Thomas Friedman - The World is Flat

Up to now, though, argued Gates, “we have not given these people a chance [to be in the flat world]. The kid who is connected to the Internet today, if he has the curiosity and an Internet connection, is as [empowered] as me. But if he does not get the right nutrition, he will never play that game. Yes, the world is smaller, but do we really see the conditions that people live in? Isn't the world still really big enough that we don't see the real conditions that people live in, the kid whose life can be saved for $80?”

Let's stop here for a moment and imagine how beneficial it would be for the world, and for America, if rural China, India, and Africa were to grow into little Americas or European Unions in economic and opportunity terms. But the chances of their getting into such a virtuous cycle is tiny without a real humanitarian push by flat-world businesses, philanthropies, and governments to devote more resources to their problems. The only way out is through new ways of collaboration between the flat and unflat parts of the world.

In 2003, the Gates Foundation launched a project called Grand Challenges in Global Health. What I like about it is the way the Gates Foundation approached solving this problem. They didn't say, “We, the rich Western foundation, will now deliver you the solution,” and then issue instructions and write some checks. They said, “Let's collaborate horizontally on defining both the problem and the solutions-let's create value that way-and then [the foundation] will invest our money in the solutions we both define.” So the Gates Foundation placed ads on the Web and in more conventional channels across both the developed and the developing worlds, asking scientists to respond to one big question: What are the biggest problems that, if science attended to them and solved them, could most dramatically change the fate of the several billion people trapped in the vicious cycle of infant mortality, low life expectancy, and disease? The foundation got about eight thousand pages of ideas from hundreds of scientists from around the world, including Nobel laureates. It then culled through them and distilled them down to a list of fourteen Grand Challenges-challenges where a technological innovation could remove a critical barrier to the solving of an important health problem in the developing world. In the fall of 2003, it announced these fourteen Grand Challenges worldwide. They include the following: How to create effective single-dose vaccines that can be used soon after birth, how to prepare vaccines that do not require refrigeration, how to develop needle-free delivery systems for vaccines, how to better understand which immunological responses provide protective immunity, how to better control insects that transmit agents of disease, how to develop a genetic or chemical strategy to incapacitate a disease-transmitting insect population, how to create a full range of optimal bioavailable nutrients in a single staple plant species, and how to create immunological methods that can cure chronic infections. Within a year, the foundation received sixteen hundred proposals for ways to meet these challenges from scientists in seventy-five countries, and the foundation is now in the process of funding the best proposals with $250 million in cash.

“We're trying to accomplish two things with this program,” explained Rick Klausner, a former head of the National Cancer Institute who now runs the global health programs for the Gates Foundation. “The first is [to make] a moral appeal to the scientific imagination, [pointing out] that there are great problems to be solved that we, the scientific community, have ignored, even though we pride ourselves in how international we are. We have not taken our responsibilities as global problem solvers as seriously as our self-identity as an international community. We wanted the Grand Challenges to say these are the most exciting, sexy, scientific things that anyone in the world could work on right now... The idea was to fire the imagination. The second thing is to actually direct some of the foundation's resources to see if we could do it.”

Given the phenomenal advances in technology in the last twenty years, it is easy to assume that we already have all the tools to address some of these challenges and that the only thing lacking is money. I wish that were the case. But it is not. In the instance of malaria, for example, it isn't just the drugs that are missing. As anyone who has visited Africa or rural India knows, the health-care systems in these areas are often broken or functioning at a very low level. So the Gates Foundation is trying to stimulate the development of drugs and delivery systems that presume a broken health-care system and therefore can be safely self-administered by ordinary people in the field. That may be the grandest challenge of all: to use the tools of the flat world to design tools that work in an unflat world. “The most important health-care system in the world is a mother,” said Klausner. “How do you get things in her hands that she understands and can afford and can use?”

The tragedy of all these people is really a dual tragedy, added Klausner. There is the individual tragedy of facing a death sentence from disease or a life sentence of broken families and limited expectations. And there is the tragedy for the world because of the incredible lost contribution that all these people still outside the flat world could be making. In a flat world, where we are connecting all the knowledge pools together, imagine what knowledge those people could bring to science or education. In a flat world, where innovation can come from anywhere, we are letting a huge pool of potential contributors and collaborators slip under the waves. There is no question that poverty causes ill health, but ill health also traps people in poverty, which in turn weakens them and keeps them from grasping the first rung of the ladder to middle-class hope. Until and unless we can meet some of these grand challenges, much of that 50 percent of the world that is still not flat will stay that way-no matter how flat the other 50 percent gets.

Too Dlsempowered

There's not just the flat world and the unflat world. Many people live in the twilight zone between the two. Among these are the people I call the too disempowered. They are a large group of people who have not been fully encompassed by the flattening of the world. Unlike the too sick, who have yet even to get a chance to step onto the flat world, the too disempowered are people who you might say are half flat. They are healthy people who live in countries with significant areas that have been flattened but who don't have the tools or the skills or the infrastructure to participate in any meaningful or sustained way. They have just enough information to know that the world is flattening around them and that they aren't really getting any of the benefits. Being flat is good but full of pressure, being unflat is awful and full of pain, but being half flat has its own special anxiety. As exciting and as visible as the flat Indian high-tech sector is, have no illusions: It accounts for 0.2 percent of employment in India. Add those Indians involved in manufacturing for export, and you get a total of 2 percent of employment in India.

The half flat are all those other hundreds of millions of people, particularly in rural India, rural China, and rural Eastern Europe, who are close enough to see, touch, and occasionally benefit from the flat world but who are not really living inside it themselves. We saw how big and how angry this group can be in the spring of 2004 Indian national elections, in which the ruling BJP was surprisingly tossed out of office-despite having overseen a surge in India's growth rate-largely because of the discontent of rural Indian voters with the slow pace of globalization outside the giant cities. These voters were not saying, “Stop the globalization train, we want to get off.” They were saying, “Stop the globalization train, we want to get on, but someone needs to help us by building a better stepstool.”