A single-parent family of three in New York, making $8000 per year, makes under half the income level of the Federal poverty line and qualifies for food stamps, TANF (direct cash benefits) and Medicaid. (Details at our guide to U.S. public assistance)

And yet, at $2,667 per person per year, this family is wealthier than 70% of the people in the world. (See the Global Rich List calculator as well as the Giving What We Can version, which may be using more up-to-date data.)

In the poorest parts of the world, fewer than half have access to a latrine or toilet; only 17% own a television; and 19-45% lack access to a reliable source of clean water. In the U.S., practically everyone has all three. (Details.) As we wrote yesterday, the two areas have completely different concepts of “hunger.” And finally, while anyone in the U.S. can ultimately be served in an emergency room, people across the world die or suffer from health conditions for which proven solutions exist.

In the U.S., helping the less fortunate usually means tackling a thorny “equality of opportunity” problem such as improving education or helping struggling adults to find and retain jobs. These problems have a long history of failure and few proven approaches to them. By contrast, helping people overseas can mean delivering something as proven and life-changing as a bednet or tuberculosis treatment.

Hopefully, these observations give some context on why a charitable dollar goes so much further overseas. If you are looking to use your wealth to help those less fortunate, we believe it’s hard to argue the case for U.S. as opposed to international charity, unless you believe that American lives are orders of magnitude more valuable.

There has been a fair amount of buzz lately (examples here, here, here, here) about “food insecurity” in the U.S. According to the Reuters headline, one in seven Americans is short of food. In looking into the data, what has surprised us is how different the meaning of “hunger” is when we’re talking about the U.S. vs. the developing world.

Developing-world hunger: 30% of children underweight

Developing-world hunger is usually discussed in terms of incredibly severe indicators of hunger. For example, a 2008 Lancet study estimates that

• 32% of under-5 children in developing countries are “stunted” (height-for-age severely below normal, such that only 2.3% of children should be “stunted” in a normal distribution)
  
• 20% are “underweight” (weight-for-age severely below normal, such that only 2.3% of children should be “underweight” in a normal distribution)
• 3.5% are “wasted” (weight-for-age even more severely below normal, such that only 0.13% of children should be “wasted” in a normal distribution).

These are indicators of severe, long-term consequences of constant undernutrition for young children.

Food insecurity in the U.S. means anything other than complete and constant food security

The recent USDA release that has formed the basis of the recent discussion of U.S. hunger states:

Eighty-five percent of American households were food secure throughout the entire year in 2008, meaning that they had access at all times to enough food for an active, healthy life for all household members. The remaining households (14.6 percent) were food insecure at least some time during the year, including 5.7 percent with very low food security—meaning that the food intake of one or more household members was reduced and their eating patterns were disrupted at times during the year because the household lacked money and other resources for food. (Emphasis mine)

The report’s summary specifies that food insecurity is usually temporary as opposed to chronic (pg 9) and that children are usually protected from food insecurity even in food-insecure households (pg 6-7).

The “food insecurity” categories are derived from people’s answers to questions like “We worried about whether our food would run out before we got money to buy more” and “We couldn’t afford to eat balanced meals” (full list on pg 3). The details of the answers are found on page 45:

These data imply that anything approaching the sort of hunger measured in the developing world is practically nonexistent in the U.S.

Note in particular the difference regarding children. In the developing world, as shown above, severe child hunger is rampant. In the U.S., even in “food insecure” families, it’s extraordinarily rare for children to go hungry even temporarily. And indeed, World Bank data estimates that 1.3% of U.S. children under 5 are “underweight” - less than the 2.3% that would be expected in a fully normal distribution.

Also note that the USDA report estimates costs for different levels of “food plans” (pg 55), and that its “Thrifty” plan - the cheapest - ranges from $21-$40 per week ($3-$6 per day) depending on age. In the developing world, meanwhile, over 2.5 billion people are estimated to live on less than US$2.50 a day total.

Bottom line

We have no intention of trivializing the situation of those in poverty in the U.S. But for a donor making choices, it can be stunning to see what a different meaning “hunger” takes on when applied at home vs. abroad. Do you value the lives of Americans so much more that you’d rather help people with the second kind of hunger than people with the first?

When we argue that donors should give internationally, one of the most common questions we get is, “Sure, you may be able to save a life in Africa, but what type of life are you saving? If you save a child from malaria will s/he likely die from something else soon after? Will s/he suffer from other problems that significantly reduce his/her quality of life?”

We recently published a report on standard of living in the developing world that tries to answer that question. It looks at what facts are available from relatively broad, plausibly representative studies to answer “what is life like in a poor country?” Here’s a summary of what we learned:

• There’s a strong cross-country correlation between income and reported happiness. The Gallup Poll asked people around the world to rate their life satisfaction on a scale from 1 (the worst) to 10 (the best). People in poor countries are less satisfied with their lives (they ranked their satisfaction as 4.3 out of 10, while rich country residents ranked theirs as 6.7). (More at our review of the Gallup World Poll data.)
• A child who lives past his/her 5th birthday will likely live a full life. Child mortality is much higher in poor countries than in rich countries. But those who live past age 5 have nearly a 70% chance of living until age 60. (More at our overview of life expectancy in the developing world.)
• Most people in the developing world do not have AIDS, river blindness or other severe chronic conditions. Many of the diseases commonly associated with the developing world are fairly rare across all developing counties. Fewer than 1 out of 100 people have HIV/AIDS, 1 out of 40 have lymphatic filariasis, and about 1 out of 2,700 have river blindness. (More on the prevalence of disease in the developing world.)
• Less severe chronic conditions, such as malnutrition and parasite infections, are very common. For example, about a third of children are stunted (significantly shorter than normal due to undernutrition). We are not sure to what extent stunting and other results of a poor or inadequate diet are likely to affect a child’s standard of living over the long term. (More on non-fatal health problems.)
• Incomes are low, but discretionary spending does exist even among the poorest. People in extreme poverty (defined in the past as under US $1 a day of income) do not spend every “additional dollar” on additional food; they frequently own TVs and radios and participate in festivals. (More on what it means to live on less than $1 or $2 per day)

Bottom line

On one hand, people in the developing world have a tangibly lower quality of life. On the other hand, a life saved probably means many more years of functional life. We feel strongly that it’s worth addressing a major problem (such as tuberculosis or immunizations) even if other problems remain unaddressed.