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Text Content

2024 Report The Event The Mission The Work The Goalkeepers
Introduction
Solutions
The Next Frontier
Afterword
Explore The Data
Download the Report



THE WORLD'S WORST


CHILD HEALTH CRISIS


IS MALNUTRITION.

NO COUNTRY, HOWEVER RICH,

IS IMMUNE.


MORE THAN


400 MILLION


CHILDREN


AREN’T GETTING THE


NUTRIENTS THEY NEED


TO GROW AND THRIVE.




CLIMATE CHANGE


IS MAKING IT


EVEN HARDER


TO SOLVE.




WE HAVE NEW TOOLS


AND PROMISING


RESEARCH TO ENSURE


KIDS GET HEALTHIER


EVEN AS THE WORLD


GETS HOTTER.




THE RACE TO NOURISH
A WARMING WORLD

THE WORLD'S WORST CHILD HEALTH CRISIS IS MALNUTRITION. CLIMATE CHANGE IS MAKING
IT EVEN HARDER TO SOLVE. TO PROTECT THE WORLD’S CHILDREN FROM HUNGER’S WORST
EFFECTS, WE MUST INVEST IN GLOBAL HEALTH.

by Bill Gates

Co-chair, Bill & Melinda Gates Foundation

When historians write about the first quarter of the 21st century, I think they
may sum it up this way: Twenty years of unprecedented progress followed by five
years of stagnation.

This is true for nearly every issue the Bill & Melinda Gates Foundation works
on, from poverty reduction to primary school enrollment. But nowhere is the
contrast more stark or tragic than in health.

Between 2000 and 2020, the world witnessed a “global health boom.” Child
mortality fell by 50%. In 2000, more than 10 million children died every year,
and now that number is down to fewer than five million children. The prevalence
of the world's deadliest infectious diseases fell by half, too. Best of all, the
progress was happening in regions where the disease burden had been the highest.
Sub-Saharan Africa and South Asia saw the most improvement.

This health boom had many causes. A new generation of political leaders embraced
humanitarianism. Hundreds of thousands of health workers fanned out across the
globe, bringing the latest medicine to places that doctors had rarely visited.
But one often overlooked factor was a small—yet crucial—increase in funding.

Starting in 2000, the world's wealthiest countries began steadily increasing
their funding to supplement low-income countries as they increased their own
investments in health. This funding fueled the work of organizations like Gavi,
the Vaccine Alliance, and the Global Fund to Fight AIDS, Tuberculosis, and
Malaria, which gave poorer nations access to life-saving vaccines, drugs, and
other medical breakthroughs.

Aid is relatively small. By 2020, wealthy countries were spending less than one
quarter of 1% of their budgets on aid. That’s an average of $10.47 on health per
person in the poorest countries. But that $10.47 made a remarkable difference.

Then COVID-19 hit, and progress came to a screeching halt.

STALLED FINANCING THREATENS DECADES OF HEALTH PROGRESS

Legend
DAH, excluding COVID-19 funding
DAH projection
Child mortality

Development assistance for health (DAH) (2022 $USD)

Under-5 deaths per 1,000 live births

A line graph showing the decline in child deaths from 2000 to 2030, which halved
from 2000 to 2019, stalled from 2020 to 2023, and is expected to decline up to
2030. This is juxtaposed by a bar chart showing an increase in development
assistance for health from 2000 to 2019, with slower growth from 2020 to 2023,
and stalling up to 2030. 2000 2020 2024 2030 $0 $10bn $20bn $30bn $40bn $50bn
$60bn 0 20 40 60 80 31
Annualized growth: 6.6%
2.3%
-0.2%

Development assistance for health is provided by governments and private
organizations in high-income countries to low- and middle-income countries.

Download
Share

Today, the world is contending with more challenges than at any point in my
adult life: inflation, debt, new wars. Unfortunately, aid isn’t keeping pace
with these needs, particularly in the places that need it the most.

For instance, more than half of all child deaths still occur in sub-Saharan
Africa. Since 2010, the percentage of the world’s poor living in the region has
also increased by more than 20 percentage points. Despite this, during the same
period, the share of total foreign aid to Africa has dropped from nearly 40% to
only 25%—the lowest percentage in 20 years. Fewer resources mean more children
will die of preventable causes.

The global health boom is over. But for how long?

That's the question I have been wrestling with for the past five years: Will we
look back on this period as the end of a golden era? Or is it just a brief
intermission before another global health boom begins?

I’m still an optimist. I think we can give global health a second act—even in a
world where competing challenges require governments to stretch their budgets.

To do this, we’ll need a two-pronged approach. First, the world has to recommit
to the work that drove the progress in the early 2000s, especially investments
in crucial vaccines and medicines. They’re still saving millions of lives each
year, and we can't afford to backslide.

But we also need to look forward. The R&D pipeline is brimming with powerful—and
surprisingly cost-effective—new breakthroughs. Now we just need to put them to
work fighting the world’s most pervasive health crises. And it starts with good
nutrition.

Every now and then, somebody will ask me what I would do if I had a magic wand.
For years, I’ve given the same answer: I would solve malnutrition.

This summer, UNICEF released its first report on child food poverty. The
findings were stark. Two-thirds of the world’s children—more than 400 million
kids—are not getting enough nutrients to grow and thrive, putting them at higher
risk for malnutrition. In 2023, the WHO estimated that 148 million children
experienced stunting, and 45 million children experienced wasting—the most
severe forms of chronic and acute malnutrition. It prevents them from growing to
their full potential—and, in the worst cases, from growing up at all.

When a child dies, half the time the underlying cause is malnutrition.

And now a significant headwind is making malnutrition harder to solve: climate
change. We worked with our partners at the Institute for Health Metrics and
Evaluation to better understand how difficult the headwind is:

Between 2024 and 2050, climate change will mean 40 million additional children
will be stunted, and 28 million additional children will be wasted.

It’s an important projection, and it should inform where country leaders devote
their aid money to reverse the current trends and the growing burden of
malnutrition.

Obviously, fighting climate change is crucial. But what these data show is that
the health crisis and the climate crisis are the same thing in the poorest
countries near the equator. In fact, the best way to fight the impacts of
climate change is by investing in nutrition.


NATIONS CAN’T GROW IF THEIR PEOPLE CAN’T

Clockwise:
© Getty Images, Bali
© Gates Archive/ Mansi Midha, India
© UNICEF/UN0856865/Abdou, Niger


Most people associate malnutrition with hunger. We’ve all seen the awful photos
of starving children. That’s the most visible kind of malnutrition—but it’s not
the only kind.

Malnutrition also includes what doctors call “hidden hunger.” Kids can be eating
enough calories and still not getting the right nutrients. When this happens to
very young children, it interrupts the development of their bodies and brains.
The effects are irreversible.

With most serious childhood diseases, the kids who survive eventually grow up
fine. But the kids who survive malnutrition never truly escape it. It follows
them to school. A child who has a severe brush with malnutrition before the age
of three will complete five fewer years of schooling than well-nourished kids.
And the malnourished kids who do remain in school tend to do poorly and take
longer to complete each grade than their peers.

As these kids become adults, it continues to haunt them. Studies show that
people who went hungry as kids earn 10% less over their lifetimes and are 33%
less likely to escape poverty.

Nations can’t grow if their people can’t. The economic costs of undernutrition
are significant: It is estimated that every year, the cost of undernutrition is
US$3 trillion in productivity loss because malnutrition has stunted people’s
physical and cognitive abilities. In low-income countries, that loss ranges from
3 to 16 percent (or more) of GDP. It’s the equivalent of a permanent 2008-level
global recession.

Today, one in every five of the world’s children suffers from stunting, and
climate change threatens to increase that number. We should ask: What will that
mean for the global economy in 20 years when these children are in the prime of
their working lives?

Few economists think of the malnutrition rate as a critical economic data
point—but they should start. Nutritional deficits quickly translate into
financial deficits.


WE HAVE NEW TOOLS TO HELP SOLVE MALNUTRITION

By now, it’s clear: Malnutrition makes every forward step our species wants to
take heavier and harder.

But the inverse is also true. If we solve malnutrition, we make it easier to
solve every other problem. We solve extreme poverty. Vaccines are more
effective. And deadly diseases like malaria and pneumonia become far less fatal.

That’s why I believe we can jumpstart a second global health boom by getting
kids the right nutrients.

This is especially true now, because we have more tools to ensure kids gets
healthier even as the world gets hotter.

The science of nutrition has experienced a renaissance over the past decade.
Animal scientists have discovered how to breed more productive livestock, while
food scientists have found new ways to fortify more nutrients into the staples
of people’s diets—like salt, flour, and bouillon cubes. Doctors are even
beginning to unlock the mysteries of the microbiome, the teeming universe of
bacteria that lives inside our digestive tracts.

As you read on, you’ll hear from people on the front line of nourishing people
around the world. Together, they’re showing us how we can jumpstart another
golden age for health: with a lot of grit, creativity, and enormous generosity
toward their fellow human beings.


BILL GATES: JUMPSTARTING A GLOBAL HEALTH BOOM STARTS WITH NUTRITION.




WE HAVE THE TOOLS TO


SOLVE MALNUTRITION


—AND MAKE PEOPLE


HEALTHIER AND MORE


CLIMATE-RESILIENT.




A RECIPE FOR PROGRESS:
4 SOLUTIONS TO NOURISH OUR PLANET

NO OTHER GLOBAL HEALTH PROBLEM REQUIRES A LARGER-SCALE SOLUTION THAN
MALNUTRITION. THESE PROVEN SOLUTIONS CAN MAKE A DIFFERENCE NOW.

One of the hardest things to do in global health is scaling a solution.

No global health problem requires a larger-scale solution than malnutrition.
Every single person on the planet needs to eat a healthy, nutritious diet every
day.

Brazil, India, Kenya, Rwanda, and dozens of other emerging nations have leaned
into this challenge. They’ve found gaps in their food systems and are repairing
them to deliver the right macro- and micronutrients to as much of the population
as possible.

For these countries, building a more nutritious food system produces a double
benefit. It lowers the malnutrition rate, improving health outcomes. It also can
lead to a remarkable amount of economic growth.


6X MORE

MILK PRODUCED BY COWS

New agricultural technologies are being developed to increase the amount of milk
that cows produce in Kenya.


109 MILLION

STUNTING CASES PREVENTED

Improving dairy productivity and supply in just five countries—Ethiopia, India,
Kenya, Nigeria, and Tanzania—could prevent millions of cases of childhood
stunting between 2020 and 2050.


16.6 MILLION

ANEMIA CASES PREVENTED PER YEAR

In Nigeria, fortifying bouillon cubes wouldn't just prevent anemia, it would
also avert more than 11,000 deaths from neural tube defects.


5,000

LIVES SAVED EACH YEAR

Ethiopia is exploring adding folic acid to iodized salt. This “double-fortified”
salt could eliminate nearly 75% of all deaths and stillbirths due to neural tube
defects each year.


500,000

LIVES SAVED

If low- and middle-income countries adopted Multiple Micronutrient Supplements,
the world’s most complete prenatal vitamins, almost half a million lives could
be saved by 2040.


$2.60

FOR AN ENTIRE PREGNANCY

Now, throughout the world, it costs only a few dollars to take MMS, which
contains 15 vitamins and minerals proven to significantly reduce the risk of
adverse birth outcomes.


ENSURING MORE PRODUCTIVE COWS AND SAFER MILK

Milk is a nutrient-rich food that addresses many of the nutritional deficits
children face, including calcium, vitamins (including A and B12), protein, and
healthy fats—it makes them healthier and even more climate-resilient over the
long term.

But producing enough of it, ensuring it is affordable, and preventing it from
spoiling remains a challenge in low-income regions.

But new agriculture technologies are changing that. Some technologies use DNA
and data to select cows that give birth to more productive offspring. Others
help farmers produce more high-quality forage or repurpose crop waste for
nutritious cow feed. As a result, Kenyan cows are now producing 6 to 10 times
more milk than before. That’s more milk to drink at home and more income for
dairy farmers and vendors, most of whom are women.

It’s also better health for children: New analysis from the International Food
Policy Research Institute shows that improving dairy productivity and
consumption in five countries—Ethiopia, India, Kenya, Nigeria, and
Tanzania—could prevent as many as 109 million cases of childhood stunting by
2050.

And training is an essential part. Programs like Livestock Enhancement and
Advancement Programme (LEAP) and MoreMilk are helping dairy farmers and market
sellers learn and follow best practices for safe storage and handling.

Sushama Das, 

Odisha, India

Coletta Kemboi, 

Maili Nne, Kenya

Read their stories
Close
© Gates Archive / Ryan Lobo, India
Sushama Das, a dairy farmer in Astaranga, in the Indian state of Odisha, shared
how easier access to government subsidies, training, and services has helped her
family expand their farm and earn more money:

I was married at a very young age. My new husband was a farmer; he grew crops.
After we had our three children, we realized that it would be better to have
both of us working on the farm. I had always had affection for cows, so I took
up dairy farming. I have never seen this as a business. Rather, it’s a way of
sustaining my family. I do my work for them.

After about a decade of working with just two cows, my son-in-law helped me
apply for a government subsidy online, which allowed me to purchase more cows.
And over the years, I have been able to participate in several training schemes
targeted toward dairy farmers like me, which have helped me improve the health
of the cows and the productivity of my farm.

Once I expanded my herd using the government subsidy, I participated in a
program called LEAP. Local livestock inspectors taught me how to keep our cow
shed clean and how to properly sterilize the drum where we collect our milk.
Veterinarians with a mobile clinic have stopped by our shed and given my cows
free vaccinations; they have not fallen sick ever since. And now I can go online
to book artificial insemination services for the cows, which is helping me
expand my herd.

Today, we have eight cows, and they are producing 60 liters of milk every day. I
am able to employ someone who helps me with the milking; we do one milking in
the morning and one in the evening. And then workers from a local milk
processing company come directly to our shed to pick up the milk drum and sell
it to the community.

The subsidies and training schemes have helped our family earn more money—our
monthly income is now five times as much as it used to be. Before, I felt a
sense of emptiness whenever I wanted to spend any money. Now, there is a sense
of fullness. I can spend money on things that give me happiness.

© Bill & Melinda Gates Foundation / Bryan Jaybee, Kenya
Coletta Kemboi, a dairy farmer in Maili Nne, Kenya, leveraged new skills to care
for her cows, expand her business, and provide for her family.

My husband, Daniel, and I started dairy farming 15 years ago, with just two
cows. When we started our business, it was hard to find customers. Sometimes our
milk spoiled, and the customers we did have would complain.

When I took a training with MoreMilk, I learned about how to improve hygiene
across the dairy farm. I learned where to keep your cows, how to clean them, and
how to prevent transferring bacteria from the cows to the milk. And I learned
that the containers used to collect the milk should be very clean, not reused
from cooking—something I have taught our customers as well.

Since then, we have not had any complaints about spoilage. The milk we produce,
about 110 liters per day, is high quality. And that has helped us recruit new
customers because once one of them buys our milk, he goes and tells others.
We’ve gotten at least 20 new customers since I did the training, including
people who work in hotels.

When the inspectors from the dairy board visit our shop in Maili Nne, they take
tests of our milk. Before, there were some traces of unclean milk, but since I
went through the training, they have come to our shop around three times. And
their tests are proof that our milk is good.

Our cows have also been more productive because I now know how to feed them
better and make sure they have water. And I learned that when there is excess
milk, there is added value. I started making mala, a malted milk, with the
excess. No milk is wasted. And I can sell mala in the shop for 100 shillings per
liter, while fresh milk sells for 70 shillings per liter.

The extra money we are earning goes to the farm—we are planting beans—and to our
house. And we are able to pay my three children’s school fees, including for my
daughter, who will join university this year.

So I am proud and happy, and I thank God for the training I received.


FORTIFYING THE GLOBAL PANTRY AGAINST MICRONUTRIENT DEFICIENCIES

Large-scale food fortification is an old technology—but we’re unlocking new ways
of using it to increase micronutrients in the food found in pantries all over
the world.

After all, micronutrient deficiencies have an outsized impact on health. For
example, vitamin A deficiencies are the leading cause of childhood blindness,
while folate deficiencies are the leading cause of neural tube defects.

In the United States and Switzerland, iodized salt has been sold in supermarkets
since the 1920s, which has led to the virtual elimination of iodine deficiency
and the improvement of IQ scores. Leveraging that success, Ethiopia is now
exploring adding another critical nutrient, folic acid, to iodized salt. They
are testing a way to produce this “double-fortified” salt. This pioneering
approach holds the potential to eliminate half of all deaths and stillbirths due
to neural tube defects, up to 5,000 per year in Ethiopia, and helping to reduce
anemia up to 4% across the country.

And now leaders at the Nigerian Ministry of Health and Social Welfare are
leading a large-scale effort to fortify bouillon, already a common item in
Nigerian kitchens.

Ladidi Bako-Aiyegbusi, 

Nigeria

Read her story
Close
© Gates Archive / Nyancho NwaNri, Nigeria
In West Africa, leaders like Ladidi Bako-Aiyegbusi,mni, director of nutrition at
the Nigerian Ministry of Health and Social Welfare, are spearheading a
large-scale effort towards the first guided voluntary fortification of
condiment, bouillon cubes, a staple of local cuisine in Nigeria. It is estimated
that fortified bouillon cubes could halve deaths and stillbirths from neural
tube defects—up to 11,000 per year—and avert up to 16.6 million cases of anemia
each year in Nigeria.

What you might not know is that simple bouillon seasoning cubes, made up of
dehydrated broth and filled with salt and spices, are one of the ingredients
found in most kitchens across my country of Nigeria, irrespective of the
geographical location, economy, or educational status of the family.

As the director of nutrition at the Ministry of Health, my job is to monitor and
improve the nutritional status of the Nigerian people. Without access to the
essential nutrients the children under 5 years need to grow, thrive, and lead
healthy lives, they are being robbed of their future.

Available evidence shows that although we have made some progress over the past
few decades, malnutrition is still an underlying cause of nearly half of the
deaths of children under 5 years old. According to the 2018 Nigeria Demographic
Health Survey, Nigeria has the second-highest burden of stunted children in the
world, with 37%—or 6 million children—that are stunted annually, and 7% of
children diagnosed with wasting each year. Moreover, the prevalence of folate
deficiency remains alarmingly high, contributing to serious health outcomes such
as still births due to neural tube defects and anemia.

That is the reason our government is investing in comprehensive nutrition
services throughout the country—efforts that we believe will prevent more than
11 million children, or one in every three children under 5 years of age, from
experiencing severe child food poverty.

Hence, as part of our nutrition program, we are working in collaboration with
the Nigeria Country Working Group on Bouillon Fortification, which includes
public and private partners, the National Agency for Food and Drug
Administration and Control, Standard Organisation of Nigeria, Federal
Competition and Consumer Protection Commission, Dangote, Promasidor, and Sweet
Nutrition. This group is exploring the feasibility of fortifying the bouillon
cubes to include the nutrients that individuals, especially vulnerable children
and women, need most—such as iron, folic acid, zinc, and vitamin B12.

Given the high prevalence of folate deficiency in Nigeria, fortifying staple
foods like rice, wheat and bouillon cubes represents a critical opportunity to
address this public health challenge. Leaning heavily on what has made iodized
salt programs successful, we believe that these bouillon cubes can help to
reduce devastating ailments caused by micronutrient deficiencies and needs to be
aligned with our Ministry’s efforts to reduce salt and sodium intake.

Fortifying bouillon cubes would support ongoing strategies to combat
micronutrient deficiencies “hidden hunger” here. While we all value a more
nutritious diet filled with fresh fruits and vegetables, and rich-in-protein
animal products, fortified bouillon can contribute to meeting the micronutrients
needs of families as we continue to strengthen our overall food system for the
future.

If we’re successful, that would mean that the fortified bouillon seasoning cubes
in so many Nigerian dishes would also contribute to improving the micronutrient
content of the dishes in my country. The project impact is improvement of the
nutritional status of all Nigerians, with particular emphasis on the vulnerable
groups—namely children, women, and the elderly.


EXPANDING ACCESS TO BETTER PRENATAL VITAMINS

Healthy diets are crucial for good nutrition. But, in different stages of life
with different needs, they’re not always sufficient. Doctors know that mothers
need extra nourishment during pregnancy and the critical days that follow to
stay healthy and give their children the best start in life.

These increased needs make it difficult for pregnant women all over the world to
consume the full range of necessary nutrients, especially in countries where
healthy foods are out of budget or out of reach.

One solution is the United Nations International Multiple Micronutrient
Antenatal Preparation Multiple Micronutrient Supplements—the world’s most
complete prenatal vitamin. It contains 15 vitamins and minerals proven to
significantly reduce the risk of adverse birth outcomes. It is more effective
and powerful than the iron and folic acid supplements that many women typically
receive in low- and middle-income countries. If all low- and middle-income
countries switched to MMS, which costs only $2.60 for an entire pregnancy,
almost half a million lives would be saved and 25 million babies would have
improved birth outcomes by 2040.

Dr. Sabin Nsanzimana, 

Rwanda

Read his story
Close
© UNICEF/UNI504353/Iyakaremye, Rwanda
Dr. Sabin Nsanzimana, the minister of health in Rwanda, is leading the effort to
ensure pregnant women in his country have access to these supplements:

Prenatal vitamins save lives. That’s why you can find them on grocery store
shelves in wealthy nations. But for women in low- and middle-income countries,
like Rwanda, they are at once more essential and harder to find.

That’s because the nutrients that build a baby’s brain—folic acid, iron, zinc,
and iodine, as well as protein and fatty acids—are often limited in our local
food supply. And when pregnant women do get nutrition supplementation, it's
likely just folic acid and iron.

The consequences are real and tragic. Here in Rwanda, nearly a quarter of
pregnant women are anemic—which can lead to deadly complications for both mother
and baby. Neonatal mortality is common. And for the babies who survive, around
one-third will experience stunting. That means too many children don’t get the
chance to grow up and realize their potential—and Rwanda doesn’t get to benefit
from the full expression of their talents.

In partnership with UNICEF, my colleagues at the Ministry of Health and the
Rwanda Biomedical Centre set out to do something about it. In the seven
districts with the highest rates of stunted growth, we have started giving
expectant mothers [multiple] micronutrient supplementation (MMS) with 15
essential micronutrients proven to reduce low birthweight, anemia, infant
mortality, and stillbirths. Health care workers are providing women with the one
pill that can help them stay healthy during pregnancy and give their children a
better start in life. Since we started distributing MMS in January, we’ve
already reached over 50,000 women.

Down the line, MMS+, which adds in two other nutrients that promote fetal
growth, has the potential to accelerate our progress even further.

When we set a child on a trajectory for healthy growth, we do the same for our
whole country. MMS, and soon MMS+, help us all thrive.


FINANCING PROGRESS THROUGH THE CHILD NUTRITION FUND

Although all of the interventions we’ve covered have life-saving potential on a
global scale, without resources and extensible plans for implementation behind
them, they would be little more than good ideas.

That’s why the Bill & Melinda Gates Foundation worked with UNICEF and other
partners to launch the Child Nutrition Fund—a new financing mechanism designed
to bring these innovative solutions to life and transform the way the world
addresses child malnutrition.

Before the Child Nutrition Fund, there was no dedicated platform to coordinate
efforts to address child malnutrition, to encourage domestic funding, or to
support local production of the nutrient-rich foods and food supplements
children need most.

The Child Nutrition Fund provides solutions to all three of these problems, in
one place. And we know it will be effective, because we’ve already seen these
financing mechanisms in action—the Global Fund to Fight AIDS, Tuberculosis, and
Malaria is a great example. It is one of the fastest-scaling, most effective
institutions ever created. The interventions it has funded and deployed have
saved nearly 60 million lives.

Now, the Child Nutrition Fund is using a similar approach to attack child
malnutrition, head-on, in partnership with countries around the world.

Dr. Víctor Aguayo, 

UNICEF

Read his story
Close
© Getty Images, Bangladesh
Dr. Victor Aguayo, director of child nutrition and development, UNICEF, leads
that organization’s nutrition efforts to ensure children not only survive, but
thrive:

The Child Nutrition Fund could be a game changer. It holds the potential to
address the child malnutrition crisis and transform philanthropy for maternal
and child nutrition.

Historically, the world of maternal and child nutrition has been overly reliant
on the generosity of global donors. This strategy has created a boom to address
some nutrition challenges but has also left critical areas of work inevitably
neglected, particularly those related to the early prevention of malnutrition
among the most vulnerable children: the youngest, the poorest, and those left
behind by socio-economic inequities.

Public and private donors have their hearts in the right place, but that doesn’t
mean they always know how to put their resources in the right place. Some
nutrition programs receive most of the global funding, while other nutrition
interventions can’t get off the ground in key geographic areas or for critical
population groups where the early prevention, detection, and treatment of child
malnutrition is urgent.

Simply put, we have long needed a different approach to accelerate our response
to the global child malnutrition crisis and a way to fund global maternal and
child nutrition efforts sustainably at scale.

The Child Nutrition Fund is that new approach. It’s targeted, it’s
sustainable—and most importantly, it works. Since launching last year, we’ve
already seen it drive remarkable progress.

For example, in Mauritania, it was able to support and complement national
efforts and resources to cover 100% of the financial needs for ready-to-use
therapeutic foods for the treatment of severe wasting in young children.

And in Bangladesh and Indonesia, it will allow national programs to
progressively reach universal coverage of all pregnant women with multiple
micronutrient supplements—in what would become two of the largest maternal
nutrition programs for the prevention of maternal anemia and low birthweight in
the world.

That early success is truly incredible—as is the immediate buy-in by the host
governments we work with. It’s why I’ve never been more hopeful about our
chances of solving child malnutrition around the world for good, thanks to the
Child Nutrition Fund.


IN RICH COUNTRIES


AND POOR ONES,


THE FUTURE OF HUMAN


PROGRESS DEPENDS


ON WHAT’S HAPPENING


IN OUR GUTS.




THE MICROBIOME:
THE NEXT NUTRITION FRONTIER

A FINAL WORD FROM BILL GATES

“A pregnant woman eats for two” is a common saying. But doctors have realized it
needs updating.

A pregnant woman is actually eating for three ... trillion: herself, her child,
and the vast network of microorganisms that lives inside her digestive tract.

Around 15 years ago, researchers began to suspect that the bacteria that live in
your gut—your microbiome—may play a crucial role in health after noticing that
oral childhood vaccines like polio weren’t as effective in places with high
rates of malnutrition.

A series of succeeding studies revealed the fundamental problem: When
undernourished children are exposed to too many pathogens in their environment,
they can get what we call “environmental enteric dysfunction.”

To oversimplify a very complex set of processes: Their guts become inflamed,
their intestines get blunted, and they struggle to absorb nutrients. In other
words, a child with an unhealthy microbiome can eat a full and healthy diet—but
still be undernourished.

This discovery has changed the way the Bill & Melinda Gates Foundation thinks
about nutrition. We still support work in agricultural development and a
diversity of nutritious, affordable food for a healthy diet because making sure
there is enough food to eat has to be the starting point. But it’s no longer the
end point. Today, we are also thinking about how to improve gut health to make
sure children can absorb nutrients, develop strong immune systems, and grow as
they should to thrive.

Clockwise:
© Gates Archive / Ryan Lobo, India
© Bill & Melinda Gates Foundation / Patrick Meinhardt, Kenya
© Gates Archive / Diana Zeyneb Alhindawi, Rwanda


Just a few years ago, researchers hoped to identify a gold-standard microbiome:
the precise contents of a healthy gut that applied to everyone, everywhere. We
know now that what we really need to understand is how these metabolic networks
function and design diets to complement and feed our gut bacteria. For example,
we know that certain locally appropriate therapeutic foods, like specific sugars
in green bananas in Bangladesh, appear to work especially well because they feed
not only the child, but also the bacteria in their gut.

There is still so much we don’t know about these networks, but the good news is
that they might be relatively easy to understand in children relative to adults.

Compared to the adult microbiome, which contains 100 trillion cells, the infant
microbiome starts out simple. We now know that early-in-life microbes need to
colonize the gut in a very specific sequence to pave the way for healthy growth,
development, and immune function. During this early life stage, the infant
microbiome is more easily molded. And once it sets, it impacts us for the rest
of our lives.

This research isn’t just useful for addressing malnutrition in low-income
nations. It has huge implications for the overnutrition problem in wealthy
countries. In the United States, an estimated 60% of the population is
overweight or obese, often because of high-fat, high-sugar diets. These diets
alter the biology of the gut and lead to inflammation.

In rich countries and poor ones, we’re realizing that the future of human
progress depends on what’s happening in our guts.

It’s a thrilling time to be standing at the frontier of nutrition. We’re on the
cusp of unlocking not only a deeper understanding of the microbiome—but with it,
solutions that could forever change how the world treats malnutrition, our most
pervasive health crisis. But this will only be possible if the world commits to
funding the progress of the future today.

That starts with a commitment that no child should die before their fifth
birthday. That’s a commitment the world has made before. Halving the rate of
under-5 child mortality was perhaps humanity’s most important achievement—and we
can do it again, if countries around the world do three things.

First, they must maintain their global health funding.
Second, they must commit to fully replenishing Gavi, the Vaccine Alliance, and
the Global Fund to Fight AIDS, Tuberculosis, and Malaria—organizations that have
the hard-earned know-how to distribute vaccines, drugs, and other medical
breakthroughs to the people who need them most.
And third, they must immediately address the growing threat of child
malnutrition. We have a new funding mechanism, the Child Nutrition Fund, that
has great potential to focus resources where they are needed most.

If we do these three things, we won’t just usher in a new global health boom and
save millions of lives—we’ll also prove that humanity can still rise to meet our
greatest challenges.


A SPECIAL NOTE FROM MARCUS SAMUELSSON, AWARD-WINNING CHEF AND PHILANTHROPIST

© Samuelsson Group, New York City, NY

I was born in Ethiopia, in a small farming village called Abrugandana. When I
was two, a tuberculosis outbreak hit. My mother got sick, I got sick, and so did
my sister Fantaye.

When our health took a turn for the worse, the three of us made the 75-mile
journey to the hospital in Addis Ababa, on foot. I don’t know how my mother
managed to get us there while barely able to breathe—but I do know that she
never left the hospital alive. And I also know that Fantaye’s and my survival
was a miracle, especially because tuberculosis was not the only thing ravaging
my body.

Long before the outbreak, Ethiopia had been plagued by malnutrition. And because
we were extremely poor, without access to the milk, food, or nutrients my
growing body needed, I was not immune. At 2 1/2 years old, I weighed just 22
pounds—the average size of a 12-month-old child.

Today, there are still millions of malnourished children around the world, just
like I was. But I was lucky. Because I was given a rare chance at a better
life—and a better, more nutritious diet.

After being adopted by two incredible parents, my sister and I were raised in
Sweden. In our house, taste and nutrition went hand in hand. And over time, I
grew to understand that it’s not just about how much you eat, it’s also about
what you eat.

That knowledge formed the foundation of my personal journey through food. It’s
why, in my restaurants, our menus feature locally grown and nutrient-rich
ingredients. And it’s why I believe my responsibility as a chef is bigger than
just making good food. It’s also about giving voice to the idea that having
access to a nutritious diet is a basic human right.

For millions of children around the world, that right is being denied. They are
not getting the nutrients they need to grow, develop, and thrive—a reality that
will only get worse as the effects of climate change intensify. That is both an
outrage and a tragedy, because malnutrition is so thoroughly preventable.

That’s why I’m grateful that The Gates Foundation is confronting this crisis
head-on. The work they’re doing is critical. It will help ensure that millions
of children can unlock their full potential—just as I was able to.


EXPLORE THE DATA

Each year, Goalkeepers share the latest estimates on 18 indicators, ranging from
poverty to education. These indicators help us understand the progress toward
the Sustainable Development Goals—where innovation and investment are creating
bright spots, and where we’re collectively falling short. These data remind us
that progress is possible but not inevitable.

But with just six years remaining, the world is off track. Urgent action is
needed to meet the SDG targets and create a more equitable and safe future for
all by 2030.

No Poverty


POVERTY


Population below the international poverty line
Line chart showing the percentage of the global population living below the
international poverty line (US$2.15/day), also known as extreme poverty, from
1981 to 2022. Rates of extreme poverty have declined from 44% in 1981 to 9% in
2022. 1981 2022 2022 8.95% 8.95%
Close
No Poverty


POVERTY


SDG TARGET 1.1

Eradicate extreme poverty for all people everywhere.

Zero Hunger


STUNTING


Stunting among children under age 5
Line chart showing the global prevalence of stunting among children under age
five from 1990 to 2023, with projected scenarios to 2030. In 2023, an estimated
24% of children under 5 are stunted; at the current pace of progress, the 2030
projection estimates that 23% of children will be stunted—missing the target of
15% by 2030. 1990 2023 2030 Target 24% 24% 15%21% 23% 25%
Close
Zero Hunger


STUNTING


SDG TARGET 2.2

End all forms of malnutrition, including achieving, by 2025, the internationally
agreed-upon targets on stunting and wasting in children under 5.

Zero Hunger


AGRICULTURE


Rate of income growth of small-scale producers, 2014–2019
Bar chart showing the average annual income growth rate from agriculture for
smallholder food producers in 14 selected countries. 0.5x 1.5x 2x Target 1x No
growth 1x No growth 1x No growth 1x No growth
Close
Zero Hunger


AGRICULTURE


SDG TARGET 2.3

Double the agricultural productivity and incomes of smallholder food producers,
in particular women, indigenous peoples, family farmers, pastoralists, and
fishers.

Good Health & Well-Being


MATERNAL MORTALITY


Maternal deaths per 100,000 live births
Line chart showing the global maternal mortality ratio from 1990 to 2023, with
projected scenarios to 2030. In 2023, an estimated 139 maternal deaths per
100,000 live births occurred; at the current pace of progress, the 2030
projection estimates 125 maternal deaths per 100,000 live births—missing the
target of 70 maternal deaths per 100,000 live births by 2030. 1990 2023 2030
Target 139 139 70101 125 174
Close
Good Health & Well-Being


MATERNAL MORTALITY


SDG TARGET 3.1

Reduce the global maternal mortality ratio to less than 70 per 100,000 live
births.

Good Health & Well-Being


UNDER-5 MORTALITY


Under-5 deaths per 1,000 live births
Line chart showing the global under-5 mortality rate from 1990 to 2023, with
projected scenarios to 2030. In 2023, an estimated 36 under-5 deaths per 1,000
live births occurred; the 2030 projection estimates 31 under-5 deaths per 1,000
live births—missing the target of 25 under-5 deaths per 1,000 live births by
2030. 1990 2023 2030 Target 36 36 2527 31 35
Close
Good Health & Well-Being


UNDER-5 MORTALITY


SDG TARGET 3.2

End preventable deaths of children under 5 years of age, with all countries
aiming to reduce under-5 mortality to at least as low as 25 per 1,000 live
births.

Good Health & Well-Being


NEONATAL MORTALITY


Neonatal deaths per 1,000 live births
Line chart showing the global neonatal mortality rate from 1990 to 2023, with
projected scenarios to 2030. In 2023, an estimated 17 neonatal deaths per 1,000
live births occurred; the 2030 projection estimates 15 neonatal deaths per 1,000
live births—missing the target of 12 neonatal deaths per 1,000 live births by
2030. 1990 2023 2030 Target 17 17 1213 15 17
Close
Good Health & Well-Being


NEONATAL MORTALITY


SDG TARGET 3.2

End preventable deaths of newborns, with all countries aiming to reduce neonatal
mortality to at least as low as 12 per 1,000 live births.

Good Health & Well-Being


HIV


New cases of HIV per 1,000 people
Line chart showing the new global cases of HIV per 1,000 people from 1990 to
2023, with projected scenarios to 2030. The 2023 global estimate is 0.23 new
cases of HIV per 1,000 people; the 2030 projection estimates 0.21 new cases of
HIV per 1,000 people—missing the target of 0.02 new cases of HIV per 1,000
people. 1990 2023 2030 Target 0.23 0.23 0.020.16 0.21 0.23
Close
Good Health & Well-Being


HIV


SDG TARGET 3.3

End the epidemics of AIDS, tuberculosis, malaria, and neglected tropical
diseases and combat hepatitis, water-borne diseases, and other communicable
diseases.

Good Health & Well-Being


TUBERCULOSIS


New cases of tuberculosis per 100,000 people
Line chart showing new global cases of tuberculosis per 100,000 people from 1990
to 2023, with projected scenarios to 2030. The 2023 global estimate is 119 new
cases of tuberculosis per 100,000 people; at the current pace of progress, the
2030 projection estimates 107 new cases of tuberculosis per 100,000
people—missing the target of 20 new cases per 100,000 people. 1990 2023 2030
Target 119 119 2095 107 120
Close
Good Health & Well-Being


TUBERCULOSIS


SDG TARGET 3.3

End the epidemics of AIDS, tuberculosis, malaria, and neglected tropical
diseases and combat hepatitis, water-borne diseases, and other communicable
diseases.

Good Health & Well-Being


MALARIA


New cases of malaria per 1,000 people
Line chart showing new global cases of malaria per 1,000 people from 1990 to
2023, with projected scenarios to 2030. The 2023 global estimate is 32 new cases
of malaria per 1,000 people; the 2030 projection estimates new cases will remain
unchanged until 2030—missing the target of nine new cases per 1,000 people. 1990
2023 2030 Target 32 32 925 31 35
Close
Good Health & Well-Being


MALARIA


SDG TARGET 3.3

End the epidemics of AIDS, tuberculosis, malaria, and neglected tropical
diseases and combat hepatitis, water-borne diseases, and other communicable
diseases.

Good Health & Well-Being


NEGLECTED TROPICAL DISEASES


Prevalence of 15 NTDs per 100,000 people
Line chart showing the global prevalence of 15 neglected tropical diseases
(NTDs) per 100,000 people from 1990 to 2023, with projected scenarios to 2030.
The 2023 global estimate is 13,277 cases of 15 NTDs per 100,000 people; the 2030
projection estimates 10,604 cases of 15 NTDs per 100,000 people. 1990 2023 2030
13.3k 13.3k 9.2k 10.6k 13.4k
Close
Good Health & Well-Being


NEGLECTED TROPICAL DISEASES


SDG TARGET 3.3

End the epidemics of AIDS, tuberculosis, malaria, and neglected tropical
diseases (NTDs) and combat hepatitis, water-borne diseases, and other
communicable diseases.

Good Health & Well-Being


FAMILY PLANNING


Percentage of family planning needs met with modern methods
Line chart showing the global percentage of women of reproductive age (ages 15
to 49), who have their need for family planning satisfied with modern methods
from 1990 to 2023, with projected scenarios to 2030. The 2023 global estimate is
78% of women have their need for family planning satisfied; the 2030 projection
estimates the percentage of women who have their need for family planning met
increases slightly to 79% by 2030—missing the target of ensure all women of
reproductive age have their need for family planning satisfied with modern
methods. 1990 2023 2030 Target 78% 78% 76% 79% 81% 100%
Close
Good Health & Well-Being


FAMILY PLANNING


SDG TARGET 3.7

Ensure universal access to sexual and reproductive health care services,
including those for family planning.

Good Health & Well-Being


UNIVERSAL HEALTH COVERAGE


UHC effective coverage index score
Line chart showing the global performance score of the universal health coverage
(UHC) effective coverage index from 1990 to 2023, with projected scenarios to
2030. The 2023 global estimate is a performance score of 61; the 2030 projection
estimates a performance score of 63 by 2030—missing the target of 100. 1990 2023
2030 Target 61 61 61 63 65 100
Close
Good Health & Well-Being


UNIVERSAL HEALTH COVERAGE


SDG TARGET 3.8

Achieve universal health coverage for all.

Good Health & Well-Being


SMOKING


Prevalence among people ages 15 and older
Line chart showing global age-standardized smoking prevalence among people ages
15 and older from 1990 to 2023, with projected scenarios to 2030. In 2023,
smoking prevalence among people ages 15 and older was 18%; the 2030 projection
estimates 17% smoking prevalence among people ages 15 and older. 1990 2023 2030
18% 18% 16% 17% 18%
Close
Good Health & Well-Being


SMOKING


SDG TARGET 3.A

Strengthen the implementation of the World Health Organization Framework
Convention on Tobacco Control in all countries.

Good Health & Well-Being


VACCINES


Coverage of DTP (third dose)
Line chart showing the global coverage for diphtheria, tetanus, and pertussis
(DTP) third-dose vaccine from 1990 to 2023, with projected scenarios to 2030.
The 2023 global estimate is 80% coverage. At the current pace of progress, the
2030 projection estimates 84% coverage by 2030. 1990 2023 2030 80% 80% 74% 84%
93%
Close
Good Health & Well-Being


VACCINES


SDG TARGET 3.B

Support the research and development of vaccines and medicines for the
communicable and noncommunicable diseases that primarily affect developing
countries and provide access to affordable essential medicines and vaccines.

Quality Education


EDUCATION


Children who cannot read and understand a simple text by age 10
Line chart showing global and regional rates of learning poverty for
pre-pandemic years 2015 and 2019, with post-pandemic simulations for the year
2022. Pre-pandemic, learning poverty rates in low- and middle-income countries
were 53% in 2015 and 57% in 2019. Simulations for 2022 estimate learning poverty
rates in low- and middle-income countries have increased to 70%. 2015 2019 2022
48% 48% 51.9% 51.9% 62.4%64.3%65.5%
Close
Quality Education


EDUCATION


SDG TARGET 4.1

Ensure that all girls and boys complete free, equitable, and quality primary and
secondary education leading to relevant and effective learning outcomes.

Gender Equality


GENDER EQUALITY


SDG Gender Index score
Line chart showing the global SDG Gender Index score from 2015 to 2022 with
projections to 2030. In 2022, the score was 66, with a 2030 projection of
69—with global gender equality only achieved in the 22nd century. 2015 2019 2022
2030 64 65 66 69
Close
Gender Equality


GENDER EQUALITY


SDG TARGET 5

Achieve gender equality and empower all women and girls.

Clean Water and Sanitation


SANITATION


Population using safely managed sanitation
Line chart showing the global proportion of the population using safely managed
sanitation from 1990 to 2023, with projected scenarios to 2030. The 2023 global
estimate is 63% of the population using safely managed sanitation; the 2030
projection estimates 68% of the population using safely managed
sanitation—missing the target of 100%. 1990 2023 2030 Target 63% 63% 66% 68% 70%
100%
Close
Clean Water and Sanitation


SANITATION


SDG TARGET 6.2

Achieve access to adequate and equitable sanitation and hygiene for all and end
open defecation, paying special attention to the needs of women and girls and
those in vulnerable situations.

Decent Work and Economic Growth


INCLUSIVE FINANCIAL SYSTEMS


Adult financial account ownership
Line chart showing the percentage of adults (ages 15 and older) with an account
at a financial institution or with a mobile-money service provider, aggregated
by country-level income and gender, for the years 2011, 2014, 2017, and 2021.
Global estimates for account ownership by adults increased from 51% in 2011 to
76% in 2021. 2011 2014 2017 2021 51% 62% 69% 76%
Close
Decent Work and Economic Growth


INCLUSIVE FINANCIAL SYSTEMS


SDG TARGET 8.10

Strengthen the capacity of domestic financial institutions to encourage and
expand access to banking, insurance, and financial services for all.

Read the full methodology description and data sources
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