An Evidence Based View of Public Health

>>> GOOD MORNING EVERYBODY.
GOOD MORNING IN ATLANTA.
GOOD MORNING AROUND THE U.S.
GOOD MORNING AROUND THE WORLD.
IT'S A PLEASURE TO WELCOME YOU TO THE MOUNTIN LECTURE.
AS YOU KNOW JOSEPH MOUNTIN WAS THE FIRST DIRECTOR OR FOUNDER OF
CDC.
THE OFFICE OF MALARIA IN WAR AREAS.
THIS IS THE 32nd ANNUAL MOUNTIN LECTURE.
I WANT TO THANK YOU FOR BEING HERE.
I WANT TO THANK OUR SPEAKER FOR COMING.
IT'S A TREMENDOUS PLEASURE TO INTRODUCE HANS ROSLING.
IT'S A TREMENDOUS PLEASURE FOR TWO REASONS IN PARTICULAR.
FIRST, BECAUSE HE'S A WONDERFUL SPEAKER.
HE'S ONE OF THE VERY FEW PEOPLE, SCIENTISTS WHO CAN MAKE DATA
COME TO LIFE.
YOU CAN COMBINE TREMENDOUS CREATIVITY WITH RIGOR.
SECOND, BECAUSE BY INTRODUCING HIM, I KNOW THAT I'M SPEAKING
BEFORE HIM AND NOT AFTER.
I WOULD HATE TO HAVE TO SPEAK AFTER HIM.
THERE ARE TWO PEOPLE I HATE TO SPEAK AFTER.
DR. ROSLING AND DR. BOWL SAYING I.
BOTH ARE HERE IN THE FRONT ROW.
SO WELCOME.
DR. ROSLING IS PROFESSOR OF INTERNATIONAL HEALTH AT THE
KAROLINSKA INSTITUTE AND DIRECTOR O OF THE GAPMINDER
FOUNDATION.
HE IDENTIFIED KONZO, RARE PARALYTIC DISEASE AND HE'LL BE
MEETING LATER TODAY WITH OUR TEAMWORKING ON A DISEASE IN
AFRICA TO SHARE INSIGHTS.
HE IDENTIFIED THAT IT WAS BADLY PROCESSED ROOT THAT PEOPLE WERE
EATING TO STAVE OFF FAMINE.
GOING BACK TO THAT FUNDAMENTAL CONNECTION BETWEEN HEALTH AND
ECONOMY, BETWEEN HEALTH AND POLITICS.
HE CO-FOUNDED DOCTORS WITHOUT BORDERS OF SWEDEN, AS WELL AS
THE GAPMINDER FOUNDATION.
AND THE GAPMINDER WEBSITE, WHICH I THINK MANY OF YOU HAVE SEEN.
A RARE BREED THAT COMBINES GREAT SCIENCE WITH GREAT
COMMUNICATION.
RONALD COAST O, A GREAT ECONOMIST SAID IF YOU TORTURE
THE DATA ENOUGH, IT WILL CONFESS.
[ LAUGHTER ] NOW, THAT'S SOMETIMES MISQUOTED
AS IT WILL CONFESS TO ANYTHING.
THAT'S NOT TRUE.
THERE IS SUCH A THING AS THE RIGHT ANALYSIS.
AND I THINK WHAT YOU'LL FIND IS THAT DR. ROSLING HAS AN UNCANNY
ABILITY TO TRANSLATE DATA INTO FASCINATING, UNDERSTANDABLE AND
INSIGHTFUL PRESENTATIONS.
DATA DOESN'T HAVE TO BE AND IN FACT SHOULDN'T BE DULL.
DR. ROSLING IS A REPEAT TED PRESENTER.
HE HAS MORE THAN 11 MILLION VIEWS OF HIS DIFFERENT TED
PRESENTATIONS AND THEY ARE, I THINK, REALLY UNPARALLELED IN
THEIR CLARITY AND IMPORTANCE.
MY PERSONAL FAVORITE INTRODUCES A NEW MARK OF ECONOMIC
DEVELOPMENT, THE WASHING MACHINE LINE.
WHAT IS THE LEVEL ABOVE WHICH PEOPLE CAN AFFORD WASHING
MACHINES AND HOW DOES THAT CHANGE SOCIETY.
YOGI BERRA, GREAT AMERICAN PHILOSOPHER SAID, YOU CAN
OBSERVE A LOT JUST BY WATCHING.
[ LAUGHTER ] SO PLEASE JOIN ME IN WELCOMING
AND WATCHING AS DR. ROSLING GIVES OUR MOUNTIN LECTURE.
[ APPLAUSE ]
>>> THANK YOU SO MUCH. THOSE WERE KIND WORDS.
I STARTED WITH MY MOST IMPORTANT PROFESSIONAL AND TRAINING PERIOD
WHEN I WAS DISTRICT MEDICAL OFFICER, YES, IT'S ME OVER
THERE -- [ LAUGHTER ]
THE YOUNGER VERSION.
MY WIFE IN FRONT OF ME AND MY COLLEAGUE FROM SWEDEN, AT THE
HOSPITAL IN NORTHERN MOZAMBIQUE.
WE WERE NOT AID WORKERS.
WE WERE IMMIGRANTS.
I WORKED DIRECTLY ON THE GOVERNMENT CONTRACT IN THE
GOVERNMENT HEALTH SERVICE.
THAT MADE QUITE A DIFFERENCE.
AND IT WAS BEING IN CHARGE FOR BOTH PUBLIC HEALTH AND
CORRECTIVE HEALTH.
HERE I'M TREATING A WOMAN IN THE MATERNITY WARD.
AND ONE CAN MAKE THE DIAGNOSIS?
SHE DELIVERED NINE DAYS AGO.
SHE HAS A FUNNY SMILE.
SAHR DOEN KISS.
WE MET THE SITUATION WHERE NOT EVEN THE BASIC VACCINES ARE
AVAILABLE BUT SHE HAD ONE SHOT DURING THE NATIONAL CAMPAIGN AND
SHE DID SURVIVE A TETANUS WITH LIMITED RESOURCES.
NOW, IN SWEDEN, I DID MY INTERNSHIP IN A DISTRICT IN
NORTHERN SWEDEN -- [ LAUGHTER ]
YEAH.
THIS IS A PROTOTYPE.
DEVELOPING THE ORGANIC LASER POINTER.
[ LAUGHTER ] [ LAUGHTER ]
PSYCHOLOGISTS SAY IT'S MUCH, MUCH BETTER THAN THE NORMAL ONE.
I CONSIDER IT A NEUROLOGICAL DISORDER, YOU KNOW.
[ LAUGHTER ] THIS WAS THE DISTRICT.
WE HAD FIVE HOSPITALS AND THE NUMBER OF PEOPLE YOU CAN SEE
OVER HERE, 360,000 PEOPLE, 8 MDs AND 30 CHILDREN ARE DYING EVERY
YEAR.
NOW, IN MOZAMBIQUE, I CAME TO WORK IN A DISTRICT WHICH HAD THE
SAME SIZE GEOGRAPHICALLY AND ALMOST THE SAME NUMBER OF
PEOPLE.
BUT IT WAS JUST ONE LITTLE SMALL HOSPITAL.
YOU SAW THE PHOTO OF THE ENTIRE STAFF IN FRONT OF THAT HOSPITAL.
THAT WAS THE ENTIRE STAFF FOR 300,000 PEOPLE.
AND THERE WERE 3,000 CHILDREN DYING EVERY YEAR.
AND WE WERE JUST TWO M.D.s.
ONE YEAR I WAS ALONE.
THE DIFFERENCE BETWEEN BEING ALONE AND BEING TWO IS THE
BIGGEST, BIGGEST CHANGE IN HEALTH SERVICE YOU CAN THINK
ABOUT.
BECAUSE YOU CAN'T GO TO REST SOME DAYS.
THIS SITUATION FOLLOWED ME ALL MY LIFE.
I'VE BEEN TRYING TO UNDERSTAND THOSE TWO THEORIES.
HA DOES IT MEAN TO HAVE 100 TIMES MORE RESOURCES?
100 TIMES MORE RESOURCES, WHAT DOES IT MEAN TO HAVE 100 FOLD
BIGGER NEED?
BECAUSE IT GOES IN BOTH DIRECTIONS.
ACTUALLY, THE DIFFERENCE BETWEEN NEED AND RESOURCES IS 10,000
TIMES.
BECAUSE THIS POPULATION WAS SO SICK AND THEY WERE LIVING IN
SUCH REMOTE AREAS AND DIFFICULT CONDITIONS.
SO IT HAS FOLLOWED ME TO TRY TO UNDERSTAND THIS, HOW IT COULD BE
LIKE THIS.
NOW, IN THE MIDST OF THIS, I GOT A MESSAGE WHEN WE TRIED TO RUN
THE HEALTH SERVICE, THE ORDINARY HEALTH SERVICE, IN 1981 THERE
WAS A SEVERE DROUGHT AND FROM THAT LITTLE HEALTH POST UP
THERE, WE GOT THE MESSAGE AND IT READ MORE LIKE THIS.
IN SHORT NOTE.
IT WAS SISTER LUCIA, A CATHOLIC NUN WORKING THERE FOR 20 YEARS
AND SHE SAID, I'VE SEEN 30 WOMEN AND CHILDREN WITH SUDDEN ONSET
OF PARAPLEGIA.
I'VE NEVER SEEN THE DISEASE BEFORE.
SOMEONE HAVE WORKED IN THAT HEALTH POST FOR 20 YEARS.
THIS WAS A MESSAGE.
I HAD TO GO THERE AND THIS IS WHAT I MET.
CHILDREN WITH VARYING DEGREE OF SEVERE SPASTIC PARALYSIS IN
THEIR LEGS, WITH SUDDEN ONSET AND ABSOLUTELY NO OTHER
SYMPTOMS.
I WENT THROUGH THE NEUROLOGY BOOK.
WE ONLY FOUND ONE THING CLOSE BUT THERE WAS NOTHING IN THE
AREA.
IT WAS A SHOCKING THING.
I STILL REMEMBER THOSE 20 MINUTES WHEN I REALIZED THIS IS
A NEW DISEASE.
I'M SITTING HERE ALONE IN FRONT OF A NEW DISEASE AND YET THREE
MONTHS AGO WE HAD THE SOUTH AFRICAN SUBMARINE OUT IN THE BAY
BEHIND.
IS THIS BIOLOGICAL WARFARE?
THIS WAS THE SORT OF POINT.
YOU KNOW WHAT YOU THINK ABOUT, WHAT OCCUPIES YOUR ENTIRE MIND
IN THAT MOMENT?
IT'S EMBARRASSING.
99% OF YOUR MENTAL POWER GOES TO, I WILL GET INFECTED, WILL I
DIE?
YOU ARE JUST LEFT WITH 1% TO BE USEFUL.
YOU GET SO SCARED.
THAT WAS MY PROBLEM.
YOU GET SO SCARED YOURSELF.
YOU HAVE REALLY THE CONTROL.
HADN'T IT HAVE BEEN FOR THE NUN WHO WERE CALM AND TALKED ME
DOWN, I WOULDN'T BE ABLE TO BE USEFUL.
BUT I REALLY HAD -- I'M DEEPLY GRATEFUL FOR THEM.
THIS WAS OUR FIRST EPIDEMIOLOGICAL SURVEY.
WE WITHOUT ANY EXTERNAL FUNDS, WE SURVEYED 500,000 PEOPLE IN
FOUR WEEKS WITH NURSES ON MOTORBIKES.
THAT MADE VERY SIMPLE NEUROLOGICAL EXAMINATION OF THE
REFLEXES.
AND WE COULD SUMMARIZE THAT INDEED WE HAD AN AREA WITH
SEVERE DROUGHT AND MAINLY -- WE HAD 2 TO 3% AFFECTED.
YOU COULD SEE THAT WHAT THIS SHOWS HERE IS 29 PER THOUSAND.
WE HAD MAPPED IT ALREADY.
WE HAD A CENSUS AFTER THE WAR IN MOZAMBIQUE
MOZAMBIQUE.
IF YOU HAVE A CENSUS, YOU HAVE A DENOMINATOR.
THAT'S THE MOST IMPORTANT THING.
WITH THE DENOMINATOR AND WE HAD THIS ON THE SMALL VILLAGE AREA
AND WE HAD THAT, THEN WE COULD GET THE NUMERATOR ON TOP OF THAT
AND SEE WHAT SHARP GEOGRAPHICAL DISTRIBUTION WE HAD OF THIS
DISEASE.
IT WAS FULLY CLEAR THERE WERE NO CASES ALONG THE COAST WHERE THEY
WERE FISHING, NO CASES ON THE INLAND WHERE THERE HADN'T BEEN A
DROUGHT AND NO CASES IN THE CITIES.
IT DIDN'T TRANSMIT.
THE 14, 15 DAYS WOULD THE EPIDEMIC I GOT MY WIFE TO COME
BACK WITH THE CHILDREN BECAUSE THAT'S WHAT WE DID.
WE EVACUATED THE FAMILY AND WE PUT THE INVESTIGATION INTO OUR
HOME.
WE DECIDED THAT THE NUMBER OF PEOPLE WHO INVESTIGATED THE CASE
IS WE ALL LIVE TOGETHER FOR THE FIRST QUITE TRAUMATIC.
>> WE FOUND AN ASSOCIATION.
THEY KNEW THAT THEY HAD LOST EVERYTHING ELSE THAT THEY WERE
SHORT.
IT WAS NOT LACK OF KNOWLEDGE.
IT WAS LACK OF FOOT.
THEY JUST DIDN'T HAVE ANYTHING MORE TOO EAT.
>> IT'S THE BEST CONVERTER OF SUNSHINE TO CALORIES IN FOOD
THAT MAN CAN HAVE COME ACROSS.
IT'S THE FIFTH STAPLE CROP OF THE WORLD.
BUT THE BITTER ROOT YIELD CYANIDE.
THAT'S GOOD, BECAUSE IT PROTECTS THE CROP.
IT HAS BEEN SELECTED PURPOSELY FOR IT AND YOU CAN PROCESS IT.
BUT IN THIS DROUGHT THEY DIDN'T HAVE TIME.
WE FOUND SIMILAR OUTBREAKS ACROSS AFRICA.
TOOK 20 YEARS TO DEFINE THIS DISEASE AND Ph.D. STUDENTS.
I'M PROUD OF MY STUDENTS TEACHING NUTRITION AND IT WAS
POVERTY.
SEVERE POVERTY.
I HAVE THE PERMISSION OF THE FAMILY TO SHOW THIS PHOTO.
I'VE TAKEN AS A ROUTINE FROM THE VERY START TO ALWAYS HAVE
PERMISSION OF IT AND PEOPLE ARE AWARE FOR EDUCATIONAL PURPOSES
YOU CAN USE THIS.
AND IT'S DEEP, DEEP PUBLIC.
WE PUBLIC -- THE NEW DISEASE.
WE TOOK THE NAME OF THE FIRST AFFECTED POPULATION, REPORTING
IN THE COLONIAL ARCHIVE KONZO, NOT TO LINK THE NAME TO A
POSSIBLE ETIOLOGY.
BECAUSE WE WERE NOT SURE OF A LINK.
THAT'S WHY WE SAID LET'S NAME THE CLINICAL CONDITION SO THAT
SOMEONE CAN PROVE US WRONG ON THE ETIOLOGY.
ON THE NEW CLINICAL CONDITION, WE WERE ABSOLUTELY SURE THAT WE
WERE RIGHT, IT WAS A NEW DISEASE.
NOW, AT THIS POINT, I HAD TO MAKE A CHOICE IN MY CAREER.
WOULD I GO TO TRY TO FIND OUT THE BRAIN, WHAT WAS THE MEASURE
OF THIS.
I MET WITH SOMEONE AND GOT ADVICE ON HOW TO GO THE
NEUROLOGICAL WAY.
I WAS MORE MOTIVATED TO GO ON AND LOOK INTO THE POVERTY.
THE REST OF MY CAREER HAD BEEN TO TRY TO UNDERSTAND THE DEEP
POVERTY AND REMOTE RURAL AREAS OF AFRICA.
AND WHY THE WORLD LOOKED AT IT.
ESPECIALLY, I GOT ANNOYED AT THE TIME ABOUT THE IDEA OF A WORLD
WITH DEVELOPING COUNTRIES AND DEVELOPED COUNTRIES.
IF WE LOOK AT THE MAP HERE, I REGARD THIS SOFTWARE HERE AS A
MAP.
I'LL GIVE YOU A FULL SCREEN THERE.
IN THIS MAP, INSTEAD OF NORTH AND SOUTH, I HAVE HEALTHY 80
YEARS LIFE EXPECTANCY IN THE NORTH AND 30 YEARS IN THE SOUTH.
AND THEN I HAVE LOW INCOME, 300, 3,000 AND $30,000.
THAT MEANS THAT YOU CAN SEE THAT THERE ARE COUNTRIES, 191,
MOZAMBIQUE WAS ONE OF THE POOREST COUNTRIES AND ONE OF THE
COUNTRIES WITH THE LOWEST HEALTH SITUATION.
THIS WAS BEFORE HIV AND AIDS.
WE'RE HERE YEARS BEFORE THE HIV OUTBREAK.
BUT THE COLONIAL PAST AND THE PAST WAR OF INDEPENDENCE HAVE
PUT MOZAMBIQUE THERE AND SWEDEN WAS UP HERE.
YOU CAN IMAGINE THE DIFFERENCE AS A YOUNG PHYSICIAN TO GO FROM
THERE TO THERE.
BUT I FOUND THAT MOST OF THE WORLD WAS IN BETWEEN.
WHEN I STUDIED IT CAREFULLY, I COULDN'T SEE ANY CUTOFF.
CAN YOU SEE A CUTOFF BETWEEN THE DEVELOPING WORLD AND THE
DEVELOPED WORLD IN?
>> NO.
IT WAS IN THE MIND-SET.
IT'S IN THE MIND-SET.
THERE WERE COUNTRIES ALL THE WAY.
THIS WAS CHINA, THE GREEN -- THE SIZE OF THESE BUBBLE IS THE SIZE
OF THE POPULATION.
THAT IS RUSSIA, THIS IS UNITED STATES.
YELLOWISH ONES HERE IS AMERICA.
BROWN EUROPE, RED EAST ASIA.
LIGHT BLUE, SOUTH ASIA.
DARK BLUE IS AFRICA AND GREEN IS THE MIDDLE EAST.
THERE ARE COUNTRIES ALL THE WAY.
AND I COULDN'T UNDERSTAND HOW PEOPLE WOULD THINK ABOUT THE
DEVELOPING WORLD, YOU'VE WORKED IN THE DEVELOPING WORLD.
I GOT THE CONCEPT.
YOU CAN'T DESCRIBE THE AMERICAN HISTORY INTO TWO CHAPTERS AND
PUT MAYFLOWER AND EISENHOWER IN THE SAME CHAPTER.
IT DOESN'T MAKE SENSE.
THINK ABOUT THE PROGRESS OF THIS COUNTRY FROM MAYFLOWER TO
WASHINGTON TO LINCOLN TO EISENHOWER TO OBAMA.
THOSE ARE DIFFERENT STAGES IN DEVELOPMENT, IN HEALTH AND
ECONOMY, IN CIVIL RIGHT, EVERYTHING.
AND THE WORLD IS IN THE SAME WAY.
WE NEED MORE CATEGORIES.
THE IDEA OF UNDERSTANDING THE WORLD IN TWO CATEGORIES DOESN'T
HAVE INTELLECTUAL CONTENT.
I'M NOT TALKING ABOUT POLITICS.
I'M NOT TALKING ABOUT ADVOCATES.
PURELY INTELLECTUAL.
IT DOESN'T MAKE SENSE.
AND THIS IS WHY I CAME TO STUDY AFTER WHY THE -- I REALIZED THAT
IF WE GO BACK INTO HISTORY, THEY WERE ALL POOR AND SICK.
[ LAUGHTER ] EVEN IF UNITED KINGDOM WAS A
LITTLE RICHER THAN THE UNITED STATES, AND IT WAS A VERY BAD
IDEA OF UNITED STATES TO GO FOR INDEPENDENCE.
[ LAUGHTER ] >> OF COURSE, YOU COULD SEE THAT
YOU WOULD BE RICHER HERE.
THEY SAID, LOOK, YOU'RE STILL BETTER OFF WITH NETHERLANDS IS
EVEN HERE IN BETWEEN.
[ LAUGHTER ] AND THEN WHAT HAPPENED IS THIS.
THAT UNITED KINGDOM FORGED ON AND UNITED STATES TRIED TO PROVE
THAT INDEPENDENCE WAS A GOOD IDEA AND HERE THEY CAME UP AND
THERE THE PROOF OF INDEPENDENCE CAME.
[ LAUGHTER ] IT WAS A GOOD IDEA, WASN'T IT?
AND THE REST OF THE WORLD LOOKED AT THE YOU STATE AND SAID, YEAH,
IT'S A GOOD IDEA TO BE INDEPENDENT.
WHY DON'T WE GET INDEPENDENT JUST LIKE THE YOU STATE OF
AMERICA?
AND IN 1918 AFTER THE FIRST WORLD WAR, UNITED STATES STOOD
UP AS THE BIG EXAMPLE FOR THE COLONIZED COUNTRIES IN THE
WORLD.
TO BECOME INDEPENDENT.
BUT THAT WAS TO TAKE ANOTHER RECESSION AND ANOTHER WORLD WAR
AND THEN THEY GOT INDEPENDENT.
AND THEY RAISED UP HERE, THEY CAME.
THEY GOT HEALTHY FIRST.
AND THEN THEY GOT RICH.
LOOK AT THE COMPARISON IF WE GO BACK HERE AND WE COMPARE CHINA
AND U.S.
UNITED STATES AND CHINA.
WHAT WE LEARNED IS THAT, WHILE UNITED STATES WAS DEVELOPING
TECHNOLOGY, IMPROVING ITS ECONOMY, YOU KNOW, AND GRADUALLY
RESEARCH WAS GIVING MORE AND MORE, WE CAN PUT ON THE BUBBLES.
IT WAS REALLY MONEY FIRST AND THEN CAME HEALTH.
THEN CAME HEALTH.
CHINA WAS DOWN IN THE CORNER.
WHEN CHINA EMERGED, THEY WENT STRAIGHT UP IN HEALTH UNTIL THE
STUPID GREAT LEAP THEY FELL DOWN AND THEN THEY CAME UP HERE AND
THEN THEY DIED AND SAIDLET GO FOR THE MONEY.
[ LAUGHTER ] IT'S INTERESTING.
IT STANDS OUT.
THEY GOT HEALTHY FIRST AND THEN THEY GOT WEALTHY.
WEDNESDAY MORNING, I LECTURED TO A SIMILAR GROUP AT GOLDMAN SACHS
IN MANHATTAN.
THEY ARE DESPERATE.
THEY INVITE ME THIS PUBLIC HEALTH PROFESSOR.
[ LAUGHTER ] I TOLD THEM, WHY DO YOU DO THIS?
YOU DO THIS BECAUSE TODAY IN THE WORLD HEALTH IMPROVEMENT
DEMOGRAPHIC CHANGE PRECEDES ECONOMIC GROWTH.
IT'S ANOTHER PATTERN.
EVERYONE WANT TO GO FROM BEING POOR AND SICK TO BEING RICH AND
WEALTHY.
BUT THERE ARE DIFFERENT TRACKS YOU CAN FOLLOW.
THE HISTORICAL TRACK WAS YOU HAD TO BE WEALTHY FIRST AND THEN
PROCTER & GAMBLE, 1834 STARTED TO MAKE INDUSTRIALLY PRODUCED
SOAP AND SHIPPED IT OFF THE OHIO RIVER AND THAT'S MAJOR PUBLIC
HEALTH INTERVENTION.
ALWAYS REMEMBER THE SOAP.
TODAY WE TALK ABOUT HAND WASHING.
IT WAS ONE OF THE MAJOR REASON FOR IMPROVED HEALTH IN THE
MIDWEST WAS THE SOAP AND THE CANDLES, WHICH CAME HANDY AT
RELATIVELY LOW COST BECAUSE OF EFFICIENT PRODUCTION.
NOW, THIS IS THE WORLD TODAY.
THIS IS WHAT TOM FRIEDEN CALLED THE FLAT WORLD.
THEY'RE HEALTHY ALL THE WAY.
THERE'S ACTUALLY A BIGGER DIFFERENCE IN THIS DIMENSION.
IN ONE TENTH OF THE INCOME THAT ALMOST -- ALMOST HAVE THE SAME
HEALTH AS IT IS IN THE STILL TERRIBLE UNACCEPTABLE VARIATION
IN HEALTH FROM 50 TO 80 YEARS.
WE HAVE A WORLD WHICH INDEED HAVE CHANGED.
SOMEONE WHO SAW THIS YESTERDAY CITED DOROTHY WHEN SHE CAME TO
THAT EMERALD CITY AND SAID THIS IS NOT KANSAS ANYMORE.
LOOK HERE.
THIS WAS THE WORLD WE WERE USED TO.
AND NOW THEY'VE COME UP VERY FAST LIKE THIS.
NOW, LET ME SHOW YOU WHAT I'VE COME TO CONCLUDE.
IS THAT THE -- THIS IS OUR WEBSITE.
WE HAVE THIS.
THIS IS FREE OF CHARGE.
WE RUN GAPMINDER FOUNDATION.
IT'S A NONPROFIT, STRATEGICALLY NONPROFIT.
LIKE A MUSEUM THAT STAYS AT ARM'S LENGTH FROM CORPORATE AND
GOVERNMENT AND WE DON'T RUN ADVOCACY FOR ANYTHING.
IT'S JUST A ROADMAP FOR THE WORLD WHICH YOU CAN USE.
NOW, LOOK HERE.
WE FOUND THAT THERE ARE SOME POINTS IN GLOBAL DEVELOPMENT
THAT ARE WELL-KNOWN.
WHEN I WAS BORN, 1948, THERE WAS LESS THAN ONE BILLION CHILDREN
IN THE WORLD.
ZERO TO 50.
AND THEN DURING MY LIFETIME, THE NUMBER OF CHILDREN INDEED
INCREASED AT THE TURN OF THE CENTURY, THERE WERE 2 BILLION.
AND UNITED NATIONS POPULATION DIVISION, WHICH IS JUST CIVIL
SERVANTS OF THE WORLD AS YOU ARE, THEY MADE AN ESTIMATE.
DID THEY ESTIMATE IT WAS GOING TO CONTINUE TO GROW TO 4
BILLION, THAT IT WOULD SLOW DOWN AND BE 3 BILLION OR DID THEY SAY
HUH-UH, WE ARE NOT GOING TO GET ANY MORE CHILDREN IN THE WORLD,
THEY HAVE STOPPED GROWING?
HOW MANY HERE THINK THAT WE'LL BE 4 BILLION?
HANDS UP.
HOW MANY THINK 3 BILLION?
HOW MANY KNOW THAT IT WILL BE 2 BILLION?
[ LAUGHTER ] THAT'S INTERESTING, HUH?
IT'S ONE OF THE MAJOR NEWS.
IT'S OF COURSE, AN ESTIMATE.
BUT WITH THE UNCERTAINTY LEVEL IT WILL BE MORE OR LESS AT THIS
LEVEL.
WHY IS IT SO?
WELL, LET ME SHOW YOU ANOTHER GRAPH HERE WHICH WILL EXPLAIN
THIS.
AND THIS IS VERY IMPORTANT.
BECAUSE THE MOST COMMON QUESTION OR PROTEST THAT BILL GATES GETS
FOR THEIR REALLY, REALLY GOOD DONATION, BOTH IN SIZE AND IN
QUALITY FOR HEALTH OF THE POOREST, IS IF YOU SAVE THE POOR
CHILDREN, YOU DESTROY THE PLANET.
THIS IS A SINGLE MOST COMMON THAT THE ECONOMISTS GET BY MAIL
WHEN THEY WRITE ABOUT IT.
THE IDEA THAT SAVING POOR CHILDREN WILL CAUSE A POPULATION
EXPLOSION.
NOW, THIS IS 1962.
50 YEARS AGO.
HERE I HAVE NOW EIGHT CHILDREN, SEVEN, SIX, FIVE, FOUR, THREE,
TWO.
SMALL FAMILIES HERE.
BIG FAMILIES THERE.
HERE, WE HAVE CHILD MORTALITY.
100, 200, 300 PERFECT THOUSAND.
THAT MEANS 1/3 OF THE CHILDREN DIE.
TO 1962.
VERY CLEARLY, THERE WERE TWO COUNTRIES, TWO TYPES OF
COUNTRIES.
I HAVE A CLUSTER HERE AND I HAVE A INCLUDESCLUSTER OVER THERE.
ALMOST NO COUNTRY WAS IN BETWEEN.
JUST ONE LITTLE ONE HERE AND THERE.
CAN YOU SEE IT?
WHICH ONE IS THIS INTERMEDIATE?
IT'S CUBA.
IT WAS A SUCCESS OF ENORMOUS PROPORTION WHEN CASTRO MANAGED
TO BECOME LEADER OF THIS GROUP TO WHICH HE DIDN'T BELONG.
CUBA WAS IN BETWEEN.
THE CHILD MORTALITY IN HAVANA WAS THE SAME AS IN BERLIN AND
PARIS.
CUBA WAS QUITE ADVANCED.
NOW, THERE WERE OTHER POLITICAL INJUSTICES AND OTHER POLITICAL
REASONS THAT BROUGHT ABOUT THE REVOLUTION.
NOT THAT CUBA WAS ONE OF THE POOREST COUNTRIES OF THE WORLD.
MUCH LIKE THIS GROUP UP HERE.
REALLY, WITH THAT EXCEPTION AND SOME OTHER SMALL EXCEPTION LIKE
SINGAPORE, AHA, IF YOU COMPARE CUBA'S PROGRESS, YOU SHOULD
COMPARE IT WITH SINGAPORE.
THEY WERE THE CLOSEST NEIGHBOR.
THAT WAS BASELINE THERE.
NOW, WHAT HAPPENED HERE?
THEY HAD FEW FAMILIES AND THEY HAD A FEW CHILDREN.
THEY HAD MANY CHILDREN.
IT LOOKED ALMOST THE SAME 1968 AND THEN THIS IS TOO MUCH IT WAS
SAID.
IT THIS WOULD BE A POPULATION BOOM AND HE SCARED THE WORLD.
WHAT HAS HAPPENED SINCE THEN?
IT WAS OVER.
FAMILY PLANNING STARTED IN CHINA.
THEY WERE SUCCESSFUL WITH THAT.
GOT SMALLER FAMILY AND TRIED TO FOLLOW, BRAZIL AND MEXICO GO FOR
FAMILY PLANNING.
HERE COMES -- LOOK AT IRAN.
THE ISLAMIC REPUBLIC OF IRAN IS MOVING FORWARDS.
PAKISTAN, BANGLADESH IS OVERTAKING INDIA AND ALMOST ALL
COUNTRIES IS MOVING DOWN TO THERE.
A COMPLETELY NEW WORLD.
IT'S MORE BIGGER CHANGE THAN WHEN I SHOWED THE ECONOMY.
AND WHAT AM I MEASURING HERE?
WHAT AM I MEASURING HERE WHEN I SHOW THIS ENORMOUS CHANGE?
CHILD MORTALITY YOU KNOW.
THIS I CONSIDER TO BE THE BEDROOM.
IT'S THE ONLY DECENT AND ACCEPTABLE WAY IN WHICH YOU CAN
PEEP INTO THE BEDROOM OF OTHER PEOPLE.
IT'S LIKE LOOKING AT FERTILITY RATE.
YOU HAVE A WONDERFUL EXPRESSION IN AMERICA ABOUT THIS.
YOU CALL THIS PILLOW TALK.
[ LAUGHTER ] IT'S A YOUNG COUPLE WHISPERING
INTO EACH OTHER'S EARS WE'LL MAKE A BABY TONIGHT.
[ LAUGHTER ] WE'LL HAVE TWO.
[ LAUGHTER ] WE'LL WORK HARD OUR ENTIRE LIFE
TO MAKE THEIR LIFE BETTER THAN OURS WAS.
THAT COMBINATION OF LOVE, CHILDREN AND HARD WORK,
THAT BUILDS THE WORLD. THAT BUILDS COUNTRIES.
THAT'S WHAT I TOLD GOLDMAN SACHS.
IT AIN'T YOU THAT MAKES THE EMERGING ECONOMY.
IT'S THE YOUNG COUPLES WORKING HARD FOR THEIR CHILDREN AND
THEIR GRANDCHILDREN.
THAT'S WHAT MAKES THE WORLD.
THEN YOU CAN FACILITATE IT IF YOU BEHAVE.
THEN GOVERNMENT CAN FACILITATE, GOVERNMENT INSTITUTIONS, YOURS
IS EXTREMELY IMPORTANT FOR THIS.
LOOK WHAT WE HAVE.
THE AVERAGE NUMBER OF CHILDREN PER WOMAN IN THE WORLD IS 2.4
TODAY.
IT ISN'T LIKE THAT ANYMORE.
IT HAS CHANGED.
YOU STILL FIND CONGO AND AFGHANISTAN OVER THERE.
BUT A PERCENTAGE OF THE WORLD POPULATION LIVE WHERE TWO-CHILD
FAMILIES ARE THE MOST COMMON SIZE.
THAT HAS ALREADY HAPPENED.
THAT HAS ALREADY HAPPENED.
AND IF I CHANGE THE CHILD MORTALITY HERE OVER TO LIFE
EXPECTANCY, IT BECOMES SORT OF QUITE CLEAR THAT MOST COUNTRIES
ARE UP HERE.
THEY SAY, OH, IT'S BECAUSE OF COMMUNIST IN CHINA HAS A
ONE-CHILD POLICY.
>> COMMUNISTS NORMALLY ARE NOT SO SUCCESSFUL.
THEY WANT TO MADE IT TO 1.6.
SOME METHODS CRUEL AND UNACCEPTED.
HOW COME, IF IT WAS THE COMMUNIST WHO MADE IT, HOW COME
THAT JAPAN HAS LESS CHILDREN PER?
HOW COME THAT THE ONLY PART OF MAINLAND CHINA THAT NEVER HAD A
ONE CHILD POLICY HAD ONE CHILD PER HONG KONG?
I WAS UNDER THE INVESTMENT CONFERENCE RECENTLY IN HONG KONG
AND ENDED UP AT THE DINNER WITH A MOST SUCCESSFUL BANKER
RECENTLY IN HONG KONG.
SHE WAS ONLY 35 YEARS OLD.
AND I ASKED HER AT THE DESSERT, YOU WORK SO HARD.
DON'T YOU THINK ABOUT FAMILY?
SHE SAID, YES.
EVERY DAY I THINK ABOUT CHILDREN.
IT'S THE IDEA OF A HUSBAND I CAN'T STAND.
[ LAUGHTER ] SO THIS IS WHAT YOU SEE
HAPPENING.
WE ASK OF YOU TOO MUCH.
TWO RELIGIOUS LEADERS AND POLITICAL LEADERS, IF THEY ARE
BAD THEY CAN BE PROBLEM.
BUT PEOPLE MAKE THE DECISIONS IN THEIR BEDROOMS TODAY ACROSS
RELIGIONS.
THERE IS NO MORE CHILDREN PER WOMAN IN MUSLIM COUNTRIES THAN
OTHER COUNTRIES TO DATE.
IT'S THE SAME.
QATAR HAS ONE CHILD PER WOMAN, BANGLADESH AND INDONESIA, THE
SAME NUMBER OF CHILDREN PER WOMAN AS THIS COUNTRY HAS.
NO RELIGIOUS DIFFERENCE.
THEN THERE ARE MUSLIM COUNTRIES LIKE SOMALIA WITH VERY MANY
CHILDREN AND CHRISTIAN COUNTRIES LIKE HONG KONG.
SO REALLY WE HAVE HAD AN ENORMOUS CHANGE HERE AND WHAT WE
CAN SEE, IF WE LOOK AT THIS MAP, OF COURSE, YOU WOULD SEE HERE
THAT -- I'M BACK NOW WITH CHILD MORTALITY OVER THERE.
YOU SEE THAT AFRICA TENDS TO BE HERE.
THERE'S A BIG DIVERSITY WITHIN AFRICAN COUNTRIES.
THEY SEEM TO HAVE HIGHER CHILD MORTALITY AND HIGHER FERTILITY
RATE.
INDEED, THOSE ARE GOOD FIGURES.
THAT'S RIGHT.
BUT THERE'S VERY BIG DIFFERENCE IN AFRICA.
TIME HAS COME, NEVER MORE TO THINK ABOUT SUB SA HARR AN
AFRICA AS ONE UNIT.
THINK ABOUT ASIA 1970.
YOU SAW THAILAND AND MALAYSIA FORGING AHEAD.
CAMBODIA AND AFGHANISTAN HEADING FOR TRAGEDIES.
THE SAME THING WE'RE SEEING IN AFRICA.
DIFFERENCE BETWEEN COUNTRIES.
AND DIFFERENCE WITHIN COUNTRIES.
I SPLIT TANZANIA, RURAL IS THERE.
LACK OF ACCESS TO CONTRACEPTION.
THERE ARE 30% OF WOMEN WHO WANT TO HAVE CONTRACEPTION.
YOU DON'T HAVE TO RUN POPULATION PROGRAM AND INTERTWIENG PEOPLE'S
DECISIONS.
LET THEM DECIDE FOR THEIR OWN.
THEY SEE WHEN TIME HAS COME TO HAVE FEWER CHILDREN.
WHEN CHILDREN DON'T HAVE TO CARRY WATER BUT GO TO SCHOOL
INSTEAD.
THEN THEY WILL HAVE LESS CHILDREN.
NEVER INTERVENE WITH PEOPLE'S DECISION, JUST MAKE IT POSSIBLE
FOR THEM TO LIVE THE LIFE THEY WANT.
ETHIOPIA HAD LESS CHILDREN THAN IN THE UNITED STATES OF AMERICA.
IN THE SOMALI REGION, WHERE THERE'S CIVIL WAR, IT'S WORSE
THAN AFGHANISTAN.
THIS IS THE WORLD.
CATHOLICS IN MEXICO, NEWS LUMS IN BANGLADESH, HINDUS IN INDIA,
BUDDHISTS IN THAILAND FOR THE FUTURE WITH TWO CHILDREN AND
THEY INVEST IN THEM.
THIS IS THE DRIVER OF THE EMERGING ECONOMY.
THIS IS THE DRIVING OF THE WORLD.
PRECISELY AS IT'S BEEN IN THE U.S.
PEOPLE ARE AMAZINGLY SIMILAR ACROSS THE WORLD.
THEY'RE AMAZINGLY SIMILAR.
THE MOST IMPORTANT IS FAMILY LIFE.
THE MOST IMPORTANT IS THE FUTURE OF YOUR CHILDREN.
THAT'S QUITE SIMILAR ACROSS THE WORLD.
AND IT'S SO BASIC.
BEFORE THE INDUSTRIAL REVOLUTION, THE PARENTS, TYPICAL
COUPLE GOT SIX CHILDREN AND WHY DIDN'T THE PUBLIC -- BECAUSE,
BECAUSE SADLY, THREE AND FOUR CHILDREN DIED BEFORE GROWING UP
TO BECOME PARENTS THEMSELVES.
THIS WAS THE OLD.
I HEAR PEOPLE SAY IN THE RAINFOREST PEOPLE LIVE IN
ECOLOGICAL BALANCE WITH NATURE.
THIS IS WRONG.
THEY DIE IN ECOLOGICAL BALANCE WITH NATURE.
[ LAUGHTER ] BUT THEIR HUMAN RIGHTS SHOULD BE
DEFENDED.
THAT'S ANOTHER ISSUE.
IT'S A VERY TRAGIC LIFE CONDITION.
THAT'S WHY THERE ARE SO FEW PEOPLE IN THE RAINFOREST.
THERE IS NO SECRET FAMILY PLANNING CONTRACEPTIVE DEVICE
THERE.
THEY DIE, THAT'S WHY THE POPULATION IS LOW.
WHAT HAPPENED THEN WHEN THE SWEDES FILLED UP MINNESOTA?
[ LAUGHTER ] IT WAS THAT FOUR CHILDREN
SURVIVED, THERE WERE LESS DYING AND THEN THEY WENT.
IT WAS THAT LIFE GOT BETTER IN SWEDEN, THAT'S WHAT SENT THE
SWEDES ACROSS THE ATLANTIC.
AND THEN MANY THINK THAT IT'S CONTINUE LIKE THIS.
BUT IT WILL NOT.
WE HAVE ALMOST REACHED THE NEW BALANCE.
WHICH MOST OF US WOULD LIKE TO LIVE IT.
WE WOULD SEE THE BIRTH OF ABOUT TWO CHILDREN AND COE WE DON'T
WANT TO SEE A CHILD DIE BEFORE OURSELVES.
AND U.N. POPULATION DIVISION SAY WE'LL BE AT TEN BILLION AND MANY
HAVE DIFFICULTIES ACCEPTING THIS BECAUSE IT CONTINUES TO GROW.
SO THEY SAY YOU MUST BE WRONG.
IF YOU SAY THERE'S JUST LITTLE MORE THAN TWO CHILDREN PER
WOMAN.
IT CONTINUES TO GROW, BILLION AND BILLION.
IT HAS TO STOP NOW OTHERWISE THE POLAR BEAR WILL DIE.
LET'S SEE HOW GOOD THEY ARE AT UNITED NATIONS POPULATION
DIVISION.
IN 1958, THEY DID THE FIRST 42-YEAR PROJECTION OF WORLD
POPULATION AND THEY SAID BY THE YEAR 2000 WE WILL BE BETWEEN 6
AND 7 BILLION AND EVERYONE LAUGHED AT THEM.
IF YOU READ THE NEWSPAPERS FROM THAT TIME, THEY MADE JOKES OF
IT.
1968 THEY CAME BACK AND SAID, PERHAPS WE WERE LONG WRONG,
THERE WILL BE A LITTLE MORE.
SILL BELOW 7.
7 WILL BE AFTER.
THEN 1978 THEY SAID NO, NOW IT'S FOURTH IN CHINA.
WE WILL BE -- NOW WE KNOW, I CAN'T CHECK UP TO NOW BECAUSE WE
ONLY KNOW FOR SURE WE WERE IN THE YEAR THOUSAND.
THIS WAS THE RESULT.
RESPECT.
[ LAUGHTER ] I THINK WE EPIDEMIOLOGISTS, YOU
DIDN'T TELL ABOUT AIDS IN ADVANCE.
YOU DIDN'T TELL ABOUT ANYTHING IN ADVANCE.
SUDDENLY YOU -- SOMETHING U.S.
COME UP WITH.
DIDN'T KNOW ABOUT THAT.
NOW IT'S HERE, IT'S TERRIBLE, YOU KNOW.
THOSE AT GOLDMAN SACHS ARE EVEN WORSE.
THEY DON'T EVEN KNOW WHAT WILL HAPPEN WITH THE ECONOMY, YOU
KNOW, THE NEXT DAY.
[ LAUGHTER ] BUT DEMOGRAPHERS ARE VERY GOOD.
THEY KNOW PEOPLE ARE VERY SIMILAR IN THE WORLD.
IT'S JUST WHEN DEATH RATES GOES DOWN, BIRTH RATES WILL FALL OFF
AND IT'S JUST HOW THESE -- THEY KNOW THAT WE WILL BE ABOUT 10
BILLION.
BUT HOW COME WE WILL INCREASE SO MANY WHEN WE ALMOST HAVE STOPPED
DPROEG?
I'LL SHOW YOU.
THIS IS THE WORLD TODAY.
WE HAVE 2 BILLION CHILDREN BELOW 15, ALMOST 2 BILLION BETWEEN 15
AND 30, 1 BILLION 30 TO 45, 1 BILLION HERE.
THIS IS ME.
YOU CAN RECOGNIZE ME UP THERE.
[ LAUGHTER ] 60-PLUS.
WHY ARE THESE PERSONS MISSING?
HAVE THEY DIED?
>> NO.
THEY WERE NEVER BORN.
BECAUSE WHEN I WAS BORN, THERE WERE MUCH LESS WOMEN GIVING
BIRTH AND EVEN IF THEY GAVE BIRTH TO MORE CHILDREN, THERE
WERE FEWER CHILDREN BORN.
SO THIS MEANS THAT THIS IS THE SORT OF THE GLOBAL POPULATION
PYRAMID.
NOW I WILL SHOW YOU WHY WE WILL BE 3 BILLION MORE WITHOUT
GETTING MORE CHILDREN AND WITHOUT LIVING LONGER.
QUESTION NUMBER 1.
WHAT HAPPENS TO PEOPLE LIKE ME?
THIS IS CDC.
YOU MUST KNOW.
[ LAUGHTER ] WHAT HAPPENS TO OLD PEOPLE?
THEY DIE.
YES.
DON'T BE MEGALOMANIC AND THINK YOU CAN'T WIN.
THIS IS YOU.
THE YOUNG FELLOWS, YOU KNOW.
YOU ARE IN THE 15 TO 30.
THIS IS THE YOUNG PEOPLE HERE, YOU KNOW.
PEOPLE LIKE ME WILL GO DOWN LIKE THERE AND THEY WILL GO BYE BYE.
AND THE REST WILL GROW OLDER AND THEY WILL GET THEIR CHILDREN.
WHERE ARE THE YOUNG FELLOWS, THEY'RE UP THERE.
BECAME 15 YEARS OLDER.
THE OLD -- THEY HAVE HIGH AMBITIONS X YOUR STAFF.
THEY REALLY WANT TO GO AT IT.
THEY GET TO HOLD, THEY GET THE CHILDREN AND THERE YOU ARE.
THEY GO AWAY AND THEN THEY GET OLDER AND THEY GET THEIR
CHILDREN.
AND THE YOUNG FELLOWS -- I WON'T RUN IT THROUGH -- THE YOUNG
PEOPLE DON'T KNOW WHAT HAPPENS TO THEM.
I'LL SPARE THEM FOR TODAY.
ONE, TWO, THREE BILLION MORE WITHOUT HAVING MORE CHILDREN
WITHOUT LIVING LONGER.
DID YOU SEE?
THE BIG FILL-UP.
IT'S CALLED POPULATION MOMENTUM.
NO ONE UNDERSTOOD IT.
IT'S INEVITABLE, WE'LL BE 2 BILLION MORE AS WE START GETTING
FEWER CHILDREN, WE STOP AT NINE, 9.5.
IT'S INEVITABLE THAT WE WILL BE TWO MORE.
THIS IS A BIG, BIG HISTORICAL CHANGE.
1 BILLION IN AMERICA, 1 BILLION IN EUROPE, 1 BILLION IN AFRICA.
1, 2, 3, 4 IN ASIA.
AS SIMPLE AS THAT.
2 BILLION MORE BY 2050.
1 BILLION MORE IN AFRICA.
1 BILLION MORE IN ASIA.
BY THE END OF THE CENTURY, AS PROJECTIONS SAY 1 BILLION MORE
IN AFRICA.
WHICH WAS THE FIRST HEAD OF MARKETING IN AFRICA THAT PHONED
ME FOR A LONG CONVERSATION FROM THE CORPORATE SECTOR.
COCA-COLA.
I HAVE THE IDEA, WELL, THERE IS THE VILLAGE, THERE SHOULD BE A
COKE.
I TO A CERTAIN EXTENT COMING FROM SWEDEN LIKE COKE.
WHEN IT REPLACES HEAVY BEER AND ALCOHOL, IT DOES WELL FOR PUBLIC
HEALTH.
THAT'S WHY GORBACHEV LIKED COCA-COLA.
IT REPLACED VODKA.
COCA-COLA IS GOOD FOR HEALTH, HUH?
[ LAUGHTER ] THEN IF I DIVIDE AMERICA INTO
NORTH AND SOUTH AND EUROPE INTO EAST AND WEST.
YOU GET WHAT WE USED TO CALL AND SOME STILL CALL THE WESTERN
WORLD.
THOUGH THEY HAVE NO DEFINITION.
SORT OF DIFFICULT HOW BIG PART OF GREECE I SHOULD INCLUDE HERE.
BUT I TOOK A PART OF IT HERE.
IT'S REALLY A CONTINUUM.
THE MOST IMPORTANT TO UNDERSTAND IS IN THE FUTURE, THOSE WHO USED
TO DOMINATE THE WORLD ECONOMY WILL ONLY BE 10% OF THE WORLD
POPULATION.
80% WILL LIVE IN ASIA AND AFRICA.
AND THE TAKE-HOME MESSAGE FOR GOLDMAN SACHS WAS BUY REAL
ESTATE AROUND THE INDIAN OCEAN.
THAT'S WHERE THE WORLD -- THE WORLD TRADE WILL BE IN THE
FUTURE.
IT WILL BE AN ENORMOUS CHANGE.
THIS IS THE STRONG DEMOGRAPHIC CHANGE WHICH WILL NOT BE MUCH
EFFECTED BY OTHER THINGS.
WE CALL THIS DEVELOPING WORLD.
CHANGE THE NAME IMMEDIATELY.
IT'S THE WORLD.
IT'S THE WORLD.
THAT DIVISION DOESN'T MAKE MUCH SENSE TO ME.
AND WE SHALL -- WE HAVE TO GET TO KNOW THIS BETTER.
I GOT THE OPPORTUNITY IN SWEDEN TO TEST THE KNOWLEDGE OF THE
SWEDISH POPULATION.
OUR GOVERNMENT MAKE A SURVEY EVERY YEAR ABOUT THEIR WILL TO
GIVE FOREIGN AID AND ABOUT THE MAJORITY OF THE PEOPLE WANT TO
CONTINUE WITH FOREIGN AID.
THEY HAVE MANY IDEAS ABOUT HOW TO GIVE IT.
BUT THAT THEY SHOULD GIVE IT IS VERY STRONG.
I PUT KNOWLEDGE QUESTION.
THESE ARE TWO OF THEM.
HOW MANY OF THE 20 YEARS OLD CAN READ TANZANIA.
FOUR.
NUMBERS OF BABIES IN BANGLADESH.
FOUR.
THESE WERE THE SWEDISH ANSWERS.
THIS IS THE CORRECT.
OF FOUR POSSIBLE, THEY GOT 5%.
I NEEDED THE CONTROL GROUP, I WENT TO THE ZOO.
I ASKED THE CHIMP.
THEY GOT 25%.
[ LAUGHTER ] CAN YOU IMAGINE HOW
EMBARRASSING, I HAD TO SPEND THE REST OF MY LIFE TO LIFT THE
SWEDISH POPULATION UP TO THE CHIMP LEVEL.
[ LAUGHTER ] BECAUSE THE PROBLEM IS NOT
IGNORANCE.
IF IT WAS IGNORANCE, THEY WOULD GET 25% RIGHT.
THE PROBLEM IS PRE-CONCEIVED IDEAS THAT THE WORLD STILL IS AS
IT WAS 25 YEARS AGO.
THAT'S 25-YEAR TIME LAG ABOUT UNDERSTANDING THE WORLD.
THESE TRENDS HAVE FALLEN IN BETWEEN THE TEXTBOOKS AND THE
NEWS MEDIA.
WE DON'T MANAGE TO GET THEM THROUGH.
NOW, YOU CAN SEE WHAT IT MEANS, THIS POPULATION GROWTH.
THIS IS THE WORLD.
1968.
IN MORE SERIOUS GRAPHICS.
IT WAS GROWING LIKE THIS.
THE ZERO TO 14 WAS GROWING.
THERE THEY STOPPED GROWING.
YOU SEE THE NUMBER OF CHILDREN STOPPED GROWING.
THEN THE OTHER AGE GROUPS ARE GROWING.
THEN THEY'RE GROWING.
THIS IS THE BIG FILL-UP.
THERE'S NO WAY YOU CAN STOP THIS.
THIS IS THE YOUNGER GROWING UP.
WE WOULD BE ABOUT 10 BILLION BY THE END OF THIS CENTURY.
THERE'S ANOTHER ONE WHICH I WOULD LIKE TO SHOW YOU AND THAT
IS TANZANIA.
THIS IS TANZANIA TODAY, 46 MILLION PEOPLE.
AND THEY HAVE QUITE A HIGH FERTILITY RATE.
YOU SAW THE RURAL AREAS, ALMOST LIKE AFGHANISTAN.
THE NUMBER OF CHILDREN IS GROWING.
AND HERE THEY WILL BYPASS GERMANY IN SIZE.
36, HUH?
THEN THEY WILL COME UP AND TANZANIA WILL MATCH THE UNITED
STATES OF AMERICA.
THIS IS WHY IT'S SO WISE AND SO GOOD THAT THIS KNOWLEDGEABLE
CATHOLIC WOMAN FROM THE UNITED STATES IS TELLING THE RIGHT
THING.
MELINDA GATES SAID WE HAVE FORGOTTEN FAMILY PLANNING IN THE
POOREST 1 TO 2 BILLION.
WE HAVE TO PROVIDE IT IN THE SAME WAY AS WE HAVE DONE.
NOT INTERVENING PEOPLE IN ANY WAY.
NOT COMING WITH VALUE JUDGMENT.
YOU HAVE TO MAKE IT AVAILABLE.
I HAVE MET SO MANY WOMEN ACROSS RURAL AFRICA, VERY POOR WOMEN
WHO HAVE TO WALK FOR MILES AND MILES TO GET THAT SHOT OR THAT
PILL WHICH THEY BADLY NEED BECAUSE THEY WANT TO TAKE CARE
OF THE CHILDREN THEY HAVE AND GET THEM THROUGH SCHOOL AND MAKE
A DECENT FUTURE FOR THEM.
TANZANIA NEED THAT ASSISTANCE.
ONCE UPON A TIME IT WAS THE UNITED STATES OF AMERICA WHO
STARTED WORLD FERTILITY STUDY AND WHO STARTED TO PROVIDE THE
MODERN CONTRACEPTIVE TO THE WORLD.
CONTINUE TO DO SO.
IT WILL BE GOOD FOR YOU.
IT WILL BE GOOD FOR THE POOR PEOPLE.
IT WILL BE GOOD FOR THE WORLD.
AND THIS REALITY WE CAN SHOW YOU IN A LITTLE MORE COMPLEX WAY
PERHAPS.
LET ME TRY.
CAN YOU SEE WHAT I'M DOING?
I'M USING TWO FINGERS.
NORMALLY PROFESSORS JUST USE ONE FINGER.
NEXT, NEXT, NEXT.
I DO -- I HAVE SEVERAL OPEN WINDOWS HERE IN MY LECTURE AND I
CAN GO AND CHOOSE THE ONES I WANT TO CONTINUE WITH WHERE I
WERE IN MY LECTURE.
THERE I WAS.
SO NOW I'M IN MY POWER POINT AGAIN.
NOW, EACH DOLL HERE IS 100 MILLION.
THESE ARE THE ONES BELOW 50.
THERE ARE 20.
MOST ARE ASIANS, THIS IS AFRICA.
THIS IS AMERICA.
LOOK AT EUROPE.
ALREADY SHRINKING.
A BORING PLACE.
[ LAUGHTER ] GREAT MUSEUMS.
[ LAUGHTER ] COME VISIT.
AMERICA ISN'T THAT EXCITED EITHER.
THE ONLY THING YOU WILL ADD IS 100 MILLION SENIORS IN LATIN
AMERICA.
THAT'S IT.
AFRICA HAS 400 MILLION BELOW 50 YEARS TODAY AFTER CHILD
MORTALITY HAS TAKEN OUT SOME THE FIRST YEARS.
THAT MEANS THAT AFRICA TURNS THAILAND TONIGHT WITH 75 YEARS
LIFE SPAN AND TWO CHILDREN PER WOMAN, AFRICA WILL STILL DOUBLE
ITS POPULATION.
THERE'S NO WAY AFRICA CAN STOP GROWING BELOW 2 BILLION.
THAT'S WHY COCA-COLA PHONED ME.
THIS WILL BE A VERY IMPORTANT PLACE IN THE WORLD.
AND THEY HAVE RESOURCES AND NOW THEY HAVE HUMAN SKILLS AND NOW
AFRICA HAS 5% ECONOMIC GROWTH.
TAKE OUT SOUTH AFRICA, STILL 5% ECONOMIC GROWTH.
IT'S NOT OIL AND MINERALS.
IT'S DIVERSIFIED ECONOMIC GROWTH.
5%.
EUROPE 0.3.
I NEVER THOUGHT I WOULD LIVE TO THE DAY THAT AFRICA WAS GROWING
15 FOLD THAN EUROPE.
WHEN YOU VISIT, IT'S REAL FIGURES.
THINGS ARE CHANGING.
CHANGING TO THE BETTER 20 TO 40% OF THE POPULATION.
NOT ALL THE WAY UP.
IT'S THE REMOTE RURAL AREAS THAT REMAINS THE CHALLENGE.
WHAT WILL HAPPEN, THE OLD DIE, THE REST GROW OLDER AND THEY GET
THEIR CHILDREN.
THE OLD DIE, THE REST GROW OLDER AND THEY GET THEIR CHILDREN.
THE OLD DIE, THE REST GROW OLDER AND THEY GET THEIR CHILDREN AND
THE OLD DIE AND THEY GROW OLDER AND THEY GET THEIR CHILDREN.
THE REASON THE NUMBER OF CHILDREN IS NOT GROWING IN THE
WORLD IS THAT THEY ARE DECREASING IN AFRICA.
REMEMBER THE BANKER IN HONG KONG.
GENDER EQUITIES LACKING IN ASIA.
WOMEN PREFER NOT TO MARRY OR HAVE VERY FEW CHILDREN.
IN AFRICA, POVERTY IS STILL THERE.
NOW, HOW MUCH OF THIS IS INEVITABLE?
THIS IS THE INEVITABLE FILL-UP?
THIS IS UP FOR DISCUSSION AND ACTION.
BECAUSE AS POVERTY GOES AWAY FAST IN AFRICA, THIS CAN BE LIKE
THIS.
PROBABLY BE BETTER FOR EVERYONE, FOR FAMILIES, COMMUNITIES AND
COUNTRIES IN TANZANIA.
I TELL AFRICAN LEADERS, YOU HAVE THE CHOICE.
EITHER YOU BECOME MANY AND RICH OR VERY MANY AND STILL POOR.
THIS IS REAL -- TO FILL UP.
IT'S NOT -- FAMILY PLANNING IS NOT THE SOLUTION.
IT'S JUST AN INTERMEDIATE STEP.
IT'S ONE COMPONENT OF IT.
IT'S NOT THAT AS IT WAS TALKED IN THE PAST WHERE THE FAMILY
PLANNING TO STOP THE POOR.
NOT AT ALL.
ONE COMPONENT AND YOU CAN CONSIDER IT AS A HUMAN RIGHT.
LONGER LIFE SPAN IS NOT AS THAT IMPORTANT.
I KNOW THAT CDC IS MOVING INTO CHRONIC DISEASES.
YOU MAY HAVE SOME SUCCESS.
I'VE ADDED ONE DOLL FOR YOU FOR THE CARDIOVASCULAR GROUP.
IT IS THIS IS WHAT YOU'RE FIGHTING.
I HOPE I WILL BE THAT ONE.
THERE MAY BE ONE IN AFRICA.
THAT'S A MINOR THING.
[ LAUGHTER ] >> WE KNOW THAT LIFE SPAN IS
STILL ABOUT INEQUALITIES, ALCOHOL AND TOBACCO.
THAT'S WHAT IT'S ABOUT.
SO THIS IS WHAT WE KNOW.
WE KNOW FAIRLY WELL WHAT WILL HAPPEN.
IN EUROPE IT HAPPENED FIRST.
NOW SHRINKING.
AMERICA, STOPPING ITS GROWTH FROM CANADA TO ARGENTINA.
ASIA, STOPPING WITH WITHIN 30 TO 40 YEARS.
THE INTERESTING THING, GROWING AMONG THE OLD WHILE SHRINKING IN
THE YOUNG.
MANY PEOPLE SAY, OH, CHINA IS GROWING OLD BECAUSE THEY LIVE
LONGER.
NO.
THE POPULATION GETS A HIGHER PROPORTION OF OLD PEOPLE BECAUSE
THEY GET FEW CHILDREN.
GERMANY AND JAPAN GET A HIGH PROPORTION OF ALL PEOPLE BECAUSE
THEY DON'T GIVE BIRTH TO CHILDREN BECAUSE WOMEN DOESN'T
HAVE A GOOD EQUITY.
PROVIDE A GOOD EQUITY FOR KIDS, YOU GET LIKE IN SWEDEN, ALMOST
TWO CHILDREN PER WOMAN AGAIN.
WE'VE BEEN DOWN THERE, WE'VE COME UP THERE.
UNITED STATES OF AMERICA IS ESPECIALLY -- IT DOESN'T COMPARE
WITH ANYONE.
SO IT'S A DIVERSITY THAT NEEDS ITS OWN ANALYSIS.
GENERALLY, IT'S LIKE THIS.
THAT IT'S THE BALANCE, THE DEMOGRAPHERS TALK ABOUT BALANCE
OF POPULATION, RATHER.
NOW HOW DO WE LOOK AT THE WORLD?
LOOK AT THIS GRAPH.
CHILD MORTALITY ON THIS SCALE.
TENS, HUNDREDS AND MORE.
HERE I HAVE THE ECONOMY ON THE SCALE.
IT'S ALMOST AS LIFE, ALMOST A LINEAR RELATION BETWEEN MONEY
AND CHILD MORTALITY.
THAT'S WHY I LOVE MONEY.
[ LAUGHTER ] BECAUSE I KNOW HOW TO SPEND IT.
I CAN THE PUBLIC KNOWS HOW TO SPEND MONEY.
WITHOUT ECONOMIC GROWTH, WE WILL NOT BE ABLE TO IMPROVE HEALTH
UNTIL A CERTAIN LIMIT.
THAT'S THIS LOWER LINE HERE.
IF YOU LOOK AT THIS, YOU HAVE A PROBLEM HERE KNOWING WHERE IS
THE CAPITAL FOR DEVELOPING COUNTRIES?
UNICEF USED TO HAVE THIS CUTOFF.
THEY SAID THESE ARE THE DEVELOPING COUNTRIES.
QATAR IS NOT A DEVELOPING COUNTRY BECAUSE THEY'RE ARABS
AND SOUTH KOREA IS NOT DEVELOPING AND SINGAPORE IS A
DEVELOPING COUNTRY AND THEN THEY GO UP HERE, RUSSIA IS DEVELOPED.
THEY GO DOWN.
MALAYSIA IS DEVELOPING COUNTRY.
ALBANIA IS DEVELOPING.
IT'S QUITE AN ADVANCED ALGORITHM, ISN'T IT?
[ LAUGHTER ] I TOLD TONY LAKE, YOU ARE SOME
SORT OF A MATHEMATICIAN, I SAID.
THEN I GOT A PHONE CALL FROM TONY LAKE AND SAID YOU'RE RIGHT.
WE'LL STOP IT.
AS OF THIS YEAR, UNICEF AND THEIR STATISTIC DOES NOT USE THE
CONCEPT ANY LONGER.
THEY TAKE THE WORLD, THEY TAKE REGIONS AND COUNTRIES AND GO
DOWN TO INEQUALITIES IN COUNTRIES.
I THINK IT'S A GOOD MOVE.
YOU LOOK HERE.
BANGLADESH, THIS IS WHAT I CALL THE MAX EQUALITY AND THE MINIMUM
EQUALITY LINE.
THIS IS BANGLADESH.
HERE, I LET THE SIZE OF THE BUBBLE BE THE NUMBER OF CHILD
DEATHS.
VERY FEW BELOW -- LOWER IS THERE.
ALSO FOLLOW IT.
SURPRISINGLY, EQUITABLE COUNTRY.
DENSELY POPULATED.
DENSE POPULATION USED TO BE CONSIDERED BAD.
IT'S GOOD FOR US.
BECAUSE YOU GET THE SERVICES AROUND, YOU GET THE KNOWLEDGE
AROUND THIS.
THESE CUTS OFF ARE INTERESTING.
THIS IS THE CUTOFF FOR GETTING VACCINES, YOU GET FEEDBACK BY
AID HERE.
HERE YOU PAY.
THIS IS THE CUTOFF FOR AID AND STRONGLY CRITICAL TO THAT.
WE SHOULD CONSIDER BRAZIL AND RUSSIA AND TURKEY AS EMERGING
DONORS AND MOVE THIS LINE TO HERE.
IT DOESN'T MAKE SENSE TO CONSIDER BRAZIL A RECIPIENT OF
DEVELOPMENT AID WHEN BRAZIL, SINCE FIVE YEARS BACK LEND THIS
COUNTRY $30 BILLION A YEAR TO COVER THE BUDGET DEFICIT.
IT'S EXACTLY THE SAME AMOUNT OF MONEY AS U.S. AID BUDGET.
IT WAS THE CASH ON THE TABLE FOR THE USA BUDGET.
WE HAVE A RULE IN SWEDEN.
THOSE WHO LEND MONEY TO U.S.
SHOULDN'T GET AID FROM US.
IT SORT OF MAKES SENSE.
WE HAVE REACHED AN AGREEMENT WITH BRAZIL TO JOIN HANDS WITH
BRAZIL TO IMPROVE THE QUALITY OF OUR AID TO AFRICA.
BECAUSE THEY'RE QUITE GOOD TO WORK WITH IN MANY WAYS.
THIS IS GOOD.
BECAUSE THERE WILL BE COUNTRIES GRADUATING FROM AID.
I THINK PEOPLE WILL THRS THAT QUITE WELL.
THAT IT HAS BEEN SUCCESSFUL, THEY DON'T NEED AID ANY LONGER.
WE FOCUS ON THE POOREST BECAUSE THAT'S REALLY WHAT WE NEED DO.
IF WE WOULD LOOK AT THE INCOME DISTRIBUTION OF THE WORLD, IT'S
LOOKING MORE OR LESS LIKE THIS.
$1 POVERTY LINE, $10 AND HERE $100.
THIS WAS 2000, ABOUT 19% IN POVERTY.
THIS IS AFRICA.
THIS IS COUNTRIES, WHICH USED TO BE CALLED THE WEST.
THIS IS LATIN AMERICA LIKE A GREEN ANACONDA.
THIS IS EAST EUROPE, FORMER SOVIET.
THIS IS EAST ASIA AND THIS IS SOUTH ASIA.
IF WE GO BACK TO WHEN I WAS A STUDENT AND I TRAINED IN PUBLIC
HEALTH IN BANGALORE, 1972.
IT WAS AN ENORMOUSLY GOOD EXPERIENCE.
THEN YOU CAN SEE HOW THINGS HAVE CHANGED.
THE POPULATION HAVE GROWN AND INDEED PEOPLE HAVE COME OUT OF
POVERTY.
WE HAVE SO MANY DIFFERENT LEVELS PEOPLE LIVE ON TODAY.
WE GO UP TO ALMOST HERE TODAY.
2011 A PROJECTION.
THIS IS WHERE WE ARE.
WE HAVE TO HAVE DIFFERENT UNDERSTANDING OF THOSE IN
EXTREME POVERTY.
THOSE ARE SPECIAL ACTIONS NEEDED.
WE NEED TO HAVE ANOTHER HEALTH POLICY HERE AT LOW INCOME
COUNTRIES, LOWER, MIDDLE INCOME COUNTRIES AND HIGH INCOME
COUNTRIES.
LET ME GIVE YOU AN EXAMPLE OF THIS.
LET ME GIVE YOU AN EXAMPLE.
THAT IS, MIDDLE INCOME COUNTRIES.
MRS. BARLOW, CHRONIC MILO LEUKEMIA AT THE AGE OF 55.
TWO CHILDREN, FOUR GRANDCHILDREN.
SHE WANT TO LIVE.
SHE KNOWS IF SHE GETS IT, SHE WILL LIVE.
IT'S A FANTASTIC DRUG.
IT'S A TRUE INNOVATION.
IT'S LIKE THOSE -- IT REALLY KEEPS PEOPLE WITH A SEVERE
DISEASE ALIVE FOR A LONG TIME.
PROBLEM IS, SHE AND HER CHILDREN CANNOT COVER THE RESEARCH COST.
WHAT SHOULD HER DAUGHTER TELL HER?
DEAR MOTHER THERE IS A TREATMENT BUT THAT WAS DONE BY GREAT
RESEARCH.
AND THEY HAVE TO RECOVER THE COST OF THAT RESEARCH.
SO WE CANNOT TREAT YOU NOW.
WE WILL HAVE YOUR FUNERAL AND WITHIN 17 YEARS, THERE WILL BE A
GENERIC GENERIC.
THEN WE CAN OPEN THE GRAVE AND WE CAN FEED YOU.
DOESN'T MAKE SENSE.
BIG PHARMA IS A FAILURE OF BUSINESS.
I'M NOT AGAINST PROFIT OR INNOVATION OR PATENT.
I'M JUST IN FAVOR OF CLEVER BUSINESS MODEL.
CLEVER BUSINESS MODEL.
THIS CAN BE DONE BETTER.
HERE WE HAVE THIS DOCTOR THAT I HIGHLY RESPECT AND MR. YUSEF, IN
INDIA THAT I HIGHLY RESPECT.
THIS IS MY PROBLEM.
I RESPECT THEM BOTH FROM THEIR PERSPECTIVE.
ONE SAYS YOU'RE A PIRATE IF YOU COPY THIS DRUG WITHOUT
AGREEMENT.
YOU ARE A MONDAY ON LIST WITH THE DEMANDS YOU HAVE.
WE HAVE TO GET THROUGH THIS.
WE HAVE TO HAVE CLEVER BUSINESS MODEL FOR THIS.
BECAUSE PEOPLE IN MIDDLE INCOME COUNTRIES NEED TO HAVE TREATMENT
FOR THIS DISEASE.
AND IN THE HIGH INCOME COUNTRIES, COCHLEAR IMPLANTS CAN
MAKE PEOPLE HEAR.
THAT'S VERY COSTLY.
COULD THAT BE PROVIDED?
SHOULD THAT BE PROVIDED?
IT CAN'T BE DONE ALL OVER THE WORLD.
WE NEED GOOD SIGN LANGUAGE THROUGHOUT THE WORLD SO THAT THE
DEAF COMMUNITY CAN HAVE A RICH LIFE.
BUT WE ALSO HAVE ANOTHER POSSIBILITY NOW.
NOW, THERE ARE SO MANY DIFFERENT COST LEVELS AND WHEN WE WENT
BACK TO MOZAMBIQUE, MY WIFE AND I, AFTER 30 YEARS, I MET A
DOCTOR WITH MY REPLACEMENT NOW, 30 YEARS LATER.
MORE CLEVER, MORE KNOWLEDGEABLE, BETTER APT FOR THE TASK THERE,
MORE SENIOR TO WHEN I WORKED THERE.
I BECAME SPEECHLESS LISTENING TO HIM.
THAT'S VERY RARE THAT I BECOME SPEECHLESS.
>> MY WIFE SAID YOU DIDN'T SAY ANYTHING FOR 40 MINUTES.
IT WAS NICE SITTING NEXT TO YOU, SHE SAID.
[ LAUGHTER ] HE KNEW EVERYTHING.
HE WAS VERY AWARE OF WHAT HE COULD TREAT, WHAT HE COULDN'T
TREAT.
AND MY WIFE WHO WAS A MIDWIFE WHEN WE WERE THERE, SHE WAS
AMAZED BY THE KNEW MATERNITY WARD.
LOOK WHAT THEY'VE DONE 2011.
THEY HAVE DOUBLED THE POPULATION.
THEY HAVE ADDED ONE MORE HOSPITAL.
THEY HAVE FIX 16 MEDICAL DOCTORS INSTEAD OF TWO.
THAT'S A GROWTH OF 7% A YEAR.
THAT'S QUITE FAST GROWTH.
AND THEY STILL HAVE 3,000 CHILDREN BUT TWICE THE
POPULATION.
BUT THE PROBLEM WAS WHEN WE WENT HERE, TO THE REMOTE PART OF THE
DISTRICT.
AND WE CUT THE LINE HERE.
THEN WE FOUND TWO YOUNG COLLEAGUES AS INEXPERIENCED AS I
WAS WHEN I WAS THERE 30 YEARS AGO AND THERE'S STILL TWO M.D.'S
PER 300,000 PEOPLE.
THE COUNTRY, THE WORLD HAS TO PROGRESS SO FAST SO THAT THE
POOR PEOPLE DOESN'T GROW FASTER THAN THE PROGRESS.
AND AT LEAST THEY NEED TO HAVE ACCESS TO CONTRACEPTIVES WHEN
THEY WANT IT THEMSELVES.
THIS IS THE MAIN CHALLENGE I THINK FOR HEALTH IS TO REACH UP
HERE WE STILL SAW 13-YEAR-OLD GIRLS PREGNANT, DYING IN THE
TRANSVERSE LIFE WITH A UTERINE RUPTURE BECAUSE THEY CAME TOO
LATE TO GO HERE FOR THE CESAREAN.
WE DOESN'T DO THEM.
NOW THEY DO 300 A YEAR.
THEY ARE SKILLED.
THE BIGGEST CHANGE MY WIFE SAW AT THE MATERNITY WARD WAS NOT
THE MATERIAL, WALLS AND NICE SHINY, IT WAS THE QUALITY OF THE
STAFF.
THE YOUNG MOZAMBIQUEANS WERE IMPRESSIVE.
THEY CAN DO IT BUT IT HAS TO BE FASTER.
WE MUST ELIMINATE EXTREME POVERTY AND HEALTH IS ONE
IMPORTANT COMPONENT.
THANK YOU VERY MUCH.
[ APPLAUSE ] >>> WE HAVE TIME FOR A FEW
QUESTIONS.
>> YES.
PROTEST.
I MAKE SEVERE SIMPLIFICATION.
I CALL IT EVIDENCE-BASED SIMPLIFICATION.
DID YOU HEAR ABOUT THAT GUY WHO WENT UP BY A BALLOON 30
KILOMETERS UP.
I'M WAY ABOVE MY COMPETENCE LEVEL.
THE ONLY THING I CAN DO BEING SO HIGH IS MAKING THAT PRECISION AN
ADVANTAGE.
TRYING TO LOOK FROM ABOVE.
I MAY HAVE COMMITTED SOME SEVERE ERRORS IN THIS AND IN SUCH A
KNOWLEDGEABLE AUDIENCE AS HERE.
I VERY MUCH WELCOME PROTESTS AND CORRECTIONS.
>> NO PROTEST HERE.
THANK YOU VERY MUCH.
I HAD A QUESTION BASED ON YOUR COMMENTS ABOUT URBAN DENSITY.
YOU MADE A COMMENT THAT PERHAPS SOME OF THE DENSITY WAS ABOUT
KNOWLEDGE TRANSMISSION IN CLOSER SETTINGS.
I WAS WONDERING IF YOU'VE LOOKED AT TECHNOLOGY, PARTICULARLY CELL
PHONES AND THE ABILITY TO CONNECT POPULATIONS MOTT JUST BY
URBAN DENSITY AND WHETHER THAT HAS CAUSED ANY OF THAT TYPE OF
EFFECT THAT YOU WERE SUGGESTING.
>> NEXT WEEK MEETING THE CEO AT ERICSSON AND I'VE ASKED HIM TO
GET THE MAP OF CELL PHONE COVERAGE.
I THINK WE NEED TO PUT THE CENSUS MAP AND ON TOP OF THAT
THE CELL PHONE COVERAGE MAP.
WE MAY GET SO CARRIED AWAY BY THE CELL PHONE COVERAGE THAT WE
DON'T THINK ABOUT THOSE WHO LIVE WITHOUT CELL PHONE COVERAGE.
THEN YOU CAN DO A LOT.
CELL PHONES ARE BEING USED NOW IN DISASTERS.
BUT THAT'S THE SMALL PROBLEM COMPARED TO POVERTY.
YOU CAN USE THAT PATTERN OF CELL PHONE USE AND SEE WHERE YOU HAVE
MORE TEXTS THAN VOICE, THAT'S WHERE YOU HAVE POVERTY.
AT GOOGLE WE DID A SURVEY IN UGANDA AND ONE COMMON SPEAKS TO
ME AND THAT THE PERSON SAID IF I HAVE A LOT TO SAY, I TEXT.
IF IT'S JUST A LITTLE, I VOICE.
STILL TODAY THE MOBILE CELL PHONE COMPANIES LET THE TEXT
SUBSIDIZE THE VOICE.
TEXT MESSAGES ARE SO CHEAP, THEY DON'T OCCUPY ANY BANDWIDTH AT
ALL.
THEY CAN ALMOST BE FREE.
INSTEAD ON THE $100 COMPUTER, MAKE THE $1 TEXT.
WE SAW THAT IMAGE.
TEXT CAN BE VERY, VERY CHEAP AND THE COVERAGE WILL PROBABLY
FUNCTION WITH MARKET MECHANISMS.
BUT THE PROBLEM IS THE COVERAGE.
I HAVEN'T SEEN THE MAP.
I HAVEN'T SEEN THE MAP WITH COVERAGE.
I ASKED -- YOU KNOW THE MILLENNIUM VILLAGES, I LIKE A
LOT OF THINGS THAT THEY'VE DONE.
I DON'T LIKE THE MILLENNIUM VILLAGE.
IT'S TRYING TO DO MISSIONARY STATIONS IN A NEW VERSION.
YOU NEED TO HAVE -- BUT HIS EVALUATION SHOWED TWO THINGS.
FIRST, REALLY PICKED THE REMOVED AREAS AND CELL PHONE COVERAGE
WAS VERY LOW.
IT'S THE MOST IMPORTANT IN THAT PUBLICATION.
THE NUMBER WAS LIKE 20% BY CELL PHONE COVERAGE.
WE MUST REMEMBER, I PROBABLY THINK THAT WE HAVE MOST OF THE
CHILD -- THE POSSIBLE NEW EMERGING DISEASES, YOU KNOW,
SEVERE -- CELL PHONE COVERAGE.
THE POOR PEOPLE, WHEN THE POPULATION GROWS IN THE POOR
REMOTE VILLAGES AN FRAGILE LAND, THE YOUNG COUPLE HAVE TWO
CHOICES, GO TO THE URBAN AREA OR GO FURTHER OUT IN THE OUTSKIRTS
AND OPEN A NEW VILLAGE.
JUST LIKE THE BIG FRONTIER IN THE WEST HERE.
LIKE MY FOLKS -- WHEN MINNESOTA FILLED UP THEY WENT ON THE
OREGON TRAIL.
PEOPLE ARE DOING THIS ALL THE TIME OUT IN REMOTE AREAS AND
THEY MOVE OUTSIDE CELL PHONE COVERAGE.
ONLY WHEN THEY HAVE RAISED ENOUGH MONEY, SOMEONE WILL PUT
THEM UP THERE.
I MAY BE WRONG ON THIS BUT I HAVEN'T SEEN THIS ANALOGY.
WE GET TOO CARRIED AWAY WITH THE CELL PHONES, WE MAY MISS THE
DEEP POVERTY.
>> SEEMS EVERYTHING -- >> [ INAUDIBLE QUESTION ]
[ LAUGHTER ] >> PAUSE YOU'RE A MANAGER.
THAT'S WHY THEY OPPOSE YOU.
>> I WANT TO THANK YOU VERY MUCH FOR COMING AND EVEN MORE FOR THE
WORK THAT YOU'VE DONE IN HELPING US TO COME TO, I THINK, A MORE
SOPHISTICATED AND DETAILED AWARENESS OF HOW THE WORLD WORKS
AND HOW HEALTH WORKS.
WE NEED TO LOOK AT NOT JUST THE BIG TRENDS BUT BOTH THE BIG
TRENDS AND THE MICRO TRENDS.
YOU'RE EXPLODING OF COUNTRIES WITHIN COUNTRIES AND SEEING THE
DIFFERENCES THERE, I THINK, ARE CRUCIAL AS WE SEE AN INCREASING
NUMBER OF OWE INCREASING AMOUNT OF THE PREVENTIBLE ILLNESS OF
THE WORLD IS GOING TO BE IN MIDDLE INCOME COUNTRIES, NOT IN
LOW-INCOME COUNTRIES AND FROM A CHANGING PATTERN OF DISEASES.
ONLY BY LOOKING AT THAT DATA AND MAKING OUR PROGRAMS MATCH THAT
DATA ARE WE GOING TO BE EFFECTIVE.
THANK YOU VERY MUCH FOR WHAT YOU HAVE DONE.
>> THANK YOU.
[ APPLAUSE ]
>> OHH!!!
[ LAUGHTER ]
>> THANK YOU SO MUCH.
>> THANK YOU SO MUCH
[ APPLAUSE ]