JOHN SEFFRIN: Good afternoon. It is indeed my honor and pleasure as chair of INDEPENDENT SECTOR and CEO of the American Cancer Society to serve as moderator for the final session of what has been a remarkable three days.

This week we have talked about social and health inequities. We have grappled with budget cuts, we have confronted challenges in nonprofit leadership, and we've offered solutions for closing the gap in access to education, health care, and human rights.

One thread, one important thread unites all of these: the critical role played by a strong, vibrant, independent sector. In spite of our challenges and some of the discouraging and disappointing things we've talked about this week, we have just such a vibrant sector in the country, and we should never forget that. It's a privilege that many across the globe lack.

And I should add, it's instrumental in effecting any kind of meaningful and long-term solution to the problems we all confront on a daily basis. In my own work, I see the differences between a country like the United States, where groups like the American Cancer Society and others have been catalysts for government and private involvement in and commitment to reducing the burden of human cancer, and countries in the developing world, where cancer is what it was like here a half-century ago—when it was misunderstood, increasing in incidence, and generally, yes, fatal.

Even sadder is the fact that so much of this mortality is entirely preventable. May I repeat: So much of human suffering and mortality to cancer is entirely preventable with what we know today, if treatments that are known to work were widely available, if knowledge were shared better, if advocacy were permitted and promoted by the nonprofit sector in communities in every country all around the world.

Nowhere is it more heartbreaking to me than in the case of tobacco, the source of the most preventable cause of premature death in recorded history. Over 500 million alive in the world today, 250 million of whom are children, will die prematurely due to tobacco if the tobacco industry continues to keep children in its marketing cross-hairs and if current rates persist. Yet a strong nonprofit sector, that has made such great progress in fighting tobacco in this country, could at least halve those rates if the work we do were better disseminated around the globe.

I want you to think about that as I now introduce our speaker, because it is incumbent upon us not only to continue to make our sector better within the United States, but we are duty-bound in this global village, it seems to me, to reach out and help others less fortunate than we.

Now we are privileged to have one of the most dedicated and skilled leaders in our field, a woman who moved from the private sector to the independent sector herself in order to head up the world's largest private foundation.

Patty Stonesifer is co-chair and president of the Bill & Melinda Gates Foundation, leading the foundation's mission to improve access to advances in global health and learning for all people as we move into the 21st century. She has overseen the foundation's commitment of close to $5 billion to share new health technologies with those living in developing countries, provide underserved communities with computers and Internet access, and sponsor the creation of smaller, more effective high schools.

Patty has brought new international understanding to the solutions and resources needed to bridge the deep disparities in health around the world. Her leadership created one of the most innovative public-private partnerships in global health ever—GAVI. The Global Alliance for Vaccines and Immunization and the formation of the Vaccine Fund have ensured that immunization will remain a priority at the highest levels, saving literally millions and millions of lives.

She serves on the board of the Vaccine Fund, launched in 1999 to address the need for vaccines among the world's countries. Patty also served as an official member of the U.S. delegation to the United Nations General Assembly special session on AIDS.

In addition to her responsibilities with the foundation, Patty is an active community volunteer, donating both time and resources to a number of regional nonprofit organizations, and she serves on the board of directors of the Seattle Foundation. Patty serves on the Board of Regents for the Smithsonian Institution and on the board of directors of Amazon.com and Viacom.

Prior to being asked by Bill & Melinda Gates to launch the work of the Gates Learning Foundation in 1997, Patty held a senior vice president position at Microsoft, and she ran her own management consulting firm, working with such corporations and DreamWorks SKG.

Patty's presentation will start with a short video about the Gates Foundation. Following her speech, she will field questions from the floor. It is my great honor to welcome Patty Stonesifer and have you listen and watch this video.

MS. STONESIFER: Good afternoon. And thanks, John, for that great introduction and thank you all for staying through the final luncheon.

It has been an incredible few days, from the feedback that I've received about all of the conversations and work and networking that has gone on here. And we at the foundation feel very privileged to have joined INDEPENDENT SECTOR and joined with so many of you in trying to achieve the goals that you've not just laid out in the last few days, but in the decades and decades that you've been working on these issues—before we ever came to the same place. So we thank you for that.

Well, in that little video—this is the first time I saw it—you saw something of the work that Bill & Melinda have set in motion based on their simple belief—and those of you who have heard Bill speak before will recognize his voice in this—that the random geography of one child's birth should not be the determinant of whether he or she can receive a quality education or a chance at a healthy life.

Each one of you in this room serves an organization with a similar commitment to changing the world we live in, based on the values and ideals and the competencies that inspire your lives and your institutions. And over the last few days we've heard discussions of ways to protect human rights, to serve urban communities, and to fight poverty here and around the globe.

The rights we take for granted here are denied to millions around the globe. That is why we do the work we do, and you do the work you do. We have to stand with these folks and help them achieve the changes that they are seeking.

Yet, for all of our energy and enthusiasm, the enormous inequities of the world are unsolvable with the resources of just one family, just one institution, or all the families and institutions represented in this room today. One of our biggest goals must be to find a way to inspire the rest of the world with the same vision that drives us—that yes, the world's problems are indeed deep and urgent, but we can solve these problems. We know of interventions, we know of efforts, we know of solutions that can and will work.

Of course, we would be foolish if we tried to inspire the world to respond to the needs of the sick and the young and the poor and the oppressed and the disenfranchised without first learning from the leaders who have done this before. Just as science is building on decades of discoveries of generations of great minds, we stand today on the shoulders of the great leaders of the past who set a precedent for compassion with action, and for achieving great changes in the face of great odds.

A few years ago, I was able to travel to India to see first-hand some of the projects we fund for children's health. And there I was able to visit the Mahatma Gandhi Memorial. He is a great inspiration to me. You may recall that Gandhi was once asked what he thought of Western civilization. It tells you something of his wit and wisdom that he simply replied, "I think it would be a good idea."

Well, while I was there, the director of the memorial gave me a banner, which hangs next to my desk at the foundation, and whose message inspires me every day. It is a list simply called, "The Seven Social Sins"—a list that Gandhi published first in 1925 in a magazine he edited called "Young India." And here is his list of seven sins of society: Politics without Principle, Wealth without Work, Pleasure without Conscience, Commerce without Morality, Science without Humanity, Worship without Sacrifice, and last but far from least, Knowledge without Character.

Seventy-seven years later it's still a compelling litany of the sins that hold us back around the world.

But rather than thinking of this as a litany of our ills, in my mind I've inverted this list into a set of prescriptions that guide my own life and work. So let me share just a few of those with you today.

We can and must demand politics with principle. Yesterday's luncheon with Senator Wofford was enough to inspire all of us that we can promote politics with principle when we work closely with our government leaders to increase the right funding to the right programs.

There are dozens of examples of this effort in this room, but one is Peter Goldberg, the president of the Alliance for Children and Families, who is working with many of you to ensure that the new welfare reform legislation addresses serious problems, such as lack of child care services for mothers who want to return to work. This and many other examples that you can cite represent politics with principle. And we must not only demand it, but we have to stand with those who seek it, whether they are seeking election or the activists moving these issues forward.

We also must demand commerce with morality every day. We can promote commerce with morality if more businesses, like many of yours represented here, consider the social consequences in the development, the selection, the pricing, the availability of their products, and in the treatment of their employees, and in the communities where they work and the environments that they affect. Corporate social responsibility should not be a buzz phrase, it should be a norm. And we can and must demand that of the corporations around us.

A hometown example of this comes to mind. Starbucks, a Seattle-based organization, has done more than revolutionize the coffee shop, it's also built into its organization community building programs, where employees reach out to local nonprofits to work in the communities that they serve. Where they serve coffee, they serve the needs of the community too. Kiehl's, a very hip product organization, is donating the sales of one of its body cleansers to YouthAIDS, an organization promoting AIDS prevention among teens.

We can all cite dozens of corporations that are bringing corporate social responsibility to life; that instead of it being a heading on a slide show, it is a basic part of their corporate culture. And we must not only demand this from our corporations, we must support those corporations who pursue it when we see it.

We can and must in the 21st century, demand science with humanity. We can promote science with humanity if we make sure the phenomenal breakthroughs that are happening all around us, and are going to accelerate during this century, reach those who need the most—that new vaccines reach every child everywhere, and that research and development for new drugs, whether it's in our universities, our pharmaceutical companies, or our biotech companies, address the needs, address the issues of the poorest of the poor.

The health program at the Gates Foundation, as you saw, is focused on accelerating the research and development of new vaccines, new drugs, and new diagnostics—or tests—against malaria, against AIDS, against the parasitic diseases costing so much in the social and family and economic structures around the world.

Why would a foundation address that issue? Let me tell you, some of the numbers are astonishing. The FDA approved 1,500 drugs in the last 25 years—1,500 new drugs to improve life. Yet less than 20—just one percent—were specifically for the illnesses taking lives in the developing world. Less than one percent. And of the $70 billion spent globally each year on medical research and development, only 10 percent is devoted to the diseases that cause 90 percent of the health burden on this planet. Ten percent against 90 percent of the health burden.

We're committed to pushing harder to ensure that product development in the health sciences proceeds in these critical areas. But we do need your support.

And then once these new technologies are proven, be they health technologies or digital technologies or other forms of technology, we must work with governments and others—INDEPENDENT SECTOR around the globe, influential leaders, business leaders around the globe—to ensure that these products are rolled out quickly to the people who need them most.

If we can find an AIDS vaccine, the cost for every month's failure to deploy—every month we fail to get that vaccine out—costs 500,000 lives. If it takes us a year to get our act together in deploying an AIDS vaccine, we will lose 6 million lives—equivalent, essentially, to those lives lost in the Holocaust. What would we do now if we could have predicted that loss? Well, we can predict this one if we are not ready to deploy the new health technologies as they become available.

It's a disgrace that has already happened. It has taken us more than 15 years to make the hepatitis B vaccine available to those who need it most, where that vaccine could prevent an enormous amount of suffering. And it's a global disgrace that it has taken us more than 50 years after we discovered an effective vaccine for polio, more than 25 years since we saw polio vanish from our midst, to even begin to approach eradication of this terrible disease.

So we must not only reduce the gaps in product development, we must reduce the lags in deployment of new technologies. Because if we don't, new technology is just going to become one more factor separating the privileged from the poor and widening the gaps that we despair of today. If we do that, if we work to push deployment and decrease that lag, then we will see science with humanity.

And we can and must demand knowledge with character. We promote knowledge with character when we stand up and say it is simply not acceptable that in most of our urban communities in this country, less than 50 percent of our kids are graduating from high school. Less than 50 percent of our kids are graduating from high school. We need to stand up and insist that as community leaders and as government and as private entities, we must provide opportunities for all students no matter where they live.

We know that today's large anonymous high schools do not serve the new student bodies well. Here in Cleveland, for instance, less than 40 percent of high schoolers are graduating. I spent this morning visiting East Technical High School and meeting with the mayor and the CEO, which is their superintendent of schools, Barbara Byrd-Bennett. And they have made a district-wide commitment to transform their large high schools into smaller learning environments and to try to ensure that all students have an opportunity not just to graduate, but to graduate ready for college, ready for work, and ready for civic leadership. The discussion there was heartening, and we heard from individual students working on this effort, teachers, and leadership around the city.

And here today is Hilary Pennington, president of Jobs for the Future. And she is one of the partners with the Gates Foundation committed to creating 70 new small high schools that not only ensure that students graduate with a high school diploma, but also graduate with an opportunity for significant college credit, ensuring that they are college-ready, that they are ready to pursue college, work, and civic leadership.

By providing a rigorous and more personalized learning experience, we believe high schools can help thousands and tens of thousands and hundreds of thousands of students who, with today's system, are unlikely to even graduate from high school.

Barbara's efforts, Hilary's efforts, and the work of hundreds of like-minded groups—many of you represented here—and thousands and thousands of education and parent leaders around the country are committed to building knowledge with character as a fundamental tenet of our education system. And when we see that effort, we must stand with them, whether it means voting for the right funding or supporting them when radical change causes radical response.

We can and must demand wealth with work. We promote wealth with work when we invest our resources, both our fiscal resources as well as our service resources in people here and around the world. Each of us has an opportunity and an obligation to give back, whether it's 25 cents or $2500 or 25 hours of service a month. This is something that most of us learned in our home from our parents. It was built into the assumption of who we are.

But we need to make sure that every child and every family and every citizen understands that this is part of what we must do. In building wealth, we must also work not just for ourselves, but for others. And we need to foster a situation where, later this week, that child who decides to forego the big bag of candy and instead is rattling that can for UNICEF, understands the value of that kind of work. Or the tortilla maker in Honduras who actually uses a significant part of her earnings to support the orphans in her village. Or the young executive who recently gave a million dollars to Rotary's effort to eradicate polio, when the last elements of polio are not in his community or in his state or in his country, but all around the globe—in India, and other hard-to-reach places where we still have work to do.

I'm sure each of you could cite hundreds and hundreds of heroes who are quietly going out and doing work of this sort in the community and giving of their resources. But when we do know them, when we do see them, when we do learn from them, we must stand with them and draw the attention and the respect and the acknowledgement—and the inspiration for ourselves—that their example demands.

Well, these principles, Gandhi's principles inverted in this way, have become my own guide for social action. But as we know, it takes a lot more than good guidance to really get things done. It takes determination to stand together and do it. And again, we must look to others for examples.

Before I close, I'd like to share one last experience that gave me new insight but, in particular, additional resolve to do all that I could and to help our institution do all that we could.

In 1999, President Nelson Mandela actually came to Seattle to meet with us at the Gates Foundation, to talk about our work in Africa, and in AIDS, and in other efforts. And it was a phenomenal thrill. But I was also able to follow him around the community the rest of the day. And later in the day, he was talking to Seattle leaders in a room very much like this one. He stopped and looked out at the audience filled, very much like this one, with community leaders committed to making a change, to addressing the needs of those who need them the most. And he very quietly and simply and elegantly, in his way, just said, "Will those of you who took personal action, any action big or small, to end the terrible injustice of apartheid please stand up."

And then he said, "And will those of you who took personal action, something, anything, big or small, to help me walk free from Robben Island please stand up."

And the next 60 seconds were among the most uncomfortable moments of my life thus far. Because—and it was the same for everyone in the room—those of us who had done nothing wished we had done something, and those of us who had done something wished we had done far, far more.

The power of the moment was magnified by the bearing of President Mandela. There was no anger in his question. There really was no recrimination. He was not judging us; he was simply asking us to judge ourselves.

And I thought to myself when we did—besides the obvious, that we all felt we came up short—why had we not done more? His was a cause that mattered greatly to all of us. Perhaps we thought our efforts wouldn't matter in the face of such an enormous problem, in the face of such enormous inequity. Perhaps we had given up without really trying, without demanding action of ourselves.

And I fundamentally believe that, while we could go through a litany of all the dangers facing us, this is one of the greatest dangers in the world today. It's not that we're unaware of the problems. The danger is not enough of us believe there are solutions. Not enough of us believe that we can and should make the changes that are in our power to change.

So that gives us our mission. That gives all of us our mission. We know we can change the world by changing the world's belief as to what is possible—and by showing them what is responsible. If we show that there are affordable, effective solutions to the problems we face, whether they are problems of encouraging more service, fixing our high schools, moving health technologies, preventing the spread of lung cancer around the globe—if we can prove that there are affordable, effective solutions to these problems, we can create a demand for action. We can create a demand for change.

I've thought about these things a lot since I faced these soul-searching questions from President Mandela, and I made a commitment to myself then and there, that when it came to reducing inequities—to giving children a chance to learn, to giving a children a chance to be healthy, a chance to live their dreams, I wanted to be able to say I had done all I could and that our foundation had done all we could, and that I'd taken every chance given to me to encourage others to do what they could, whether those others are the presidents of countries, the influential leaders, those in the marketplace, or those in the Independent Sector.

And you can do that, too, taking the solutions you know, delivering on them, and challenging others. If together we can prove there are solutions to the problems that paralyze so many who are well-intentioned but are paralyzed with doubt or disbelief, then the next time a leader like President Mandela stands in front of a room like this one and says "What about you? Have you taken action against inequity and injustice?" then I will stand, and you will stand, and you will stand, and hopefully people around the globe will stand together and say, "Yes. Yes, we have. We did all we could, and what a change we made."

Thank you.

JOHN SEFFRIN: Thank you, Patty. I know I speak for my colleagues as well as myself in saying how much we appreciate the substance as well as the passion of your remarks.

We're going to have questions, as we do in these sessions, from the floor in just a moment, and I might start it off by asking a question that, in a sense, has two parts that I think are related but aren't one and the same.

And one is, it strikes me that even though you're known as the largest foundation now in the world, there's a tremendous need for grant-making coordination and that it can't be done in a vacuum. And I'd like to ask you to speak to that and talk to us about how you go about that. And maybe what we talked about a little bit at lunch, that you spend about 25 percent of your time outside the country where about 60 percent of your resources go and the idea of leveraging those resources; that even, no matter how many foundations we have, there's not enough. And I was struck by that. So if you could talk about both grant-making coordination and how you've gone about the issue of being synergistic in the process of leveraging other resources.

PATTY STONESIFER: You know, there's a whole set of buzz words. One of the first things you have to do when you move from business into the independent sector is learn all the buzz words, and “catalyst” and “leverage” and all those things came up right away. I thought they had one meaning and it turns out they had a whole other one. But for us, because we're so new, working with others has been a very fundamental tenet for us. 

We do have extraordinary resources because the Gates were part of an unusual time in history where extraordinary resources came to fruition in the technology sector. But we have very limited knowledge and very limited staff or presence in the communities we wanted to change. 

So I'll just use a local example: Our effort with high schools—we hope to work with thousands of high schools around the country, but here in the State of Ohio, a series of foundations came together committed to really trying to change the situation with high school graduation rate. The Knowledge Works Foundation, The Gund Foundation, the Cleveland Foundation, all kinds of efforts on the ground and influential players. And the education leadership, going from the governor, to today when I met with the mayor, to the actual superintendents and then teacher leaders in every single school that we're talking about.

And we were able to provide a significant part of the dollars to begin the work to plan and then change a series of schools. There is no way that those dollars would have mattered a bit without being asked to the table and joined at the table by so many local leaders, be they in the government or private or independent sector. That's made an enormous difference to the speed with which we could deploy resources, and the reason that we're prepared to spend hundreds of millions of dollars on this high school effort.

And the same would be true—and, again, using government example—even more with some of our work in health. We talked a lot about vaccines and immunizations, but one of the recent projects that we are pleased to come to the table with is an acronym called GAIN, the Global Alliance for Increased Nutrition (that might be it—it's pretty close, one way or the other). And GAIN is an effort to actually bring low-cost micronutrients into the supplies in local markets. So the milling of the grains or the milling of the basic food. A lot of these nutrients can be put into the food at that point at incredibly low cost, if people would coordinate. And their failure to coordinate was really hindering rolling out these nutritional basic foodstuffs. And USAID, many of our European Union leaders, and The World Bank all came together and said it's time to stop doing this in 42 different ways, what if we did a coordinated effort? And we were glad to join that and put significant money into it to say that there has to be a way for us to reach out together. If we start all of our programs pointing at the same problem, and resources for some of these local suppliers to actually to begin to add these nutrients into their foodstuffs, how fast and how far can we go? 

So, in most cases, we are giving money in some form of an alliance. There are very, very few circumstances where you would see a Gates Foundation resource going alone. And that's true on the local basis as well as international basis.

JOHN SEFFRIN: Just a quick follow-up and if I heard you correctly, you said in many cases you're calling on government officials in other developing countries. What has your success rate been in getting them—I take it this is after you've already invested and then you're trying to get them to invest more. 

PATTY STONESIFER: Let me give an example from the immunization project because that's a real favorite. One of the things that I've been discouraged to see is how, when multiple donors go into a country, the country often loses the opportunity to have a coordinated approach because one donor has one set of requirements, the next donor has one set and that, of course, happens as much here in Cleveland as it does in Botswana. But it's painful when they have the challenges that they have that a huge part of what they need to do is 75 different reports and meeting modestly different requirements for each of those donors. 

So in this Global Alliance for Vaccines and Immunizations, the countries put together a plan that shows what they'll do with immunization rates, their basic immunization package rates if, in fact, the Global Alliance comes in and funds the introduction of a hepatitis-B vaccine or another vaccine that's a new introduction. So they show their own commitment to increasing basic immunization and then the donors coordinate their resources to introduce new vaccines on top of it. So, in that particular case, the entire process for applying requires that the country come to the table first. But that, instead of getting a little bit of money from the EU and a little bit of money from the Gates and a little bit of money here, we have pooled those monies together to make them have one plan for national immunization and work that way with their own commitment. And it's caused immunization rates—basic immunization rates—to really go up in those countries.

JOHN SEFFRIN: That's great, good. Questions from the floor. Please go right ahead.

HILARY JOHNSON (YouthNOISE): My question is how you decide how to allocate scarce dollars between initiatives that may result in a sea change but you won't know for years. They're not as measurable, but they are those innovations that you think, “aha,” this could do it, versus the much more easily measurable direct service outcome-oriented programs. How you personally, in the foundation, deal with that tension between wanting to do both?

PATTY STONESIFER: Like all truthful answers, the real answer is it depends. But in our—let's use our health program, for example. We have three major thrusts. One is the accelerating research and development of new low-cost technology that can save lives in the developing world. And so those are largely prevention technologies. And that's our first and foremost priority. But, secondly, you have to ensure it can be deployed. So we have to do service tests and other things to show that things can go to scale to prove that there's cost effectiveness so that the heads of health in Botswana can see that it's worthwhile increasing immunization rates. 

So we fund service when there is an important proof of concept. We do believe that most forms of health service can and must be a government responsibility but that philanthropy has to take a lot of the risk out, show that certain things can be done, and use good metrics to prove it.

And then last, but not least, we are also entering funding alliances to ensure supplies of service or product when there are other funders—both government funders and others. So, our first priority really is trying to create interventions that can be deployed across all governments, across all environments that we work in. But we do get involved in the service. We try to say that philanthropy—especially at our scale because we have been given an exceptional amount of resources—we should do the risky stuff that it is hard for governments to do. So the development of low-cost tests for TB or trying to find a better TB vaccine because our current vaccine doesn't address an awful lot of problems. Those are things that private philanthropic dollars can really get moving—malaria and other things. But deploying those—we think the further down you go, the more the government must step in. And that's where service and the private sector pharmaceutical companies and others need to be working.

So we try to say, look, we'll do some of the risk stuff at the front end. We should take that 20-year thing. We keep talking in our staff about our responsibility to be good ancestors and that what will my daughter wish we had done. What will Bill and Melinda's children wish they had done in the year 2002. And so we're trying to take a leap forward while ensuring that adequate service levels are provided today.

JOHN SEFFRIN: David?

DAVID BERGHOLZ ( The George Gund Foundation): ...I would raise kind of a rhetorical concern about the '80s when I was working in Pittsburgh on public school issues. The Casey Foundation came to town with something called the New Futures Program and they dangled, in a variety of cities, about $12 or $13 million over a 4- or 5-year period for funding to kind of work on community efforts around public school improvement.

In our town, at the time, that $12 million, which is not a large amount of money these days but was significant, changed the whole dynamic around the conversation. Much of the work that we had done to kind of clear the decks of extraneous organizations and people—all these folks were drawn back into the fray by the amount of money that was on the table. And the program failed over an extended period of time. And in its failure, it took down all of what I would consider good efforts that were leading towards building a base around school improvement.

I think I would agree with the basic premise that small high schools are better than large high schools, but being old enough to have been around for the big campus high school movement in the '50s and the '60s, followed by the open classroom and all the other kinds of changes that have been proposed to the physical infrastructure of schools and with some feeling that maybe 30 or 40 percent of most of what happens with kids is really the responsibility of the district, as opposed to parents and community and so forth. I guess my cautionary note is that notion may or may not drive change.

And I guess the other cautionary note, which I don't have any answer for, running a foundation myself and understanding what kind of weight you bring to the table—is that no matter how involved you are with others, how much of an alliance you build, having done some work with Ford Foundation money, also during the same period, the weight of what you bring to the table drives the conversation. There are very few people who are going to stand in the face of the amount of money that you can leverage and all the good works that you can do and talk about other issues. And so, if you come to the table with a notion, lots of people are going to buy in because of the amount of money that you can bring to the table. 

And so I'm—you know, this whole period we're in a kind of big-box philanthropy where you don't really know where ideas are coming from and how they're shaped and who's driving the bus—I think it is something that causes a lot of concern as I begin to find my way out of this field and my own experience.

So I wonder if you have feelings about how you drive that kind of question? And I say that all in the context of thinking, particularly on the public health side, your work is incredibly admirable.

PATTY STONESIFER: I guess your question was, what do I think about the possibility that unintended consequences happen and, I mean, that is one of the reasons that you might say don't do anything at scale. But the other—the other fact is, our education is failing 50 percent of the kids today and we want to do what we can. We didn't come up with the agenda. Obviously, as young as we are, independently, we came up with it from a series of people who have been at this for a lot longer than we have.

But I agree with you, unintended consequences of good intentions oftentimes have further reaching impact than the good intentions do. And it's—we're all responsible for listening, learning, and measuring as we go. That's not adequate all the time because there's an awful lot that happens that's unmeasurable.

But one of the commitments that we are making—and that doesn't mean our current actions might not cause bad consequences—but one of the things that we are doing is we are putting an incredible percentage of our resources into the measurement and monitoring of impacts, whether that's on attendance rates, whether it's on safety in the school, but ultimately is it on graduation rates, teacher retention, turnover and a whole series of factors so that even if we fail, we fail transparently so that we can see what happens.

And one of our biggest concerns—and I know that it's a concern shared by many of you—if you fix some schools, at what cost to other schools in the area? Are you draining off the teachers, the parents, the kids that are interested in that small school, but you still have this 1,400 student school? So our measurements will also measure the impact of what happens in the surrounding community to the schools that were not part of the program, because there are so many factors at play.

I wish I could tell you we won't end up changing the dynamics, but change requires a change in the dynamics, too. A dissatisfaction with the status quo has been how most major change in this country has happened and so we hope we're causing a change in the dynamics. Large dollars can, perhaps, have a disproportionate level of change. So I hope we're listening. You know, if you knew an answer that I didn't, I'd be happy to hear it. The alternative is to write smaller checks and we could do that, too. But we really do believe that proving to the country that we can do a better job at high schools is going to require going and doing it at a certain scale with a certain number of schools. So many good high schools exist that have not been replicated because people don't believe they can do that in their towns or with their dollars or with their leadership. And so we are committed to doing it in thousands of schools.

I hope we're right and I hope that those who have an alternative voice in it raise that voice and tell us. And I hope we'll be smart enough to listen, and I think we are. But one of the things we're not doing is adding dozens and dozens and dozens of staff members, so that we do rely on intermediaries and locals to implement. Because I do believe they hear better. They have to go to the grocery store with the people whose schools are being impacted. They go to the polls with the people whose schools are being impacted. So these hundreds of millions of dollars we'll put into high schools will be with a staff of well under 15 people, and the majority of them are moving those grant papers through and doing what the IRS requires of us; with a small number of experts who are finding those in the field. And by staying lean in Seattle, we hope to ensure that we actually are reflecting the needs of the communities that we serve whether it's in Botswana where we rely on locals to do the work or it's in Cleveland where we rely on locals to do the work, because they will be better listeners, I think.

JOHN SEFFRIN: Well, said, let me—I really regret the fact that we've expired our time. But let me make three quick points if I could, and I think Patty would be very willing to talk to some of you one-on-one later, but I think we should ponder just how truly important the Gates Foundation's efforts are at this particular point in time in history.

First, the banner for this had to do with interdependence. And the Gates Foundation, of course, has recognized from the very beginning the importance of focusing on the word. I think it was Francis Thompson in "Mistress of Vision," who said, "All things by immortal power near or far, hiddenly to each other linked are that thou canst not stir a flower without troubling of a star." And so what happens on the other side of this world, this global village of ours, is happening to us in ways that we don't often understand.

Second, the gap is growing. With all the good work being done by people in this room and the Gates Foundation, the reality is, and with our best metrics, the gap is growing. And it's said that the human being is the only animal that both laughs and cries and that's because we somehow intuitively know the difference between what is and what ought to be. And people care all over the world—it's a common human train, that people care and they care about gaps and they ask questions about why is that gap there. And if we're not in the business of closing those gaps all over the world, then I think we're perceived in a very different way than we would want to be perceived.

And let me, then, finally say that it is important to note that everyone in this room shares one thing in common and that is we've dedicated no small part of our lives to closing that gap. And that makes you and Patty and the Gates Foundation very, very special. And for that I think God should bless you all, each and all, always and in all ways. Join me in thanking Patty Stonesifer for sharing her time with us. 

Patty Stonesifer is Co-Chair & President of the Bill & Melinda Gates Foundation in Seattle, Washington.