For decades, Microsoft founder Bill Gates and his wife Melinda have dedicated time, money, and perseverance towards improving global health and education, and advocating for energy innovation and other solutions to the climate crisis. The couple — co-chairs of the Bill and Melinda Gates Foundation — have just published their Annual Letter about what they learned about the world in 2018:

From especially devastating natural disasters on the one hand to record numbers of women campaigning for office on the other, 2018 felt to us like a series of surprises. The world looking backward from today is very different from what we pictured a couple years ago looking forward.

A benefit of surprises is that they’re often a prod to action. It can gnaw at people to realize that the realities of the world don’t match their expectations for it. Some surprises help people see that the status quo needs to change. Some surprises underscore that transformation is happening already.


This year, like in years past, surprise invariably leads to outrage and/or inspiration, activating the goal-oriented Gates Foundation to focus on making the planet a better place for all its inhabitants. Here are nine surprises from 2018 that are motivating Bill and Melinda Gates for philanthropic advocacy in 2019 and beyond. In the list, and with some of the included quotes, you will note an emphasis on youth and the health of girls and women:

Surprise #1: Africa is the youngest continent. Its median age is the lowest in the world.

“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.”


Surprise #2: At-home DNA tests can find serial killers—and could also help prevent premature birth. Scientists have discovered a potential link between preterm labor and certain genes.

“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 […], and premature babies in low-income countries are much more likely to die than ones in richer countries.”


Surprise #3: We will build an entire New York City every month for 40 years! The world’s building stock will double by 2060.

“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.”


Surprise #4: Data can be sexist. How much more time do girls spend on chores than boys do? Answer: We don’t know, and that’s the problem.

“How much income did women in developing countries earn last year? How much property do they own? How many more hours do girls spend on household chores than boys?

“I don’t know. Neither does anyone else. The data just doesn’t exist.”

“What we choose to measure is a reflection of what society values. That’s why when it comes to understanding the lives of women and girls, the world can’t accept “I don’t know” as an answer.”


Surprise #5: You can learn a lot about processing your anger from teenage boys.

“BAM [Becoming a Man] helps young men in neighborhoods with a lot of crime and gang activity explore their emotions and hone their decision-making skills. It’s drawn a lot of attention for its success: A study by the University of Chicago found that BAM reduces its participants’ violent crime arrests by almost half.”


Surprise #6: There’s a nationalist case for globalism. Countries like the U.S. invest in foreign aid because it makes the world more stable and secure.”

Bill and I love our country. We believe in what it stands for. We agree that our leaders have a duty to protect it. And for all of those reasons, we consider global engagement our patriotic duty.”

“There is nothing about putting your country first that requires turning your back on the rest of the world. If anything, the opposite is true.


Surprise #7: When was the modern flush toilet patented? Alexander Cumming patented the modern flush toilet in 1775, although it wasn’t mass-produced until the mid-1800s.

“Unlike today’s commodes, the toilets of the future are self-contained. They’re essentially tiny treatment plants capable of killing pathogens and rendering waste safe on their own. Many of them even turn human feces and urine into useful byproducts, like fertilizer for crops and water for handwashing.

“They might not be the sexiest innovations in the world, but the toilets of the future will save millions of lives.”

“They’ll also improve lives—especially for women and girls. Life without a toilet is hard for anyone, but it tends to be women and girls who suffer most.”


Surprise #8: Textbooks are becoming obsolete. Software is finally changing how students learn.


Surprise #9: Mobile phones are most powerful in the hands of the poorest women. Mobile phones give women the power to build an entire new life.

“[W]omen are not only using their mobile phones to access services and opportunities. They’re using them to change social norms and challenge the power structures that perpetuate gender inequality.”


While the challenges to improve global health and well-being are enormous, Bill and Melinda Gates are still optimistic that positive outcomes are entirely possible. Read why — and why you should be an optimist, too — in their “Annual Letter 2019″ here.


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