Gates served as a member of Duke University's Board of Trustees from 1996 to 2003. She attends the annual Bilderberg Group conference and has held a seat on the Board of Directors of The Washington Post company since 2004. She was also on the Board of Directors at Drugstore.com, but left in August 2006 to focus on philanthropy projects. Since 2000, Gates has been active in the public eye, stating "As I thought about strong women of history, I realized that they stepped out in some way". This has helped her work become recognized, while shaping and delivering goals of the Bill & Melinda Gates Foundation. As of 2014, Bill and Melinda have donated US$28 billion to the Foundation. In 2015 Gates founded Pivotal Ventures as a separate, independent organization to identify, help develop and implement innovative solutions to problems affecting U.S. women and families.
In November 2006, Melinda was awarded the Insignia of the Order of the Aztec Eagle, together with Bill, who was awarded the Placard of the same order, both for their philanthropic work around the world in the areas of health and education, particularly in Mexico, and specifically in the program "Un país de lectores".
In May 2006, in honor of her work to improve the lives of children locally and around the world, Seattle Children's Hospital dedicated the Melinda French Gates Ambulatory Care building at Seattle Children's (formerly Children's Hospital and Regional Medical Center). She chaired a campaign for the hospital to fundraise $300 million to expand facilities, fund under-compensated and uncompensated care, and grow the hospital's research program to find cures and treatments.