Bill and Melinda Gates: How your birthplace determines the future

Where you are born is still the biggest predictor of your future, and life will be harder if you are a girl, no matter where you’re born.

This is the finding in the third annual Goalkeepers Data Report released on Tuesday in Seattle, US, by the Bill & Melinda Gates Foundation.

It says that despite gains in female educational attainment, opportunities for girls are limited by social norms, discriminatory laws and policies, and gender-based violence.

Global inequality, therefore, remains the main hurdle towards the achievement of the UN sustainable development goals, the report says. The data, however, show significant progress on health and development.

“Even in the worst-off parts of low- and low-middle-income countries, more than 99 per cent of communities have seen an improvement in child mortality and schooling. Yet, despite this progress, persistent gaps in opportunity mean that nearly half a billion people — about one in 15 — still do not have access to basic health and education,” a statement by the foundation said.

According to the report, gaps between countries, subcounties, and boys and girls “prove that the world’s investments in development aren’t reaching everyone”.

The report illustrates that at adolescence is when girls’ and boys’ futures really start to diverge.

The boys’ worlds expand. They rely less on their parents, venture farther and farther from home, and enroll in high school or college or get a job, which puts them in contact with wider society.

“At the same time, girls’ worlds contract. They transition, sometimes at a very young age, from being subservient to their parents to being subservient to their husbands,” says the report.

Although the girls enjoyed some measure of freedom while attending primary school, at adolescence they are expected to return to the confines of the home, to devote themselves to cooking, cleaning, and raising children.

The report uses new sub-national data to uncover the vast inequalities “within countries that are masked by averages”. It tracks progress in achieving the Global Goals, cites examples of success and inspires leaders to intensify their efforts — the goal being identifying “what’s working and where we’re falling short”.

“Billions of people are projected to miss the targets that we all agreed represent a decent life,” Bill and Melinda Gates write in Examining Inequality 2019 — the Goalkeepers Data Report they co-authored.

“We believe that seeing where the world is succeeding will inspire leaders to do more, and seeing where the world is falling short will focus their attention.”

Bill and Melinda Gates call for a new approach to development. They want emphasis placed on the poorest people in areas that need to make up the most ground. They have urged governments to prioritise primary healthcare to “deliver a health system that works for the poorest”.

Such efforts should also include the adoption of digital governance so governments are responsive to their least-empowered citizens. Further, they call for more support for farmers to help them be resilient in the face of the worst effects of climate change.                      

This year, the report features an opinion by Githinji Gitahi, the global CEO of Amref Health Africa & Co-Chair UHC2030.

He describes what Ethiopia, Rwanda, and Thailand are doing right when it comes to delivering basic care to all their citizens and explains what countries like Kenya can learn from their experience.

“My own country, Kenya, is much richer than Ethiopia and Rwanda, but the primary care system is weaker (though there is finally high-level political commitment to strengthening it). What matters are the choices that politicians make,” he says.

Gitahi offers three suggestions for countries to achieve the Universal Health Coverage.

First, he says the countries must spend more on health than they currently do.

“Kenya currently spends $36 per person per year, or 7 percent of its budget, on health. If that went up to, say, $51, the universe of the possible would expand significantly. At $86, according to an analysis based on WHO data, governments of low-income countries could fully fund primary health care,” he explains.

Gitahi, who runs the largest health NGO in Africa, also says countries must spend on the right priorities. He advises African governments to make the difficult decision of shifting their focus to primary health coverage.

Gitahi further says governments must spend their money more efficiently.

“You still have to decide where to put your resources, based not on generic global calculations but on actual conditions on the ground,” he writes.

He makes a strong case for government to protect poor people from financial hardship and to invest in reproductive health.

“Kenya, with 80 percent of its population employed informally, is working on developing rigorous methodologies to target services more effectively. Ideally, as primary health systems begin to get the same results for less money, they’ll invest what’s left over in getting even better results,” says Gitahi.

Bill and Melinda Gates will produce a Goalkeepers Data Report annually through 2030, timing it to the annual gathering of world leaders in New York City for the UN General Assembly.

The report is designed to track progress in achieving the Global Goals, highlight examples of success, and inspire leaders around the world to accelerate their efforts.