Gates Foundation Examined Inequality

For the next 2 weeks, Midtown Manhattan will be even busier and more diverse than usual. Leaders and bureaucrats from all over the world have descended on the United Nations for the 74th Session of the UN General Assembly, known by those in the know as UNGA 74. At the 2015 General Assembly (UNGA 70), the Assembly announced the Sustainable Development Goals. The SDGs are a collection of 17 goals meant to make the world safer, healthier, wealthier, and more just by 2030. What makes these goals so powerful? In his book, Influence: Science and Practice, Robert Cialdini writes, “Once we have made a choice or taken a stand, we will encounter personal and interpersonal pressures to behave consistently with that commitment.” The UNGA is the world stage for politicians and development actors to make commitments and hold themselves accountable. To this end, the Bill & Melinda Gates Foundation has published a report, Examining Inequality, on how the world is doing. In short, it’s not great. It’s even worse if you are a girl. 

According to their report, “Very few developing countries are projected to meet the health and education SDGs. Nearly two-thirds of the children in low- and low-middle income countries live in districts that, at their current rate of progress, won’t reach the SDG target for child mortality by 2030.” More children die each day in Chad, a country in Central Africa, than in Finland in a year. The report makes its statistics visceral. Taking a young girl from Chad, they write, “The data says she has probably been close to starving to death several times…It is likely that she can’t read or write, and that she will get pregnant well before she turns 20, although her body won’t be ready for the rigours of childbirth.” If we look at these two dimensions, health and schooling, women in Africa are not getting the investment they deserve. Girls go to school for two fewer years than boys and even well-educated women find it harder to find jobs. Girls are kept home from school in part to help around the house. According to the report, the average woman does 4 hours of unpaid domestic work per day. This represents $10T  of value per year. The average man does just over an hour per day. Regardless of gender, there needs to be more investment in healthcare in Africa. World Health Organization (WHO) data suggests that governments in low-income countries need to spend $86 per capita annually to fully fund primary health care. Today, Kenya, for example, is spending only $36 per capita. When primary care is under-funded, women suffer. Childbirth is still dangerous in most parts of Africa. In the Central African Republic, Chad’s southern neighbour, 594 out of 100,000 mothers die during childbirth

The report shows that there is good news and bad news. The good news is that these public goals have catalysed effort and innovation. According to the report, Botswana has implemented gender-inclusive laws and policies. This has contributed to women in Botswana being three times more likely to find formal employment than women in Ghana, despite both countries averaging 8 years of schooling. In Rwanda, Ethiopia, and across the continent, governments, entrepreneurs, and NGOs have created community health care worker programs to deliver cost-efficient primary care to women (and their families) in their homes and communities. In Kenya, Access Afya, has treated 125,907 patients at 12 clinics with a 96% success rate according to their website. They make treatment, medicines, insurance, and financing available within the communities that need it. The report’s bad news is that “gender inequality cuts across every single country on Earth. No matter where you are born, your life will be harder if you are born a girl.” Until girls and women get the health care, education, and economic inclusion that men enjoy, we will not reach the SDGs and the world will never be safer, healthier, wealthier, and more just. Especially not by 2030.

Credit: Meghan McCormick for Forbes, 18 September 2019.