盖茨夫妇如何改变数十亿人的生活？

如果想更深入了解盖茨夫妇的领导风格，可以看看厕所的例子。

提醒一下，或许只是个猜测，但全球可能很少有人像比尔·盖茨一样热爱讨论马桶。世界卫生组织称，全球多达45亿人没有“安全卫生设施”，将近9亿人（大多数生活在农村）仍然在户外排便。其实既不需要自来水也不需要下水道，安全廉价又设施齐全的废物处理设施是公共卫生必不可少的部分。

为了强调该点，去年11月比尔飞往北京参加新世代厕所博览会，也再次发表演讲。在他旁边小一些的演讲台上专门放着一罐人的粪便，也是演讲主题的道具。“这么少的粪便里就可能有多达200万亿个轮状病毒、200亿个贺氏菌和10万个寄生虫卵。”

虽然现场观众报以大笑，但小容器里确实有很多致命物。对很多发展中国家来说算得上大规模杀伤性武器，历史上似乎不断涌现的霍乱、伤寒、痢疾、肝炎和腹泻病流行已无数次证明。

厕所博览会展示了一些巧妙的设计，用比尔的来说是“近200年来卫生领域最重要的进展”，目前盖茨基金会已投入约2亿美元。

但正如3月底比尔和梅琳达在西雅图一次联合采访中解释的，重新改造后的马桶还代表着潜在更自由的意义。卫生厕所直接关系到女孩和妇女的健康，最终关系到经济能力。根据联合国儿童基金会提供的数据，在撒哈拉以南非洲，适龄女孩当中有十分之一月经期间不上学，还有很多女孩出现月经开始后辍学。“想想一个孩子五、六天不上学是什么感觉，学业会落后多少，” 梅琳达说。有时暴力的威胁也会导致女性或女孩躲开公共厕所，而且因为通常由女性带孩子上厕所，该现象会产生连锁反应。

To understand how the Gateses lead, it helps to think of toilets.

This is just a guess, mind you, but it’s likely that there are few people on the planet who get more excited talking about commodes than Bill Gates does. In a world where as many as 4.5 billion don’t have “safely managed sanitation,” according to the World Health Organization—and of whom nearly 900 million (mostly rural) people still defecate in the open—a safe, affordable, self-contained waste treatment apparatus that requires neither running water nor sewers is the sine qua non of public health interventions.

To make the point, Bill again took to the podium, flying to Beijing this past November for the Reinvented Toilet Expo. Next to him, for their shared keynote—and resting on its own, shorter podium—was a jar of human excrement. “This small amount of feces,” said Gates, “could contain as many as 200 trillion rotavirus cells, 20 billion shigella bacteria, and 100,000 parasitic worm eggs.”

Despite the laughter in the audience, the container was filled with deadly stuff: In much of the developing world, in fact, it is a weapon of mass destruction, as proven by history’s seemingly unbroken epidemics of cholera, typhoid, dysentery, hepatitis, and diarrheal disease.

The toilet expo showcased a number of ingenious prototypes—the “most significant advances in sanitation in nearly 200 years,” Bill called them—and the Gates Foundation has put some $200 million into the effort so far.

But as Bill and Melinda explained in a joint interview in Seattle in late March, the reinvented commodes represented something potentially more liberating still. The toilets were a direct link to girls’ and women’s health and, ultimately, their economic empowerment. In sub-Saharan Africa, one in 10 school-age girls don’t go to school during their menstrual period, according to UNICEF, and many drop out after menstruation begins. “Think about what it’s like for a child to miss five or six days and how far behind they get,” says Melinda. Sometimes it is the threat of violence that keeps a woman or a girl from a public latrine—and because it’s usually women who take their children to the bathroom, that has a cascading effect.

“我们必须在各种数据连接点之间划上线，”她表示。“如果不强调联系，如果我们只从人们健康的角度谈论卫生的重要性，”就无法深入理解错失的机会和挑战。“我们从工作中学到的是，一定要讨论性别因素，因为明确存在。”

事实上，梅琳达在发展中国家奔波20年后发现，几乎所有限制人力资本的因素都能以某种形式与性别联系起来。当然最明显的便是女性是否有权决定是否结婚与何时结婚，是否生孩子与何时生孩子。在世界上许多地方，女性无权在两方面做决定，也由此产生毁灭性和跨代际传递的后果。

梅琳达是一位践行信仰的天主教徒，她毕业于达拉斯一所天主教女子高中（还曾作为优秀代表发表演讲），但在推行生育计划，包括向妇女提供避孕措施方面遇到了一些阻力。但驻华盛顿的联合国基金会高级研究员吉塔·拉奥·古普塔解释称，盖茨基金会在生育计划上的立场跟其他事一样，目标都是“满足未满足的需求”。

拉奥·古普塔表示，该项目并不是让发展中国家妇女少生孩子，“关键在于让妇女掌控生育权。女性希望有避孕措施，不想生太多孩子，但并没有能力也没有工具做选择。”

填补这一空白不仅要了解社会、文化或宗教障碍，虽然都很重要。“梅琳达发现，向妇女提供避孕用品存在供应和补给方面的障碍。因此即便社会对相关想法态度开放，仍然存在挑战，”拉奥·古普塔说，他还为女孩和妇女创建了3D项目，关键在于提升经济能力。

性别方面还存在其他联系，比如出生选择与教育以及与儿童死亡率的联系。盖茨基金会首席执行官休·德斯蒙德-赫尔曼博士说，如果要看5岁以下的孩子存活率，“对儿童健康最大决定因素之一便是母亲的教育状况。” 他是一名内科医师，也曾担任加州大学旧金山分校校长。

“We have to draw the line” between all of these connecting data points, she says. “Because if people don’t draw the lines—if we just talk about the importance of sanitation in terms of people’s health,” we fail to fully comprehend the missed opportunities and challenges. “What we’ve learned in our work is that you have to talk about the gender pieces, too, because they are specific.”

Indeed, as Melinda discovered in her two-decade journey through the developing world, for virtually everything that tends to limit human capital, there is a line connecting it to gender in some way. The boldest of these lines, certainly, concern the rights of women to decide if and when they get married, and if and when they have children. Both of these choices, in much of the world, have been taken away from women, with devastating and transgenerational consequence.

Melinda, a practicing Catholic who attended an all-girls Catholic high school in Dallas (where she graduated as valedictorian), has met resistance from some quarters on some of her family planning efforts, which involve offering women access to contraception. But as Geeta Rao Gupta, a senior fellow at the UN Foundation in Washington, D.C., explains, the Gates Foundation stance on family planning has been, as with everything else it does, about “meeting unmet need.”

The effort isn’t about telling women in the developing world to have fewer kids, says Rao Gupta: “It’s that women want to control their fertility. They’re asking for contraception. They don’t want this many children or too many children, and they don’t have the ability, the tools that are available to the world, to be able to make that choice.”

Filling that gap is not just about understanding social, cultural, or religious barriers, as important as they are. “What Melinda found was that there were supply barriers and logistical barriers in getting contraceptives into the hands of women. So then even when societies were open to that idea, there were challenges,” says Rao Gupta, who also founded the 3D Program for Girls and Women, which focuses on economic empowerment.

There were other gender lines, too—like those connecting birth choices to education, and then to child mortality. When it comes to the survival of kids under 5 years old, says Gates Foundation CEO Sue Desmond-¬Hellmann, who is both a physician scientist and former chancellor of the University of California, San Francisco, “one of the best determinants of a child’s health is the educational status of the mom.”

“因此，虽然现在全世界很愿意投资于男孩和女孩教育，实际上投资的是母亲的未来，以及孩子的健康。”

梅琳达曾在杜克大学获得计算机科学学士学位，后来在杜克大学福库商学院获得工商管理硕士学位，接下来九年里她一直在微软研究与性别障碍有关的数据。如果需要有些尚未整理的数据，她便通过基金会申请。但她主要还是通过人际交流学习，也是一种潜移默化。她听印度自助团体的妇女说话，与孟加拉国到印度尼西亚的各地女孩和母亲交谈。她跟当时17岁的女儿珍在坦桑尼亚小村姆布尤尼过夜，住在马赛人夫妇的“山羊小屋”里，由此了解另一种生活。她跟儿子罗里在马拉维的寄宿家庭里也一样。

“基金会成立之初，性别问题并不是着重考虑的问题，”梅琳达说。“但我想说，过去六、七年里我们已经真正开始讨论性别问题，也切实投资确保真正解决问题。”

“And so when you invest in education for both boys and girls, which most of the world happily does now, you’re investing in the future of those women as mothers—and in the health of their children.”

Melinda, who earned a bachelor’s degree in computer science from Duke University and an MBA from Duke’s Fuqua School—and who spent the next nine years at Microsoft—has carefully studied the data on gender-based barriers. And the data that wasn’t already available, she has commissioned through her foundation. But mostly she has learned through in-person absorption—through a kind of human osmosis: from listening to women in self-help groups in India; from talking to girls and mothers everywhere from Bangladesh to Indonesia. The insights came when she and her then 17-year-old daughter Jenn spent the night in the “goat hut” of a Maasai couple in the Tanzanian village of Mbuyuni, as they did in her homestay with son Rory in Malawi.

“It’s not at all where we started as a foundation,” Melinda says. “But I would say in the last six, seven years, we’ve really started to talk about this gender piece and have put specific investments down to make sure we address it.”