“There’s a myth of the foundation that we’re all about science,” she says during a panel discussion. “Where do Bill and I come from? We have a belief in science. We focused on what we were good at first. We developed vaccines, we got prices down. But there is enormous belief that you can’t get that life-saving technology out there without people adopting it. And that’s the critical next piece.”
She describes a high-tech bed net that the foundation is working on to reduce malaria, including one that burns the legs off mosquitoes when they land on it. But even if they find the distribution networks to get them to people in Africa, and even if they bring the price down to an affordable level or give them away for free, there is no guarantee that people will actually hang them over their beds at night, she says.
Gates speaks with the clarity of a business executive all too familiar with PowerPoint presentations and speeches. But it is clear that she is there more to learn from the attendees than to tell them what to do. She is humble. She does diligent research and speaks on issues only when she feels fully informed. She is analytical, her interest most piqued by strategies based on evidence and backed by numbers.
But she is also guided by her emotions, her own experience as a mother clearly providing part of the drive to help other mothers in Africa deliver and raise healthy children.“I really believe that any of us in the US are just lucky to have been born in a country like this,” she says. Meeting women in India and Africa who have lost a child, or must walk eight hours to the paediatrician to get their children immunised, “hits you at a human scale. You say, ‘There but for the grace of God go I.’ I could be that person.”
Gates sits with those women in their homes, and holds their babies in her arms. As she talks to them about their lives, their challenges, their desires, Gates is studying their culture, their social networks and the practices that help and hinder the foundation in achieving its public health goals.
At the conference, she talks about a ritual in a north Indian community where mothers rub newborn babies with mustard seed oil, a practice shown to introduce infections to babies. The foundation looked for an alternative and found that sunflower seed oil can prevent infection.
Getting women to switch requires the “science of behaviour change”, Gates says. It requires advanced social marketing strategies, on a par with the ones Coca-Cola uses to make its soft drink the number one beverage of choice in far-flung rural villages. It requires deliberate social networking, on a par with Facebook’s elaborate social graph, to identify who in a community has the connections to influence others’ behaviours.
The foundation worked with mothers in the Indian community to write a song, a jingle set to a catchy Indian tune, that explains what oil to use, where to put it, and where not to. They taught it to grandmothers, because they have the influence to spread messages in the community. “We hope it will spread to many, many villages, so it works in a culturally appropriate way, so it actually saves the lives of newborns,” Gates says.
The Gateses have always taken a business approach to solving philanthropic problems, a strategy that has won them praise, mostly from the business world, and intense criticism, mostly from the philanthropic world. “One of the problems in philanthropy is you’re dealing with social problems that are going to take a long time to solve,” says Stacy Palmer. “You can’t look at a quarterly statement and say, ‘We’ve made this much progress but it’s not enough, so we’re going to shut this programme down.’ Looking at long-term solutions is hard because that’s not how business operates, but that is how philanthropy works.”
Other critics say the Gateses’ wealth has allowed them to monopolise the market for change, essentially outfunding other philanthropists. Diane Ravitch, an education historian, has blasted the Gates Foundation for its focus on test scores as a measure of teacher effectiveness, and for effectively quashing opposition by hiring or funding the bulk of education advocates, then using their studies to influence federal policymakers.