My favorite cause used to be U.S. equality of opportunity. But over the years since we started GiveWell, I’ve become more and more convinced that the best giving opportunities for individual donors lie in the area of global health and nutrition.
Fundamentally, this area stands out because it involves a lot of interventions that have measurable, demonstrable, quantifiable benefits, yet also haven’t been funded to reach everyone who can benefit from them. (See our list.) It’s the only aid area I know of fitting this description. This has made charities working in this area a good fit for our criteria.
One might retort that this just shows our criteria to have the problem of focusing on what can be measured, rather than on what’s best, but I would disagree. I think that there are good reasons to believe that the cause of global health and nutrition really does contain the best – and not just the most easily understood – giving opportunities.
- Global health and nutrition interventions have the most impressive track record in international aid, with the possible exception of funding scientific research. I believe (though we are still investigating this) that the same holds for aid in general. To some extent this may be an artifact of how measurable the goals are, but it’s still a point in this cause’s favor.
- Global health and nutrition interventions are incredibly cheap on a per-person basis. We don’t have “cost per life saved” type figures for any programs outside of health, largely because the effects of these programs aren’t well-known enough. But consider that
- An insecticide-treated net costs under $6, and a deworming treatment costs around 50c – these figures include all shipping costs, administration costs, etc. By contrast, GiveDirectly’s cash transfers cost $500 per household per year; the promising Ultra Poor Graduation program appears to have similar costs (PDF, pg 3); educating a child, even in the poorest countries, costs $50+ (sometimes much more) per year (PDF pg 39); even in microfinance, $12-17 per year is spent in grants alone for each current person who is served by microfinance. Programs that don’t target the poorest of the poor – such as U.S. programs – cost far more. These are far from apples-to-apples comparisons, but my intuition is that the health interventions compare favorably on “quality-of-life impact for the money.”
- Speaking more informally, on our site visits it has struck me how lean health interventions often are. Because the evidence is so strong, people generally know exactly what has to be delivered, and how, in order to benefit people. This means they can design programs to deliver these crucial items and services with maximal efficiency. Other programs are much more intensive – again, for not clearly more life benefit. This observation makes the above point make more sense to me: health interventions are cheap because they are small and precisely defined but involve major known benefits.
- Health and nutrition programs are particularly good at having clear goals and accountability, leading to learning over time. Because benefits can be quantified and predicted, targets can be set, and adjustments can be made when they’re not met. We’ve been placing more emphasis on the criterion of accountability, i.e., the likelihood that giving will lead to learning. Health and nutrition interventions stand out in terms of the likelihood that giving will lead to learning.
- Room for more funding is relatively easy to gauge in the area of health and nutrition. We believe that one of the thorniest issues that a donor has to contend with is that of room for more funding. In an area like funding scientific research (which otherwise has much to recommend it as a charitable cause), it’s particularly hard to answer the question, “How does the value of the next study on the priority list – the one that no one else has funded and that my funding will make possible – compare to the value of the average study overall?” This isn’t nearly as much of an issue when delivering global health and nutrition interventions; the expected benefits of running an additional project tend to be easier to quantify.
- Health and nutrition are fundamental to quality of life. In my view, the value of additional education – or additional income – depends a lot on the context, but health and nutrition are fundamental and universal needs. In addition, with economic empowerment or education interventions, I tend to worry about the difficulty of distinguishing “zero-sum benefits” (helping some people at the expense of others) from “positive-sum benefits” – a well-intentioned business training or education program could end up simply transferring power/wealth from some people in a community to others, and this could be very difficult to distinguish from actually improving these people’s productivity. I feel this is much less of a concern when it comes to health and nutrition.
What problems are best suited to having money thrown at them?
I’m not arguing that health and nutrition are the most important issues in the world. There are many changes in the world that I’d like to see and that I believe are worth fighting for. There are many fantastic uses of money outside the sector of global health and nutrition; many involve taking risks on building institutions and producing public goods. But when thinking about how individual donors can do good, my mind jumps to the easiest ways to have impact without having special insight – the problems that are most likely to be solved by “throwing money at them.” When this is the goal, being able to measure, demonstrate and quantify one’s impact is enormously helpful.
According to our analysis, ~$5 can buy a bednet or 10 years of deworming – either of which will have a substantial, quantifiable, definite impact on quality of life. That can empower a person who is better positioned than you are to address many of their other problems. I believe that for a donor interested in making the world better just by writing a check, this sort of value-for-money may not be available in any other cause.