ministry spokesperson Akifumi Sekine tells The Telegraph.
Children will be encouraged to do outdoor activities and, should the
transition prove traumatic, they will have access to psychiatrists and
psychotherapists.
US
In September, the Behavioral
Health Services at Bradford Regional Medical Center in Pennsylvania
opened the first Internet addiction clinic in the United States.
The voluntary, inpatient program lasts for 10 days. Patients refrain
from using phones, tablets or the Net for at least three days. Therapy
and educational sessions help them control their compulsion.
According to the program’s founder, US psychologist Kimberly Young,
typical addicts are young, male, intelligent, “struggle socially” and
have low self-esteem. Most are obsessed with games such as World of
Warcraft.
“Like any other addiction, we look at whether it has
jeopardized their career, whether they lie about their usage or whether
it interferes with relationships,” Young tells “Good Morning, America.”
The program costs $14,000, which is not covered by insurance. Patients
are trained to return eventually to computer use, but in a healthy way.
The goal is not to completely turn away from computers (which is
impossible in today’s wired world), but to use them wisely.
Many Filipinos, particularly the youth, are also digital addicts.
Parents, teachers and our government should address this problem before
the majority of our youth fall into the gadget trap like their South
Korean and Japanese counterparts.
Erick Munoz had filed suit to end his pregnant wife's life support, arguing she was legally deceased
A Texas judge has ordered a hospital to remove the life support of a brain-dead woman being kept alive because she is pregnant.
Judge RH Wallace gave John Peter Smith Hospital until Monday evening to cease life-saving measures for Marlise Munoz.
Mrs Munoz, 33, was 14 weeks pregnant when she fell unconscious in November. It is believed she had a blood clot.
The hospital had argued that a state law prohibits denying life-saving treatment to pregnant patients. 'Legally dead'
Mrs Munoz's husband, Erick, filed suit against the hospital on
14 January, arguing that life-support efforts go against her wishes as a
paramedic familiar with end-of-life issues.
"Marlise Munoz is legally dead, and to further conduct
surgical procedures on a deceased body is nothing short of outrageous,"
he claimed in court documents.
The court filing also stipulated that, as Mrs Munoz is
technically deceased, "she cannot possibly be a 'pregnant patient'"
under Texas health and safety codes.
Mrs Munoz, 33, has remained unconscious since her husband
discovered her on the kitchen floor on 26 November while pregnant with
the couple's second child.
A blood clot has been listed as a possible cause.
Mr Munoz's lawyers subsequently revealed that Mrs Munoz's
foetus - believed to be at 22 weeks gestation and to have been without
oxygen for some time before medical intervention in November - was
"distinctly abnormal", according to hospital medical records.
On Friday, Judge Wallace ruled the Fort Worth hospital must
remove Mrs Munoz's life support by 17:00 local time (23:00 GMT) on
Monday.
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.”
Look at the photo of Mexico City from 1986, and compare it to one from 2011.
These photos illustrate a powerful story: The global
picture of poverty has been completely redrawn in my lifetime.
Per-person incomes in Turkey and Chile are where the United States level
was in 1960. Malaysia is nearly there, as is Gabon. And that
no-man’s-land between rich and poor countries has been filled in by
China, India, Brazil, and others. Since 1960, China’s real income per
person has gone up eightfold. India’s has quadrupled, Brazil’s has
almost quintupled, and the small country of Botswana, with shrewd
management of its mineral resources, has seen a thirty-fold increase.
There is a class of nations in the middle that barely existed 50 years
ago, and it includes more than half of the world’s population. Here’s another way to see the transition: by counting people instead of countries:
So the easiest way to respond to the myth that poor
countries are doomed to stay poor is to point to one fact: They haven’t
stayed poor. Many—though by no means all—of the countries we used to
call poor now have thriving economies. And the percentage of very poor
people has dropped by more than half since 1990.
That still leaves more than one billion people in extreme poverty, so
it’s not time to celebrate. But it is fair to say that the world has
changed so much that the terms “developing countries” and “developed
countries” have outlived their usefulness.
Any category that lumps China and the Democratic Republic of Congo
together confuses more than it clarifies. Some so-called developing
countries have come so far that it’s fair to say they have developed. A
handful of failed states are hardly developing at all. Most countries
are somewhere in the middle. That’s why it’s more instructive to think
about countries as low-, middle-, or high-income. (Some experts even
divide middle-income into two sub-categories: lower-middle and
upper-middle.)
With that in mind, I’ll turn back to the more specific
and pernicious version of this myth: “Sure, the Asian tigers are doing
fine, but life in Africa never gets better, and it never will.”
First, don’t let anyone tell you that Africa is worse off today than
it was 50 years ago. Income per person has in fact risen in sub-Saharan
Africa over that time, and quite a bit in a few countries. After
plummeting during the debt crisis of the 1980s, it has climbed by two
thirds since 1998, to nearly $2,200 from just over $1,300. Today, more
and more countries are turning toward strong sustained development, and
more will follow. Seven of the 10 fastest-growing economies of the past
half-decade are in Africa.
Africa has also made big strides in health and education. Since 1960,
the life span for women in sub-Saharan Africa has gone up from 41 to 57
years, despite the HIV epidemic. Without HIV it would be 61 years. The
percentage of children in school has gone from the low 40s to over 75
percent since 1970. Fewer people are hungry, and more people have good
nutrition. If getting enough to eat, going to school, and living longer
are measures of a good life, then life is definitely getting better
there. These improvements are not the end of the story; they’re the
foundation for more progress.
A growing number of countries in Africa are building community health
systems, which are extremely cost-effective (Accra, Ghana, 2013).
Of course, these regional averages obscure big
differences among countries. In Ethiopia, income is only $800 a year per
person. In Botswana it’s nearly $12,000. You see this huge variation
within countries too: Life in a major urban area like Nairobi looks
nothing like life in a rural Kenyan village. You should look skeptically
at anyone who treats an entire continent as an undifferentiated mass of
poverty and disease. The bottom line: Poor countries are not doomed to
stay poor. Some of the so-called developing nations have already
developed. Many more are on their way. The nations that are still
finding their way are not trying to do something unprecedented. They
have good examples to learn from.
I am optimistic enough about this that I am willing to make a prediction. By 2035, there will be almost no poor countries left in the world. (I mean by our current definition of poor.)2
Almost all countries will be what we now call lower-middle income or
richer. Countries will learn from their most productive neighbors and
benefit from innovations like new vaccines, better seeds, and the
digital revolution. Their labor forces, buoyed by expanded education,
will attract new investments.
A few countries will be held back by war, politics (North
Korea, barring a big change there), or geography (landlocked nations in
central Africa). And inequality will still be a problem: There will be
poor people in every region.
But most of them will live in countries that are self-sufficient.
Every nation in South America, Asia, and Central America (with the
possible exception of Haiti), and most in coastal Africa, will have
joined the ranks of today’s middle-income nations. More than 70 percent
of countries will have a higher per-person income than China does today.
Nearly 90 percent will have a higher income than India does today.
It will be a remarkable achievement. When I was born, most countries
in the world were poor. In the next two decades, desperately poor
countries will become the exception rather than the rule. Billions of
people will have been lifted out of extreme poverty. The idea that this
will happen within my lifetime is simply amazing to me.
Some people will say that helping almost every country develop to
middle-income status will not solve all the world’s problems and will
even exacerbate some. It is true that we’ll need to develop cheaper,
cleaner sources of energy to keep all this growth from making the
climate and environment worse. We will also need to solve the problems
that come with affluence, like higher rates of diabetes. However, as
more people are educated, they will contribute to solving these
problems. Bringing the development agenda near to completion will do
more to improve human lives than anything else we do.
Share this section
Myth Two
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.
Foreign aid helps refugees like Nikuze Aziza feed their families and stay healthy (Kiziba Camp, Rwanda, 2011).
The Amount of Aid
Many people think that development aid is a large part of rich
countries’ budgets, which would mean a lot can be saved by cutting back.
When pollsters ask Americans what share of the budget goes to aid, the
average response is “25 percent.” When asked how much the government
should spend, people tend to say “10 percent.” I suspect you would get
similar results in the United Kingdom, Germany, and elsewhere.
Here are the actual numbers. For Norway, the most generous nation in
the world, it’s less than 3 percent. For the United States, it’s less
than 1 percent.
One percent of the U.S. budget is about $30 billion a year. Of that,
roughly $11 billion is spent on health: vaccines, bed nets, family
planning, drugs to keep people with HIV alive, and so on. (The other $19
billion goes to things like building schools, roads, and irrigation
systems.)
I don’t want to imply that $11 billion a year isn’t a lot of
money. But to put it in perspective, it’s about $30 for every American.
Imagine that the income tax form asked, “Can we use $30 of the taxes
you’re already paying to protect 120 children from measles?”4 Would you check yes or no?
It also helps to look at the overall impact this spending
has. To get a rough figure, I added up all the money spent by donors on
health-related aid since 1980. Then I divided by the number of
children’s deaths that have been prevented in that same time. It comes
to less than $5,000 per child saved (and that doesn’t include the
improvements in health that go beyond saving the lives of young
children).5 $5,000 may sound expensive, but keep in mind that
U.S. government agencies typically value the life of an American at
several million dollars.
Also remember that healthy children do more than merely survive. They
go to school and eventually work, and over time they make their
countries more self-sufficient. This is why I say aid is such a bargain.
This graphic shows you a few of the programs supported by aid from
the United States and other donors. As you can see, the impact is quite
impressive.
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.
Since 2000, a global effort against malaria has saved 3.3 million lives (Phnom Dambang village, Cambodia, 2011).
More and more, technology will help in the fight against
corruption. The Internet is making it easier for citizens to know what
their government should be delivering—like how much money their health
clinic should get—so they can hold officials accountable. As public
knowledge goes up, corruption goes down, and more money goes where it’s
supposed to. Aid Dependence
Another argument from critics is that aid holds back normal economic
development, keeping countries dependent on generosity from outsiders.
This argument makes several mistakes. First, it lumps different kinds
of aid together. It doesn’t differentiate aid that is sent directly to
governments from funding that is used for research into new tools like
vaccines and seeds. The money America spent in the 1960s to develop more
productive crops made Asian and Latin American countries less dependent
on us, not more. The money we spend today on a Green Revolution for
Africa is helping countries grow more food, making them less dependent
as well. Aid is a crucial funding source for these “global public goods”
that are key for health and economic growth. That’s why our foundation
spends over a third of our grants on developing new tools.
Second, the “aid breeds dependency” argument misses all the countries
that have graduated from being aid recipients, and focuses only on the
most difficult remaining cases. Here is a quick list of former major
recipients that have grown so much that they receive hardly any aid
today: Botswana, Morocco, Brazil, Mexico, Chile, Costa Rica, Peru,
Thailand, Mauritius, Singapore, and Malaysia. South Korea received
enormous amounts of aid after the Korean War, and is now a net donor.
China is also a net aid donor and funds a lot of science to help
developing countries. India receives 0.09 percent of its GDP in aid,
down from 1 percent in 1991.
Even in sub-Saharan Africa, the share of the economy that comes from
aid is a third lower now than it was 20 years ago, while the total
amount of aid to the region has doubled. There are a few countries like
Ethiopia that depend on aid, and while we all—especially Ethiopians
themselves—want to get to a point where that is no longer true, I don’t
know of any compelling argument that says Ethiopia would be better off
with a lot less aid today.
Critics are right to say there is no definitive proof that aid drives
economic growth. But you could say the same thing about almost any
other factor in the economy. It is very hard to know exactly which
investments will spark economic growth, especially in the near term.
However, we do know that aid drives improvements in health, agriculture,
and infrastructure that correlate strongly with growth in the long run.
Health aid saves lives and allows children to develop mentally and
physically, which will pay off within a generation. Studies show that
these children become healthier adults who work more productively. If
you’re arguing against that kind of aid, you’ve got to argue that saving
lives doesn’t matter to economic growth, or that saving lives simply
doesn’t matter.
Explainer: How Does Foreign Aid Work?
The lifesaving power of aid is so obvious that even aid critics acknowledge it. In the middle of his book White Man’s Burden,
William Easterly (one of the best-known aid critics) lists several
global health successes that were funded by aid. Here are a few
highlights:
“A vaccination campaign in southern Africa virtually eliminated measles as a killer of children.”
“An international effort eradicated smallpox worldwide.”
“A program to control tuberculosis in China cut the number of cases by 40 percent between 1990 and 2000.”
“A regional program to eliminate polio in Latin America after 1985 has eliminated it as a public health threat in the Americas.”
The last point is worth expanding on. Today there are only three
countries left that have never been polio-free: Afghanistan, Pakistan,
and Nigeria. Last year the global health community adopted a
comprehensive plan aimed at getting the world polio-free by 2018, and
dozens of donors stepped up to fund it. Once we get rid of polio, the
world will save about $2 billion a year that it now spends fighting the
disease.
The bottom line: Health aid is a phenomenal
investment. When I look at how many fewer children are dying than 30
years ago, and how many people are living longer and healthier lives, I
get quite optimistic about the future. The foundation worked with a
group of eminent economists and global health experts to look at what’s
possible in the years ahead. As they wrote last month in the medical
journal The Lancet, with the right investments and changes in policies, by 2035, every country will have child-mortality rates that are as low as the rate in America or the U.K. in 1980.6
You can see here just how dramatic this convergence will be:
Let’s put this achievement in historical perspective. A
baby born in 1960 had an 18 percent chance of dying before her fifth
birthday. For a child born today, the odds are less than 5 percent. In
2035, they will be 1.6 percent. I can’t think of any other 75-year
improvement in human welfare that would even come close.
To get there, the world will need to unite around this goal, from
scientists and health workers to donors and recipient countries. If this
vision is reflected in the next round of the United Nations’ Millennium
Development Goals, it will help get everyone working on this milestone.
Many low- and middle-income countries will develop enough to pay for
this convergence themselves. Others will need continued generosity from
donors, including investments in health-related R&D. Governments
will also have to set the right policies. For example middle-income
countries should look at taxing tobacco, and at cutting fossil-fuel
subsidies to free up funding for health.
Above all, I hope we can stop discussing whether aid works, and spend
more time talking about how it can work better. This is especially
important as you move from upstream research on global public goods into
the downstream effort of delivering these innovations. Are the
recipient countries in charge of figuring out where health clinics
should be built and training the workers? Are donors helping local teams
build up the expertise they need to put the Western experts out of
business? Are the best performers sharing the lessons they’ve learned so
other countries can follow suit? This has been a big area of learning
for the foundation.
I have believed for a long time that disparities in health are some
of the worst inequities in the world—that it is unjust and unacceptable
that millions of children die every year from causes that we can prevent
or treat. I don’t think a child’s fate should be left to what Warren
Buffett calls the “ovarian lottery.” If we hit this goal of convergence,
the ovarian lottery for health outcomes will be closed for good.
Share this section
Myth Three
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.
This pattern of falling death rates followed by falling
birth rates applies for the vast majority of the world. Demographers
have written a lot about this phenomenon. The French were the first to
start this transition, toward the end of the 18th century. In France,
average family size went down every decade for 150 years in a row. In
Germany, women started having fewer children in the 1880s, and in just
50 years family size had mostly stabilized again. In Southeast Asia and
Latin America, average fertility dropped from six or seven children per
woman to two or three in a single generation, thanks in large measure to
the modern contraceptives available by the 1960s.
Because most countries—with exceptions in sub-Saharan Africa and
South Asia—have now gone through this transition, the global population
is growing more slowly every year. As Hans Rosling, a professor at the
Karolinska Institute in Sweden and one of my favorite data geeks, said,
“The amount of children in the world today is probably the most there
will be! We are entering into the age of the Peak Child!”
Given all the evidence, my view of a sustainable future
is much more optimistic than the Malthusians’ view. The planet does not
thrive when the sickest are allowed to die off, but rather when they are
able to improve their lives. Human beings are not machines. We don’t
reproduce mindlessly. We make decisions based on the circumstances we
face.
Here’s an example: Mothers in Mozambique are 80 times more likely to
lose a child than mothers in Portugal, the country that ruled Mozambique
until 1975. This appalling aggregate statistic represents a grim
reality that individual Mozambican women must confront; they can never
be confident their children will live. I’ve spoken to mothers who gave
birth to many babies and lost most of them. They tell me all their
mourning was worth it, so they could end up with the number of surviving
children they wanted.
When children are well-nourished, fully vaccinated, and treated for
common illnesses like diarrhea, malaria, and pneumonia, the future gets a
lot more predictable. Parents start making decisions based on the
reasonable expectation that their children will live.
Death rates are just one of many factors that affect birth rates. For
example, women’s empowerment, as measured by age of marriage and level
of education, matters a great deal. Girls who marry in their mid-teens
tend to start getting pregnant earlier and therefore have more children.
They usually drop out of school, which limits their opportunities to
learn about their bodies, sex, and reproduction—and to gain other kinds
of knowledge that helps them improve their lives. And it’s typically
very difficult for adolescent brides to speak up in their marriages
about their desire to plan their families. I just traveled to Ethiopia,
where I had a long conversation with young brides, most of whom were
married at 11 years old. They all talked about wanting a different
future for their children, but the information they had about
contraceptives was spotty at best, and they knew that when they were
forced to leave school their best pathway to opportunity was closed off.
In fact, when girls delay marriage and stay in school, everything
changes. In a recent study of 30 developing countries, women with no
schooling had three more children on average than women who attended
high school. When women are empowered with knowledge and skills, they
start to change their minds about the kind of future they want.
I recently spent an afternoon with a woman named Sadi Seyni, who
scratches out a living for five children on an arid farm in a desert
region of Niger. She didn’t know about contraceptives when she got
married as a teenager. Now she knows, and she’s spacing her pregnancies
several years apart, to protect her health and the health of her
newborns. I visited the place where she learned about family planning:
her village’s well, where women go to talk. And talk. And talk. While we
were telling stories, a young bride came to get water. Through a
translator, this girl told me that her pregnancies were “God’s will” and
therefore out of her control. Sadi suggested that as long as this girl
keeps coming to the well and listening, she’ll change her view over
time. Even the informal education that happens when a little knowledge
spreads among friends transforms the way people think about what’s
possible.
Like millions of women in sub-Saharan Africa, Sadi didn’t know about contraceptives when she got married (Talle, Niger, 2012).
It is important to note that the desire to plan is only
part of the equation; women need access to contraceptives to follow
through on their plan. Sadi lives a stone’s throw away from a health
clinic, but it doesn’t carry the contraceptive injections she prefers.
She has to walk 10 miles every three months to get her shots. Sadi is
incensed, as she should be, about how difficult it is for her to care
for her family. Many women like Sadi have no information about planning
their pregnancies in a healthy way—and no access to contraceptives. More
than 200 million women say they don’t want to be pregnant but aren’t
using contraceptives. These women are being robbed of opportunities to
decide how to raise their families. And because they can’t determine how
many children to have or when to have them, they also have a harder
time feeding them, paying for medical care, or sending them to school.
It’s a vicious cycle of poverty.
With
access to a range of contraceptives and information about birth
spacing, women like Sharmila Devi are able to raise healthier families
(Dedaur village, India, 2013).
On the other hand, the virtuous cycle that starts with basic
health and empowerment ends not only with a better life for women and
their families, but with significant economic growth at the country
level. In fact, one reason for the so-called Asian economic miracle of
the 1980s was the fact that fertility across Southeast Asia declined so
rapidly. Experts call this phenomenon the demographic dividend.8
As fewer children die and fewer are born, the age structure of the
population gradually changes, as you can see in the graphic below.
Eventually, there’s a bulge of people in their prime working years.
This means more of the population is in the workforce and generating
economic growth. At the same time, since the number of young children is
relatively smaller, the government and parents are able to invest more
in each child’s education and health care, which can lead to more
economic growth over the long term.
These changes don’t just happen by themselves.
Governments need to set policies to help countries take advantage of the
opportunity created by demographic transitions. With help from donors,
they need to invest in health and education, prioritize family planning,
and create jobs. But if leaders set the right strategic priorities, the
prospect of a virtuous cycle of development that transforms whole
societies is very real.
The virtuous cycle is not just development jargon. It’s a phenomenon
that millions of poor people understand very well, and it guides their
decisions from day to day. I have the privilege of meeting women and men
in poor countries who commit the small acts of love and optimism—like
going without so they can pay their children’s school fees—that propel
this cycle forward. The future they hope for and work hard for is the
future I believe in.
Children who have a healthy start in life kick off a virtuous cycle of development (Dakar, Senegal, 2013).
In this version of the future, currently poor countries
are healthier, richer, and more equal—and growing sustainably. The
alternate vision summed up by the Malthusian myth—a world where
sustainability depends on permanent misery for some—is a misreading of
the evidence and a failure of imagination.
Saving lives doesn’t lead to overpopulation. In fact, it’s quite the
opposite. Creating societies where people enjoy basic health, relative
prosperity, fundamental equality, and access to contraceptives is the
only way to secure a sustainable world. We will build a better future
for everyone by giving people the freedom and the power to build a
better future for themselves and their families.
Share this section
Looking Ahead
If you read the news every day, it’s easy to get the
impression that the world is getting worse. There is nothing inherently
wrong with focusing on bad news, of course—as long as you get it in
context. Melinda and I are disgusted by the fact that more than six
million children died last year. But we are motivated by the fact that
this number is the lowest ever recorded. We want to make sure it keeps
going down.
We hope you will help get the word out on all these myths. Help your
friends put the bad news in context. Tell political leaders that you
care about saving lives and that you support foreign aid. If you’re
looking to donate a few dollars, you should know that organizations
working in health and development offer a phenomenal return on your
money. The next time you’re in an online forum and someone claims that
saving children causes overpopulation, you can explain the facts. You
can help bring about a new global belief that every life has equal
value.
We all have the chance to create a world where extreme poverty is the
exception rather than the rule, and where all children have the same
chance to thrive, no matter where they’re born. For those of us who
believe in the value of every human life, there isn’t any more inspiring
work under way in the world today.
Help our partners #stopthemyth
Share the Letter
Bill and Melinda Gates
Co-chairs, Bill & Melinda Gates Foundation
January 2014
VATICAN
CITY — Less than a year into his papacy, Pope Francis has raised
expectations among the world’s one billion Roman Catholics that change
is coming. He has already transformed the tone of the papacy, confessing
himself a sinner, declaring “Who am I to judge?” when asked about gays, and kneeling to wash the feet of inmates, including Muslims.
Less
apparent, if equally significant for the future of the church, is how
Francis has taken on a Vatican bureaucracy so plagued by intrigue and
inertia that it contributed, numerous church officials now believe, to
the historic resignation of his predecessor, Pope Benedict XVI, last February.
Francis’
reign may not ultimately affect centuries-old church doctrine, but it
is already reshaping the way the church is run and who is running it.
Francis is steadily replacing traditionalists with moderates as the
church prepares for a debate about the role of far-flung bishops in
Vatican decision-making and a broad discussion on the family that could
touch on delicate issues such as homosexuality and divorce.
Launch media viewer
Cardinals
listened to Pope Francis in December at the Vatican. Francis warned
them that the church’s leadership risked drifting “towards mediocrity.”Pool photo by Claudio Peri
In
St. Peter’s Basilica on New Year’s Eve, Francis, dressed in golden
robes, hinted at the major changes he had already set in motion. “What
happened this year?” he asked. “What is happening, and what will
happen?”
To
some of the scarlet-clad cardinals seated in rows of gilded armchairs
at the New Year’s service, the answer was becoming clear. Cardinal
Raymond L. Burke, one of the highest-ranking Americans in the Vatican, found his influence diluted. Another conservative, Cardinal Mauro Piacenza, was demoted. Among the bishops, Archbishop Guido Pozzo was sidelined.
To
some degree, Francis, 77, is simply bringing in his own team and
equipping it to carry out his stated mission of creating a more
inclusive and relevant church that is more sensitive to the needs of
local parishes and the poor. But he is also breaking up the rival blocs
of Italians with entrenched influence in the Roman Curia, the
bureaucracy that runs the church. He is increasing financial transparency in the murky Vatican Bank and upending the career ladder that many prelates have spent their lives climbing.
On
Sunday, Francis made his first mark on the exclusive College of
Cardinals that will elect his successor by naming prelates who in many
cases hail from developing countries and the Southern Hemisphere. He
pointedly instructed the new cardinals not to consider the job a
promotion or to waste money with celebratory parties.
“It
was an important year,” said Secretary of State Pietro Parolin, the
Vatican’s second-ranking official and one of only four Vatican officials
Francis will make a cardinal in February. Asked in a New Year’s Eve
interview about the personnel changes, he replied that it was only
natural that the Argentine pope should prefer to have “certain people
who are able to advance his policy.”
Interviews
with cardinals, bishops, priests, Vatican officials, Italian
politicians, diplomats and analysts indicate that the mood inside the
Vatican ranges from adulation to uncertainty to deep anxiety, even a
touch of paranoia. Several people say they fear Francis is going
department by department looking for heads to roll. Others whisper about
six mysterious Jesuit spies who act as the pope’s eyes and ears on the
Vatican grounds. Mostly, once-powerful officials feel out of the loop.
“It’s
awkward,” said one senior Vatican official, who, like many others,
insisted on anonymity for fear of retribution from Francis. “Many are
saying, what are we doing this for?” He said some officials had stopped
showing up for meetings. “It’s like frustrated teenagers closing the
door and putting their headphones on.”
Francis
remains tricky to define, a doctrinal conservative whose humble style
and symbolic gestures have thrilled many liberals. On Christmas, the
destitute poured into an ancient church in Rome for a holiday lunch
sponsored by a Catholic lay organization. The group’s founder, Andrea
Riccardi, once a liaison to the church when he served as an Italian
government minister, expressed hopes for change, but also wariness about
Vatican officials ignoring the pope’s agenda.
“You
hear people talk about it in the corridors of the church,” Mr. Riccardi
said. “The real resistance is to continue business as usual.”
Four
days earlier, Francis met with the Curia in the Sala Clementina, the
16th-century reception hall in the Apostolic Palace, to deliver one of
the most important papal speeches of the year. Benedict used his last
such Christmas address to denounce same-sex marriage. Francis used his
first to castigate his own colleagues in the Curia.
He
warned the men in red and purple skullcaps and black cassocks arrayed
around him that the Curia risked drifting “downwards towards mediocrity”
and becoming “a ponderous, bureaucratic customhouse.” He also called on
the prelates to be “conscientious objectors” to gossip.
Not New to the Battle
It
was a pointed rebuke of the poisonous atmosphere that had troubled
Benedict’s papacy, and for which the former secretary of state, Cardinal
Tarcisio Bertone, was often blamed. And it was a reminder that Francis,
if a new pope, was not new to the machinations of the Curia, having
tangled while in Argentina with a powerful conservative faction.
“He
was not an ingénue coming out into the world,” said Elisabetta Piqué,
an Argentine journalist who has known Francis for more than two decades
and whose recent book, “Francis: Life and Revolution,” documented his
past clashes with Rome. “He had had almost a war with this section of
the Roman Curia.”
Now
Francis talks disparagingly of “airport bishops” who are more
interested in their careers than flocks, and warns that priests can
become “little monsters” if they are not trained properly as
seminarians.
Launch media viewer
Pope Benedict XVI, left, with Cardinal Tarcisio Bertone last February.Alessandro Bianchi/Reuters
He
is dismantling the power circle of Cardinal Bertone, who led a ring of
conservatives centered on the city of Genoa. In September, Francis
demoted Cardinal Piacenza, a Bertone ally, from his post running the
powerful Congregation for the Clergy.
To
some it was an indication that the new pope could act with a measure of
ruthlessness. Several Vatican officials said that Cardinal Piacenza’s
greatest transgression had been undermining his predecessor, a Brazilian
prelate close to Francis who appeared with him on the balcony of St.
Peter’s after his election.
Francis
also removed a top official of the Vatican City government, although
arranging a soft landing pad. Others were less fortunate.
As
a priest, Guido Pozzo led a Vatican commission tasked with bridging the
schism between the church and traditionalists critical of the Second
Vatican Council. In November 2012, Cardinal Bertone elevated him to the
rank of archbishop and Benedict appointed him to run the church’s
charity office. Francis, who is much less interested than Benedict was
in appealing to the schismatic conservatives, has since sent Archbishop
Pozzo back to his former post.
Another
is Cardinal Burke. In 2008, Benedict installed his fellow
traditionalist as president of the Apostolic Signatura, the Vatican’s
highest court, and the next year appointed him to the Congregation for
Bishops. The post gave Cardinal Burke tremendous sway in selecting new
bishops in the United States.
In
December, Francis replaced him with a more moderate cardinal. “He’s
looking for places to put his people,” said one official critical of the
pope.
Another
Vatican conservative took offense at Francis’ disdain for elaborate
dress. And speculation that Francis might convert the papal vacation
home of Castel Gandolfo into a museum or a rehabilitation center has
also raised alarms. “If he does that,” said an ally of the old guard,
“the cardinals will rebel.”
For
now, the resistance is not gaining traction. “The Holy Spirit succeeds
also in melting the ice and overcoming any resistance,” Secretary of
State Parolin said. “So there will be resistance. But I wouldn’t give
too much importance to these things.”
Francis
also has empowered a group of eight cardinals representing five
continents to spearhead reform of the Curia. He has hired secular
consultants and set up a special commission to oversee the Vatican Bank.
And while he has spoken infrequently on clerical sexual abuse, he has
formed another commission “for the protection of minors.”
He
may also delegate some of the powers traditionally held by the office
of secretary of state by creating a new papal enforcer, who would wrest
power away from Curia bureaucrats.
“This
is a very real possibility,” said Cardinal Donald Wuerl, the archbishop
of Washington, who replaced Cardinal Burke on the Congregation for
Bishops.
Shunning Italian Politics
For
years, Italian politicians have courted the Vatican, and vice versa, as
both Pope John Paul II and Benedict encouraged Italy’s prelates to
speak out on issues that concerned the church. Francis’ distaste for
directly involving the church in politics has now threatened that old
link between Italian prelates and Italy’s conservative politicians.
“Today,
the Italian bishops are keeping silent,” said Pier Ferdinando Casini, a
prominent politician who once met with cardinals and even popes but has
yet to meet Francis.
The
Vatican remains a disproportionately Italian institution, with Italy
boasting the biggest bloc of cardinals even as it now accounts for only 4
percent of the world’s Catholics. Vatican employees are overwhelmingly
Italian, with lifetime job security, sometimes extending for
generations.
Launch media viewer
Cardinal Raymond Burke at a Mass on Saturday. His influence has been diluted.Stefano Rellandini/Reuters
Perks
abound. On a recent afternoon inside the Vatican’s department store,
bargain hunters shopped for tax-free wine, cigarettes, Ferragamo
clutches and North Face jackets beneath clocks reading the time in New
York, Vatican City and Tokyo.
The
Italian problem, as many non-Italian cardinals called it, loomed over
the conclave that elected Francis in March. An undue Italian influence
was blamed for suspicious accounts and mismanagement of the Vatican Bank
and the gossip mongering that fueled an embarrassing scandal centered
on leaks of Benedict’s private letters.
“What
is necessary is that at this stage that the culture becomes less
Italian,” one senior Vatican official said, “particularly as people work
towards greater transparency and meritocracy.”
Off the Career Track
Francis,
whose father was an Italian immigrant, and whose second language is
Italian, does have key Italian allies, including Secretary of State
Parolin and two other Curia department prefects he named as cardinals on
Sunday. But analysts say his passing over of traditional Italian
powerhouses, such as Venice, where the archbishop is close to Cardinal
Bertone, shows that he is trying to break the established career track
in the Italian church.
Francis
is also tinkering with the once mighty conference of Italian bishops,
which he sits atop in his role as bishop of Rome. Popes have
traditionally appointed the president of the Italian conference, but
Francis may introduce elections, as happens in other bishops’
conferences.
Under
Benedict, the conference’s president, Cardinal Angelo Bagnasco, jousted
for influence in Italian politics with Cardinal Bertone, whom Francis
has largely sidelined. But the pope also recently removed Cardinal
Bagnasco from the powerful Congregation for Bishops.
In
a recent Saturday homily, Francis warned an audience that included
Cardinal Bagnasco of the danger of becoming a “smarmy” priest.
Succumbing to worldly temptations, he added, made for
“priest-wheeler-dealers, priest-tycoons.”
The
New Year’s Eve Mass at St. Peter’s ended with a procession of priests
escorting Francis out of the basilica, followed by the thousands of the
faithful. In the emptied church, the cardinals and bishops rose from
their seats, shook hands with dignitaries and milled about around St.
Peter’s tomb.
Cardinal
Piacenza collected his umbrella from a prayer bench. Archbishop Pozzo
made his way to the door. Asked about the changes underway in the Curia,
he replied, “It’s been a surprising year!”
Not far away, Cardinal Burke blessed a few stragglers and declined to comment without permission from his “superiors.”
Weeks
earlier, Cardinal Burke seemed poised to be the most prominent voice of
resistance to Francis’ reign, telling a Catholic television network
that he was not “exactly sure why” the pope “thinks we’re talking too
much about abortion” and other culture war issues. When it came to
changes in the Curia, he bemoaned “a kind of unpredictability about life
in Rome in these days.”
At
roughly the same time, Francis gave an interview to the Italian
newspaper La Stampa. The pope spoke again about “tenderness” and opening
up the church. But he also added: “Prudence is a virtue of government.
So is boldness.”
It
was a telling point. On Dec. 15 Cardinal Burke returned to his boyhood
parish in Stratford, Wis., to celebrate a special Mass. Dressed in the
tall miter cap and traditional pink for the Christmas season, he spoke
about his dairy farm roots but disappointed some of his parishioners by
making no mention of Francis or the events happening in the Vatican.
“I was hoping he would,” said Marge Pospyhalla, who attended the Mass. “But, no, we did not get that.”
His silence said enough. The day after the Mass, Francis took Cardinal Burke off the Congregation for Bishops.
A growing number of countries in Africa are building community health
systems, which are extremely cost-effective (Accra, Ghana, 2013).
Foreign aid helps refugees like Nikuze Aziza feed their families and stay healthy (Kiziba Camp, Rwanda, 2011).
Since 2000, a global effort against malaria has saved 3.3 million lives (Phnom Dambang village, Cambodia, 2011).
Like millions of women in sub-Saharan Africa, Sadi didn’t know about contraceptives when she got married (Talle, Niger, 2012).
With
access to a range of contraceptives and information about birth
spacing, women like Sharmila Devi are able to raise healthier families
(Dedaur village, India, 2013).
Children who have a healthy start in life kick off a virtuous cycle of development (Dakar, Senegal, 2013).
Bill and Melinda Gates
