The
World’s 50
Greatest
Leaders
The List50
FORTUNE.COM // MAY.1.19
est Leader. The pick, pointedly, is a singular
one; the power of their leadership is definitely
double-barreled.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 mil-
lion (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 rein-
vented commodes represented something po-
tentially more liberating still. The toilets were a
direct link to girls’ and women’s health and, ul-
timately, 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.“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 at-
tended 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 contracep-
tion. But as Geeta Rao Gupta, a senior fellow
at the UN Foundation in Washington, D.C.,
explains, the Gates Foundation stance on fam-
ily 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 under-
standing social, cultural, or religious barri-
ers, 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 scientistIn The Moment
of Lift, which
debuted in April,
Melinda Gates
shares stories
that capture
the interplay
between
gender, global
health, and
opportunity.1 - Bill and Melinda GatesGFT.W.05.01.19.XMIT.indd 50 4/17/19 6:00 PM