Global & Disaster Medicine

Archive for the ‘Global Health’ Category

Venezuelan health crisis: At hospitals in border cities like Cucuta, patients are packed side by side on stretchers that spill into hallways, not much unlike the deplorable conditions they fled back home and authorities project that Venezuelan admissions to Colombian hospitals could double in 2018 and say the nation’s already overstretched public health system is unprepared to handle the sudden swell.


Nursing Now aims to improve health globally by raising the profile and status of nurses worldwide – influencing policymakers and supporting nurses themselves to lead, learn and build a global movement.


Uganda, where the Government has joined with nursing, health and academic organisations to set out a Nursing Now road map for developing nursing and midwifery. This work is laying the groundwork for Nursing Now Africa.

Singapore, where the Government is running a campaign to promote nursing as an exciting career. They are creating new opportunities for nurses, celebrating their achievements and engaging nurses at the forefront of developing community services.

Narayana Health in India, where the founder Dr Devi Shetty and the Board have recognised the enhanced role that nurses can play and established a development programme for nurses. They are using nurses to lead the way in extending their services into Africa.


Rwanda, where a private organisation is working with the government to support nurse entrepreneurs providing vital services in the most rural areas.

Albert Einstein Hospital in São Paolo, Brazil, where nurses are engaging the many men who do not attend the basic health units for consultations. They are reaching out by going to bars to talk to people about how they can take better care of their health.

Jamaica, where the Government is working with partners to tackle violence against women and children as the first programme of Nursing Now Jamaica.

Community Aging in Place, Advancing Better Living for Elders (CAPABLE) in the USA, which is providing a multi-disciplinary service to support elderly people to live in their own homes.

Vitamin A deficiency threatens the vision and lives of millions of children in sub-Saharan Africa, but biofortified staple crops could provide a nutritional safety net.

Hopkins/Bloomberg Public Health

“….Yet while supplements work wonders—UNICEF estimates that if every child who needed supplements received them, as many as 1 million lives could be saved each year—even massive distribution campaigns can’t reach everyone who requires them. And industrially fortifying foods does not always work in developing countries, where it can be difficult to identify a commonly eaten food that can be centrally—and reliably—processed. Several Central American countries, for example, have successfully reduced vitamin A deficiency by fortifying sugar with vitamin A; but….attempts to do so in Zambia failed due to flawed fortification processes.….

Biofortification  would allow vulnerable populations to grow and eat their own nutritionally enhanced crops, sidestepping many of the obstacles to supplementation and industrial fortification.


Chile: During the long fight over the food law, Senator Girardi, 56, publicly assailed big food companies as “21st century pedophiles”

NY Times

“….Until the late 1980s, malnutrition was widespread among poor Chileans, especially children. Today, three-quarters of adults are overweight or obese, according to the country’s health ministry. Officials have been particularly alarmed by childhood obesity rates that are among the world’s highest, with over half of 6-year-old children overweight or obese.

In 2016, the medical costs of obesity reached $800 million, or 2.4 percent of all health care spending, a figure that analysts say will reach nearly 4 percent in 2030…..”

WHO: Global Violence and Injury



Globally, some 470 000 homicides occur each year and millions of people suffer violence-related injuries. Beyond death and injury, exposure to violence can increase the risk of smoking, alcohol and drug abuse; mental illness and suicidality; chronic diseases like heart disease, diabetes and cancer; infectious diseases such as HIV, and social problems such as crime and further violence.

Road traffic injuries

Mixed traffic in New Delhi, India

Over 3 400 people die on the world’s roads every day and tens of millions of people are injured or disabled every year. Children, pedestrians, cyclists and older people are among the most vulnerable of road users.



Drowning is a leading killer. The latest WHO Global Health Estimates indicate that almost 360 000 people lost their lives to drowning in 2015. Nearly 60% of these deaths occur among those aged under 30 years, and drowning is the third leading cause of death worldwide for children aged 5-14 years. Over 90% of drowning deaths occur in low- and middle-income countries.



A burn is an injury to the skin or other organic tissue primarily caused by heat but can also be due to radiation, radioactivity, electricity, friction or contact with chemicals. Skin injuries due to ultraviolet radiation, radioactivity, electricity or chemicals, as well as respiratory damage resulting from smoke inhalation, are also considered to be burns.

Globally, burns are a serious public health problem. An estimated 180 000 deaths occur each year from fires alone, with more deaths from scalds, electrical burns, and other forms of burns, for which global data are not available.

According to the 2015 Global Health Estimates, 95% of fatal fire-related burns occur in low- and middle-income countries. In addition to those who die, millions more are left with lifelong disabilities and disfigurements, often with resulting stigma and rejection.

The suffering caused by burns is even more tragic as burns are so eminently preventable.



A fall is an event which results in a person coming to rest inadvertently on the ground or floor or other lower level. Within the WHO database fall-related deaths and non-fatal injuries exclude those due to assault and intentional self-harm. Falls from animals, burning buildings and transport vehicles, and falls into fire, water and machinery are also excluded.

Globally, an estimated 391 000 people died due to falls in 2002, making it the 2nd leading cause of unintentional injury death globally after road traffic injuries. A quarter of all fatal falls occurred in the high-income countries. Europe and the Western Pacific region combined account for nearly 60 % of the total number of fall-related deaths worldwide

Males in the low- and middle-income countries of Europe have by far the highest fall-related mortality rates worldwide.

In all regions of the world, adults over the age of 70 years, particularly females, have significantly higher fall-related mortality rates than younger people. However, children account for the largest morbidity- almost 50% of the total number of DALYs lost globally to falls occur in children under 15 years of age.

India: Wanting to Give Half a Billion People Free Health Care

NY Times

“…..The health care plan, part of the government’s 2018-19 budget presented on Thursday, would offer 100 million families up to 500,000 rupees, or about $7,860, of coverage each year. That sum, while small by Western standards, would be enough to cover the equivalent of five heart surgeries in India…..”


Obesity rates in sub-Saharan Africa are shooting up faster than in just about anywhere else in the world, causing a public health crisis that is catching Africa, and the world, by surprise.

NY Times


Obesity and overweight

Fact sheet
Updated October 2017

Key facts

  • Worldwide obesity has nearly tripled since 1975.
  • In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese.
  • 39% of adults aged 18 years and over were overweight in 2016, and 13% were obese.
  • Most of the world’s population live in countries where overweight and obesity kills more people than underweight.
  • 41 million children under the age of 5 were overweight or obese in 2016.
  • Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016.
  • Obesity is preventable.

What are overweight and obesity?

Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health.

Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person’s weight in kilograms divided by the square of his height in meters (kg/m2).


For adults, WHO defines overweight and obesity as follows:

  • overweight is a BMI greater than or equal to 25; and
  • obesity is a BMI greater than or equal to 30.

BMI provides the most useful population-level measure of overweight and obesity as it is the same for both sexes and for all ages of adults. However, it should be considered a rough guide because it may not correspond to the same degree of fatness in different individuals.

For children, age needs to be considered when defining overweight and obesity.

Children under 5 years of age

For children under 5 years of age:

  • overweight is weight-for-height greater than 2 standard deviations above WHO Child Growth Standards median; and
  • obesity is weight-for-height greater than 3 standard deviations above the WHO Child Growth Standards median.

Children aged between 5–19 years

Overweight and obesity are defined as follows for children aged between 5–19 years:

  • overweight is BMI-for-age greater than 1 standard deviation above the WHO Growth Reference median; and
  • obesity is greater than 2 standard deviations above the WHO Growth Reference median.

Facts about overweight and obesity

Some recent WHO global estimates follow.

  • In 2016, more than 1.9 billion adults aged 18 years and older were overweight. Of these over 650 million adults were obese.
  • In 2016, 39% of adults aged 18 years and over (39% of men and 40% of women) were overweight.
  • Overall, about 13% of the world’s adult population (11% of men and 15% of women) were obese in 2016.
  • The worldwide prevalence of obesity nearly tripled between 1975 and 2016.

In 2016, an estimated 41 million children under the age of 5 years were overweight or obese. Once considered a high-income country problem, overweight and obesity are now on the rise in low- and middle-income countries, particularly in urban settings. In Africa, the number of overweight children under 5 has increased by nearly 50 per cent since 2000. Nearly half of the children under 5 who were overweight or obese in 2016 lived in Asia.

Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016.

The prevalence of overweight and obesity among children and adolescents aged 5-19 has risen dramatically from just 4% in 1975 to just over 18% in 2016. The rise has occurred similarly among both boys and girls: in 2016 18% of girls and 19% of boys were overweight.

While just under 1% of children and adolescents aged 5-19 were obese in 1975, more 124 million children and adolescents (6% of girls and 8% of boys) were obese in 2016.

Overweight and obesity are linked to more deaths worldwide than underweight. Globally there are more people who are obese than underweight – this occurs in every region except parts of sub-Saharan Africa and Asia.

What causes obesity and overweight?

The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Globally, there has been:

  • an increased intake of energy-dense foods that are high in fat; and
  • an increase in physical inactivity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization.

Changes in dietary and physical activity patterns are often the result of environmental and societal changes associated with development and lack of supportive policies in sectors such as health, agriculture, transport, urban planning, environment, food processing, distribution, marketing, and education.

What are common health consequences of overweight and obesity?

Raised BMI is a major risk factor for noncommunicable diseases such as:

  • cardiovascular diseases (mainly heart disease and stroke), which were the leading cause of death in 2012;
  • diabetes;
  • musculoskeletal disorders (especially osteoarthritis – a highly disabling degenerative disease of the joints);
  • some cancers (including endometrial, breast, ovarian, prostate, liver, gallbladder, kidney, and colon).

The risk for these noncommunicable diseases increases, with increases in BMI.

Childhood obesity is associated with a higher chance of obesity, premature death and disability in adulthood. But in addition to increased future risks, obese children experience breathing difficulties, increased risk of fractures, hypertension, early markers of cardiovascular disease, insulin resistance and psychological effects.

Facing a double burden of disease

Many low- and middle-income countries are now facing a “double burden” of disease.

  • While these countries continue to deal with the problems of infectious diseases and undernutrition, they are also experiencing a rapid upsurge in noncommunicable disease risk factors such as obesity and overweight, particularly in urban settings.
  • It is not uncommon to find undernutrition and obesity co-existing within the same country, the same community and the same household.

Children in low- and middle-income countries are more vulnerable to inadequate pre-natal, infant, and young child nutrition. At the same time, these children are exposed to high-fat, high-sugar, high-salt, energy-dense, and micronutrient-poor foods, which tend to be lower in cost but also lower in nutrient quality. These dietary patterns, in conjunction with lower levels of physical activity, result in sharp increases in childhood obesity while undernutrition issues remain unsolved.

How can overweight and obesity be reduced?

Overweight and obesity, as well as their related noncommunicable diseases, are largely preventable. Supportive environments and communities are fundamental in shaping people’s choices, by making the choice of healthier foods and regular physical activity the easiest choice (the choice that is the most accessible, available and affordable), and therefore preventing overweight and obesity.

At the individual level, people can:

  • limit energy intake from total fats and sugars;
  • increase consumption of fruit and vegetables, as well as legumes, whole grains and nuts; and
  • engage in regular physical activity (60 minutes a day for children and 150 minutes spread through the week for adults).

Individual responsibility can only have its full effect where people have access to a healthy lifestyle. Therefore, at the societal level it is important to support individuals in following the recommendations above, through sustained implementation of evidence based and population based policies that make regular physical activity and healthier dietary choices available, affordable and easily accessible to everyone, particularly to the poorest individuals. An example of such a policy is a tax on sugar sweetened beverages.

The food industry can play a significant role in promoting healthy diets by:

  • reducing the fat, sugar and salt content of processed foods;
  • ensuring that healthy and nutritious choices are available and affordable to all consumers;
  • restricting marketing of foods high in sugars, salt and fats, especially those foods aimed at children and teenagers; and
  • ensuring the availability of healthy food choices and supporting regular physical activity practice in the workplace.

WHO response

Adopted by the World Health Assembly in 2004, the “WHO Global Strategy on Diet, Physical Activity and Health” describes the actions needed to support healthy diets and regular physical activity. The Strategy calls upon all stakeholders to take action at global, regional and local levels to improve diets and physical activity patterns at the population level.

The Political Declaration of the High Level Meeting of the United Nations General Assembly on the Prevention and Control of Noncommunicable Diseases of September 2011, recognizes the critical importance of reducing unhealthy diet and physical inactivity. The political declaration commits to advancing the implementation of the “WHO Global Strategy on Diet, Physical Activity and Health“, including, where appropriate, through the introduction of policies and actions aimed at promoting healthy diets and increasing physical activity in the entire population.

WHO has also developed the “Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020” which aims to achieve the commitments of the UN Political Declaration on Noncommunicable diseases (NCDs) which was endorsed by Heads of State and Government in September 2011. The “Global Action Plan” will contribute to progress on 9 global NCD targets to be attained by 2025, including a 25% relative reduction in premature mortality from NCDs by 2025 and a halt in the rise of global obesity to match the rates of 2010.

The World Health Assembly welcomed the report of the Commission on Ending Childhood Obesity (2016) and its 6 recommendations to address the obesogenic environment and critical periods in the life course to tackle childhood obesity. The implementation plan to guide countries in taking action to implement the recommendations of the Commission was welcomed by the World Health Assembly in 2017.


China: One Belt One Road

Health Affairs

“…..This year, at the opening of the One Belt and One Road Initiative forum, Xi Jinping reiterated his pledge to create 100 health projects for women and children in the developing world—a commitment to maternal and child health that fills a void left by the US withdrawal of funding to the United Nations Population Fund. China is also investing in vaccine development and collaboration in biomedical advances with support from organizations such as the Bill & Melinda Gates Foundation. Between 2000 and 2012, China committed a total of $3 billion to 255 projects on health, population, and water and sanitation in Africa. The country also built hospitals and malaria control centers, invested in medical equipment, provided anti-malarial treatment, and trained health care workers. China’s assistance was crucial to both the response to the 2014 Ebola outbreak in West Africa and expanding its soft power further into Africa. China is also increasing its global health partnerships, both academically and across governments, and now boasts multilateral and bilateral partnerships with UN agencies, developed and developing nations, and many international non-governmental organizations. The country is forming public/private partnerships for global health and is engaging in many academic partnerships. It has even established a consortium organization much like the Consortium of Universities for Global Health called the China Consortium of Universities for Global Health, which so far includes 23 member universities…..”


Antimicrobial Resistance (AMR): Another type of pandemic? “We still face two trends that spell potential disaster: new classes of drugs are not being invented and resistance to existing drugs continues to spread inexorably.”

World Economic Forum

“…..The risks posed by AMR have continued to intensify in the five years since the 2013 report. Numerous welcome initiatives have been launched, but concrete successes in addressing the two drivers identified above remain elusive. We still face two trends that spell potential disaster: new classes of drugs are not being invented and resistance to existing drugs continues to spread inexorably. The stakes are incredibly high—if resistance overtakes all our available antibiotics, it would spell the “the end of modern medicine”.…..”

The Pharmaceutical Journal. 2017. “Chief Medical Officer Warns Antibiotic Resistance Could Signal ‘End of Modern Medicine’”. The Pharmaceutical Journal. 17 October 2017.

Selected AMR Rates 

Resistance of Staphylococcus aureus to Oxadcillin (MRSA), % Resistant (invasive isolates)

Resistance of Klebsiella pneumoniae to Cephalosporins (3rd gen), % Resistant (invasive isolates)

Source: Figure courtesy Center for Disease Dynamics, Economics and Policy. Used with permission via Creative Commons license.
Note: Countries in white indicate no data available.


Bill Gates at J.P. Morgan’s 36th Annual Healthcare Conference

Bill Gates

The business of improving global health

Some of the world’s most debilitating diseases are treated by a medication that was originally created for dogs.

It sounds weird, but it’s true. In 1978, a researcher at Merck hypothesized that a new heartworm preventative called ivermectin could help people suffering from onchocerciasis, a neglected tropical disease that causes river blindness primarily in sub-Saharan Africa. Less than a decade later, the drug was approved for use in humans, and Merck announced that it would provide ivermectin for free to anyone who needs it.

Today, it’s used to treat people suffering from a number of parasitic diseases. I recently saw firsthand how the Tanzanian government is administering ivermectin to whole communities to wipe out lymphatic filariasis.

The next ivermectin could be sitting in a lab right now, but we need to be purposeful about finding it. Private sector research can have tremendous benefits for the world’s poorest. If you look at the research agendas of many biotech and pharma companies today, I think there are enormous opportunities to make progress on some of the toughest health challenges.

I spoke about the possibilities that exist at the intersection of global health and the private sector earlier today at J.P. Morgan’s 36th Annual Healthcare Conference in San Francisco. Here is the full text of my prepared remarks:

Remarks as prepared
J.P. Morgan’s 36th Annual Healthcare Conference
San Francisco, CA
January 8, 2018


Thank you. It’s great to be here today.

No matter where I go, no matter who I talk to, there’s one point I always try to get across. It’s been my key message for more than a decade. It’s that health is getting better, and it’s getting better faster than ever before.

Since 1990, the world has cut child mortality in half. HIV is no longer a certain death sentence. Many of the so-called neglected diseases that affect a billion people every year aren’t neglected anymore.

I talk about what we’ve accomplished in the past because it makes me optimistic about what we can accomplish in the future. But there’s still a lot of room for improvement. This year, 5 million children under the age of five will die, mostly in poor countries. And hundreds of millions of others will suffer from diseases and malnutrition that sap them, and their countries, of their strength and their potential.

Some of this can be addressed by doing a better job of getting lifesaving drugs and vaccines to the people who need them. But there is still a substantial gap between the tools we have and the tools we need to eliminate the most persistent diseases of poverty.

The way to fill that gap is to innovate, and that’s why I’m excited to be here today. Because the tools and discoveries your companies are working on can also lead to breakthrough solutions that save millions of lives in the world’s poorest countries.

It’s true that government-funded basic science research shines a light on promising pathways to health advances.

Philanthropy can help nurture the best ideas through discovery and development, and balance the risk-reward equation for private-sector partners.

But industry has the skills, experience, and capacity necessary to turn discoveries into commercially viable products.

The fact is that global health needs the private sector. And, frankly, the private sector has much to gain from pursuing breakthroughs in global health.

Over the next few decades, developing economies will continue to expand. By 2050, the population of Africa will more than double to almost 2.5 billion. That’s more than twice the forecasted population of the U.S. and Europe combined.

But we don’t have to wait 20 or 30 years. Even in the shorter term, impact and earnings are not mutually exclusive for the private-sector.

As you probably know, global health is our primary focus at the Gates Foundation—although we also work in a few other areas that are big levers for impact . . . like agricultural development . . . and public education here in the U.S. Over the last five years, we have invested nearly $12 billion in global health.

This includes grants and equity investments in companies with promising technologies that have potential application in global health. We also use creative price and volume guarantees that help the private sector mitigate the risk in developing a new product for which demand is unproven.

Our investments have led to new drugs and vector control tools for malaria . . . accelerated the introduction of new vaccines in poor countries . . . and ensured that millions of people in the developing world have access to long-lasting contraceptives and the best-available antiretroviral treatment for HIV.

We are also working with the WHO and regulatory entities in China and Africa to eliminate systemic barriers that slow development of new products and access to new markets. A few years ago, we looked at the data, which showed that in high-income countries it took 6-12 months to get a product registered—compared to 4-7 years in low-income countries. We realized this was as big a challenge as anything else in getting new health solutions to the people who need them.

I’m particularly excited about our work with the Chinese FDA to provide a more efficient and consistent mechanism for testing, review, and approval of medicines and vaccines—using international standards. This would be a game changer in getting quality products into and out of China.

There is another critical intersection emerging between what you do and what we do—and that’s what I’d like to talk about today.

The questions driving your research agendas today in biotech and pharma—and the problems we’re trying to solve in global health—are starting to converge in exciting ways. Many of the solutions you’re working on—harnessing the immune system to tackle cancer, unraveling the mysteries of the brain to treat Alzheimer’s, and learning how bodies absorb nutrition to address the obesity epidemic and other diseases—also have clear applications in global health.

The global health community may not be thinking as much about treatments for cancer, but we need to understand the immune system to tackle deadly diseases like HIV, malaria, and TB.

We aren’t focused on the neurodegenerative diseases commonly associated with aging, but we are concerned about the cognitive development of hundreds of millions of young children in poor countries.

We aren’t dealing with a crisis of obesity in Africa and South Asia, but we are trying to address its inverse, a crisis of stunting, wasting, and undernutrition.

You may be interested in developing products for rich-world markets, but the breakthroughs happening in your labs can also save millions of lives in the world’s poorest countries.

In health and medicine, we learn by analogy. We borrow insights from other fields. And when we ask one kind of question about key systems like the immune system, the brain, or our human microbiota, the answers may also apply to a totally different line of questioning.

A few months ago, a headline caught my eye in The Wall Street Journal. The story was one of many that have highlighted how the HIV virus’s genetic machinery can be used as a tool to modify T-cells so they are capable of attacking specific cancers.

I’m confident that a decade from now, we’ll see a headline that says: “How Cancer Tools are Helping Cure HIV.”

Of course, it’s not quite that simple. Immunotherapy today works only against certain types of cancers and only in certain patients. And, like cancer, infectious diseases such as HIV, TB, and malaria have complex interactions with the immune system of infected individuals.

But there is reason to hope that the insights uncovered in ongoing immunotherapy research for cancer will eventually help us control all infectious diseases. This would be a huge victory for humanity—and potentially a significant market for the life sciences.

Others seem to think so too. Venture capitalists like Bob Nelsen and Bob More have helped raise over $500 million for VIR Biotechnology—including funding from us—to discover and develop treatments for serious infectious diseases.

We are also investors in Immunocore, which is using T-cell technology to help stimulate the body’s immune system. Initially, Immunocore’s “T-cell receptor” technology targeted cancers, but it could also be applied against infectious diseases.

We are backing companies like CureVac and Moderna on mRNA approaches for vaccine and drug development, which have the potential to help us tackle cancer. This approach is also intriguing as a potential immunological intervention for HIV, malaria, flu and the Zika virus.
And mRNA vaccines are likely to be cheaper, easier, and faster to make than traditional vaccines. This would be particularly helpful in containing epidemics—whether they occur through nature or are the result of an intentional biological attack. Today, it typically takes up to 10 years to develop and license a new vaccine. To significantly curb deaths from a fast-moving airborne pathogen, we would have to get that down considerably—to 90 days or less.

Of course, fighting infectious disease is only one of the global health challenges that demand our attention. Another is newborn health. Despite the great progress in reducing child mortality, nearly 5 million children under the age of five will die this year—close to half in the first 28 days of life.

To make inroads against neonatal mortality, we first have to understand and address the underlying vulnerabilities of newborns, especially in poor countries. Right now, we don’t know exactly why many newborns in poor countries die, which makes it very difficult to save them.

But we’re enthusiastic about leveraging the tools of genetics and other research the private sector is working on to help children survive birth, fend off deadly infections, and thrive both physically and cognitively.

I’m also excited about a 20-year study we’re funding in Southeast Asia and Sub Saharan Africa that will give us epidemiological data about what is causing stillbirths and child deaths.

We have a lot to learn from the data, but we already know that one critical factor is the prevalence of preterm birth. It is the single largest cause of newborn deaths, and the children who survive it often face serious and lifelong health problems. Although most premature births occur in Africa and Asia, this remains a problem in rich countries, too.

One of every 10 infants in the U.S. is born preterm, which threatens the health and wellbeing of those children and significantly drives up healthcare costs.

We are just now getting the first effective diagnostic test to identify women at risk for early delivery. A company called Sera Prognostics developed a blood-based diagnostic that recently went on the market in the U.S.

We’re supporting their work on a low-cost version for use in poor countries. By itself, this won’t solve the problem. But it will give healthcare providers a way to identify women at risk and provide care that extends their pregnancy toward full-term.

We also need to better understand the biological mechanisms that underpin preterm birth, starting with the health of the mother during pregnancy. We recently co-funded a genome wide association study that illuminated a correlation between selenium deficiency in pregnant women and preterm birth. More research is needed, but the hope is that dietary supplements could help reduce the incidence of preterm births and newborn deaths.

It is also increasingly clear that the gut microbiome and nutrition—and the interplay between the two—is a big factor in the survival and healthy development of children, no matter where they live.

We know that children in poor countries who are malnourished and vulnerable to enteric infections have underdeveloped microbiomes that weaken their immune system and make them more susceptible to disease and to impaired brain development that lasts a lifetime.

There is also evidence that children in wealthy countries who grow up in super-hygienic environments—with an abundance of processed foods and antibiotics—have poor gut health that makes them more susceptible to obesity, auto-immune diseases, diabetes—and later in life—hypertension.

The solution in both instances is making sure that kids have the right constellation of microbes in their gut—and that they’re eating the right foods to support a healthy microbiome.

We’ve recently begun working with partners who are developing solutions to replace or augment healthy microbes using probiotics, nutritious foods with locally-available ingredients, and even fecal transplants.

We also have to better understand which children are not progressing developmentally, and why that is.

As I mentioned, malnourished children are at risk of being cognitively impaired for the rest of their lives. Recent estimates indicate that 250 million children under the age of five fit this criterion. That’s four of every 10 children in low- and middle-income countries who are more likely to drop out of school and less likely to succeed in the workplace.

In human terms, this is a heartbreaking tragedy. In economic terms, it is a huge drag on the ability of developing countries to lift themselves out of poverty.

One challenge is that we don’t have good tools to assess the brain development of children. The proxy measures we use today are a child’s height—if it’s well below the norm for their age—and whether they live in poverty. There is, of course, value in these indicators. But we can’t adequately gauge the development of an organ that contains 100 billion cells and that scientists have called “the most complex object in the known universe” through measures that are apparent to the naked eye.

We are working with partners to determine if neuroimaging and other technologies can be used in early infancy and young children to accurately predict cognitive development. These are the same tools that companies are using to assess dementia and cognitive decline late in life.

We have some early data showing the promise of these tools in parts of the world with a high incidence of stunting. These images show fewer neural connections in the brains of children who are stunted compared to the brains of normally developing children at 2-3 months of age.

We’re also supporting research to better understand the factors that most affect brain development in children so we can intervene more quickly to minimize the impact of neurocognitive deficits early in life.

On a personal level, I’m particularly interested in deepening our understanding of both the development and the decline of brain function.

I’ve seen first-hand the devastating consequences of stunting on the development of children in developing countries. And men in my own family have suffered from Alzheimer’s.

Although Alzheimer’s research is outside the scope of what we do as a foundation, I’ve personally committed to investing $100 million on new approaches to dementia, including Alzheimer’s—on top of the brain development research we’re supporting through the foundation.

People often ask why Melinda and I decided to focus so much of our philanthropy on global health. It started with a simple question we asked ourselves: how could we do the most good for the greatest number of people?

When we looked at it that way, the answer quickly became clear. The health disparity between rich and poor countries was a big problem. We saw a gap that wasn’t being filled by others. And we believed that our investments in global health could be catalytic. By helping poor countries ease the devastating burden of disease, we could help ease the burden of poverty, too.

One of the major obstacles we faced early on is that in health—as in many other aspects of life—the free market tends to work well for people who can pay . . . and not so well for people who can’t. But over the last decade, our experience has shown that we can stretch the reach of market forces so the private sector’s most exciting innovations also benefit people with the most urgent needs. And with creative thinking, we can do it in ways that are both sustainable and profitable.

Our foundation is in a unique position to share the risk on promising bets that can lead to important new discoveries. And we can help provide more predictability to companies interested in entering new markets that present real challenges—but also tremendous opportunities.

We all share the goal of improving the health and well-being of people globally. Imagine what’s possible if we work together.

Consider a world where the age-old scourge of malaria is finally eradicated . . . where hundreds of millions of people no longer suffer from tuberculosis . . . and where we have a cure for HIV.

In a quarter century, we cut childhood mortality in half. With the passion, expertise, and resources of the people in this room, we can cut child mortality in half again by 2030.

There are many technical challenges to overcome. But when I think about the breathtaking pace of innovation in just the last 10 or 20 years, I believe that even more extraordinary things are possible in our lifetime.

I can think of no more noble purpose than erasing the divide between those who suffer the relentlessness of disease and poverty—and those of us who enjoy good health and prosperity.

Achieving health equity in our lifetime is not only a possibility. It is an imperative, because everyone—no matter where they live—deserves the chance to live a healthy and productive life.

Thank you.


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