“I wish our president would treat ... women with more respect,” Melinda Gates says in an annual letter that also addresses the Gates Foundation’s outsized influence and controversial education programs.

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The annual letter from Bill and Melinda Gates usually paints a rosy view, with carefully curated success stories from the battle against global disease and poverty, and praise for new technologies backed by the Gates Foundation.

But for this year, the co-founders of the world’s richest philanthropy have instead opted to answer a selection of critical and skeptical questions about the foundation’s work and the power it wields.

Among them: “Why don’t you give more in the United States?” “Does saving kids’ lives lead to overpopulation?” And “Is it fair that you have so much influence?”

The Gateses also address the impact of President Donald Trump and his policies, a topic about which both have been largely circumspect.

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“I believe one of the duties of the president of the United States is to role model American values in the world,” Melinda Gates wrote. “I wish our president would treat people, and especially women, with more respect when he speaks and tweets.”

Bill Gates said he’s concerned by Trump’s focus on “America First,” and his proposal to slash foreign-aid funding. “The world is not a safer place when more people are sick or hungry,” Gates wrote.

Although the Gates Foundation has worked with every presidential administration since its founding, Bill Gates said they “disagree with this administration more than the others.”

On the question of philanthropy at home, the Gateses acknowledge that the $500 million they spend in the United States each year — mostly on education — pales compared to the $4 billion the foundation spends in developing countries. That reflects the foundation’s conviction that it can save more lives in poorer countries, where investments in simple solutions like vaccines can have big payoffs.

But the Gateses also say they are looking for ways to expand their work in the United States, particularly to help people move up the economic ladder.

Last fall, the couple who are better known for visiting villages in Africa and India took a trip to Atlanta to learn more about the lives of poor Americans. Residents of an apartment complex pointed out mold growing on the walls and explained how they hide their children in the bathtub when gunfire breaks out. A single mom described how she was evicted from her apartment while in the hospital with her newborn son.

“The visit made us think through other ways we could help people get out of poverty,” Bill Gates wrote. “We haven’t decided how what we’ve been learning might affect our giving, but it has certainly had an effect on us.”

In the United States, the Gates Foundation’s education programs have met with resistance and criticism, as reflected by a question in the letter that asks: “What do you have to show for the billions you’ve spent?”

“A lot, but not as much as either of us would like,” Bill Gates answered.

After an early push to cut classroom size didn’t pan out, the foundation supported programs to boost low-performing high schools and evaluate teachers. Now, instead of imposing certain approaches, the foundation is working with schools to develop local strategies to help students succeed.

The question of saving children versus overpopulation in poor countries is one that Melinda Gates said she and her husband asked themselves early in the foundation’s history. The answer may seem counterintuitive, she wrote, but the evidence is clear in historical birth trends from around the world.

“When more children live past the age of five, and when mothers can decide if and when to have children, population sizes don’t go up. They go down,” the letter says.

Melinda Gates also acknowledged that the foundation wields outsized influence because of her family’s vast wealth. An analysis by the Institute for Policy Studies estimated that America’s three richest people — Jeff Bezos, Bill Gates and Warren Buffett, have more money than the 160 million Americans at the bottom of the economic ladder combined.

Wealth opens doors that are closed to most people, Melinda Gates wrote. “World leaders tend to take our phone calls seriously … Cash-strapped school districts are more likely to divert money and talent toward ideas they think we will fund.”

But she and Bill Gates both argue that they strive to use their influence to help as many people as possible and to act as an incubator for innovative approaches.

“Although we have had some success,” Melinda Gates wrote, “ I think it would be hard to argue at this point that we made the world focus too much on health, education and poverty.”