Melinda Gates

Remarks at the World Health Assembly - May 20, 2014

Melinda Gates
May 20, 2014— Geneva, Switzerland
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Mr. President, Director-General Dr. Chan, First Lady Dr. Christine Kaseba-Sata, Excellencies, ladies, and gentlemen.

Thank you for having me here today.

Global health is my second career. I wasn’t formally trained in the field, but I have spent the last 15 years learning about it from experts, many of you in this room. I have travelled to dozens of countries to see for myself how the right investments can help people tap into potential that has been buried under the burden of poverty and disease.

One thing I’ve learned during my apprenticeship in global health is how complex and how absolutely critical your work is, both as part of this assembly and out in your ministries. Here, you debate what is possible, and you encourage the world to see what we can accomplish together. Back at home, you do the challenging work that comes from today to bring those plans into reality and into results.

Simply put, you have proved that your bold ambition is justified. The world is getting healthier—faster—than ever before in history. To me, the best measure of success is declining child mortality we've been seeing in the last 20 years. When you think about global health as a choice between saving more children or letting more children die, I think it is very clear what we want.

The world’s record on child mortality is strong. Since 1990, the baseline year for the Millennium Development Goals, the number of children dying has gone down by 47 percent. This improvement is even more impressive if you account for the population growth that's happened during that time. If the rate of death had remained constant since 1990, then 17 million children would have died last year. Instead, the number was 6.6 million. That is incredible progress. It's also, though, still too many children dying.

The progress, to us, is stunning. And yet when you think of the 6.6 million children that died—almost all who could have been saved—that's just as stunning. It’s also an urgent call to us for action. Getting that number down as close to zero as possible is a cornerstone of your work.

My husband Bill has had the honor of addressing this assembly on two different occasions. The first time was in 2005, when our foundation was still very young, he explained who we are, why we were getting involved in global health at that time, and how we think together about solving problems with our partners.

He told the story of the newspaper article that he and I both first read about rotavirus. we couldn't believe that rotavirus, a diarrheal disease, was still killing hundreds of thousands of children a year in poor countries but almost no children in rich countries. How could that be? We just couldn't believe it.

We were shocked by this glaring inequity, an inequity that doesn't need to exist, but we were also inspired by the world’s ability to address that problem. Innovations like oral rehydration therapy and rotavirus vaccines are making it possible to save those lives of those children—and to live out the principle that Bill and I believe in, and that is that all lives have equal value.

In 2011, Bill talked specifically in this assembly about our foundation’s work on vaccines. This body committed to make this the Decade of Vaccines, and you committed to reaching all children with the vaccines they need by 2020. The WHO regional committees are tracking progress against this Global Vaccine Action Plan.

The GAVI Alliance, which has worked with you to drive global immunization rates higher than ever before, will be hosting its replenishment in this next year. The results of that process will have a major impact on the story of child survival in the coming years.

Bill also has spoken about the world’s fight to eradicate polio. At the time he spoke, there were four polio-endemic countries in the world. Now, thanks to India’s heroic efforts, we're down just to just three endemic countries. We still face serious challenges, including outbreaks. But new partners are joining the initiative. And they are using innovative approaches, including creating a Global Islamic Advisory Group under the Grand Imam of Mecca to support vaccination.

Since you first heard about our foundation's work, our core values have not changed—and they never will. We will always do this work because we despise inequity, and because we believe in the power of innovation to solve these problems.

Today, I’d like to talk about the issue I spend the majority of my time on and thinking about: and that is the health of women and children around the globe.

A few years ago, I visited a hospital in Lilongwe, Malawi, and I was privileged enough to be there when a brand new baby was born, and they rushed the child across from the maternity ward onto a warmer that was there in front of me. And as that baby gasped for her first breaths of life, a health care worker was there to use a bag and mask to help her breathe. She faced birth asphyxia but was fine in that situation.

Because the hospital was crowded, laying side by side on that same warmer was a newborn baby boy who had been delivered out on the road a few hours earlier while his mom tried to get transport to the hospital and was unable. And as I saw those two babies lying side by side on that warmer, a baby gasping for her first breaths and a child dying and gasping for his last, it showed exactly the inequities that we face today in newborn mortality.

There are two versions of the future. One is full of promise. The other is a broken promise. How well we care for women and children will determine which future comes to pass.

To the global health community, newborns are part of a broader continuum. We talk about their lives in the context of five letters: RMNCH. Reproductive, Maternal, Newborn, and Child Health.

It’s a cumbersome acronym and a mouthful, but there are good reasons to link those letters together.

In people’s experience, in their lives, they are inextricably linked. Newborns don’t undergo some sort of transformation on the 29th day of their lives, regardless of the fact that we as a global community start to call them children on that day. As far as parents are concerned, there is no difference between the N and the C in that acronym.

And each step along that continuum relies on the previous step that comes before it.

  • If a woman can plan her family, she's more likely to space her pregnancies.
  • If a woman spaces her pregnancies, they are more likely to have healthy babies.
  • If women's babies are healthy, they are more likely to flourish as children and later as adults.

The positive benefits of a child thriving at the beginning last a lifetime.

This isn’t true just in developing countries where maternal and child mortality is relatively high. It’s true everywhere. In fact, we keep seeing new evidence that links maternal and child health to non-communicable diseases like cardiovascular disease, obesity diabetes—all things that plague countries around the world today.

The data is convincing. If we want thriving societies tomorrow, we need healthier mothers and babies today.

I have three children. When I travel, I find myself drawn to the mothers who I meet around the world. Their stories—which are about their tenacious fight to give their children a better life than they've had—ring in my ears and inspire me to do the work I do. When I look at the data about maternal and child mortality, I always try to remember that behind those numbers are women's stories and children's stories around the world, the stories of their lives.

Women and children are a leading indicator of health of the world. So the trend lines that we're seeing are encouraging. I already mentioned child mortality. And it’s not just that more children are surviving; it’s also that more children are developing cognitively and physically in ways that will help them lead productive lives.

The trajectory for maternal mortality is also similar. Between 1990 and 2010, the annual number of maternal deaths has dropped from about 550,000 to fewer than 300,000. When you think of the ripple effect that 250,000 mothers who are alive and well, the effect on their communities is momentous.

However, this exciting child and maternal health news and data highlights the fact that the data for newborn health still isn’t nearly good enough. The world is saving newborns at a slower rate than we are children under five. Each year, 2.9 million children die in their first month of life. One million children die on their first day of life.

The vast majority of these newborn deaths are preventable. I want to be very clear about what I mean about preventable. I don’t mean theoretically preventable under some ideal or unrealistic circumstances. I mean preventable with relatively simple and inexpensive interventions. Preventable with systems and technology available we have now in almost every single country out there.

Let me give five examples of these interventions, which you can read more about in the Lancet series on newborns that was published just today.

  • Resuscitating babies who aren’t breathing, like I saw those nurses do in that hospital in Malawi. It requires basic training and a bag mask that costs all of $5.
  • Drying the baby immediately and thoroughly, which helps prevent hypothermia. That's the second intervention.
  • The third is using chlorhexidine, a basic antiseptic that costs just a few cents, to clean the umbilical cord and stop infection into the newborn.
  • Breastfeeding within the first hour, and breastfeeding exclusively for the first six months. Breast milk is the global gold standard for infant nutrition, and it serves as a baby’s first immunization by delivering antibodies from the mother to the child.
  • And finally, kangaroo mother care, skin-to-skin contact between a mother and a newborn to regulate the baby’s temperature, heart rate, and breathing that prevents infection and will promote the flow of breast milk.

These are best practices in the world everywhere, but that aren’t being used optimally anywhere. The United States – the country I'm from – spends more than $10 billion a year to treat babies with conditions resulting from sub-optimal breastfeeding. And U.S. pediatricians only recently began to recommend skin-to-skin care for newborns, instead of incubators.

Resuscitation. Drying the baby. Chlorhexidine cord care. Immediate breastfeeding. Skin-to-skin contact.

If we could manage to get these five interventions scaled up around the world, we would save hundreds of thousands of newborns a year.

What’s more, these inexpensive measures can be incorporated into health systems that are already in place in countries throughout the world.

When it comes to managing serious complications, it’s best for mothers and newborns, we know today, to be in health facilities, provided that the quality of care in those facilities is high.

However, the high-impact interventions that I just mentioned can also be delivered by frontline health workers. For example, Ethiopia trained health extension workers in certain regions to provide improved maternal and newborn care, including the five interventions I that just mentioned. The result was an impressive 28 percent reduction in newborn mortality – 28 percent reduction.

That same frontline health care worker who manages sepsis can counsel women about contraceptives, conduct pre-natal visits, and give vaccines. Ultimately, it’s the combination of all these interventions that will help women and children lead healthy and productive lives. Even though I have been focusing on newborn health, I want to reiterate that the goal is not to prioritize newborns above these other priorities that are part of RMNCH, but to look at the continuum of care and to keep each of them properly in their right place alongside that continuum of care.

These interventions have to be integrated, and, with your leadership, they can be.

This week, you're going to consider the Every Newborn Action Plan in front of this assembly. If you endorse that plan, I encourage you to use the full power of this assembly, as well as the regional committees and national engagements of the WHO, to track its progress in detail. We will be tracking alongside you at our foundation, because we are also aligning our investments to help newborns thrive alongside yours. It is one of our top priorities.

You will be the ones responsible for translating this plan into action when you go back home. No public health intervention, no matter how successful it seems to be in a laboratory, can succeed without great leadership and management on the ground. The clinical science is one thing. The complex process of making sure that women and children in your countries benefit from the science is something else.

I don’t claim to know all of the competing pressures that cross your desk every single day. But I do know that no health minister can drive change alone. Progress requires working with other government officials, not to mention the private sector, civil society, religious organizations, and community leaders. And winning allies requires making a case that newborn health is more than just one priority amongst many.

Saving newborns lives is a tender-hearted act of love, and it also makes hard-headed benefit. The Lancet recently published the most advanced analysis to date of the links between public health and economic growth. The report finds that lower mortality by itself has accounted for about 11 percent of economic growth in low- and middle-income countries. And that’s not counting the enormous economic advantages of a healthier, more productive labor force. The report modelled a package of health interventions focused on RMNCH and found that every dollar invested leads to at least $9 of economic benefit.

At the Gates Foundation, we’re committed to supporting your leadership. That’s why we’re working with you to generate the evidence you need to strengthen your case that investments in women and children’s health provide value for money. For example, because of requests from you, we funded research into the demographic dividend that shows the connection between family planning, maternal and newborn mortality, child survival, nutrition, and economic growth. We will continue to gather whatever evidence you need to advocate for your priorities. Your priorities are our priorities.

Another way we can help is by supporting additional clinical and operational research. For instance, which interventions are most effective? Can they be cheaper? Can they be adapted so they’re easier to use? Can they be implemented more efficiently? The answers to these questions will help you get more impact per dollar, and we are investing with you to find the answers to those questions.

Finally, we will always advocate for these issues—and for the women and children who are fighting for a better life.

As you define your national priorities and draw up your national plans, we will work with global donors, both private and public, to align around shared priorities. We will explain why we are investing our money in these issues, and we will try to persuade donors that they should as well.

For most of human history, we have been resigned to the fact that women and children die.

But you and I are fortunate to be living at a time when we don’t have to be resigned to that face any longer. The facts are clear: When we invest in health, we get results. That’s a paradigm shift, the notion that we have the power to prevent sickness and promote better health. That exists in front of us today.

But there are other perceptions that still need to change. There is still a sense that cutting-edge health care requires expensive technology. There is still a sense that improving health is a nice thing to do, but not a smart way for a country to invest money.

That is why this assembly is so important.

You are representing nations around the world at a historic moment—at the moment when we have solid proof that investing in health is the best use of our collective resources. People sometimes say that investing in women and children has too uncertain of a return. Well guess what – you and I get to be the ones to say that is simply not true.

And we can use that evidence that we built today to insist to the world—from this day forward, every baby born will be a promise kept. Thank you.

Gates, Melinda. 2014. "Melinda Gates World Health Assembly Remarks (against delivery)." World Health Organization.

World Health Organization. "WHO: Melinda Gates speech - 67th World Health Assembly 20 May 2014." May 20, 2014. YouTube video, 22:03.