Kristof: Bill and Melinda Gates’ pillow talk

What do Bill and Melinda Gates argue about?

Not whose turn it is to wash the dishes or take out the garbage, it seems, but headier stuff. The prospects for eradicating polio. The utility of empowering women. The best ways to save lives.

Oh, and maybe how much to acknowledge to a prying columnist that they sometimes do argue.

It has been 15 years since Bill and Melinda Gates created what is now the largest foundation in the world. This milestone seemed the right moment to ask them what they have learned from giving away $34 billion, what mistakes they have made and what they disagree about.

But first, just a reminder of how historic this foundation has been. It has played a central role in a campaign to transform health and nutrition for the world’s poor.

In all of history, humans have eradicated only one disease affecting them, smallpox. Bill and Melinda Gates foresee eradicating four more in the next 15 years: polio and Guinea worm disease and, for the other two, perhaps elephantiasis and blinding trachoma. They say, quite plausibly, that we’ll be poised to eradicate malaria soon afterward and to make enormous progress against AIDS, too.

By my conservative back-of-envelope calculations, the world has saved more than 33 million children’s lives since the foundation was established (although obviously the foundation doesn’t get all the credit). And Bill and Melinda Gates foresee the world saving 61 million children’s lives over the next 15 years with the right investments, as child death rates drop more quickly than they ever have in the history of the world.

That’s the amazing news. In contrast, they acknowledge, the foundation’s investments in education here in the United States haven’t paid off as well.

“There’s no dramatic change,” Bill acknowledged. “It’s not like under-5 mortality, where you see this dramatic improvement.”

But both Bill and Melinda insist that they aren’t dispirited by the lack of transformational progress in education. “We’re still very committed,” Bill says.

One giant leap: Bill and Melinda say the foundation is now going to further expand beyond K-12 to also invest nationwide in early childhood programs. I’m thrilled, for I’m a believer that helping children ages 0 to 5 (when the brain is developing rapidly) is crucial for the most at-risk children.

So what mistakes did they make in their philanthropy? They say they started out too tech-focused. Now some of the measures they promote are distinctly low-tech - like breast-feeding, which could save the lives of more than 800,000 children worldwide each year.

Likewise, they say, they didn’t appreciate how hard it was to translate scientific breakthroughs into actual progress in remote villages. The challenges of delivering real impact, in environments where nothing works as anticipated, were far greater than expected.

That challenge is what led them to focus on gender and empowering women, which they initially had neglected but came to see as crucial to getting things done. The foundation has invested in areas like contraceptives, women’s self-help groups and battling sex trafficking.

There’s sometimes a debate about who saved the most lives worldwide. Edward Jenner, of the smallpox vaccine? Fritz Haber, who laid the basis for modern fertilizers (and also explosives)? Norman Borlaug of the green revolution? James Grant, who directed child survival campaigns? Bill and Melinda Gates could be contenders if their health and nutrition investments pay off in coming decades.

But when I asked about their legacy, Bill didn’t much want to talk about it.

“Legacy?” he asked. “We don’t optimize for that.”

So, finally, what do Bill and Melinda disagree on?

Ah, here the conversation gets a little awkward. Bill clams up; Melinda is only a bit more forthcoming.

“On the foundation, there’s always a lot of pillow talk,” Melinda said. “We do push hard on each other.”

Examples?

There is a hushed marital discussion.

I gather from hints that follow that Melinda has been more enthusiastic about gender issues and family planning, while Bill worried that metrics in the area are squishy. Conversely, Bill is fervent about science research and polio, while Melinda pushes him to consider how well those investments will translate into real-life gains.

It also seems that on trips, Bill thought Melinda focused too much on field visits, while Melinda thought Bill spent too much time with officials. But they seem experienced at listening to each other, adjusting and working things out. “We trust each other,” Melinda says. Kind of like any good couple, I guess - just with higher stakes.

They also teach each other, Melinda says. In the case of gender, they’ve followed her lead in investing in contraception but also they developed new metrics to satisfy Bill.

So among their lessons learned from 15 years of philanthropy, one applies to any couple, even nonbillionaires:

Listen to your spouse!

Nicholas Kristof is a columnist for the New York Times.