The last few decades of the 20th century brought an incredible burst of innovation, particularly in medical science and information technology. But many of those innovations have yet to reach people living in poverty. The central challenge of the decades ahead will be to share lifesaving advances such as vaccines and new medicines, as well as the benefits of the revolution in information technology, with those who need them most.

The primary goal of our global health grants is to reduce what Dr. William Foege, our senior health adviser, calls the "unconscionable disparity" that exists between the way that we live and the way that the people of the developing world live.

Our focus on global health equity was born of a growing realization that many of the diseases that have been all but eliminated in this country, such as measles, kill and disable nearly 1 million children in the developing world each year. Our grant making is grounded in the belief that the death of a child in Africa is no less tragic than the death of a child in America, and the understanding that those of us who were born in rich countries have a fundamental responsibility to help those who weren't.

In the 1980s, a combination of political will and unprecedented cooperation among governments, health officials, NGOs, corporations, and other donors brought global vaccination rates from 5 percent to 80 percent for six basic childhood diseases: measles, diphtheria, pertussis, tetanus, polio, and tuberculosis. Unfortunately, as political will among donors and developing nations tapered off, those rates declined.

We are optimistic that the world can again attain, and even surpass, those rates, while adding several newer vaccines that are used routinely in the developed world. Belief in the premise that children have a basic right to lifesaving vaccines is gaining momentum. Several countries, including Norway, the United Kingdom, Canada, and the United States, have contributed to the Global Alliance for Vaccines and Immunization in order to purchase and deliver vaccines to the 74 poorest countries in the world. But we need more resources to reach every child, with every available vaccine.

And we need to develop new vaccines to stop malaria, tuberculosis, and AIDS. These diseases are destroying families and communities, and rolling back hard-fought gains in developing nations. Africa is home to 70 percent of the adults and 80 percent of the children living with HIV in the world, and, according to UNAIDS, has buried three-quarters of the more than 20 million people worldwide who have died of AIDS since the epidemic began. In hard-hit nations such as South Africa, AIDS is projected to reduce the gross domestic product by 17 percent over the next decade, removing $22 billion from an already fragile economy. To reverse the course of the epidemic, we must aggressively pursue a comprehensive approach that emphasizes preventive measures that will enable individuals to protect themselves and others, and we must marshal the will and resources necessary to develop and distribute an AIDS vaccine.

Improving health is key to reaching other development goals, such as reducing poverty. Some worry that by reducing the burdens and deaths caused by disease we may be inadvertently contributing to another serious problem: rapid population growth and high fertility. Actually, the reverse is true. Studies show that mothers voluntarily limit the number of children they have when they have confidence that existing children will survive. We need to empower women by providing voluntary family planning services to the 150 million women in developing nations who want to prevent or delay their next pregnancy, but lack access to contraception.

Helping All Students Achieve

Here in the United States, research consistently shows that education is a top concern of the public. The foundation’s education programs were launched in March 2000, with a $350 million commitment to support education improvements in three priority areas over three years. Our investments support model schools and districts; provide professional development opportunities for teachers, principals, and superintendents; and help to eliminate financial barriers to higher education by providing scholarships.

In the last year, the foundation has helped 19 public school districts, 13 individual schools, and 11 school networks begin the process of creating smaller, more personalized learning environments. Though many of these recipients are clustered in Washington state, the portfolio represents schools from Alaska to Boston, San Diego to Cleveland. Efforts are also under way to improve the leadership and technology training of teachers, principals, and superintendents in every state. Finally, the foundation has embarked on three scholarship programs: one for low-income students in Washington state, a second for low-income minority students in all states, and a third that allows outstanding scholars and leaders from every country in the world to pursue graduate degrees at Cambridge University in England.

Bridging the Digital Divide

This year marked the midway point of our commitment to bring computers with Internet access to every public library serving a low-income community in the United States and Canada. The Library Program was our first large-scale, private philanthropic effort.

In reaching this milestone, Library Program trainers have logged more than 11 million air and road miles, traveling to libraries in 18 states, the District of Columbia, and 12 Canadian provinces and territories. Approximately 28,978 computers have been installed in communities stretching from the Yukon Territory to Texas and from New York to California, providing free access to information to roughly 145.3 million people—almost half the population of North America.

We believe that our efforts, combined with other creative efforts from diverse groups that range from international agencies to local Boys and Girls Clubs, are making a dent in the digital divide. The U.S. National Commission on Libraries and Information Science recently issued the results of its 2000 Internet Connectivity Study, which found that in the last two years Internet connectivity in public libraries has increased from 83 percent of libraries being connected to more than 95 percent. In the same time period, libraries have also nearly doubled the number of public access workstations.

An independent assessment of the Library Program’s impact in the initial half-dozen states shows positive results. According to the study, students and low-income patrons use library computers most frequently and for the longest periods of time. And library computers are the only source of access for more than half of those who are unemployed but looking for work. Also notable is the fact that library traffic and staff morale increased significantly in libraries that received computers and training.

This new century brings with it exciting advances in health and learning. We all share the responsibility of ensuring that these opportunities are not out of reach for the people who need them the most.