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Why Africans are not living longer, by Gates


Bill and Melinda Gates Foundation

*At-home DNA tests can find serial killers, help prevent premature birth
Two of the nine things that surprised Bill and Melinda Gates in 2018 are: people in other parts of the world are living longer except in Sub Saharan Africa; and at-home Deoxy ribo-Nucleic Acid (DNA)/genetic material tests can find serial killers and could also help prevent premature birth. Scientists discovered a potential link between preterm labour and six genes.

These were contained in Bill and Melinda Gates 2019 Annual Letter titled: “Things We Didn’t See Coming.”In this year’s letter, Bill and Melinda shared nine things that have surprised them over the course of their nearly two decades of work together in global health and development.

They shared surprises that both worry and inspire them, and observed that surprises are often powerful calls to action: “Twenty-five years ago, we read an article that said hundreds of thousands of kids in poor countries were dying from diarrhoea. We believe in a world where innovation is for everyone—where no child dies from a disease it is possible to prevent. But what we saw was a world still shaped by inequity,” Bill and Melinda Gates wrote. “That discovery was one of the most important steps in our journey to philanthropy.”


Surprises in this year’s letter addressed topics including the importance of investing in Africa’s growing population of young people, sources of greenhouse gas emissions that do not get enough attention, the reasons data can be sexist, and the nationalist case for globalism.

The Gates dedicated this year’s letter to their dear friend and Bill’s Microsoft co-founder, Paul Allen, who died of cancer last October.
Africa is the youngest continent.Bill said: “The world keeps getting older, but Africa stays (nearly) the same age. It sounds confusing, but it makes sense when you break it down. The global median age is on the rise. In every part of the world, people are living longer. As more children survive to adulthood, women are having fewer kids than ever before. The result is a global population that is creeping slowly toward middle age.

“Except in Africa. The median age there is just 18. In North America, it is 35. And the number of young Africans is expected to rise in the decades to come. There are a lot of reasons for this. One is that the annual number of births is going up in the poorest parts of sub-Saharan Africa, even as it goes down in other parts of Africa. This can be either an asset or a source of instability. Melinda and I believe that the right investments will unlock the continent’s enormous potential. Young Africans will shape the future of not only their own communities but the entire world.”

To Melinda: “When economists describe the conditions under which countries prosper, one of the factors they stress is ‘human capital,’ which is another way of saying that the future depends on young people’s access to high-quality health and education services. Health and education are the twin engines of economic growth.

“If sub-Saharan Africa commits to investing in its young people, the region could double its share of the global labor force by 2050, unlocking a better life for hundreds of millions of people. Girls’ education, especially, is among the most powerful forces on the planet. Educated girls are healthier. They are wealthier. (If all girls received 12 years of high-quality education, women’s lifetime earnings would increase by as much as $30 trillion, which is bigger than the entire U.S. economy.) And their families benefit, too.

“The more education a woman has, the better equipped she is to raise healthy children. In fact, the United Nations Educational, Scientific and Cultural Organisation (UNESCO) estimates that if all women in low- and middle-income countries finished secondary school, child mortality in those countries would fall by about half. A healthy, educated, and empowered African youth boom that lifts girls instead of leaving them behind would be the best indicator of progress I can imagine.”

At-home DNA tests can find serial killers—and could also help prevent premature birth
Bill said: “When police used genetic test results to catch the Golden State Killer last year, the story made headlines around the world. But it’s not the only discovery to come out of at-home DNA tests. By looking at more than 40,000 samples voluntarily submitted by 23andMe users, scientists discovered a potential link between preterm labor and six genes—including one that regulates how the body uses a mineral called selenium. Some people have a gene that prevents them from processing selenium properly. The 23andMe study (which our foundation helped fund) found that expectant mothers who carry that gene were more likely to give birth early. This suggests that selenium plays a role in determining when a woman begins labour.

“Understanding what causes prematurity is hugely important. Fifteen million babies are born premature every year, making it the leading cause of death in children under age five. Preterm birth affects mothers in every part of the world—although some groups experience it at a higher rate (which Melinda will talk about), and premature babies in low-income countries are much more likely to die than ones in richer countries.

“Researchers won’t know until later this year how exactly the mineral affects preterm birth risk. But if the link proves substantial, selenium could one day be a cheap and easy solution to help women extend their pregnancy to full term. This connection is one of several breakthroughs we’ve made in recent years. Better tools and more data sharing mean that we’re finally starting to understand what causes babies to be born early—and what we can do to keep them in the womb longer. I’m particularly excited by the simple blood test for prematurity being developed by a team at Stanford. It can tell a woman how soon she’ll give birth, so she can work with her doctor to minimize risks.”

Melinda said: “Despite all the promising discoveries Bill just described, what’s just as amazing to me is how little we know about prematurity. I can’t think of anything else that affects 10 percent of people in every part of the world but gets so little attention. “For the vast majority of preterm births, we can’t identify the cause, nor do we know why some groups of women are more prone to delivering their babies early. For example, it’s a mystery why taller women have longer pregnancies. And in the U.S., it’s a mystery why African-American women deliver prematurely more often than women who emigrate here from African countries.

“One theory is sociocultural—that the racism and discrimination African-American women have faced their whole lives leads to stress that damages their health. Another is that the mix of micro-organisms in women’s bodies may be different when they are raised here. We just don’t know. But here’s one thing we do know: Prematurity is not binary. It matters a lot how early a baby is born; a baby born at 36 weeks is much better off than a baby born at 34 weeks. Our goal should not be to prevent prematurity categorically, which may be impossible anyway. Instead, it should be to extend pregnancies closer to full term for everyone. And we’re finally starting to fill the gaps in our knowledge about how to do so.”

Climate change
Bill said: “I wish more people fully understood what it will take to stop climate change. You have probably read about some of the progress on electricity, as renewables get cheaper. But electricity accounts for only a quarter of all the greenhouse gases emitted around the world. Manufacturing isn’t far behind, at 21 percent. When most people think of manufacturing, they picture widgets on assembly lines, but it also includes the materials used in buildings. Making cement and steel requires lots of energy from fossil fuels, and the processes involved release carbon as a byproduct.


“As the urban population continues to grow in the coming decades, the world’s building stock is expected to double by 2060—the equivalent of adding another New York City monthly between now and then. That’s a lot of cement and steel. We need to find a way to make it all without worsening climate change. Manufacturing isn’t the only big emitter. Agriculture accounts for 24 percent of greenhouse gases. That includes cattle, which give off methane when they belch and pass gas. (A personal surprise for me: I never thought I’d be writing seriously about bovine flatulence.)

“The larger point is that if we’re going to solve climate change, we need to get to near-zero emissions on all the things that drive it—agriculture, electricity, manufacturing, transportation, and buildings. I call these five areas the grand challenges in climate change. It’s not realistic to think that people will simply stop using fertilizer, running cargo ships, building offices, or flying airplanes. Nor is it fair to ask developing countries to curtail their growth for the sake of everyone else. For example, for many people in low- and middle-income countries, cattle are an essential source of income and nutrients.

“Part of the solution is to invest in innovation in all five sectors so we can do these things without destroying the climate. We need breakthrough inventions in each of the grand challenges. I can report some progress. The European Commission recently committed to invest in research and development on the five areas. And the $1 billion private fund I’m involved with, Breakthrough Energy Ventures, is using the five grand challenges to guide all our investments in clean-energy companies. (My BEV work is separate from what our foundation does to help farmers adapt to climate change.) “But we need to do a much better job of informing people about the challenges. It would help if media coverage matched the breadth of the problem. Solar panels are great, but we should be hearing about trucks, cement, and cow farts too.”

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