Melinda French Gates on the Women's Health Crisis

I have not directly, but certainly the foundation has engaged in that discussion and it has not gone well.

Oh, it's great to see you, Katie. Glad we could do this.

Well, this additional 215 million brings me up to 600 million in women's health and I believe that women have to be well to do well. That is to reach their full potential to step into their power. Our health is completely connected to the rest of our lives. So, I've been focusing for a long time in my career on reproductive health and that whole reproductive cycle that women go through whether they choose to have a baby or not. I'm now and I'm doubling down on that. But now I'm adding on this transition that women go through at midlife which happens to many women starting in their early 40s actually of perimenopause and menopause because this area has been so underfunded and underresearched and underrecognized for forever for all the years and as you said yet we go through it. We go through reproductive years and then we go through midlife and half the population goes through it.

I think it's beginning to me it's the beginning of what needs to happen. We always need to speak in public our truth which is for too long this time in layman's life has been invisible and you now have enough women who have gone through it who are saying no no no no I want to be seen during this time I want to get the health care service I deserve. Now what needs to come is credible information everybody trained in the right way when you touch that medical system primary care doctor mental health professional your OB/GYN, they need to be trained. And quite frankly, we need more money in this space, a lot more money to then be able to also do research. There's so much we do not know about women's hormones.

Well, for this period of women's life, what I'm doing initially is focusing on where I see the biggest gap at the moment, and that is one-third only one-third of OB/GYNs coming out of medical school are trained about perimenopause and menopause. So, your chance of getting credible information right now is low. So, again, they need to be trained properly. Primary care doctors, nurses, mental health providers. So, I'm focusing first on the training that needs to happen so that a woman when she touches the health care system for the very first time can get what she needs, the right information for her body, not have to touch many, many, many different doctors to go on this journey to figure out exactly what's happening to her with her hormones. And in fact, studies show that women, it takes four years for women to be diagnosed with a whole variety of diseases or illnesses versus men.

It's very frustrating. And women, we are seeing women, one in 10 drop out of the workforce in our country when they go through this transition because what's happening is they're touching the medical system. They're not getting an answer. And so they're dealing with chronic insomnia, which can lead to depression. They're dealing with all kinds of hormonal changes that all have long lasting effects for their cardiovascular system, for some cancers, you know. So, we need to reverse that trend. Even for me, Katie, I am unbelievably privileged when I go into a health care system, right? But it took me three doctors to get the proper care I needed during that time in life, right? And so we know if a woman gets the right care at the right time, the outcomes are completely different for her. And these are just critical years in a woman's life. She's often finally reached the place she wants to be in her career. She might be about to launch her kids to college or just have launched them. They amazingly can be productive years if she's not dealing with all these background issues that are unseen by the medical profession.

I don't think we fully understand why. I think there are many many factors, some of them for sure hormonal, but also we have to admit where we are as a country, right? I was just in Alabama a few weeks ago talking with a woman named Asia who'd had one her first child. She'd gone through severe depression, postpartum depression. Nobody diagnosed it. It went undiagnosed. She said the way she cared for her child. She said, 'I loved my child, but I couldn't care for her in the right way.' Then she went to have a second child and had not good medical system experience. She miscarried. And finally, with her third pregnancy, she went to the right clinic. They screened her the minute she walked in the door for her mental health. And they got her on the right anti-anxiety medications. They got her to the right counselor. She said, 'I felt seen all the way through my pregnancy, and when this baby was born, the way I could care and love for it and show my care and love is completely different than my experience back here.' And so, we need to look at all of the things going on for women. They come into these clinics and they say, 'Look, I'm worried about groceries. I'm worried about feeding a new child. I want this new child. I'm worried about child care and what it will do to my job.' So, there are also many background factors going on in our economy and our society that are also affecting women's anxiety and depression at all these stages in life.

Yes. I'm trying to show ways to move forward by putting wraparound mental health services in all healthcare clinics. We should be doing it everywhere. Whether it's a young woman who's a teenager and dealing with an eating disorder, right, right as she's entering her reproductive years, whether it's a mom who's dealing with anxiety or postpartum depression, she needs to be cared for all the way through, or whether it's a woman who's going through midlife and she has huge insomnia because her hormones are changing. Every single place a woman goes, she should be touched and screened for her mental health. It's not that hard. So, I'm trying to show places we can do this and ways of doing it in hopes that we can get all healthcare to take this up.

Well, I think you have to go back in the history of the United States and the world like who was making the decisions first of all who was applying for the research it was often men back in the day. Who was making the decisions about what gets funded? That was men. Who was graduating from medical school and understanding the human body? It was men. So the men's body got treated as the default body even in research. And the women's was, you know, a slight differentiation from that. Let's maybe titrate the medicines differently. No, no, no. We have different systems, different hormones. We're actually different cardiovascular systems. So, what you're finally seeing is enough women have graduated from medical school now. It's on par with men. You're seeing women like you who have a really big advocacy platform speaking out. You're seeing women who are stepping into their power with more resources say, 'No, this isn't right. I am going to bring others in and we're going to fund these areas.' It is time, Katie. And I, you know, I think of what you did with many others on Stand Up to Cancer, right? We look at cancer differently in our country. We look at colon cancer differently because of what you did. We look at breast cancer differently because of what Susan G. Komen Foundation did that was one woman who started that Nancy Brinker because her sister died of breast cancer at age 36. It happened to be the year I graduated from high school. Now women wear pink ribbons. We do the races and the walks and we raise money. But we also know to screen ourselves and we go in and get mammogram screenings. And so this is possible. And that's what I want people to know. We need to step in with our voices, with our money, with our power and say women's health matters.

I traveled, as you said, Katie, for 25 years, and I would often be out in very remote rural places or townships three times a year in Southeast Asia and also on the continent of Africa. And what I saw was actually the great length people will go to save their child. Great length. So they will walk miles to line up in the heat to get a vaccine. They will go miles to get that baby delivered in a healthy way. If there's a clinic available, they will stand in line to get treated for, you know, eye diseases. People want to be healthy and they want their children to be healthy and yet the disparity in the care around the world is just pretty unbelievable when you go out and see it. And I will say the US over time had been extraordinarily generous starting with President George Bush, his enormous investment in AIDS. I watched those clinics being built and visited many of them and they not only provided HIV services but they were often attached to the clinic and they made sure another clinic that was already there became more high quality because when people come into the system they don't come in for one thing they come in for full services. So, it's tragic to see what's been pulled back by our country.

Women are around the world up against many different things depending on, you know, which country or community they live in, but they know how important their health is and their kids' health. So, I've had a woman who was basically yelling at me and she said, which was fine. She said, 'I have five children. I can't have another one. Do you see that clinic?' And we could see it from her house. She said, 'I go there. It used to have contraceptives. It doesn't. Now, what am I going to do?' And again, it had to do with how the funding was flowing. I've had women who had to deliver at home because there wasn't the transport fees or no one believed her how much pain she was in in giving birth and they kept telling her to push and in fact she got in a terrible situation and lost her baby. So the system needs to work for women. We are the bearers of the children. We are the center of the family and we go to great lengths to care for our children. And even the way women spend their resources when they do have a modest or a modicum of an income, they spend it. We have great health research. They spend it on their children, feeding their children and on their children's health. So getting behind women, what I know about women, what I've learned over these 25 plus years is that when you support a woman or you invest in a woman, she supports and invests in everyone around her. And that lifts up her family, it lifts up communities, it can eventually lift up whole countries and whole economies, right? I mean it's whole economies, whole economies.

It is tragic. It is tragic to see like I have been out in places where you would see the you know the bags of seeds or food that said USAID people or this clinic is sponsored by USAID. People knew that the US government was the one that was helping fund these health clinics or some of these feeding programs. And so to see something that was over 30 years in the making, to see these health clinics, I was in Botswana before there was an AIDS clinic and then we helped set up one as a foundation and then another one came in. You could see the transformed lives. You could see men and women. I would stand with men and women who were in line with their children and ask them, you know, why did you come to this clinic? They knew about the vaccines and they knew that hey these are coming from other countries like they were so grateful. So to roll that back when it was such a fraction it was less than 1% of the budget of the US government and it had so much goodwill and it allowed people to stay in their communities. People when they can raise healthy children and have some economic means, which they could if they had seeds and were farming, they want to stay there. But now we've created a crisis because we cut this tiny little piece of the US budget.

I'm quite concerned about it and I would rate the response so far a D. If I go back again, I was working in global health with the foundation. It was a decade ago when Ebola broke out in West Africa. What happened? The US government and the other European governments came together. We flew in military planes. We fixed a runway. We set up makeshift tent clinics. We helped contain that disease. Disease travels over borders. It sees no border. This is a hemorrhagic disease. You do not want to get this. And yet, so now what we will do eventually, had we kept our system up and running in our lab system that had been invested in across the continent of Africa, we could see infectious disease early and get early warning signs. We will spend more now to clean this up and to contain it than had we had the right system already up and running. It makes no sense to me. And think about it. Even though we talk about numbers, every one of those people is a human being that a family lost. It's so sad.

And we can prepare. I mean and again we had a very good surveillance system across the world and you can stockpile. So we in global health there had been for some time and the foundation had invested in it a cholera stockpile of vaccines. So when you would see an outbreak of cholera in a country like Haiti, you could go in and vaccinate the people around it so that you didn't get it to spread, right? We should make these investments preparing for these things. You know, we don't just leave a building fire in New York City to chance and say, 'Well, let's see how many buildings it's gonna affect.' We know it's going to spread. So guess what? There's a very good fire system preventative set up in the city. Right regulations, right response. We prepare in case a fire breaks out. So now we'll see what happens. We've got an Ebola fire going on in the world.

Well, we have always had some anti-vaccine sentiment. That's true everywhere in the world. Usually it's in smaller pockets. But I do think today we've had several factors have gone on. COVID. We all lived through COVID and people had very strong feelings one way or another about that vaccine. We've gone through now, you know, a decade of social media and you see a lot of disinformation spread. So where the anti-vaccine community in the past had some information not quite right, that has spread and you see conspiracy theories spread over that. And then when you have a senior government official picking up those threads and amplifying it, we see the effect of that. The other thing we have seen when you look at cause and effect, not correlation, cause and effect, we had the largest number of measles cases in 2025 that the US has seen in 25 years. Why is that? Because people what the information coming out now from our government are causing people to have concerns about a very efficacious vaccine that has been around for decades. And so when they don't vaccinate their child, you start to see these outbreaks in communities. And you know, we forget we forget that measles can actually kill children kill. So, I think this is not headed in the right direction.

I have not directly but certainly the foundation has engaged in that discussion and it has not gone well.

I'm extremely concerned anytime we roll back something on women's health it is not good. So, you know, we had a law on the books for almost 50 years for women's health. And to roll that back, to know my two beautiful little granddaughters have fewer rights than I had growing up, that doesn't make any sense to me. And I again I was in Louisiana in the fall visiting many health clinics and the confusion that has been created in the health system about which services they can or cannot provide to women. Can they use this mifepristone which has been around for again it's a safe drug. It's been around for a very long time. Will they be able to use it? Will they not? I think you posted recently about a woman who miscarried and had to go to another state after days to eventually have the baby evacuated. I met a woman in Louisiana. She had miscarried and she had to carry a dead baby in her body for over three weeks. She did not have the money to get transported to another state. The system told her she had to wait until her body evacuated that baby. So the trauma to her, she already lost her baby. And for her health, do you know how dangerous it is to have a dead child in your womb? That just makes absolutely no sense. We have caused unnecessary chaos in the system and politics has no business being part of women's health. No business. A woman's health is her own. It's private. It's a discussion she should be able to have with her doctor and be able to get the tools that she deserves.

I think it's a mix. I think it depends on where you go. I think the problem is we have for too long treated women's health as a secondary thing or we've had women have to live with pain and suffering or created their medical conditions as invisible. And it's time to just reverse that and say no, no, no. We should all be on our front foot here and say what's right for our sisters, our daughters, ourselves. We ought to be able to deliver healthy babies in this country and get the tools that we need to decide if and when to have a child.

Well, let me say this about AI. It absolutely has big downside risks and it has enormous upside risks. We should expect as an American people that the right regulations are put on to help deal with the downside risk. We're seeing a lot of mistrust from people about AI across the United States for good reason because they're saying, 'How will I be protected from the downside risks?' Now on the upside, I do think it has unbelievable promise for health across the board and particularly in women's health. We have so many underresearched areas and yet we have safe efficacious medications and chemical compounds that can be used that we use in other diseases but we don't know if they will help in women's health. So being able to run those quickly against different types of models to see can they be used in this way and to be able to take a repository of data that we have about women's health and say what else needs to be created. How do we bring forward more quickly drug candidates and have less expense on the back end in terms of testing them? Those are all places I think there can be enormous upsides.

I think we're just on the forefront of that, you know, so we're starting to see that they can look at people's eyes and the way they move to see is there any slowdown in brain capacity, right? Is that an early sign potentially of some sort of brain issue? We can look at people's keystrokes and start to see is there any slowdown you know is there something we should be doing. I think we are just beginning to see what AI can possibly do in these areas. And where I get really encouraged is, you know, there was a prediction long ago that there would be no more radiologists. Well, guess what? That's not true. I think when you augment a human doctor, a human medical professional with the right pairing in AI, you can make great advances. And look, we're also going through a huge time in biology. There's finally, it just got announced recently, there's a new test where they can look at a woman's blood and if she does get cancer, they can actually say, okay, does she even need chemotherapy? You know, are the other tools that we have available the right ones for her? And it looks like there are a large majority of women where chemo may not be right for them at all and not needed. Think about her quality of life, right? And so again, AI is just going to speed these things up if used in the right way.

Well, this is where in the past we had good government regulations on issues. So, think about it. We don't allow a chemical company anymore to dump the residual after they've run the chemicals through and created the thing they're going to create. We don't dump them into the river anymore. That's not allowed. We have regulation against that. Remember, there was a time in the US history where our rivers burned actually. And so we created the right regulations. We have laws against drunk driving. We have laws about seat belts. Did the car manufacturers all want to put seat belts in the cars? Probably not. It's expensive, right? Or airbags, but we said this is what's right for us as a people. And so I think it is what you're hearing and why there are so many concerns in communities is without the government putting in the right regulations around these data centers, we don't trust the companies to have our best interests at heart. We don't trust that, you know, it's not going to use all of the, you know, electricity we need in our area and so our bills are going to go up. And so I think there's a trust issue going on in society and I think this is exactly where you want government to act.

I cannot speak to other people of wealth, the ones that you mentioned, to their values. I can only speak to my own. And I'll speak to something that Warren said years ago that I think was really right and I still believe this. If you were lucky enough, lucky enough to grow up in this country, you owe something back to it. Whether that's your time and you're tutoring a kid for an hour, whether that is the expertise you've gathered and so maybe you're going to help, you know, with communications at a nonprofit. If you have resources, you should give back to this country. If you started a business in this country, you benefited from our laws, our regulations, our VC community, our stock market. Warren always said he couldn't have done what he did if he had been born in many other places in the world. That is just true. So my belief is that you know with wealth comes great responsibility. And so we should be giving back. And I will say that, you know, the Giving Pledge members that I have worked with, not all of them over time, but the ones I have worked with, we're learning from one another, right? And there are many of them that I see are doing the right thing. Ren and Nancy Kinder down in Texas, they're saying, 'Look, we're giving away our wealth before we die.' And boy, are they plowing it into the community in Houston. There's another couple who I admire greatly who's been working on the incarceration system in the country. That's not my issue, but how they tackle the issue, I have learned from that. So, I think if you are lucky enough to be wealthy in this country, you should be giving a lot of it back.

Well, what I've learned in over two decades, three decades almost now, of philanthropy is at least to me, it's most effective and it has the most lasting impact if you are in deep partnership with the community. So if they are saying this is something we want in our community and you are there listening to them, working alongside them, supporting them as a peer, not as a 'I'm coming in to tell you what to do.' It needs to be to me very much in a partnership model. And to me, philanthropy has a very specific role which is it sits alongside civil society where we use our voice to get what we think is right for the country or our community. Philanthropy because it can be a catalytic wedge. It can take experiments with money that you wouldn't want the government to use with taxpayer money. It can take on experiments. It can research those, see if they're right. Then government's role is to scale that up, right? So, okay, if we get some health clinics working in the right way, okay, can government funding help that or help people with Medicaid reach those kinds of services? And then there's private sector alongside, which is hugely important. That's where you see lots and lots of innovations coming from. So, I use actually philanthropic dollars and I also use investment dollars to try and further things for instance in women's health. But philanthropy is part of an ecosystem and it can never replace government funding. Government funding is enormous. Right? I mean Medicaid alone I think in California last year was $197 billion. Right? So philanthropy can't replace that but it can show ways of using that money more effectively as a catalytic wedge.

Well, I think of this in two ways. Actually, Albert Einstein, I think, said, 'What's measured matters, but not everything that measures can be measured.' So, I try to measure where I can. So, for instance, one of my goals is to get more women and more people of color into our state legislatures. I like to support those kinds of leaders because they're creating policy that represents all of us and then they represent their communities and their states, right? I can measure over time, have we increased the needle? Like I'm looking at this over more than a decade, but we measure, okay, are there more female state legislators? Are there more legislators of color? Have we been able We've put a lot of money, advocacy money into trying to get paid family medical leave passed because we are the only high-income country in the world that doesn't have it. And yet we know from great research, it changes society when you have it. And so we worked really hard at the federal level. We weren't able to get it. But guess what? Since the partners and I have been in collaboration on this now for many years, we went from having just a couple of states. We now have 13 states and the District of Columbia that have it right. So I can measure over time, are we getting policies passed that I'm in deep partnership with the advocates to try and push forward for the things that I think will benefit society. So I can measure in those ways. And then if I go spend, which I still do at times, you know, an hour working at a food bank or working at a shelter or even if I put money into a local shelter, which I think they're deeply important for women leaving domestic violence with their family and being able to go, I can't measure, okay, how many lives exactly does that touch, but boy does it matter, right? So, you have to think of it, at least for me, I have to think of it in both ways.

Katie. Thanks for having me and thanks for everything you have done for now over 20 years to really bring attention to cancer and so many other important health issues and other issues for women across the country. I was honored to have this conversation. Thank you so much.