Contrary to the doom and gloom found in Twitter feeds and nightly news broadcasts, there’s ample evidence that humanity is headed in the right direction.

A new report from the Bill and Melinda Gates Foundation puts that progress in perspective.

The report, entitled “Goalkeepers: The Stories Behind the Data,” sheds light on how far public health officials have come in the fight against infectious disease and poverty.

The Gates Foundation plans to release a new “Goalkeepers” report every year until 2030. Here are some of the biggest wins over the last 25 years.

Childhood mortality

Since 1990, more than 100 million lives have been saved among kids 5 years and younger. The rate of death has fallen from 85 deaths per 1,000 live births to just 38.

“The key to keeping the momentum,” according to the report, “will be helping countries (or regions within countries) with the weakest health systems build up the basic infrastructure they need to reach all children with lifesaving interventions.”

Maternal mortality

Over the past 25 years, women have started giving birth in hospitals and health facilities more frequently than at home.

The biggest benefit: Mortality rates have fallen from 275 maternal deaths per 100,000 live births in 1990 to 179 deaths in 2016.

“Skilled obstetrics care is key to saving mothers’ lives, so countries must make sure that their facilities are fully supplied, staffed by skilled health professionals, and provide the highest quality of care,” the report read.

Family planning

One of the strongest defenses against the spread of sexuallty-transmitted diseases is prevention.

Between 1990 and 2016, the Gates Foundation has observed an increase from 68% to 76% in the percentage of women of reproductive age who have their family planning needs met with modern contraception.


HIV’s decline over the past 25 years is nothing short of remarkable, the report noted. Rates of infection have fallen from their high of 0.60 deaths per 1,000 people in the late 1990s to 0.25 in 2016.

In the report, Bill Gates expressed some concern that funding has started to slow down to the extent that a population boom could mean a resurgence in HIV over the coming years. He called such an event a “scary prospect.”


Over the past 25 years, there has been a modest decline in cases of stunting — a condition in which newborn babies don’t have fully-formed body parts.

The report called stunting a “proxy for overall cognitive and physical underdevelopment.”

Rates of stunting fell from 36% of children under age 5 in 1990 to 26% in 2016.


The World Bank defines global poverty as living on less than $1.90/day.

The Gates Foundation found rates of such poverty have declined considerably over the last few decades, from 35% in 1990 to 9% in 2016.

From the report: “Ultimately, the goal is to ‘end poverty in all its forms,’ which is more ambitious than simply guaranteeing a wage on which people can subsist. It means, as our foundation’s mission statement says, that all people can lead a healthy, productive life.”


Smoking rates haven’t just declined among teens and adults in the US over the past few decades; they’ve fallen worldwide among nearly all age groups.

Between 1990 and 2016, the prevalence of daily smoking among people 10 years and older has dropped from 22% to 16%.

“The great unknown is what will happen in Africa, where tobacco companies see opportunity,” the report read. “Strong tobacco laws there are critical to maintaining the downward trend.”


Greater numbers of sewer connections and water treatment plants are helping to clean up the world.

Over the last 25 years, the percentage of people relying on unsafe sanitation has fallen from 57% to 33%.

The Gates Foundation has contributed to the trend, in part by funding research to build waterless toilets and investing in purifying waste water to make it drinkable.

Financial services for the poor

Empowering people to make their own buying decisions is crucial for helping them escape poverty, research has found.

In the past few decades, a number of developing nations have started bringing their citizens online with mobile banking.

Rates of adults with bank accounts have jumped from 37% in 1990 to 65% in 2016 thanks to services like M-Pesa, a mobile-phone service that lets East Africans keep money in digital accounts rather than physical locations, where it can be more easily stolen or lost.

Neglected tropical diseases

There are a slew of neglected tropical diseases that affect 1.6 billion people but which receive far less funding and are harder to eradicate, due to being more spread out, than more common ailments such as tuberculosis and malaria. These are diseases like dengue fever and rabies.

Rates of infection of neglected tropical diseases have fallen from 47,000 cases per 100,000 people in 1990 to 27,000 cases in 2016.

“Maintaining this momentum is the key to accelerating progress,” the report read.


The Gates Foundation called widespread vaccination “one of the most impressive public health stories in global health.”

Since 1990, the proportion of target populations who have gotten covered by the eight major vaccines has risen from 73% to 89%.

“The next steps for immunization programs,” the report read, “are to battle stagnation by finding the pockets of inequity that exist within countries — even those with high average rates — and reach all children with a full set of life-saving vaccinations.”

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