In an interview with The Associated Press, the couple said they're concerned about President Donald Trump's "America first" worldview. They've made known their differences with the president and his party on issues including foreign aid, taxes and protections for immigrant youth in the country illegally.
And they said they're now digging into the layers of US poverty that they haven't been deeply involved with at the national level, including employment, race, housing, mental health, incarceration and substance abuse.
The Bill and Melinda Gates Foundation is studying these topics with no plans yet for any particular initiatives, though it has done related work at home in Washington state on a much smaller scale. Last year, it funded a grant for the Center on Budget and Policy Priorities to look into state and federal policies that can reduce poverty.
Once the world's richest man, Microsoft co-founder Bill Gates has marked a decade since transitioning away from the tech giant to focus on philanthropy. He said he's had two meetings with Trump, where they discussed innovation in education, energy and health including vaccines, which Trump has voiced skepticism about.
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Melinda Gates, who left her job at Microsoft to raise their three children before turning to the foundation full-time, has lately embraced her role as a public figure more boldly. She called out Trump's behavior, saying the president has a responsibility to be a good role model when he speaks and tweets, and that his verbal attacks don't belong in the public discourse.
"You just have to go look in Twitter to see the disparaging comments over and over and over again about women and minorities," Melinda Gates said. "That's just not what I believe. It's not the world that I see."
Taking a more reflective review of their work than in years past, the couple in their annual letter published Tuesday also answered 10 questions critics often ask them.
They acknowledge it's unfair that they have so much wealth and influence but reject the notion that they're imposing their values on other cultures.
"Behind the scenes, these are the tough, tough questions that people are asking us, and yeah, we have to wrestle with them ourselves," Melinda Gates said in the February 1 interview.
The Gates Foundation has given money to various programs in more than 100 countries, as well as in all 50 states and Washington.
Their approach to giving has shifted the philanthropy world as a whole. They've been criticized for prescribing how the money is spent and then expecting tangible proof their investments work.
About 75 per cent of the foundation's resources are dedicated to global health and development. Bill Gates said they're proudest of their efforts to help eradicate polio and curb the number of child deaths, calling those global health improvements a miracle.