GiveWell spends a lot of time on the question, “Should I give to charity A or charity B?”
One of the things that has surprised us about the world of charity is how many people insist on answering, “Both” or “You can’t/shouldn’t be asking that question.” To them, all that matters is whether a charity does some good, not how much good it does or how it compares to other options.
One statement of the idea comes from none other than the Jeffrey-Sachs led WHO Commission on Macroeconomics and Health (footnote 24):
Many have asked the Commission what to do if the donor money is not made available—in essence, how to triage with less money. We are asked to prioritize millions of readily preventable deaths per year, since we have already narrowed our focus to a small number of conditions that have an enormous social burden and that have low-cost interventions that are at least partially effective. Not only is this kind of triaging ethically and politically beyond our capacity, but it is also exceedingly hard to do in sensible way. Those who hope for a simple answer, for example to focus on the cheap interventions (immunizations) while putting off the expensive interventions (higher-cost prevention programs and antiretroviral therapy needed to fight AIDS) to a later date, misjudge the practical choices we face. The AIDS pandemic will destroy African economic development unless controlled; to fight measles but not AIDS will not begin to meet Africa’s human and economic needs. It would be wrong to go to the other extreme as well, and let the legitimate need to fight AIDS end up starving the cheaper interventions, so we advocate both. Moreover, the infrastructure developed to fight AIDS will support the infrastructure needed to fight measles, especially if strengthening such complementarities is explicitly built into the AIDS control effort. It is vastly more fruitful to design and finance a comprehensive program that addresses many critical health needs than to pick and choose the apparently inexpensive items.
Our response to these comments is simple. Most donors have a certain amount they are willing to give, and that amount is less than enough to fully fund even one of the world’s underfunded humanitarian initiatives.
We don’t believe that any problem that people suffer from should be ignored or trivialized. We do believe that individual donors must choose which to address, and that they should be factoring in questions like “What evidence is there that my money can even do anything to address this problem?” and “How cost-effectively can I create change by giving my money here?”
In their personal and business lives, people constantly make tradeoffs on a limited budget. Imagine if a salesman tried to argue, “How can you choose between this car and that one? They’re both wonderful cars and each would make the other more useful. You should buy them both!”
Yet in the world of charity, the basic and undeniable idea of triage is constantly denied.