Promise and Peril in the Global War on Poverty

The Bill & Melinda Gates Foundation issued a candid report on the health of the world. Fortune talks with its CEO, Dr. Sue Desmond-Hellmann, about why the stakes for all of us are so high.
Sue Desmond-Hellmann, CEO of the Bill & Melinda Gates Foundation, listens to mothers at Hagere Selam Kebele Health Post in the Tigray region of Ethiopia in October 2016.

FOR DECADES Ethiopia was a land of seemingly unending poverty, beset by one humanitarian crisis after another. A drought-induced famine in 1973–74 was estimated to have left 300,000 dead. A still greater famine, in the mid-1980s, killed twice as many. A third, in 1990–2000, starved tens of thousands more.

Since then, however, Ethiopia has made such remarkable strides in growing its economy—and just as important, in building a comprehensive social safety net—that the Bill & Melinda Gates Foundation now says it’s on track to “almost eliminate extreme poverty by 2050.”

Rwanda, a country torn apart by genocide barely a generation ago, has spent the years since that horror protecting its current generation of children by investing in health care—doubling down on vaccination efforts and supporting a

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