One of the things we need to do, as a transparent grantmaker, is to take the intuitions and biases that make us prefer one charity over another and make them explicit, so that everyone is aware (as much as possible) of the principles that drive us. I’m going to be doing this “out loud” on our blog; please bear in mind that what I write here is unfiltered and personal (i.e., I am expressing my own views, not those of The Clear Fund, whose short-term decisions involve Elie and whose ultimate decisions involve the entire Board).

As I explore different approaches to our five causes, I’m realizing that many of the most difficult calls to make are between organizations that serve fundamentally different populations with different needs – for example, how do you choose between an organization that provides job training for people right on the brink of employability and one that provides a comprehensive set of services for people with more complex issues (including substance abuse, mental health issues, etc.)? When I run up against these questions, the approach that keeps popping into my head is that of a wartime triage.

We’re all familiar with the idea of helping those who need it most, but when resources are scarce (as in wartime, and charity), that’s not all there is to it. As Wikipedia so helpfully explains, there are times when the protocol is instead to help people who have better odds of survival (i.e., people who need less help) – because more lives can be saved that way. That means diverting resources from most wounded to those whose injuries are more treatable. The question becomes not just “What will happen to you if I don’t help?”, but also “What will happen to you if I do?”

You might think a charity that seeks out people who need just a little help is “cherry-picking.” But to me, this seems like a great approach. If we have one set of people stuck in poverty for a simple, stupid, easily fixed reason and another stuck in poverty for a whole complex of reasons – it makes sense to focus on the first group first.

This is cold, of course, and it’s unnerving to think of things that way. That’s why you rarely hear the idea of “helping those who can benefit more easily” – it’s a concept reserved for the direst of conditions, when there’s really no other choice. But to me, the state of the world is exactly that. There are more people in need than we can help. We need to think of charity not as a service to ease our guilt or give us warm feelings, but as a war on suffering. That means making tough choices, and this general approach – help the people who can benefit the most from the least – seems like a good way of making them. Thoughts?

Please don’t tell me you’re going to run one of these “three posts on the first day, then total flaking out” blogs.

If you’re here to read the latest update on the GiveWell project, see this post.

There are a lot of possible objections to my last post; to voice them, I’m bringing back our old friend, the Straw Man, for an exclusive interview.

Straw Man: When you say you prefer charity (helping individuals) to philanthropy (addressing root causes), do you mean you ALWAYS prefer short-term to long-term solutions, and that all research/advocacy/outreach programs should be illegal?

Holden: No. But I think there’s value in making charity the default mode, asking for a higher burden of proof before switching to more difficult and ambitious methods. I think most foundations go in the opposite order, jumping straight to “How can we wipe out this problem?” The two examples I gave in my last post seem like really good ones.

Straw Man: But don’t you think that by helping individuals, you’ll be perpetuating the very problems you seek to address??

Holden: How so?

Straw Man: Hang on, I’m still recovering from how cool I sounded just now. OK. There are a couple different arguments that charity perpetuates the very problems it seeks to address. First, the lefty one: by helping people, you’ll give the government an excuse to ignore them.

Holden: Are there any instances in recorded history where a popular social program lost support because of the argument that charity takes care of it? I doubt it, and here’s why. A charity isn’t a reasonable candidate to replace the government until it’s covering all affected parties (which generally is not a possibility, even in the long term) – and until that point, the charity’s successes are just evidence that more of its activities are needed. If a charity addresses 1%-95% of the needy population, and it’s clear that what it’s doing is working and that that 1%-95% is far better off for it, that seems to me like it helps rather than hurts the case for universalizing the program. Anecdotally, I’ve already seen this with NYC education – the state is willing to partner in “experimental” initiatives (small schools, for example) that already have some track record thanks to the voluntary sector.

“This is a great program, it clearly works, it’s clearly good for our society, but we shouldn’t allocate government funding to it because 501(c)(3)’s already have it covered” doesn’t sound like an argument that would fly in an actual political contest (let me know if there are any examples of this happening). It sounds like the kind of argument that people are afraid “other people” will be snookered by.

Straw Man: OK, now the righty argument that charity perpetuates the very problems it seeks to address. By providing people with free health care, education, etc., you remove the incentive for them to pull themselves up by their own bootstraps.

Holden: I don’t think I’ll ever understand where people get the idea that depriving someone of basic needs is a necessary, or appropriate, way to motivate them to work. All of the most driven, entrepreneurial, hard-working people I know have never had to worry about having food, shelter, health care, or education. In fact, most of them have never had to worry about anything much. People want more than they have, period (whether we’re talking about money, meaning, or anything else you get from hard work). So what if food surpluses mean farmers don’t have to grow food anymore? They’ll do something else useful – just like the rest of us who’ve never had to grow food.

Straw Man: But what about sustainability? By providing free medicine, we could be stopping programs that seek to provide cheap medicine. That’s not just a waste of money – it could be stopping people from providing services in much more sustainable, expandable ways.

Holden: This is a real concern. It’s one of many reasons that charity has to be researched carefully and monitored constantly. In fact, I think one of the questions any charity has to ask itself is, “How much can our clients pay for our services?” They should charge as much as possible, until the point where they’d be pricing out people who need help. And they should always be revisiting this question.

That said, leaving people to rot until/unless “the market” solves their problems is irresponsible. There’s no question that there are people out there who need help they can’t afford to pay for, and this fact isn’t going away anytime soon (especially if nobody’s providing them with the things every human needs to become self-supporting). Serving people who need help, while constantly reassessing how much they need it, seems like the only appropriate road to take.

Straw Man: So to sum up: you just like Band-Aids, and you don’t want to see real change in the world.

Holden: First off, every person helped is real change; secondly, I do want to see large-scale change, but I’d rather learn as we go than spend 20 years trying to implement an untried master plan. What I really want to see is a kind of “research” grounded in reality: donors simultaneously helping people and learning how best to help people, by documenting and discussing what they’ve done. This approach – transparent, heavily evaluated, results-oriented charity – can’t solve all our problems or fully replace direct assaults on “root causes,” but it has the potential to build the evidence and knowledge we need for enormous changes, as well as making sure that we’re doing some actual good along the way.

It’s slowly dawned on me that I almost never see the word “charity” on the other blogs in this space, and I rarely see it in foundation literature either. Meanwhile, you’ll almost never see the word “philanthropy” on this blog. For a while, the reason for this was simply that I think “philanthropy” is one of the ugliest words that it’s possible to construct. But I’ve picked up another reason to prefer “charity,” as I’ve discovered why others avoid it. In Sean’s words, “philanthropy [is] the practice of dealing with root causes rather than the derisively referred to ‘charity’ which is ‘just about managing symptoms.’” Put me down for managing symptoms, thanks.

Severe diarrhea kills millions of children a year. When are we going to find a cure?? Um, actually, we have one – in fact, we have several reliable, simple, cheap methods of both treating it (with a packet of nutrients that costs pennies) and preventing it (with water purification tablets, among other things). So may I ask why the Gates Foundation is determined to attack this problem by developing and researching new drugs and treatments?

The Google.org blog reports that polio is nearly eradicated, with under 2000 reported cases. I don’t know anything about polio, but I have to wonder why Google feels that its funds are best spent making a movie to raise awareness about this issue rather than just attacking it head-on. Making a movie isn’t cheap, and competing with Knocked Up for attention isn’t easy; using treatments and methods that have already worked thousands of times is both.

It’s hard for me to say much about what foundations do, what they’re thinking, and whether they’re reasonable, for the usual reason: it’s incredibly hard to get information from them on why they make the choices they make. But my general impression is that they place too much emphasis on “eliminating problems,” rather than on improving human beings’ lives.

When you’re trying to accomplish as much good as possible with your dollar, as in everything else, you have to factor in certainty (the same reason that people buy stocks and CDs instead of just lottery tickets). Of course I’d love to cure cancer or save Darfur, and I’d rather eliminate a disease than save 100 people from it. But as a strategy gets longer-term and gets more moving parts, my confidence in it falls exponentially. And my confidence falls even faster when all I know about a strategy is that it involves “research” (competing with thousands of other causes for the best scientists), “advocacy” (competing for political airtime), or “raising awareness” (good luck if you don’t have Al Gore or Michael Moore in your corner). The burden of proof should be high for a direct-service charity, but it should be 1000x higher for strategies along these lines – no matter how wonderful the goal.

That – not any philosophical opposition to government intervention or anything else – is why I generally prefer my donations to work one person at a time. (That distinguishes me from this fellow, whose argument against “root causes” appears to actually be an argument against large-scale charity.) The chance to truly change the world is, of course, incredibly tempting, and there are times when it’s the right thing to aim for. But it’s also important to remember that the dichotomy between “getting results” and “treating symptoms” is a false one, if improving humans’ lives – not promoting abstractions – is your ultimate goal. Saving a person from starvation – even if makes no dent in the causes of world hunger – is itself a result, and wonderful one.

I’ve had to be judicious with my online time, but there’s a real post coming later today. Meanwhile, I just have to point out this ludicrous example of the “We can never ever take even the tiniest risk of keeping a penny away from a charity, no matter what they’re doing with it” mentality. UK site Intelligent Giving, a third-party evaluator that I generally think is fantastic (I wish we had something like it here in the U.S.), found out that the Wallace & Gromit’s Children Foundation did not give away a penny of its funding last year – but sat on the story so as not to discourage people from giving to it.

Read the post and try to figure out their reasoning. They want charities to be accountable, but they never want to risk hurting a charity’s fundraising appeal. Well, those two are incompatible. Period. You have to choose. Part of putting pressure on charities to do a good job is withholding money when they don’t.

And it’s worth it. In all other spheres, we can recognize that cutting your budget in half while making it better spent can result in a better job done. In the nonprofit sector, a third-party evaluator is afraid to disclose that a charity is doing nothing with its funds, because it might result in less funds. Talk about overvaluing money.