2004 Gates Award for Global Health
June 3, 2004
Prepared remarks by William H. Gates Sr., co-chair
Wow. That was really powerful. And yet it’s just a tiny glimpse of the work that has saved and improved millions of lives, over dozens of years, in one of the poorest places on earth.
That’s why it’s such a joy to be here this evening to present the Gates Award for Global Health. Four years ago, Bill and Melinda established this award – not just to help finance the work of heroes in global health, but to magnify the impact of their work by making sure more people know about it. The scripture admonishes us: “Don’t hide your light under a bushel.” We’re here to help our award winner share its light with the whole world.
It’s a special thrill to present the award here at this meeting of the Global Health Council. Global health is finally taking its rightful place among the world’s top priorities. We have not come as far as we would like. But we’ve come further than we would have – if the Global Health Council had not been here for the last 30 years imploring us to pay attention.
Let me say to Nils Daulaire and all the directors and staff of the Council past and present: It must have taxed your soul and spirit to work so hard for so long to call the world’s attention to the suffering and injustice of global disease – only to see the world largely ignore you. You could have given up – but you kept at it – and when the world was finally ready to listen, you were still there testifying. God bless all of you.
Today, many people are making the case that global health is an economic issue and a national security issue. That’s all right with me. If we have to make that argument to get the public funds we need to fight disease, we should do it. But to me, disease is not primarily an economic issue or a national security issue; it is a humanitarian issue. People are dying, and we can save them; and that ought to be enough.
People suffering from poverty and disease are human beings. They are not ‘national security assets’. They are not ‘markets for our exports’. They are not ‘allies in the war against terrorism’. They are human beings who have infinite worth in their own right without any reference to us. They have mothers who love them and children who need them and friends who cherish them – and we ought to help them.
The question is how. Can we actually cure the worst disease in the world? I’m not talking about AIDS, or malaria, or TB. I’m talking about the moral disease that makes us accept a world in which millions of children die needlessly every year. Everyone agrees it’s a global disgrace – but are we ever going to end it?
There is hope in the work of the man and the organization we honor tonight.
In the early 1970’s, Bangladesh was a scene of terrible suffering. Independence had been won, but so much had been lost. During the war, people were killed, property was destroyed, bridges were blown up, poverty and disease skyrocketed. After the war, refugees returning home lacked any means to make a livelihood. Many western experts called it hopeless.
Fazle Hasan Abed was living a comfortable life in Europe in the late 1960s. Educated in Britain, employed by a rich multinational corporation, he had a promising career ahead of him. But he left that career behind during the liberation struggle – and began seeking support for Bangladesh among the leaders of Europe. After liberation, he came home to start the Bangladesh Rural Advancement Committee – because, as he later said, he thought he would spend (quote) ‘a few years of my life’ (close quote) helping to rebuild his country.
‘A few years’ grew into several decades, and that small organization and the nation of Bangladesh became parallel strands of history.
Bangladesh still suffers from poverty and disease, but life is getting better by every measure – the economy has grown by more than five percent a year over the last 10 years. The number of people living in poverty has dropped 20 percentage points. Food production has doubled. The literacy rate has doubled. Infant mortality has been cut by more than half, and life expectancy has risen by 13 years.
The organization founded by Mr. Abed has played a role in every one of those advances. BRAC pioneered the practice of micro-credit, and is the largest micro-lender in the world with 3.6 million borrowers. BRAC is the largest private educator in the world, with 34,000 primary schools teaching more than one million students. BRAC provides health care at 90 clinics and 2,000 prenatal clinics. It has mobilized 130,000 volunteers throughout Bangladesh who visit millions of homes assisting in health care and literacy. BRAC members draw on its loans and resources to run a full range of businesses – from individuals who make pottery and handicrafts, to larger groups who run fish hatcheries, tea estates, dairies, a poultry feed factory, and an Internet service provider.
BRAC is also establishing the James P. Grant School of Public Health – just the second school of public health in Bangladesh – and only the fifth in all of South Asia. I understand that the school’s directors are here tonight – could I please ask them to stand? Thank you for your life-saving public service.
What I have listed is just a small slice of all BRAC does, but let me describe one of my favorite BRAC projects. As we all know, diarrhea is a terrible killer of infants in the developing world. An earlier winner of the Gates Award – the International Centre for Diarrheal Disease Research, Bangladesh – developed a simple rehydration solution capable of saving millions of lives.
BRAC took this invention and mobilized 2,000 workers to visit homes all over the country and teach mothers how to prepare this simple solution of water, sugar and salt. Over the course of ten years, BRAC workers trained 13 million mothers to prepare this fluid and give it to infants and children.
Today Bangladesh has one of the highest rates of oral rehydration use in the world, and the country’s infant and child mortality has plunged. Let’s just stop and admire that for a moment – life-saving health instruction delivered in-the-home, face-to-face, to 13 million mothers. That is phenomenal. In the foundation business, we talk about the challenge of taking something to scale. BRAC is scale.
But scale alone doesn’t explain BRAC’s success. There is more to it than that. My son, who is constantly searching for strategic leverage to save more lives, said in a talk he gave on philanthropy some years ago: “If you want to find something where there’s huge leverage, it has to be through either a unique approach or a unique cause.”
The unique approach that runs through all BRAC’s programs – the cause that is ignored by billions of people and that gives BRAC its huge leverage – is women’s rights, starting with girls’ education. BRAC knows that when you teach a girl to read, the good deed never dies. From that point forward her children will be literate, and their children will be literate, almost without exception. When a girl is educated, she gets married later, and her children are fewer and healthier. When a girl is educated, she is much more likely to understand and use information on health and nutrition to make herself and her children healthier.
Of course, women’s rights and girls education is not only a unique approach; it’s a dangerous approach in a country where some want to keep girls out of school and off the job. These opponents have attacked BRAC’s micro-lending facilities, which lend mostly to women. They have burned down BRAC schools, whose students are 70 percent girls.
Mr. Abed says: “Their reaction confirms our belief that we are on the right track.” In a speech two years ago, Mr. Abed said: “Attacking poverty and hunger is not done simply by providing food and jobs. The system that perpetuates this condition must also be undone … Ending poverty entails what is tantamount to a cultural revolution.”
Cultural revolution is the difference between treating the condition and curing it. For BRAC, it means not only teaching girls to read, but helping women understand and enforce their rights. Some years ago, BRAC women farm laborers borrowed money to build a well on their landlord’s property, for which he owed them 25 percent of his harvest. When he tried to give them only 10 percent – they declared, “you’re trying to cheat us just because we are women” and they converged on the police station and got them to enforce the agreement.
Several years back one Bangladeshi reporter told a U.S. newspaper (quote): “I saw a government minister visiting a village with a BRAC community, and I was astonished at what I saw. One old woman stood up and demanded to know why the government was not helping them with water, schools and electricity. No poor, elderly woman without education would ever have the temerity to speak that way to a government official before. It was BRAC that gave her the courage to do that.”
When BRAC taught village women to ride bicycles to reduce their commuting time, some religious leaders said: “Women don’t ride bicycles.” Mr. Abed responded: “Show me where in the Koran it says women don’t ride bicycles.” The women are still riding bicycles.
We cannot sit here and applaud Mr. Abed unless we are willing to take this stand alongside him. We have a deep and abiding belief in the value of tolerance. We strive to be respectful of different traditions. But let us make one point clear: Whatever your tradition, whatever your religion, whatever your justification – any effort to deny girls and women the chance to be educated, to earn a livelihood, to enforce their rights is flat out immoral.
I say this out of a strong personal conviction – a conviction made stronger a few years ago during a visit I paid to a BRAC school. It was an unforgettable visit. I arrived at the school by a customary mode of travel in Bangladesh – by bicycle rickshaw. The rickshaw was working fine until we came to a hill, and the driver got out and began to push. It turns out that I exceeded the weight restrictions for pedaling a rickshaw uphill.
As we approached the school, I saw a dozen little boys playing soccer in the mud without shirts or shoes – one even without his shorts. It looked like a lot of fun, but I had the sad feeling I wouldn’t fit in. So I continued on to the school and suddenly came to a bridge. It was actually just a log a few inches wide that was laid across a 15-foot drop. The kids flew across it like birds. I stepped across it very carefully. I was too heavy for the rickshaw; I hoped I wouldn’t be too heavy for the bridge.
Across the bridge, I arrived at one of the 34,000 one-room schools that BRAC runs in Bangladesh. There were about 20 young kids between the ages of 8 and 12 – most of them girls. I asked each of them, one after the other: “What do you want to be when you grow up?”
One said, “I want to be a farmer.” Another said, “I want to be a teacher.” Then one girl stood up and said: “I’m going to be a doctor.”
Not “I want to be a doctor.” But I am going to be a doctor.
I will never forget that moment – a little girl, daughter of poor, illiterate parents, sitting on a grass mat, over dirt floor, in a one-room hut with a tin roof, telling me with total confidence: “I am going to be a doctor.” I thought: this little one-room school house is changing the world. I knew you would want to see her, so I brought a photo of the future doctor.
Years ago, when Mr. Abed started BRAC and he was seeking support from anywhere he could find it, he used to recite to himself for inspiration a poem from Rabindranath Tagore. The first line goes like this: "If no one comes when you call out, start walking all alone." He started walking all alone … but he’s not alone anymore.
For its comprehensive, ingenious, and inspiring approach to improving lives and health – I am overjoyed to present the 2004 Gates Award for Global Health to BRAC and to its founder Fazle Hasan Abed.