VOA Interview: Bill Gates video player.

SEATTLE, WASHINGTON - Living conditions have improved greatly since 2000 even for the world’s poorest people, but billions remain mired in “layers of inequality.”

That is the assessment from the Bill & Melinda Gates Foundation’s third annual report on progress toward U.N. Sustainable Development Goals – 17 measures that most countries have pledged to try to reach by 2030. Those efforts are falling short, says Bill Gates.

“As much progress as we’re making, a child in many countries still over 10% are dying before the age of five. And in richer countries it is less than 1%. So the idea that any place in the world is still 10%, some almost 15%, that’s outrageous, and it should galvanize us to do a better job,” Gates told VOA.

The 63-year-old Microsoft co-founder and philanthropist sat down with VOA at the foundation’s offices in advance of the report, which was released to coincide with the opening of the United Nations General Assembly.

This year’s report uses geography and gender as lenses for examining progress, particularly in terms of health and education.

It finds “an increasing concentration of high mortality and low educational attainment levels” in Africa’s Sahel region as well as in parts of Pakistan, Afghanistan and northern India. People in those regions experience “multiple deprivations, including some of the highest fertility rates in the world, high levels of stunting and low vaccine coverage,” the report says.

Disadvantages fall more heavily on women than on men. Girls generally get less formal education than boys; those in sub-Saharan Africa average two fewer years of education. And even when girls obtain a good education, they’re less likely to parlay it into paid work. 

“Globally, there is a 26 percentage point gap between men’s and women’s labor force participation,” according to the report.

Monitoring progress on these fronts aligns with the Gates Foundation’s commitments, which include improving global health and aiding development in low-income countries. Since its start in 2000, the foundation has spent billions on efforts such as improving vaccines and nutrition, combatting malaria and other diseases, supporting innovative toilet designs to improve sanitation, and ensuring good data collection to identify problems.

As the news site Vox has pointed out, the Gates Foundation each year outspends the World Health Organization and most individual countries on global health. It has built the world’s largest trust -- $46.8 billion as of December, according to its website.

That has led to questions about whether governments have ceded too much responsibility to philanthropic organizations.

“The billions of dollars available to Gates, Rockefeller and Wellcome might be spent with benevolent intent, but they confer extensive power. A power without much accountability,” Wellcome communications director Mark Henderson wrote last week in Inside Philanthropy, announcing that the London-based health charity – second in spending after Gates – would increase its transparency.