By Melanie D.G. Kaplan
Bill Gates, co-chair and trustee of the Bill & Melinda Gates Foundation, gave a keynote address yesterday at the mHealth Summit, an annual gathering that focuses on improving health care through mobile technology.
Gates told an audience of more than 2,000 that if we could register every worldwide birth on a cell phone, we could ensure that children receive the proper vaccines. He also said the key to controlling population growth is to save the lives of children under 5; and the next big thing in technology is robots.
Gates said computing technology has been great for health care, and there are plenty of opportunities to use the cell phone in clinic settings. Although he noted that some places which need mhealth technology the most may not be able to fully benefit from it.
“We have to approach these things with some humility,” he said. “There’s not Internet connections back there. Often [patients are too sick] for some cell phone thing to do something for them.”
Gates said the key health care metric that we as a society should be trying to improve is one that is in the front of his mind all the time–the number of children who die before age 5. Today, he said the number is 8.5 million; in 1960 it was 20 million.
“About one-third [of that improvement] is by increasing income,” he said. “The majority has been through vaccines. Vaccines will be the key. If you could register every birth on a cell phone—get fingerprints, get a location—then you could [set up] systems to make sure the immunizations happen.”
Gates said he’d like to see a birth registration system, and because it’s a new technology, “we should let 1,000 new ideas blossom.”
He said vaccination rates in poorer areas, such as northern Nigeria and northern India, are below 50 percent, and mobile technology could make a significant difference.
“When I think about the biggest impacts, I think aobut patient reminders,” Gates said. He explained that technology could help remind people to take the TB drugs regularly or remind mothers to do certain things in their child’s first year of life.
He also said technology will be important in monitoring the supply chain (i.e. making sure there aren’t counterfeits among vaccinations and medications) as well as saving lives on the ground. “Malaria and TB are going to be the first things where you say, ‘Wow, without this mobile application, all these people would have died.’”
Gates told the audience that there is no such thing as a healthy, high-population growth country. “If you’re healthy, you’re low-population growth,” he said.
While most of us assume that saving the lives of children will contribute to overpopulation, Gates said the contrary is true.
“The key thing, the most important fact that people should know and make sure other people know: As you save children under 5, that is the thing that reduces population growth. That sounds paradoxal. The fact is that within a decade of improving health outcomes, parents decide to have less children.
“As the world grows from 6 billion to 9 billion, all of that population growth is in urban slums,” he said. “Slums is a growing businesses. It’s a very interesting problem.”
He said no matter what we care about—the environment, schools, nutrition, conflict—the issues are insoluble at 3 percent population growth per year. “Nobody can handle that type of situation, so the best thing you can do is avoid those deaths.”
He said we are in a tough time for foreign aid, and governments are cutting their budgets in response to the financial climate. “The U.K. is quite exemplary,” he said. “They set aside their aid budget and are on track to keep their commitment. It will grow while they cut the rest of their budget. I hope it doesn’t get cut here in the U.S., but I’ll say I’m quite concerned that it will be.”
Gates said he has resorted to pleading for money. “I’m a beggar now,” he said. “I go around and beg governments for the final [millions of dollars] needed to eradicate polio. The financial component may be why it doesn’t get done.”
When asked what’s next in our technological advancement, Gates said there’s no doubt it’s robots. “If you don’t want to go to a convention,” he said, “just send a robot. “When we look at something like infant mortality, there’s a certain level you can’t get below if you can’t do C-sections.” He said doing a caesarean section delivery requires a sterile environment, but Gates said it’s fairly routine, so it could be done by a robot.
He said that we are moving from computers sitting idle while we type; to those that can see us and have high-end applications; to computers that allow us to move and connect with other users in applications like Xbox.
“Computers are learning to see, learning to talk ,learning to listen, learning to move around,” Gates said. “The dexterity things are maybe five years behind.” But he said once a robot learns a task, “it doesn’t forget how to do it. It can do it 24 hours a day.”
Gates used an example in South Africa to illustrate how health education doesn’t always lead to behavior change. He said the Gates Foundation partnered with the Kaiser Family Foundation to educate young people about HIV, with several types of outreach, including billboards. When interviewed, there was no question that the young people understood what caused HIV, but there were not significant behavior changes, because in their minds, the disease was in the distant future.
“If AIDS killed you immediately, things would be better because you’d see these piles of bodies outside bars [and think], ‘I don’t want to go in there… looks suspicious.’ It’s these discontinuities that are the problem,” Gates said. “If all the poor people lived in your neighborhood we wouldn’t have problems with foreign aid.”