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Last year I gave a few thousand dollars to the charity Village Reach, which performs vaccinations in rural Mozambique, on the recommendation of charity evaluator GiveWell. The bottom line of the recommendation is that Village Reach can prevent a childhood death for around $400-$800 – very cheap indeed.
A natural response might be to ask what value there is in saving someone’s life in such a poor country. Though I don’t know a great deal about quality of life in rural Mozambique, living in a country with “one of the lowest GDP per capita, one of the worst human development index and amongst the highest inequality in the world” presumably isn’t great. Anywhere that you can save lives for a few hundred dollars would have to be pretty rough! Given this, the justification for vaccinations has to rest on more than just averting death. It must also be about improving people’s quality of life.
Population effects aside, reducing the rate at which people die is a significant way to improve quality of life. Being sick and dying is painful for the person involved and those who care for them. Further, raising kids only to have them die in infancy uses up resources in a community that has no resources to waste. Childhood disease reduces the intelligence and health of survivors and depresses school attendance. A high risk of a child dying discourages investment in human capital and encourages large families, both of which are probably bad for economic development.
If we want to do as much good as possible with health interventions we should aim to not only avert direct suffering from disease and death. The treatments that will most effectively improve quality of life in the long run will also spur on the economic development that allows people to support themselves.
What’s more, for someone who wants to maximise ‘total welfare’, the impact health spending has on population is not a second-tier issue. If Village Reach improves health without increasing incomes or reducing fertility, then it may just result in more people living in abject poverty, which is a questionable achievement. On the other hand folks who are optimistic about the quality of life of people living in poverty will not be so enthusiastic about fertility falling unless the population decline does a lot to improve average quality of life.
It is much harder to quantify these flow on effects on development and population, which is why they usually get short shrift. Education, health and development all cause one another with different intensities and lags, and unravelling the chains of causation between them is extremely difficult, if not impossible, in the absence of randomised experiments. A charity like Village Reach could randomly allocate villages to treatment and non-treatment groups and collect data on incomes and fertility in addition to health. Tracking these effects would require collecting data for an extended period of time, but would be a very valuable research project in its own right.
GiveWell has chosen to focus on health and nutrition interventions over others in large part because many more of them are cheap and have proven impacts. [1] Strong evidence of cost effectiveness is key for GiveWell, as a large part of what they are trying to achieve is a shift the culture among NGOs towards thorough data collection and evaluation of projects. [2] Given the current low standards of evaluation for most charities, this is a creditable goal.
A manageable improvement given this constraint would be to look at which kinds of disease do the most to depress education and productivity. A long lasting tropical parasite, childhood diarrhoea, chronic illness or fatal adult disease could all have different impacts on family structure and capacity for education and work. Likewise some countries may be in a better position to advance economic development in response to improved health than others. These flow on effects may be as important, if not more so, than the number of deaths averted per dollar.
[1] An education program which can’t demonstrate an impact on education presumably isn’t doing much for quality of life, population or development either, so it is fair enough to ignore it.
[2] While GiveWell’s evaluation style is likely to be biased towards interventions that have easily measured, short-term outcomes, this isn’t a problem necessarily. While GiveWell may miss highly effective charities, something which can’t be measured can’t be targetted.
Tagged: altrusm, causation, economics, effective altruism, efficiency, rationality, time series, utilitarianism Image may be NSFW.
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Image may be NSFW.Clik here to view.
