The goal of Cause 1 is to save lives in Africa, and we estimate that a good strategy can save a human life for somewhere in the ballpark of $1000. Sounds like an unbelievable deal, right?
Not to everyone. I was recently talking to a Board member and mentioned how much cheaper it seems to be to change/save lives in Africa vs. NYC. He responded, “Yeah, but what kind of life are you saving in Africa? Is that person just going to die of something else the next year?”
I think it’s interesting how (a) completely fair, relevant and important this question is for a donor; (b) how rarely we see questions like this (“Sure I helped someone, but what kind of life did I enable?”) brought up and analyzed. Here’s what we know right now:
Approximately 80% of children born in sub-Saharan Africa reach age 5; in the developed world, it’s 99%. The main contributors to the difference are:
- Respiratory infections (pneumonia and bronchitis)
- Diarrheal diseases
- Perinatal conditions (deaths in childbirth)
Measles is the easiest to prevent (just use a vaccine); diarrhea can be prevented with better sanitation and treated with a cheap packet of nutrients; malaria risk can be substantially reduced through use of bednets; the other three generally take some sort of skilled medical care, although improved nutrition may reduce just about everything.
Between ages 5 and 45, people in sub-Saharan Africa have relatively similar mortaility rates to those in the developed world except for the influence of HIV/AIDS, TB, and mothers dying in childbirth. Around age 45, a lot of the same diseases that kill people under 5 start killing again (maybe due to weakened immune systems).
The following chart shows the probability of making it to a given age (assuming you reach age 5) of (a) a child born in sub-Saharan Africa, (b) a child born in sub-Saharan Africa who survives HIV/AIDS, TB, and maternal conditions during adulthood, and (c) a child born in the developed world.
And the following is the same idea, but from age 5 on – i.e., if you can use a comprehensive child care program to reduce infant mortality, this is what you can expect to get.
So what’s a life saved? If you save someone right as they exit infancy (5 years old), you’ve saved someone who probably has around a 50% chance of making it to age 60 … another way of putting this is that if you save two lives (very very rough estimate of cost: $2000), you’ve in expectation given one person a full life that they wouldn’t have had. (You’re actually getting more than this, of course, since a person has a 75% chance of making it to age 30, but let’s keep it simple.)
And yeah, maybe the life you saved is a life without iPhones, but we’re still talking about a person who, at the very least, can be expected to grow up, make friends, fall in love, get in arguments, watch the sunset, have ups and downs, etc. Not bad for $2000.
As always, lots of questions remain, including:
- Is someone at risk from one disease also more likely to die of another (weaker immune system in general)? For example, when you save a 5-year-old who would have died of malaria, does that 5-year-old really have a 50% chance of making it to age 60, or less because only those with weaker immune systems are at risk in the first place?
- What is the general health we can expect for a saved life in sub-Saharan Africa? A few of the preliminary statistics we’ve seen on malnutrition and “neglected tropical diseases” (largely parasite infections) are pretty sobering, but we don’t know enough to say for sure how likely someone who lives till age 60 is to be highly debilitated vs. poor but basically healthy.
But, right now we still think there are pretty awesome deals to be had from a good charity in Africa (no such promises made for a charity that can’t demonstrate its cost-effectiveness), and we continue to explore the issue.