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TIME global health

What the Gates Foundation Has Achieved, 15 Years On

Sunny days: Melinda and Bill Gates in 2014, one year before their self-imposed deadline arrived
Sunny days: Melinda and Bill Gates in 2014, one year before their self-imposed deadline arrived Scott Olson; Getty Images

Jeffrey Kluger is Editor at Large for TIME.

Much has been done over the foundation's first decade and a half — with more still to do

There are a whole lot of things you may or may not get to do in the next 15 years, but a few of them you can take for granted: eating, for one. Having access to a bank, for another. And then there’s the simple business of not dying of a preventable or treatable disease. Good for you—and good for most of us in the developed world. But the developed world isn’t the whole story.

The bad—and familiar—news is that developing nations lag far behind in income, public health, food production, education and more. The much, much better news is that all of that is changing—and fast. The just-released Annual Letter from the Bill and Melinda Gates Foundation makes a good case for hoping there is still more to come.

The 2015 letter represents something of a threshold moment for the Foundation. It was in 2000 that the Gateses began their work and set themselves a very public 15-year deadline: show meaningful progress in narrowing the health, income and resource gap between the world’s privileged and underprivileged people, or be prepared to explain why not. So far, nobody—neither the Gates Foundation nor the numerous other global health groups like the World Health Organization and UNICEF—have much explaining to do.

The number of children under five who die each year worldwide has been nearly cut in half, from a high of nearly 13 million to 6.5 million today. Polio has been chased to the very brink of extinction, and elephantiasis, river blindness and Guinea worm are close behind. Drought-tolerant seeds are dramatically increasing agricultural yields; economies in the once-desperate countries in sub-Saharan Africa are now matching the developed world in rate of annual growth. Up to 70% of people across the developing world now have access to wireless service, making mobile banking possible—a luxury in the West but a necessity in places there is no other banking infrastructure.

The trick of course is that progress isn’t the same as success. The 13 million babies who were dying a year in the years before the Foundation began, for example, factored out to a horrific 35,000 every single day. Slashing that in half leaves you with 17,500—still an intolerable figure. For that reason and others, the Gateses are turning the 15-year chronometer back to zero, setting targets—and framing ways to achieve them—for 2030.

The most pressing concern involves those 17,500 kids. The overwhelming share of the recent reduction in mortality is due to better delivery of vaccines and treatments for diseases that are vastly less common or even nonexistent in much of the developed world—measles, pneumonia, malaria, cholera and other diarrheal ills. Those are still the cause of 60% of the remaining deaths. But the other 40%—or 2.6 million children—involve neonates, babies who die in the first 30 days of life and often on the very first day. The interventions in these cases can be remarkably simple.

“The baby must be kept warm immediately after birth, which too often doesn’t happen,” Melinda Gates told TIME. “This is basic skin-to-skin contact. Breast-feeding exclusively is the next big thing, as is basic cord care. The umbilical cord must be cut cleanly and kept clean to prevent infections.”

HIV may similarly be brought to heel, if not as easily as neonate mortality. A vaccine or a complete cure—one that would simply eliminate the virus from the body the way an antibiotic can eliminate a bacterium—remain the gold standards. But in much of the world, anti-retrovirals (ARVs) have served as what is known as a functional cure, allowing an infected person to live healthily and indefinitely while always carrying a bit of the pathogen. Gates looks forward to making ARVs more widely available, as well as to the development of other treatment protocols that we may not even be considering now.

“We’re already moving toward an HIV tipping point,” she says, “when the number of HIV-positive people in sub-Saharan Africa who are in treatment will exceed the number of people becoming newly infected.”

Food security is another achievable goal. Even as Africa remains heavily agrarian—70% of people in the sub-Saharan region are farmers compared to 2% in the U.S.—yields remain low. An acre of farmland here in America may produce 150 bushels of corn; in Africa it’s just 30. The problem is largely rooted in our increasingly unstable climate, with severe droughts burning out harvests or heavy rainstorms destroying them.

“Millions of people eat rice in Africa,” says Gates, “and rice has to be kept much wetter than other crops. At the equator it’s staying drier longer, but when the rains do come, they hit harder.”

In the case of rice and corn and all other crops, the answer is seeds engineered for the conditions in which they will have to grow, not for the more forgiving farmlands of the West. In Tanzania, site-specific seed corn has been made available and is already changing lives. “That seed,” one farmer told Gates when she visited in 2012, “made the difference between hunger and prosperity.”

Finally comes banking. Across Africa, only 37% of people are part of the formal banking system, but up to 90%, depending on the area, are part of the M-Pesa network—a mobile banking link accessible via cellphone. The Pesa part of the name is Swahili for money and the M is simply for mobile.

“Today too many people put their money in a cow or in jewelry,” Gates says. “But it’s impossible to take just a little of that money out. If someone gets sick or you have another emergency, you simply sell the cow.” Mobile banking changes all of that, making it much easier to save—and in a part of the world where even $1 set aside a day can mean economic security, that’s a very big deal.

Nothing about the past 15 years guarantees that the next 15 will see as much progress. The doctrine of low-hanging fruit means that in almost all enterprises, the early successes come easier. But 15 years is a smart timeframe. It’s far enough away that it creates room for different strategies to be tried and fail before one succeeds, but it’s close enough that you still can’t afford to waste the time you have. Wasting time, clearly, is not something the folks at the Gates Foundation have been doing so far, and they likely won’t in the 15 years to come either.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Innovation

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The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. By breaking with the Cuba lobby, President Obama could massively disrupt American interest group politics.

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The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Innovation

Five Best Ideas of the Day: December 10

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. The cheap oil American consumers are enjoying might be the result of an existential battle between Saudi Arabia and ISIS.

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2. Turns out the busts of the first dot-com era were great ideas.

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By Susan Daugherty in National Geographic

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Innovation

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The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

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2. To end the conflict with Boko Haram, Nigeria needs to address the alienation of its Muslims.

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3. “Protecting our coal workers is critical to successfully solving the climate problem.”

By Jeremy Richardson in the Union of Concerned Scientists

4. Tanzania can fight child marriage and protect the next generation of women by keeping girls in schools.

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5. When the last baby boomers move into retirement around 2030, today’s youth will carry the weight of our economy. They need support now.

By Melody Barnes in the World Economic Forum Blog

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

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The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

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The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME energy

A Brief Guide to the Keystone XL Pipeline Debate

Construction Along The Keystone XL Pipeline
Workers move a section of pipe during construction of the Gulf Coast Project pipeline, part of the Keystone XL Pipeline Project, in Atoka, Okla. on March 11, 2013. Daniel Acker—Bloomberg/Getty Images

A handy explainer

What is the Keystone XL Pipeline?

It is a proposed extension of a pipeline that transports oil from Alberta, Canada to a major petroleum exchange in Cushing, Okla., and from there to the Gulf of Mexico. The existing smaller pipeline takes a more circuitous route. The Canadian company TransCanada’s solution is to build a larger-capacity, more direct link from Alberta to the existing pipeline. That project is known as Keystone XL.

Why is Obama involved?

Because the Keystone XL link would cross an international boundary between the U.S. and Canada, the project requires presidential approval. Proponents say Keystone XL will reduce the need to move oil by freight train—which can lead to potentially dangerous accidents—and create perhaps tens of thousands of jobs. President Obama, who has not taken a public position on the project, has cited a State Department analysis that concludes the pipeline will create only about 2,000 jobs during construction and 50 around permanent jobs once it’s complete.

Why is it controversial?

Climate activists have rallied around the Keystone XL pipeline as an environmental litmus test. They worry that it will intrude on property rights—courts have allowed TransCanada to run sections of the pipeline over private land, despite objections from the property owners –and warn that it could be vulnerable to environmentally dangerous leaks along its proposed 1,700 mile route. But their primary objection is that the project will encourage the burning of fossil fuels and worsen climate change. The oil shipped through the new pipe would come from Canada’s so-called tar sands, which climate activists say is dirtier and worse for the environment than regular oil.

A State Department review released in January found that Keystone XL would have little effect on the planet’s environmental health because the oil in Canada’s tar sands will be extracted and sold through another avenue if the project is blocked.

What happens next?

The southern portion of the Keystone pipeline connecting Oklahoma to the Gulf of Mexico will open for business in 2015. The northern extension—the one everyone’s arguing about—has yet to be approved. But the Dec. 6 runoff for the Louisiana Senate seat of Democrat Mary Landrieu gave the project a jolt in Washington, as Landrieu and her Republican challenger, Rep. Bill Cassidy, jockey to claim credit for getting it built. The House passed legislation sponsored by Cassidy allowing Keystone XL on Nov. 14 and the Senate votes on a similar measure backed by Landrieu on Nov. 18. President Obama has signaled that he may veto the legislation, but he has not taken a public stance. No matter what happens at the federal level, Keystone XL is likely to face court battles in states through which it passes.

TIME Innovation

Five Best Ideas of the Day: November 13

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

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The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Innovation

Five Best Ideas of the Day: November 12

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. “Seven years after returning from Iraq, I’m finally home.” One veteran reflects on how service after his time at war changed his life.

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2. Humanity’s gift for imitation and iteration is the secret to our innovation and survival.

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The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME global health

Plant-Based Diet Is Best for the Planet, New Science Says

vegetables
Getty Images

Alternative diets could, if widely adopted, reduce global agricultural greenhouse gas emissions

Good food advocates have long argued that what’s good for your health is also good for the planet, but new science now backs up the claim. A paper published in the journal Nature by scientists at the University of Minnesota, presents numbers that suggest eating less meat, less refined fat, and less sugar will also reduce the climate change impacts of food production.

Using about 50 years’ worth of data from the world’s 100 most populous countries, UM Professor of Ecology G. David Tilman and graduate student Michael Clark show how current diet trends are contributing, not only to diet-related illnesses such as diabetes and heart disease, but also to dangerously increasing agricultural greenhouse gas emissions (GHGs).

“This is the first time this data has been put together to show these links are real and strong and not just the mutterings of food lovers and environmental advocates,” explains Tilman.

“Alternative diets that offer substantial health benefits could, if widely adopted, reduce global agricultural greenhouse gas emissions, reduce land clearing and resultant species extinctions, and help prevent such diet-related chronic non-communicable diseases,” write Tilman and Clark in the Nature article.

Agriculture currently contributes about 25 percent of the GHG emissions that are driving climate change. Grain-based livestock production–which involves clearing land and raising grain for animal feed, particularly in the world’s tropical regions–contribute more than 75 percent of those emissions.

As the rest of the world adopts American dietary habits, the rates of meat, sugar, and processed food consumption have been on to rise. (In China alone, the numbers have skyrocketed.) If the trend continues, all those burgers and pork chops are projected to be responsible for an 80 percent increase in agricultural GHG emissions by 2050.

At the same time, thanks to the exporting of American dietary habits, more than 2.1 billion of the world’s 7.2 billion people are now either overweight or obese. Tilman explains that “empty calories”—sugar, fat, oils and alcohol—now account for almost 40 percent of food purchased in the world’s 15 wealthiest countries, which helps explain the resulting health effects.

According to the data Tilman and Clark examined, which corrected for other lifestyle factors, a vegetarian diet reduced incidence of type II diabetes by 41 percent, followed by a vegetarian diet that includes seafood (25 percent), and a Mediterranean diet that combines moderate meat consumption and is rich in fruit, vegetables, and seafood (16 percent). All three diets appeared to reduce coronary heart disease deaths between 20 and 26 percent and cancer rates by between 7 and 13 percent compared to diets that included at least twice as much meat and processed foods.

Tilman and Clark caution that while the links between what makes healthy diet and what will help lower agricultural greenhouse gas emissions are clear, it’s also possible to eat “a pure junk food diet,”–think French fries, donuts, and tortilla chips–that has low GHG emissions.

So the solution to what the scientists call the “diet-environment-health trilemma” will require choosing menus high in plant-based, whole foods like those that fit in a Meditarrean, “pescetarian” or vegetarian diet. If these diets become the norm by 2050, Tilman and Clark say “there would be no net increase in food production emissions.”

But they also note that making such a change won’t necessarily be easy. “The dietary choices that individuals make are influenced by culture, nutritional knowledge, price, availability, taste and convenience, all of which must be considered if the dietary transition that is taking place is to be counteracted,” write Tilman and Clark.

So, how do we counter the trend toward eating more meat and fatty food? “There are lots of policy options,” says Doug Boucher, director of climate research at the Union of Concerned Scientists. These include carbon taxes that would include agriculture as New Zealand now does, shifting agricultural subsidies away from livestock and related feed production, and changing government dietary guidelines to include sustainability and climate change considerations, as the U.S. Department of Agriculture’s (USDA) 2015 guidelines are expected to.

The USDA’s climate change program director, William Hohenstein, explains that rather than addressing the “trilemma” by focusing on the menu, the agency’s preferred strategy is to work with growers and livestock producers on practices that will reduce GHGs. “Consumers always have a choice,” says Hohestein.

Tilman suggests “better education” is key to helping people of all income levels understand the impacts of their food choices. He also wonders if, given the clear trend toward convenience foods, it might be possible to develop new food that is healthy, low-carbon and he adds, “also tastes good.”

Meanwhile, the data strongly suggest that eating more like Bill Clinton post-heart surgery will not only improve personal and public health, but also help put the planet on a much needed version of a weight-reduction program for greenhouse gasses.

This story originally appeared on Civil Eats

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