As well as guiding everything we do at GIF, effective altruism has also shaped my personal view on how we can and should approach the greatest development challenges facing the world’s poorest and most vulnerable people.
This blog contains the first part of the speech I gave in Prague, in which I talked about what effective altruism means to me, and where I think the lessons for future progress lie.
I suppose that one way of describing an effective altruist is: hard head, soft heart.
It’s a restless way of looking at the world, isn’t it? Believing, even knowing, that change is possible – but always conscious that we may squander our opportunities to make a difference.
How do you react to the twin fact that fifty years ago nearly 1 in every 5 children didn’t live to see their fifth birthday, and today that number is now down to less than 1 in 20?
Over the past 50 years, incredible advances have been made in improving human wellbeing. People are healthier, wealthier and more educated than ever before.
We are not there yet. But what recent decades have shown us is that diseases that used to devastate, like polio, can, through our collective efforts be consigned to the history books.
To me, hearing these things, I feel a kind of agony. What examples like this so poignantly show us is that it is possible to move aside the roadblocks standing between the status quo and a world in which all people have the chance to live healthy and productive lives.
So why not more? Why not faster? How can we each contribute?
This agony, this restlessness, first led me to a small country in Africa called Swaziland when I was 19.
And it has had me coming back many times since – working to make sure that philanthropy and government resources are spent as usefully as they can be, and achieving as great a social impact as possible.
Everyone here can have a meaningful impact when it comes to improving the lives of people across the developing world. It does not have to be your full time job, or even your only area of philanthropy or volunteerism.
But the intention to do well does not by itself yield results.
I think that there are two fundamental principles which should guide our generosity:
– Fight today’s solvable problems. Using evidence to guide where you can achieve the greatest good at the least cost
– Help find the solutions of tomorrow. Take smart bets to find new solutions and generate new evidence. This is important because sometimes the most exciting ways to tackle problems of poverty come from unexpected sources.
This idea—it’s sort of tantalizing—makes me more restless than ever.
Today we have a powerful set of tools to fight poverty and disease.
It’s possible because we have done it before: not only in developed countries like those in Europe, but also in countries where most people remain extremely poor.
Take the case of under 5 mortality again. How did we go from 1 in 5 children dying under the age of five to 1 in 20? Part of the answer lies in a surprisingly simple solution: a tiny packet of sugary salt.
You see, many of these children were dying from diarrheal disease. Untreated diarrhea can quickly cause dehydration and death. The best-known solution in the 1960s was replenishment of fluids directly through an intravenous line.
This was impractical in many developing countries with limited health infrastructure. As a result, millions of children’s lives were lost each year needlessly.
Then, in the 1970s, two researchers working in Dhaka decided to try out a surprising solution.
These scientists began from the fact that sugar could help the stomach absorb water. The researchers combined sugar with salts to help restore lost electrolytes and they created what are today known as Oral Rehydration Solution.
When these packets of sugar and salt were mixed into water, it could replenish fluids, restore salts and minerals and save children’s lives.
They started by trying it on 29 patients in the middle of a cholera epidemic—none of them died. Later in larger scale studies, they showed it was more effective than even intravenous fluids at that time being used in hospitals.
The beauty of ORS is not only that it is highly effective, but it’s also extremely cheap.
A solution that costs about 10 cents (less than 3 Czech Koruna) a package, is saving millions of lives. Nowadays, you can find ORS in tiny shops in the most far flung rural villages and in store shelves, sometimes in pre-mixed colorful drinks. The medical journal Lancet called it “potentially the most important medical advance of the 20th century”.
This seemingly simple solution—a combination of sugar and salts—transformed the way the public health system responded to one of the principle killers of children under 5. And it was tremendously successful—saving hundreds of millions of lives.
But are there opportunities to solve similar problems today?
The answer is yes.
But we need more than good intentions. We need to use evidence to guide where we can achieve the greatest good at the least cost – and to take that evidence from the paper on which it is written and use it to transform the lives of the world’s poorest people.
It’s a notion that is all too often overlooked.
Are you familiar with The Millennium Villages project, a massive ‘big push’ to bring rural villages out of poverty? Rockstar economist, and my former professor who taught me so much, Jeff Sachs, raised over $120 million from a range of philanthropists to implement the project in villages across sub-Saharan Africa in the early 2000s.
The idea was that they would dramatically transform these clusters with water, health, and agriculture upgrades and that this could be scaled and replicated to end rural poverty.
Did they do it? Did this $120 million do any good? And did it do the most good that $120 million could do?
Well, the answer to this question depends on what you think or, better yet, know, would happen in those villages in the absence of the surge of aid and investment.
You need what the data wonks among us call a “counterfactual” so that you can understand how much progress to attribute to the $120m, after accounting for what would have occurred regardless.
In this case, there was no plan to understand what the counterfactual outcome was. When Professor Sachs and his colleagues faced criticism for spending so much money without a plan for measuring its impact, they did some analysis and quickly touted that MVP was a success in reducing child mortality.
But guess what? Child mortality also declined in similar villages that didn’t receive the big investment push.
The lack of a credible comparison with what would have happened in the absence of the program, prevents us from really saying with any real certainty if this was a success or failure.
Unfortunately, too often, large amounts of funding from governments and well-meaning philanthropists go to programs with little real evidence of impact and no plan of generating that evidence. This is true in both high-income and low-income countries.
We can do better than this.
We owe it to ourselves, to the people living in the villages like those that Bono went to visit, and to our neighbors.
This is not an abstraction. Let me tell you another story:
Intestinal worm infections affect nearly a third of the world’s population—many without even knowing it. Yet worm infections can have long-term chronic costs for a child’s development. In the late 90s, a team of researchers decided to try out a small experiment.
Working with a local non-profit in Kenya they rolled out a school-based deworming project, hoping to, at a minimum, reduce the prevalence of worms in that region.
But they didn’t just achieve that. They achieved far more.
Because kids had fewer worms in their system, they were getting sick less often and attending school more often. Indeed, when they did the math, the school-based deworming was so cheap that each additional year of school induced cost only $4.
This was dramatically more effective than other ways to get kids in school. We know these effects are real because data was collected to allow to understand that wonky counterfactual—what would have happened to kids if they did not get the medicine.
There are millions more today who could benefit from school-based deworming but still aren’t receiving it. Hard head—we know the benefits and the affordable costs. Soft heart—this is a real and meaningful way to help children have a better chance at success in school and healthy productive lives.
Good candidates for your restless passion, advocacy, and, yes, financial support, bring together:
– Rigorous evidence that the intervention is better than what would have happened without the intervention
– Evidence not just on the impact of the intervention, but also on the cost to achieve those impacts, such that one can be confident that you can achieve more good at less cost than the status quo.
And don’t worry, you don’t need to be an expert in these issues to know where to give your money. The Effective Altruism community can share analysis and recommendations on where your money can achieve the greatest good, whether that is close to home or across the world.
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