Thinking Like Bill Gates

by Jay Maddock, PhD


Mad About Public Health is a series that looks at the health of populations from varying creative and innovative perspectives. You might also enjoy Dr. Maddock’s previous series, From the Dean’s Perspective

Thinking Like Bill Gates

Netflix recently released a three-part docuseries entitled, Inside Bill’s Brian: Decoding Bill Gates. While anybody working in public health will be familiar with the Bill and Melinda Gates’ Foundation, I was surprised at how much of the series focuses on global health, and in particular, Bill Gates’ approach to public health issues. Each episode is built around a different global health issue, including improving sanitation through the development of a new toilet, eradicating polio, and developing cleaner and safer nuclear energy. While this might not excite the causal viewer, for a certified public health geek, it is awesome.                                Thinking Like Bill Gates

Gates addresses each of these problems like an engineer. He attacks each problem as one to be solved, not managed typically with advances in technology. In the case of sanitation, the problem starts with children playing in polluted rivers and leads to a competition to create a low-cost toilet that doesn’t use water and won’t contribute to point source pollution into the local water supply. The approach to fixing the problem starts with the children getting sick, moves backwards to the source of the illness, the river, and then to what is the major cause of pollution, human waste in the water supply. By isolating the cause, he is able to work on the specific solution that he is then able to crowd source to look for technological solutions.                                      Thinking Like Bill Gates

This reminds me of an article by Malcolm Gladwell, “Million Dollar Murray,” that I used to use in one of my courses. In this article, Gladwell discusses “power law problems,” noting that most problems are managed by addressing the middle of the curve rather than trying to solve the most difficult ones. Power law problems are areas where there are a few serious cases that cause most of the issues. In his article, he examines homelessness. The traditional approach is to manage the problem providing temporary shelters, soups kitchens, and other services to make homelessness a bit more humane and help get people back on their feet. However, the majority of people are homeless for a very short time and at least in one study the median time of homelessness is only one night. Conversely, there are a few chronic and very high-cost cases of people who are homeless for an extended period of time, often with serious addiction and mental health issues. The approach to addressing this group is very different and includes intense interventions like personal case workers and free apartments to keep these individuals off the streets and greatly reduce the total cost of homelessness to society. The power law approach focuses much more on targets and solving problems rather than managing them.

So how does this apply to how we think about domestic public health issues? A classic example is the approach to illegal drugs. The US government’s approach called the War on Drugs has been a solution-based approach at least on the supply side of the equation, while the public health approach has been a management one (eg, needle exchange, increased treatment, education). One could argue in this case that the problem-solving solution has been inadequate to addressing the root causes of the problem. For current major public health issues like obesity, diabetes, and the opioid crisis, the prevailing approach has mostly been one of management, not solutions. Mandatory physical education classes, school gardens, food deserts, walkable communities, sugar-sweetened beverage taxes, and other approaches all work around the edges. It is unclear what would really move the needle in addressing this problem or if the multifactor approach is the only way to go. Given the complexity of these problems, a concrete solution may not be possible, but it does raise the question whether we should be looking more often for solutions rather than management.                                            Thinking Like Bill Gates

Another concept that resonated with me is Bill Gates’ “think weeks.” These are weeks where he gets away from everything and brings several books and just spends the time thinking and trying to solve complex problems. While many people outside of academia probably think this is how most academics spend their time, an informal survey of my colleagues showed that this is seldom the case. Our days are filled with classes, meetings, grading, office hours, and other distractors that take away from deep thinking. I’ve previously written in this series about the relationship between health and nature and the need for macro-doses of nature a few times a year in addition to micro-doses. Mr. Gates spends his think weeks in a cabin in a natural environment. My guess is that the time for intense thinking and the exposure to nature work synergistically to help creative problem-solving. To make true advances in public health, we probably need some of these deep-thinking periods, ideally in natural settings where we can immerse ourselves in the literature and minimize interruptions.                                  Thinking Like Bill Gates

The final concept that struck me was Melinda’s role in the Foundation and in problem solving.  Where Bill is the engineer, she is the community health professional. In the high-tech toilet example, she talks to the community about usability factors, especially what would make a woman choose not to use the new toilet. These included issues like having the walls go all the way up to the ceiling and having room to bring your children in while you use the facilities. The two talk about being equal partners in the Foundation. It is a great example of how people from different backgrounds and perspectives can create better ideas in partnership, something we should constantly strive for.                        Thinking Like Bill Gates

These insights — including root-cause analysis, trying to solve rather than treat public health problems, power law, time for deep thinking, and working with collaborators — all have influenced my way of thinking. The more purposeful we are in our thought process, the more impact we can have. If you are a Netflix subscriber, this is an excellent investment of your time to start thinking differently. 


Jay E. Maddock, PhD, FAAHB, is the former Dean of the School of Public Health at Texas A&M University. He is internationally recognized for his research in social ecological approaches to increasing physical activity. He has served as principal investigator on over $18 million in extramural funding and authored over 100 scientific articles. [Full Bio]

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