Head of East Asia Relations, Global Policy and Advocacy
Bill & Melinda Gates Foundation

On alleviating poverty in the world, global health, value of a company, the role of Bill & Melinda Gates Foundation, ODA allocation, international procurement by Japanese companies, Goalkeepers, impact-weighted accounting.

Mihoko Kashiwakura: An Angry Little Girl Grows Up to Alleviate Poverty in Our World

Mihoko Kashiwakura is one of these impressive individuals who was able to pursue a childhood passion into a career that has positive impact.  That passion was to alleviate poverty from our world.  Working with Mihoko over the last couple of years in the area of global health, I thought I’ve come to know her fairly well.  However, through our conversation for this episode, I found how truly she is committed to her pursuit of making this world a better place where no one is left behind.  Mihoko’s cheery, determined spirit is priceless.   


Mihoko joined the Bill and Melinda Gates Foundation (hereinafter the Gates Foundation), a prominent figure in the area of global health, in 2017.  The journey that led her there started when Mihoko was 6 years old.  Her family had moved to the US when she was 2 years old, and while on a family trip on the streets of Mexico City, she encountered a girl about her age.  She was very thin, with very beautiful eyes.  She held up her hand, asking for money.

This was a shock to a little girl growing up in the United States.  It was her first encounter with poverty, and she felt very strong anger, towards adults.  How can adults create a world, where a little girl needs to beg for money for food, a basic human need.

This anger laid Mihoko’s path forward, to build a career alleviating poverty and making sure we are providing a society and economy where basic human needs are provided for any child born anywhere on this planet.  

Mihoko returned to Japan when she was 9 in fourth grade elementary school, not knowing how to read or write Japanese.  She had a difficult time adjusting to cultural differences, the way she had to behave, the way she had to express her opinions. She went back to the US for 2 years in high school, but this time felt unease about the ethnic divide that she experienced there.  She decided to come back to Japan for university.

Mihoko attended Keio University SFC (Shonan Fujisawa Campus), a unique school that provides multi-disciplinary studies for students that have concrete areas of interest to pursue.  Her interest was to create systemic change in order to remove poverty in the world, and after four years of study, her conclusion was not to work for international organizations like the United Nations or NGOs.  She decided to work in the finance industry where she felt there was a need to change what “value” meant.

While in school, she remembers being very engaged emotionally regarding the meaning of “value”.  The traditional sense of value was maximization profits for the shareholder.  Yet, even as a student, Mihoko felt that companies must play more multidisciplinary roles and become the engines for inclusive economic growth.  

In 2005 she joined Citigroup, because she wanted to understand how the current system worked.  While she felt that current financial accounting system and market indices focused on a narrow-minded definition of “value”, she also obtained a CPA (Certified Public Accountant).

Around this time, she learned about Prince Charles’s work on Accounting for Sustainability, which basically raised a question that with our current accounting system and standards, our planet is not going to exist in the future.

This was around the time when ESG was starting to gain recognition, and after obtaining an MBA at University of Cambridge, she worked for FTSE 4 Good, and then Sustainalytics, which provided ESG information to investors.

However, even though she realized that ESG was a growing field, back in those days, she felt it wasn’t being picked up by the bigger investors and bigger decision makers in society.  This led her to her next work at the World Economic Forum (WEF), a platform to convene top leaders in corporations, government, NGOs and other stakeholders, in 2013.

One of the initiatives that was launched at WEF was CEPI (The Coalition for Epidemic Preparedness Innovations), a global partnership launched in 2017 to develop vaccines to stop future epidemics.  The world experienced the Ebola crisis in Africa in 2016, and world leaders realized the global common good of a platform that encourages rapid vaccine development for pandemics.

Through this activity, she started to understand the role of the Gates Foundation, whose mission was poverty eradication in the world, so, she went knocking on the doors.  She was very persistent, which landed her current role.

The Gates Foundation is a powerhouse in their leadership to advance global health.  They are not just a think-tank, but a do-tank, in that they have large amounts of capital to deploy to advance global health.

When she arrived at the Gates Foundation, Mihoko found lots of good surprises there.  It was founded by Bill and Melinda Gates in 2000, on the belief that all lives have equal value wherever you are born, with the chance to lead productive and happy lives.  Nutrition, health, and education are basic human needs that enable this path.

An organization of 1300 people all around the world, the Gates Foundation has made grants of about $60 billion in the past 20 years, and when COVID-19 hit the world in 2020, $5.8 billion during that year alone.

Mihoko believes that the Gates Foundation is an organization that drives for results, so very business-like in that respect.  They work on strategy and data analysis with scientific rigor so that they can deliver the best results with impact.  Whenever an investment (grant) is made, Bill and Melinda must approve the strategy.  In Japan, the Gates Foundation works closely with the Japanese government, private corporations, NGOs, think-tanks and academia.

The COVID crisis has triggered the realization in many private corporate leaders in Japan that choices regarding global health affect lives in Japan as well, and that they can have negative impacts on the economy.  If global issues like pandemic preparedness and infectious disease are ignored, there is the risk of severe consequence for their businesses.

In the last couple of years, Mihoko and I have been working together to coordinate a working group of Japanese corporate executives for the promotion of global health as a public-private strategy. 

I found it interesting that such a group 10 years ago would have consisted of pharmaceutical or medical devices companies, but recently, the participation has become much more diverse.  We had top management of ICT companies like NEC or trading companies like Toyota Tsusho being engaged in drafting a proposal memorandum that was delivered to former Prime Minister Suga in April of 2021.

One of the key points of the proposal was to double the ODA (Overseas Development Assistance) allocation to global health.  Global health allocation of ODA from other G7 countries such as the US is 1/3 and 15~20%, and the average for OECD DAC (Development Assistance Committee) is about 8~9%.  For Japan it is only 3~5%. 

We felt that Japan should at least be aligned with other advanced nations of the world to promote global health, hence proposed doubling the ODA allocation.  Japan’s foreign policy strategy for the last couple of decades has stressed “human security,” and global health should be a big part of implementing that strategy.

But, there are many pressing domestic needs, and increasing the ODA budget is a challenge for politicians.  Why should Japanese taxpayer’s money be used for people that they will have no direct contact with?

Mihoko answers that at the global level, at the G7 or G20, there has been a lot of conversation regarding how the world needs much more resources for pandemic preparedness. If investments are made early, pandemic and risk would be mediated, and policy makers around the world realize that countries should come together to make these resources available.

Mihoko adds that even if the rich countries are fully vaccinated, it doesn’t mean COVID is eliminated from the planet since we live in a mobile and connected world.  Communicable diseases left untreated in low- and middle-income countries can also be a threat for lives in Japan.  This kind of understanding is perhaps difficult, but as we found out with the current COVID crisis, it can lead to severe economic distress for Japan as well.

I believe that 1) Japan has responsibility as one of the advanced nations of the world, 2) Japan being prepared is always a good thing, and 3) Japan should be making investments for the future.  ODA in global health covers all of these three points.

It is often difficult to see the impact of ODA, since the results often do not materialize in the short term, and it should not be about just throwing money at the problem.  Perhaps what we need is “smart ODA” that measures the impact, rather than just increasing the budget.

Another criticism about ODA is that the budget is being used for the benefit of Japanese companies doing businesses in recipient countries, rather than the actual recipients in need for assistance.  However, Mihoko points out that Japanese companies’ procurement in the area of global health is quite low, with only 0.7% being awarded through the UN procurement system.  In 2020, 3700 procurement contracts were awarded to US companies, compared to 460 for Japanese companies.

On the other hand, Mihoko sees growing interest among Japanese companies to work with UNICEF, GAVI, the Global Fund, not just for their short-term business, but also for the long-term business, in alignment with the SDGs.  Mihoko believes that procurement in international development organizations is an interesting way to build market presence abroad, and Japan needs to identify where the bottlenecks exist for procurement.

This does not mean that the Gates Foundation is encouraging the United Nations to work with Japanese companies.  However, facilitating that channel, not only for the big companies, but also for the small and medium enterprises is a way to provide technology, goods and services that will advance global health in the low- and middle -income countries, and hence of interest to the Gates Foundation.

I think that perhaps one of the barriers to entry for Japanese companies is the pool of human resources in the area of global health, and Mihoko replied that even though the Gates Foundation does not have a program to support such initiatives, it may be an area that they can consider in the long term.  They do want to identify the best models of change to ensure the Japanese government and the private sector get involved in the development of global health, both in quality and quantity.  

Regarding the promotion of the SDGs, the first thing that the Gates Foundation did was to make sure that the concept reached the public.  They invested in a PR agency called Project Everyone that designed the 17 logos for the goals as well as the colorful SDGs badge, and made them available to the United Nations for free.  The logos and badge were instrumental here in Japan to raise awareness about the SDGs.

They also launched the Goalkeepers, which is a gathering that celebrates advances in the SDGs.  They have an annual report around the time of the UN General Assembly in September. 

One of the key findings in 2021 is sad, where 90% of the rich economies are expected to regain their pre-COVID per capita income, but only a third for the low- and middle-income countries.  Women employment is 13 million people below the 2019 level, while the employment level is expected to return for men.  31 million fell into extreme poverty compared to 2019.  It is clear that the poorest population will pay most of the burden through COVID.

However, there are some great advancements as well.  Rapid development and deployment of vaccines didn’t just happen overnight.  It was the result of decades of investment in planning and coordination.  COVID did expose the fragile part of the economy, but the world also came together, and coordination mechanisms are in place for future pandemics.  Mihoko is hopeful that we are making progress.

Yet, there are inequities in the world, and there is lots of work left to do.  Mihoko wonders if she became part of the adult system that her 6-year-old self was so angry about.  She learned through the World Bank Global Financing Facility report that for every COVID related death in low-income countries, two unrelated deaths for women or child occurred because of burden on the health system.

To close our conversation, we talked about our mutual interest in promoting impact-weighted accounting in Japan.  The intellectual leader in this field is George Serafeim of Harvard Business School

Mihoko believes that this is quite a revolutionary trend if it materializes, as it will integrate environmental and social impact into the language of balance sheets and profit loss statements, a tool that corporate executives understand and therefore, can make long term strategic decisions.  Mihoko believes that global health to low- and middle-income countries can provide concrete social impact measurements for businesses.

When Mihoko was working for FTSE 4 Good and Sustainalytics, she saw how standards in ESG were developed in European and US circles.  However, every country or social environment has different contextual factors to consider.  She feels strongly that Japan should be raising a voice to be a part of that rule making process, to incorporate global health into impact accounting. 

It looks like Mihoko is still angry.  And, I agree with her.