In August 2017, GiveWell recommended a grant of $1.3 million to the Centre for Pesticide Suicide Prevention (CPSP). This grant was made as part of GiveWell’s Incubation Grants program to seed the development of potential future GiveWell top charities and to grow the pipeline of organizations we can consider for a recommendation. CPSP implements a different type of program from work GiveWell has funded in the past. Namely, CPSP identifies the pesticides which are most commonly used in suicides and advocates for governments to ban the most lethal pesticides.
Because CPSP’s goal is to encourage governments to enact bans, its work falls into the broader category of policy advocacy, an area we are newly focused on. We plan to investigate or are in the process of investigating several other policy causes, including tobacco control, lead paint regulation, and measures to improve road traffic safety.
This post will discuss:
- GiveWell’s interest in researching policy advocacy interventions as possible priority programs. (More)
- Why CPSP is promising as a policy advocacy organization and Incubation Grant recipient. (More)
- Our plans for following CPSP’s work going forward. (More)
Policy advocacy work
One of the key criteria we use to evaluate potential top charities is their cost-effectiveness—how much good each dollar donated to that charity can accomplish. In recent years, we’ve identified several charities that we estimate to be around 4 to 10 times as cost-effective as GiveDirectly, which we use as a benchmark for cost-effectiveness. Our top charities are extremely cost-effective, but we wonder whether we might be able to find opportunities that are significantly more cost-effective than the charities we currently recommend.
Our current top charities largely focus on direct implementation of health and poverty alleviation interventions. One of our best guesses for where we might find significantly more cost-effective charities is in the area of policy advocacy, or programs that aim to influence government policy. Our intuition is that spending a relatively small amount of money on advocacy could lead to policy changes resulting in long-run benefits for many people, and thus could be among the most cost-effective ways to help people. As a result, researching policy advocacy interventions is one of our biggest priorities for the year ahead.
Policy advocacy work may have the following advantages:
- Leverage: A relatively small amount of spending on advocacy may influence larger amounts of government funding;
- Sustainability: A policy may be in place for years after its adoption; and
- Feasibility: Some effective interventions can only be effectively implemented by governments, such as increasing taxes on tobacco to reduce consumption.
Policy advocacy also poses serious challenges for GiveWell when we consider it as a potential priority area:
- Evidence of effectiveness will likely be lower quality than what we’ve seen from our top charities, e.g. it may involve analyzing trends over time (where confounding factors may complicate analysis) rather than randomized controlled trials or quasi-experimental evidence;
- Causal attribution will be challenging in that multiple players are likely to be involved in any policy change and policymakers are likely to be influenced by a variety of factors;
- There may be a substantial chance of failure to pass the desired legislation; and
- Regulation may have undesirable secondary effects.
Overall, evaluating policy advocacy requires a different approach to assessing evidence and probability of success than our top charities work has in the past.
Incubation Grant to the Centre for Pesticide Suicide Prevention
CPSP began work in 2016 and aims to reduce deaths due to deliberate ingestion of lethal pesticides. With this Incubation Grant, which is intended to cover two years of expenses, CPSP expects to collect data on which pesticides are most often used in suicide attempts and which are most lethal, and then to use this data to advocate to the governments of India and Nepal to implement bans of certain lethal pesticides.
Research suggests that worldwide, approximately 14% to 20% of suicides involved the deliberate ingestion of pesticides. This method of suicide may be particularly common in agricultural populations. The case we see for this grant relies largely on data from Sri Lanka, where bans on the pesticides that were most lethal and most commonly used in suicide coincided with a substantial decrease in the overall suicide rate; we find the case that the decline in suicides was primarily caused by the pesticide bans reasonably compelling. CPSP’s director, Michael Eddleston, was involved in advocating for some of those bans. Read more here.
GiveWell learned of CPSP’s work through James Snowden, who joined GiveWell as a Research Consultant in early 2017. We decided to recommend support to CPSP based on the evidence that pesticide regulation may reduce overall suicide rates, our impression that an advocacy organization could effect changes in regulations, our view that Michael Eddleston and Leah Utyasheva (the co-founders) are well-positioned to do this type of work, and our expectation that we would be able to evaluate CPSP’s impact on pesticide regulation in Nepal and India over the next few years. We thus think CPSP is a plausible future GiveWell top charity and a good fit for an Incubation Grant.
While deciding whether to make this grant, GiveWell staff discussed how to think about the impact of preventing a suicide. Thinking about this question depends on limited empirical information, and staff did not come to an internal consensus. Our best guess at this point is that CPSP generally prevents suicide by people who are making impulsive decisions.
We see several risks to the success of this grant:
- Banning lethal pesticides may be ineffective as a means of preventing suicide, in India and Nepal or more broadly. The case for this area of policy advocacy relies largely on the observational studies from Sri Lanka mentioned above, supported by Sri Lankan medical records suggesting the decline is partially explained by a shift to less lethal pesticides in suicide attempts.
- CPSP may not be able to translate its research into policy change. This risk of failure to achieve legislative change characterizes policy advocacy work in general, to some extent, and requires us to make a type of prediction that is not needed when evaluating a charity directly implementing a program.
- Banning pesticides could lead to offsetting effects in agricultural production. The limited evidence we have seen on this question suggests that past pesticide bans have not led to notable decreases in agricultural production, but we still believe this is a risk.
- CPSP is a new organization, so it does not have a track record of successfully conducting this type of research and achieving policy change.
To quantify the risks above, GiveWell Executive Director Elie Hassenfeld and James Snowden each recorded predictions about the outcomes of this grant at the time the grant was made. Briefly (more predictions here), Elie and James predict with 33% and 55% probability, respectively, that Nepal will pass legislation banning at least one of the three pesticides most commonly used in suicide by July 1, 2020, and with 15% and 35% probability, respectively, that at least one state in India will do so.
We plan to continue having regular conversations with CPSP, and a more substantial check-in one year after the grant was made. At that point, we intend to assess whether CPSP has been meeting the milestones it expected to meet and decide whether to provide a third year of funding. If this grant is successful, we hope we may be able to evaluate CPSP as a potential top charity.