Tiger Sniffing: This is a speech by Bill Gates at the Joint Debating Hall of the University of Cambridge, England, on October 7, 2019. He was selected as Winner of the 2019 Hawking Scholarship. Bill Gates said: “I have always appreciated Stephen Hawking. He is an outstanding physicist and an equally outstanding science communicator. He can make the whole universe easy to understand and inspire millions. People are interested in science.”
“When I was thinking about what to say, I knew that I wanted to try and practice Hawking to make science interesting. I picked a topic that I was very concerned about.” Global health, and choose to do something that I hope will make Professor Hawking happy: predict the future,” Gates said.
The following is the full text of Bill Gates’s speech, which is from Visual China.
Thank you, Lucy Hawking. I have had the privilege of being with your father over the years. It is great to see you this morning.
I am honored to be selected as the recipient of this year’s Hawking Scholarship. I want to thank the selection committee, the Cambridge Federation and the entire Hawking family for the great honor they have brought me.
The first time I saw Professor Hawking was in 1997, when I was here, I announced that Microsoft and Cambridge University would work together to build a new research laboratory. Over the years, we have seen several times and have had several unforgettable dinners in Cambridge and Seattle. I hope that I can tell you something surprising about what we are talking about, but in fact we are mainly talking about physics.
Trust me: If you are interested in physics like me and have the opportunity to talk to Professor Hawking about his research, you must seize this opportunity. His personality is as special as you think. He is not only very talented in physics, but also a very talented communicator.
Hawkin wants the public to think and participate in science. His entire career has been devoted to making it easy to understand and interesting. He encourages people to remain curious – to understand the facts and ask questions.
In fact, Hawking’s last book is all about asking big questions. One big question is, can we predict the future?
Today, I want to answer this question with the platform created by Professor Hawking and his family. Can we predict the future? As far as the future of the health field is concerned, I believe the answer is yes: we can.
Why do I think we can predict the future? Because there are three facts that explain how we achieved today’s achievements.
Fact 1: Global health has improved significantly in recent decades
The countries with the worst health conditions today are better than the countries with the best health conditions a century ago. The world’s child mortality rate has fallen sharply, and life expectancy has risen dramatically.
I like this chart because it shows that we have made great progress. Each row shows the number of deaths in all ages, with the youngest group at the top and the oldest at the bottom. On the left is 1990 and on the right is 2017.
Look at the line at the top left. In 1990, the age group with the highest mortality rate was children under the age of five. There were 12 million children who died in that year. Look at the same line on the right: 6 million. By 2017, the number of deaths among children under five has been cut in half. The age group with the highest mortality rate is 80-84 years old. This means that more people in the world have lived to old age.
Although we have made these progresses, we can still see huge inequalities in health.
Let’s look at the distribution of under-five mortality rates today:
See where deaths occur: mostly in sub-Saharan Africa. These children usually die from diseases that can be prevented and treated, such as diarrhea. This is because the breakthrough in saving lives in places like Cambridge and Seattle is slow. This reminds me of the second fact…
Fact 2: Progress is achieved through innovation
When most people envision innovation in the health field, they think of major medical breakthroughs, such as the first polio vaccine developed by Salk. But innovation is not limited to new therapies, and sometimes the biggest impact comes from an optimized system that allows us to reach more people.
For example, oral polio vaccines that pushed polio to the extinction edge in recent years have been around since 1961, but for decades, not all children around the world have access to the vaccine. In 1988, this situation changed with the establishment of a new agency called the Global Polio Eradication Initiative (GPEI).
GPEI has developed an innovative strategy with the goal of reaching out and vaccinating every child. It also conducts disease surveillance to track viruses around the world. Thanks to the unremitting efforts of partners and governments, and the large-scale voluntary work of Rotary International, GPEI has reduced polio cases by more than 99.9% worldwide.
Innovation that drives progress also includes new cognitive approaches.
When me and Melinda started this work for the first time, we were shocked to discover that the world knows very little about health work, especially about the health of the poorest areas. And our understanding today is much deeper and more accurate.
When I first became interested in global health, faced with one of the world’s biggest health killers, diarrhea, everything we know about patients suffering from this disease is included in this table.
What does it tell us? Except for the fact that many people had diarrhea in 1990, this table does not show much. It tells you which diseases in different areas have caused child deaths, but it doesn’t even tell you which country or what caused them to have diarrhea. It allows you to understand the severity of the problem, but it is not particularly useful for planning.
This is the data we have about diarrhea today:
We can segment the number of diarrhea deaths by country and for more than a dozen reasons.
Better data helps us make better use of resources. For example, by observing this chart, we know that it is more meaningful to invest more money in Chad’s rotavirus vaccine than in Ethiopia, because Chad’s rotavirus mortality rate is relatively higher than Ethiopia.
This chart comes from a great tool called Global Burden of Disease. This tool is extremely valuable if you work in the global health arena. It can tell you almost everything you want to know about who is suffering from which disease. If you don’t work in the global health arena, it’s a good way to track the amazing progress we’ve made – and progress will continue. We still have a lot of things to do because…
Fact 3: Innovation is a long-lasting battle
We talk about R&D progress for a reason: Innovation often takes years to develop and accumulate. The rotavirus vaccine I mentioned before took decades to be vaccinated by the people I needed, and was even once pulled out of the market.
Many technologies that will affect human health in the next 20 years are already in the process of development. Recently, breakthroughs in understanding how the body works are bringing tremendous progress.
Fortunately, my workLet me see all the amazing discoveries in the field today. This is why I can predict the future. Based on the progress I’ve seen, I predict that human health will change dramatically due to two major advances over the next 20 years.
My first prediction is that we will address malnutrition and significantly reduce the number of nutrition-related deaths.
A lot of people ask me if I can only solve one problem, what will I choose. My answer is always malnutrition.
Remember the child mortality map? It is the map that tells us that children in sub-Saharan Africa are more likely to die than children in other parts of the world. About half of these deaths are caused by malnutrition.
This is the biggest health inequality in the world. By addressing malnutrition, we can eliminate one of the biggest causes of inequality.
Most people think of malnutrition, they will think of a hungry, skinny child. When you are underweight relative to your height, you are losing weight. Weight loss often causes death. But weight loss is not the only problem caused by malnutrition.
There are also problems with stunting. When your height is low relative to body weight and irreversible, it is stunted. Most children who survived wasting were eventually stunted. If you don’t get enough nutrition in the first three years of your life, your body and mind can’t develop normally.
Even if you live to adulthood, your chances of death will be much higher and your quality of life will be greatly reduced.
This photo is a good illustration of the long-term effects of dysplasia:
These children are all 9 years old. The three children on the left are far below the average height of their age. This is what happens when you miss the key window of growth (that is, the years before your life). You will not be able to make up.
It is no exaggeration to say that stunting hinders the development of the entire country. The most shocking thing is that despite the amazing progress we have made in health, there is still one in five children under the age of five who are stunted.
Rescuing these children is not as simple as making sure they have enough food to eat. Even if you have enough calories, you may develop stunting. To understand why, you need to understand how your child grows.
When you eat, your body absorbs energy. These energies are used to do a lot of things, such as providing energy to the brain, fueling physical activity, and supporting your immune system.
In the first few years of life, any energy you have left is used to nourish your brain, muscles and bones. Infants need to double their birth weight within 6 months. But if you don’t have the energy surplus, you won’t get the growth you deserve. You become a stunted person.
The most obvious reason is that you have not been able to consume enough and suitable food for a long time. But stunting has some less intuitive reasons.
Example: You don’t have the right micronutrients (vitamins or minerals), the infection puts your body in an inflammatory state, the beneficial bacteria in your body are not strong enough, or your mother is still in the womb or breastfeeding I suffered from this.
All of this will make it harder for your body to get the nutrients you need.
The good news is that we have a solution to three of these problems: you can fix micronutrient imbalances by fortifying food or supplements; infections can be treated with drugs or with vaccines; we can pass many Ways to improve maternal poor health, including promoting gender equality and supplementing nutrition during pregnancy.
Before, repairing microbial communities is still a mystery to us. In recent years, we have learned a lot about this and will continue to learn more in the next 20 years.
The in-depth understanding is that I predict that we will address the causes of malnutrition.
To make the body work properly, we all depend on the microbiota in the body. There are more microbial cells in our body than human cells. These bacteria protect us from infection and are especially important for digestion. For example, your body cannot break down certain types of plant fiber without the help of intestinal bacteria.
In the early 21st century, molecular sequencing technology allowed us to see which species and bacteria for the first time.The strain lives in the human microbiota.
After 2013, American biologist Jeff Gordon published a landmark study. He and his team studied how the microbial community of twin babies in Malawi developed over three years. What they are most interested in is that only one of some twins has a particularly severe malnutrition.
After analyzing long-term stool samples, they found that although these twins ate the same food and lived in the same environment, the microbial community of the twins with severe malnutrition developed more slowly than the one without malnutrition. . When Jeff’s team transplanted a microbiome of sick twins into mice, the mice began to become difficult to absorb and lose weight.
This twin study shows that microbial communities are not only a by-product of health, but can also affect your health. The first time we saw such a major clue that we may solve malnutrition by changing the gut microbiota.
We are still in the relatively early stages of this research. Over the next 10 to 20 years, we will learn more about each microbe and how it affects human health with the food it consumes. This knowledge will enable us to skillfully design interventions to “correct” them when microbes are disordered.
You may be familiar with one of the interventions: probiotics. In the future, we will be able to create the next generation of probiotic pills, which contain a combination of good bacteria and even bacteria tailored to your gut.
Another intervention may be the so-called “microbiological-oriented supplementary food”. You can think of them as microbial fertilizers. Eating them promotes the growth of healthy bacteria that help digest food and protect us from infection.
These treatments for microbes are still in their infancy. If we can find a way to make them work and widely used, then I am optimistic that we can prevent malnutrition. This will be the biggest breakthrough we can achieve in the next 20 years.
Although I am very excited about the impact this will have on the poor world, some of our basic insights into how nutrition works will also bring huge benefits to the rich world. Overnutrition and undernutrition are two sides of a coin. Finding out how to improve one of them may also help us improve the other.
Since we have a better understanding of the intestines,We can start to think of ways to change it. Not only does this help prevent malnutrition and obesity, but it also prevents many other diseases, such as asthma, allergies and some autoimmune diseases – which may be caused by imbalances in the microbial community.
If we can figure out the nutritional problems, I believe that in the next 20 years, we will save millions of lives and even improve the lives of more people.
This reminds me of my second prediction that will change the healthy future…
For the next 20 years, I predict that every country on the planet will shift the focus of health care from just saving lives to improving lives.
This shift marks the most significant change in a country’s perception of health care.
Recall the last time you went to the doctor to check. What are you most worried about with your doctor?
If you are like an ordinary Englishman, then you are likely to worry about your heart health. You may have discussed your risk factors for cancer and Alzheimer’s disease. If you have any signs, your doctor may help you plan and keep your health on the right track.
Now imagine that you live in Chad, the country with the highest proportion of preventable deaths.
You may not have regular check-ups because your local health clinic is busy treating people who are really sick. You may never see a doctor, only a nurse or other health worker.
You may actually see them when your body has some serious problems (such as high fever or persistent diarrhea) that are in urgent need of treatment.
What is the difference between these two health insurance systems? In the UK, the goal of health care is to stay healthy. In Chad, the goal of health care is to save lives.
This difference sounds subtle, but it has a huge impact on how you get health care. In twenty years, I believe that every country in the world will not only focus on survival, but on the health and quality of life.
The easiest way to track this shift is to look at the deaths of non-communicable diseases and infectious diseases, maternal, neonatal and nutritional diseases that we believe can be “prevented” in developed countries. Number ratio.
The proportion of preventable deaths in deep red and orange countries is over 50%.
For many of us here, in our country, the number of preventable deaths has fallen below 50% long before we were born. In other places, this has only recently happened. Pakistan crossed the threshold in 1997. South Africa finally achieved a transformation in 2016.
At present, most of the deaths caused by these preventable causes come from Africa. After 20 years, these countries will cross the threshold of 50%.
Why do I say that? There are several reasons.
First, as I explained earlier, we will address nutrition. This will be the biggest improvement.
I believe that by 2040, we will almost eliminate malaria. Many countries that are still above the 50% preventable death threshold are also the places with the highest number of malaria deaths each year. In Niger, for example, malaria deaths account for 17% of all deaths.
For a long time, we believe that treatment is the best way. Does it make sense? Malaria is a curable disease. If you give enough people medicine or develop a simple vaccine, you should be able to eliminate it.
The reality is much more complicated. In recent years, we have learned that the key to controlling malaria is to control the vector, and the vector of malaria is mosquitoes.
If we want to stop malaria, we must eliminate mosquitoes that carry malaria. There are several potential new developments in this work that give me hope. First, we finally know where the mosquitoes are.
Look at these two maps of Haiti:
On the left is a map showing the incidence of malaria at a resolution of 5×5 km. Believe it or not, even this detail is a huge improvement over 10 years ago. The map on the right uses data from various medical institutions, and the pixels are only accurate to 1×1 km. Can you see how clear the left side is?
This clarity means that health officials do not have to travel around the entire area to distribute mosquito nets and take other anti-malarial measures to maximize anti-malarial effects in key affected areas.
I am also excited about the potential of genetic editing. Eliminating all mosquitoes in an area is the fastest way to stop malaria, but it is risky. Most mosquitoes cannot carry malaria parasites. If you remove them, you may destroy the local ecosystem.
Gene editing lets us target mosquitoes that carry malaria. Inserting a gene that blocks the breeding of these bad mosquitoes will give us time to cure everyone in the malaria-ravaged area. Then we can make the mosquito population return without the malaria parasite.
This technology is still in beta. We first need to understand something: If one of the mosquitoes begins to die, what effect will it have on the food chain? How many kinds of mutant insects do we need to introduce? How long do we need mosquitoes to disappear? What political and government resistance needs to be overcome?
Of course, the deadly killer of malaria is not the only disease we can make great progress.
We will also eventually reverse the trend of the HIV epidemic, thanks in large part to a new generation of highly effective long-acting HIV drugs.
Today, if you are diagnosed with HIV, you can control it with antiretroviral therapy. Thanks to this therapy, infected people can now have the same life expectancy as ordinary people.
Since I am in Cambridge, I should mention that the UK is an important reason why we have made such great progress on the HIV issue. The UK government is the second largest funder of an organization called The Global Fund (The Global Fund). Without mentioning other contributions, the organization has supported more than 17.5 million people who use antiretroviral drugs to control HIV. In fact, I will also go to Lyon to attend the Global Funds Financing Conference later this week.
Antiretroviral therapy is amazing, but you must stick to it every day for the rest of your life. If you don’t stick to it, you may develop resistance and even spread a drug-resistant strain to others.
On the other hand, with modern standards, the future of AIDS therapy is a miracle. Imagine that you don’t have to take medicine every day, but every few months, even once a year. You can also implant on your arm.
The prevention of AIDS will also improve. Today, you can take a pill every day to reduce the risk of infection. In the future, these tablets may last longer, so you can reduce the frequency of taking them.
I am also very optimistic that one day we will develop an effective AIDS vaccine that will eliminate the risk of your complete infection.
When you don’t have to think about life-saving treatments and preventive measures every day, it’s much easier to integrate them into your life. We have been away from such a world for many years. But when that day comes, the rules of the game will be changed.
So what happens when a country crosses the threshold of preventable death?
As preventable diseases become more and more uncommon, chronic diseases become more common. This includes things that can kill you, such as Alzheimer’s and Diabetes, or diseases that make you feel very painful, such as arthritis. You are also more likely to suffer from mental illnesses such as depression or anxiety.
It seems strange to see depression or stroke as a sign of progress. But it’s important to remember that human health is not measured by binary standards.
Innovation is closing the gap between everyone’s health and unhealthy. The smaller it is, the better the world will be.
This is because the transition from longevity to health has not only changed the way we treat healthcare. It also opens up a variety of amazing opportunities for human and social prosperity.
When we think about how to keep a person healthy, what we really think about is their happiness. We think about how to ensure that they perform well in school, support their families and contribute to society.
It is no coincidence that countries with the highest proportion of preventable deaths have the lowest per capita gross domestic product (GDP) in the world.
Improving health is poverty alleviationbasis. Health levels are improved and people are more productive. And when more children live to adulthood, the family will decide to have fewer children, which may lead to explosive growth of the economy.
In other words, when people are healthy, the economy will grow, poverty will decrease, and the world will get better.
Seeing the health inequalities that still exist in the world can be frustrating. But if we continue to fund innovation, we can narrow these gaps. We can solve the nutritional problem, and we can ensure that the world expands its focus to improve life.
But there are still traps: the technology is easy to predict. But progress depends not only on technology. It also depends on those who are hard to predict.
Do we continue to believe that investing in innovation is worthwhile? Will we make every effort to ensure that these innovations benefit all those who need them?
The world is at a critical moment in global health and there are many key projects that need financial support. Now countries are deciding whether it is worthwhile to make these investments.
Another question asked by Stephen Hawking in his last book is: “How do we shape the future?” Investing in global health is one of the best ways we can do it. If we choose to put innovation first, then the future can be shaped by us.
Professor Hawking believes in the magic of science and research. He also helped the world believe this. Although his contribution to the field of physics is extraordinary, I still believe that this is his greatest achievement.
He reminds us: “Looking down at the foot, it is better to look up at the stars.” He taught us that if humans continue to focus on expanding the potential areas, progress will come.
Thank you for giving me this great honor.