15 Year Anniversary Celebrationn

Sustainable Housing

A House for Every Indian

Melinda: We asked ourselves the same question at first. Hans Rosling, the brilliant and inspiring public health advocate who died last year, was great at answering it. I wrote about the issue at length in our 2014 letter. But it bears repeating, because it is so counterintuitive. When more children live past the age of 5, and when mothers can decide if and when to have children, population sizes don’t go up. They go down. Parents have fewer children when they’re confident those children will survive into adulthood. Big families are in some ways an insurance policy against the tragic likelihood of losing a son or a daughter.

We see this pattern throughout history. All over the world, when death rates among children go down, so do birth rates. It happened in France in the late 1700s. It happened in Germany in the late 1800s. Argentina in the 1910s, Brazil in the 1960s, Bangladesh in the 1980s.

Bill: There’s another benefit to the pattern Melinda describes—first more children survive, then families decide to have fewer children—which is that it can lead to a burst of economic growth that economists call “the demographic dividend.” Here’s how it works.

When more children live, you get one generation that’s relatively big. Then, when families decide to have fewer children, the next generation is much smaller. Eventually, a country ends up with relatively more people in the labor force producing economically—and relatively fewer dependents (very old or very young people). That’s a recipe for rapid economic development, especially if countries take advantage of it by investing in health and education.

Fortunately, the number of child deaths is likely to keep going down. The rate of innovation in child health is extraordinary, and the world is starting to make progress on some of the most stubborn challenges in the field. For example, we now know that malnutrition is a contributing factor in half of all child deaths, but there are still many open questions about what causes malnutrition and how to prevent it. One promising area is the study of the microbiome—all the bacteria in the human gut—and the role it plays in kids’ ability to absorb nutrients. We’re also working with a partner on a device that’s the thickness of a piece of string that can go down infants’ noses and take 360-degree microscopic pictures of the gut. Soon, we’ll be able to see how a child is developing, instead of having to guess.

15 Year Anniversary Celebrationn

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