The Bill & Melinda Gates Foundation’s 2019 Goalkeepers report touches on the existential themes of our time — issues such as gender, climate, and inequality — that most regularly get activists on the streets in democracies.
These are also the hot topics around the United Nations General Assembly this week, where much of the conversation will be about how the public, private, and civil society partners campaigning on these issues can and must dramatically shift the system toward SDG-compliance. A “super-year of activism” is being organized in 2020 to launch the “decade of delivery” toward the 2030 goals.
On each of these issues, the report cites some great solutions but then leaves you craving more. Its analysis looks at inequality through the lens of geography and gender, with data-driven case study chapters on health, digital inclusion, and agriculture.
“The world seems to re-awaken only when we are rudely reminded how often the health care systems of African nations are in fact the world’s frontline defense against our oldest shared worst enemies — infectious diseases.”—
But whether around financing or how to overcome the bad politics in the way of good policy, or how to scale win-wins between climate and inequality campaigners, the report is too quiet. Campaigners armed with the great data in this report can’t be.
Activists need to seize the opportunity presented to take the argument further, faster, shifting where necessary from Bill and Melinda’s mantra of “impatient optimism” toward sometimes impolite activism.
For example, take the persuasive piece on universal health care by Dr. Githinji Gitahi. In it, he analyzes how $51 per person per year is the funding available in Africa for health, through government sources. But in the poorest countries, it’s even lower — about $11 per person is available through government sources. International aid increases to $21 per person per year for all health needs.
While there has been some great progress on health, this number is still extraordinarily low — and a key reason why 14,000 children will die today of preventable diseases, and why 830 mothers will die today in childbirth.
World — where has your outrage about this gone? Health has in the past attracted the kind of passion and concern that the climate crisis does now — such as at the height of the AIDS emergency in the 2000s or the Ebola scare in 2014. The world seems to re-awaken only when we are rudely reminded how often the health care systems of African nations are in fact the world’s frontline defense against our oldest shared worst enemies — infectious diseases. These killers have co-evolved with us and our immune systems over millions of years.
So for all those who would divide humanity, let’s remind them our common biology is inescapable before these killers. Just as with climate change, so with these infectious diseases — in both cases, we face a common threat that could help us form a stronger global identity. This isn’t vague, hippie stuff. It demands practical commensurate levels of investment to strengthen our shared frontline defense against infectious diseases.
The report underlines how the $51 available per person annually in African nations is inappropriate, to put it mildly, and how $86 is a basic needs package for primary health care. Furthermore, even the inadequate current levels of investment are unevenly distributed, with the poorest Nigerian districts getting fractions of that received by middle-class urban areas, for example.
Addressing funding for the districts that have been the most left behind demands more acute efforts to “follow the money” down to the subnational level as well as redistribution within countries to the poorest districts and between countries to those with the lowest income. It requires citizens demanding and public servants agreeing that “human capital” is more of an imperative for investment.
For lower-income nations, Brookings recently estimated it will take about $300 per person per year to supply a package of health education and other essential SDG services. Current estimates are the investment is less than $150 per person per year for all services, from all funding sources.
Where will the funds come from for even this basic mission-critical level of investment? Even great replenishments for the Global Fund, Gavi, and IDA will only modestly increase the per capita availability of funds. More redistribution within countries and between them will be necessary with clearer progressive taxation policies.
To their credit, Bill and Melinda have called for this elsewhere, but a report on inequality might have shared some data on tax policy. The world’s problems can be helped by credible billionaires investing in smart philanthropy, but inequality will be reduced far more rapidly by everyone paying their part through progressive tax policies, and then strengthening the social contract by helping ensure public funds are used smartly.
The Goalkeepers chapter on digital inclusion for gender equality by Arshi Aadil brilliantly explains the benefits of biometric identification, digital delivery, and cash transfers when focused on women’s economic empowerment. But it again begs a big question: Why if India can scale such programs can’t African and other developing nations do the same?
A well-governed Aadhar-like program for Africa, adjusting for all those different realities, must be a priority if we are to have any acceleration toward the SDGs. This is an increasing priority of many African nations and technology partners and, if focused on the poorest women’s empowerment, would be a great outcome for next year’s Generation Gender Equality Summit.
“This isn’t vague, hippie stuff. It demands practical commensurate levels of investment to strengthen our shared frontline defense against infectious diseases.”—
The end of the chapter also left a mission-critical question hanging out there, asserting how ultimately norms and legal enforcement of policies matters massively in improving outcomes toward gender equality. Unfortunately, the report doesn’t say enough or share data about how this can be done or by who.
Whether on gender or other forms of discrimination, the foundation will receive increasing criticism if it doesn’t do more to apply its impatient, evidence-based approach to this normative side and constructively challenge leaders from Kashmir to Cameroon whose policies drive the inequality the foundation opposes.
The Goalkeepers chapter on climate adaptation should connect most readily with the zeitgeist, but pulls its punches. The young Ethiopian mother who describes her struggle in the face of climate change shouldn’t just be adapting, though she must. But what about the injustice she is facing?
This chapter could share data about the fossil fuel subsidies that encourage the climate crisis or advise us on how to invest in renewables and divest from fossil fuel exploration and exploitation companies. Furthermore, it misses the chance to share the data about agriculture not just as adaptation — it can also be mitigation, through carbon sequestration in the biomass she is growing. Strategically, this report could overall work harder to make common cause with the climate campaigners on the street.
As we organize for the huge global moments in the year ahead, whether for the replenishment of the World Bank’s concessional funding arm, the Green Climate Fund, or the Generation Equality Gender Forums in Paris and Mexico — or even as we approach key elections in Tanzania, Ethiopia, Ghana, and the U.S., 2020 is a year when campaigners and citizens need to reawaken to our shared obligations and seize the opportunity both for people and for planet.
Global Goals Week 2019 and this Goalkeepers Report are all great parts of the wake-up call. We must now make it much, much louder.