You probably have better things to do than read annual letters from large charitable foundations. But I’d urge you to read this one, from Bill and Melinda Gates, because it’s one of the best pieces of writing about philanthropy that I’ve come across in years.
Oh, and it also happens to be a spectacularly good indictment of the Trump administration's know-nothing isolationism.
The letter takes the form of a reply to Warren Buffett, who asked the Gateses for a report on how they’re doing in terms of spending the $31 billion he gave them 10 years ago. In their reply, they show how they have managed to give him “a fantastic return” on his investment–while barely mentioning how they spent the money. Because the real message of the letter is that if you want to achieve anything really big, you can't do it on your own.
Most charities and philanthropies are obsessed with causality: They don’t just want to see fantastic outcomes, they want to cause fantastic outcomes: We spent this much of your money on this, this, and this, and the result was this, that, and the other. Congratulations, you’ve saved this many lives, brought this many children out of poverty. That kind of thing. Politicians, similarly, love to take credit for anything good that happens on their watch.
The Gateses, by contrast, refuse to go down that road. They know that when you’re trying to do something as ambitious as (say) eradicating tuberculosis, you can’t do that on your own. It’s therefore not only silly to try to tell Warren Buffett that his billion dollars had some particular effect, it would be counterproductive. Buffett is smarter than that: He knows that the job of the Gates Foundation is simply to work as hard as it can, as part of a global team, to try to achieve certain goals.
That’s why the Gateses start their letter with what they call their “favorite number”: the fact that 122 million children’s lives have been saved since 1990. (Basically, if you take the number of children under 5 who died in 1990, and kept that number constant through 2016, the total would be 122 million higher than the actual number of children under 5 who died in those years.)
How is that number relevant to Buffett, if Buffett’s gift to the Gates Foundation didn’t even get conceived until well over halfway into that time period? The answer is that the Gateses know that Buffett isn’t looking for “we couldn’t have done it without you” buttering-up. Instead, they’re showing him that they made a fantastic momentum trade: They saw something that was working (the number of children dying under the age of 5 was decreasing every year), and then they helped as much as they could to try to make it work even better. They joined a successful team, and strengthened it in an important yet unquantifiable way, and the results since they joined the team have been wonderful. They're not jockeying for credit, they're just reveling in the outcome.
Melinda Gates explains why this single data series is so important to her foundation:
Virtually all advances in society—nutrition, education, access to contraceptives, gender equity, economic growth—show up as gains in the childhood mortality chart, and every gain in this chart shows up in gains for society.
In other words, having fewer children dying every year is, obviously, a good thing in and of itself. But it's also evidence of improvements across nearly all of society. You can't reduce childhood mortality without improving all manner of other things, including women's rights and even broad economic growth.
Still, there is a magic bullet that reduces childhood mortality directly, and it's called vaccines. They're cheap, they're safe, and they're an incredible investment: As Bill Gates says, "for every dollar spent on childhood immunizations, you get $44 in economic benefits."
Trump, of course, has repeatedly said that he "strongly believes" in the dangerous and false idea that vaccines cause autism. So by leading with their admirable work on vaccines, the Gateses are picking an issue where the distinction between themselves and Trump is clear, where they're on the side of the angels, and where Trump is teaming up with dangerous merchants of death and disease.
For its part, the Gates Foundation helped to found and has given some $4.1 billion to Gavi, the main international organization immunizing children around the world. Again, however, this is all about teamwork: Even that enormous sum is less than 20% of Gavi's total funding. The real legacy of the Gates Foundation will be less in the sheer size of the checks it could write, and more in the fact that it got Gavi off the ground in the first place.
Look at the sums given to Gavi by the likes of the UK and Norway, or the cooperation it received from the major pharmaceutical companies, or the clever capital-markets hack called the International Finance Facility for Immunization: All of these things show that while might is important, what's even more important is how much you leverage it. In other words, the Gates Foundation effectively got 10 times as much bang for their buck by creating Gavi than they ever could have done by just going out and trying to immunize children themselves.
American presidents have understood this for decades. The entire concept of "the West" is based on the idea that America cannot and should not stand alone, that everybody is better off if we make common cause with our allies. All countries become stronger when they cooperate with others, just as all philanthropies become more effective when they can persuade governments to join their cause.
Trump, of course, with his zero-sum worldview, doesn't see things that way. In his mind, everything is a deal, with winners and losers, and if he's going to win then everybody else has to lose.
The Gates letter is a full-throated refutation of that kind of thinking–and, for good measure, it also is unapologetic in its support of contraception, another right-wing bugaboo. Contraception is a public health necessity in every country in the world, keeping both women and children much healthier than when it isn't easily available. As the Gateses say:
When women in developing countries space their births by at least three years, their babies are almost twice as likely to reach their first birthday. Over time, the ability of women to use contraceptives and space their pregnancies will become one of the largest contributors in cutting childhood deaths.
Contraceptives are also one of the greatest antipoverty innovations in history. When women are able to time and space their pregnancies, they are more likely to advance their education and earn an income—and they’re more likely to have healthy children.
Are these statistics relevant to the U.S.? Yes, they are. The United States ranks 50th in the world in terms of maternal mortality, with 24 mothers dying in childbirth per 100,000 live births. That compares to 5 in Austria, 9 in Kuwait, and just 2 in Greece. What's more, the U.S. is getting worse even as the rest of the world is getting better.
All of which is to say that as Donald Trump does his rounds with billionaires, he should really drop in on Bill Gates at some point. If Trump wants to throw out decades of progress in public health and international cooperation, he should at least do so with his eyes open.