I often focus on trying to improve my ability to estimate how much it would cost to avert a DALY or to save the life of a kid under 5 years old by donating to a particular charity. I am especially trying to find an upper limit to these amounts, so that I can very honestly, and with a lot of authority, tell a potential donor that if they donate to a particular charity, they will avert at least one DALY or save at least 1 child's life for the given cost. I want to find such an upper limit so that there can be somewhere around at least a 95% chance that it is correct.
I think a lot of people that might be interested in donating to highly cost-effective charities don't end up doing that, because they just don't trust those charities and the estimates for how cost-effective they are. And, I think trying to find better upper limit values for this kind of thing could help improve the argument for giving money to these kinds of highly cost-effective charities.
As part of this, I recently started trying to figure out how to factor in the costs from various effective altruism or global health organizations that aren't directly doing charity work or even directly giving money to the charities that are directly doing the work, but that do work that facilitates the work that those charities do. For example, the WHO seems to do a lot of work that makes it possible for lots of charities to do their work, so it seems likely that I should try to account for those costs for the WHO.
So far, the best method I have come up with for estimating these kinds of costs is to:
For example, doing this calculation for the WHO:
Thus far I'm thinking it might be good to account for these kinds of costs from the following organizations: WHO, GiveWell, Rethink Priorities, Giving What We Can, The Life You Can Save, The Centre for Effective Altruism, 80,000 Hours
So I'm wondering:
And also:
When you say your aim is
I think you're looking for a level of certainty that basically doesn't exist in any of the top recommendations, whether by GiveWell, GWWC, etc let alone the higher-EV lower-certainty giving opportunities (policy reform, field-building, etc), and that the kinds of adjustments you make won't get you where you want. You can and should argue that a particular giving opportunity is great based on multiple lines of reasoning, but you can't make your exact claim as phrased (apologies if the following may seem nitpicky — I used to require the same sort of certainty too, so consider it an attempt to legibilize why I changed my mind).
The reasons for this are hard to summarise in a persuasive way if you haven't built intuition by scrutinising a (good) CEA. You can get a sense of them by picking a charity everyone agrees is a long-running top recommendation for cost-effectiveness + evidence robustness + track record (proxying your search for authoritative certainty), e.g. the Against Malaria Foundation, and seeing what GiveWell says about them. So let's do that:
Notice how difficult it is to get the level of certainty you seek in every adjustment step of the calculation above, despite GW's almost pathologically-skeptical thoroughness. This doesn't mean AMF is "a bad recommendation" — it means virtually every other top giving opportunity is "worse" (by the standard you seek) because giving well is really hard, yet we still have very good reasons to think that AMF and all those other top recommendations are excellent giving opportunities, so you should recalibrate your expectations and communicate this to potential donors as well who seek the same.
re: the "multiple lines of reasoning" alternative for recommending great giving opportunities, GiveWell's approach is solid I think. For AMF that looks like
and GW detail their reservations as well (same link).
Thanks for the response, Mo.
I have also spent a significant amount of time looking at cost-effectiveness analyses from GiveWell and I think they're great. I even wrote a summary of GiveWell's cost-effectiveness analysis for Against Malaria Foundation similar to yours, although I think yours might be better. Mine is on this webpage (https://davehammerlecoder.com/against-malaria-foundation) on my personal website under the section 'Appendix A: GiveWell's Cost-Effectiveness Analysis for the Against Malaria Foundation'.
I'm not so much concerned with finding a really accurate measure of the cost per DALY averted or life saved as I am with finding an upper limit, even if the upper limit is pretty far above the estimated average. For example, looking at the Against Malaria Foundation, according to GiveWell, it looks like the upper end cost to save a life would be $14,493, specifically in Chad. If that's the upper end of GiveWell's estimate, then it seems like $50,000 cost per life saved might be a pretty reasonable upper limit. Meaning it seems plausible to me that someone could have a 95% confidence that AMF will save a life for less than $50,000 on average.
And if I were a normal person living in a rich country like the US, considering donating some money, saving a life for $50,000 would seem like a really good deal to me. Even if saving that life only averts 35 DALYs, that would translate into ~$1,400 per DALY or ~$4 per day of life added. So if I work an extra 1 hour for about $30/hour, I can extend someone's life by 7 days, or 168 hours. Which means that for whatever span of time extra I spend working, somebody else gets to live for ~168 times that span time. From an altruistic perspective, that's an amazingly good deal.
I can also definitely understand that being able to donate money and have it be as cost-effective as it probably is, is very impressive. I'm sure it takes a lot of work from a lot of different people in order to make that possible, including the people at GiveWell and many government entities, both African and not.
But it took me a lot of time and effort, including a bachelor's degree and a trip to EA Global in Boston to attain the degree of confidence that I currently have in my donations. To me it seems like maybe we could get more normal people interested in donating if it didn't require as much free time and effort.
I think maybe the reason most people don't want to donate to these kinds of charities is that they don't consider charities trustworthy enough. And that seems like a reasonable response to me, especially considering the kinds of ads from African charities pop up in my web browser. But I think if we can get a more consistent message out to more normal people who don't want to spend as much time on this, donating money to global health charities could become more normal in rich countries like the USA.
I think in order to accomplish that, we need a message that is consistent, and that can be verified by people who decide to really look into it. This way, normal people would have more of a reason to trust highly cost-effective global health charities. And I think a fairly consistent upper limit on the cost to avert a DALY or save the life of a kid under 5 via any given charity could help with this.
I want to account for the money spent by organizations like GiveWell, the WHO, the Centre for Effective Altruism, and Open Philanthropy in an attempt to improve these upper limits. I'm especially concerned about these costs because I recently started donating to family planning global health charities. These charities can be viewed as highly cost-effective just by reducing maternal mortality and from various other positive impacts.
But the thing I really like about family planning is that it can avert births.
Each averted birth avoids the 7.4% chance kids in sub-Saharan Africa have of dying before the age of 5 years old.
Looking at it this way, these charities can avert the death of a kid under 5 years old for under $1000, and probably substantially less.
The amount depends on odd things like which utilitarian theory one subscribes to. I go by an average-based utilitarian theory.
If you want more info about that, my post on the EA forum about it is here: https://forum.effectivealtruism.org/posts/stWZ26t9W7qi3ieJS/why-aren-t-relocated-births-accounted-for-in-cost
My problem now is that, at that degree of cost-effectiveness, costs from organizations like the WHO and GiveWell become much more significant relatively. And that's why I started trying to figure out how to estimate applicable costs from those kinds of organizations.
Nice one David! Mo has done as great job explaining here do I won't add too much.
To reiterate the costs of overheads are built into all that estimations, so I don't think you need to worry about that as a separate issue.
I love your intuition on family planning, and there are some great Organizations like FEM. And Lafiya Nigeria which have solid first effectiveness analysis showing they in probably have similar cost t effectiveness to other to charities, spend very little on overhead and help women in Northern Nigeria to take control of their family's future and improve women's health.
I love the way you are thinking and all the great on your donation journey.
Thanks for the considered response David, upvoted. I'll preface by saying that I appreciate the effort you're putting into this.
When I first read your post, I anchored hard to "... so that I can very honestly, and with a lot of authority, tell a potential donor..." which made me assume you've spoken to potential donors, which I resonated with. I've only spoken to potential small local donors in a very limited personal capacity, and a recurring concern they raise is that they simply don't want to be misled by claims of effectiveness (forget cost-effectiveness). I recall speaking to someone who felt disquieted by not just the number but also the kind of uncertainty-driven adjustments I listed above for instance, and also appreciative of me pointing them out. I recall speaking to another person who was disquieted by the nature of helping in statistical expectation, when what they wanted was certainty; they appreciated me pointing this out as well (and were unpersuaded by the arguments for expectation-oriented giving).
This disquiet is of course a personal matter, very case-by-case; instead of guessing you should just ask potential donors. In this context your comment makes me wonder if you've spoken to any, and if so what did they think of your approach? To be more direct: when you say things like "it seems plausible to me that someone could have a 95% confidence", is that from talking to them or just your own guesses for now?
I've only spoken to a few donors, mostly friends and family. They seemed to especially like the idea of donating to charities that are local to their communities, which most highly cost-effective charities don't, because they are mostly in low income places, not the USA. They were also concerned with what portion of the donated money would be spent on the charity's own overhead or administration. And they especially didn't want to receive spam mail or email from charities as a result of donating.
I suppose my assumption is that I should start with an argument I think would work on myself, if I hadn't studied global health as much as I have, and then try to figure out what part of that people are resistant to. If I hadn't studied global health, and wanted to be able to donate effectively without having to study it, I would have been looking for that upper limit with a likelihood of somewhere around 95% that the cost would be below it, even if the upper limit needed to be pretty high in order to reach that level of certainty. So now I'm trying to figure out such an upper limit myself.
I again want to say that I resonate a lot with what you're trying to do, since I've tried (and mostly failed) to do something similar myself before.
I worry a bit that you're prematurely optimising approach-wise when you conclude the thing to focus on is figuring out the cost-effectiveness upper limit at which you can tell people honestly and confidently that their donation is doing that much good, instead of asking donors how they think about giving (which you did). For instance, Sawyer's comment reiterates the sentiment I mentioned earlier that
and Jason's comment seems relevant as well:
and these aren't necessarily obvious in advance, so if you start from a (simplistic) model of giving advisory effectiveness as being [number of prospective donors in your circle] x [fraction of donors who find argument X persuasive] x [$ per donor] x [expected good per $], then starting with an argument that works on yourself (and on me too — I don't think we're that representative of the donor pool) doesn't let you get empirical input on the 2nd term, while asking donors does.
To some extent, I'm also trying to figure out a good upper limit for myself, so that I have a better idea of how much my donations are really worth. I think if I can increase my confidence that the cost is below some value, I'll have an easier time motivating myself to avoid spending money so that I can donate more.
Going back to my original post, the only reason I'm concerned with figuring out how to factor in costs from organizations like the World Health Organization, GiveWell, and the Centre for Effective Altruism is because, from an average-based utilitarian theory, I think family planning charities in sub-Saharan Africa can save the life of a kid under 5 years old for somewhere around $275. I would normally guess that costs of organizations like those would be so tiny, that they're not worth trying to account for. But $275 per life (which might be about $4.50 per DALY) is so cost-effective, that costs from those necessary organizations could have a pretty big impact on the overall cost.
From what I've read, health interventions in sub-Saharan Africa often have a cost-effectiveness of about $150 per DALY, or about $50-$80 for one of GiveWell's top charities. And I think the costs for all of those organizations together might add up to about 5-10% of the money that goes to health interventions in sub-Saharan Africa. If we assume a normal cost per DALY is about $100 and add 5-10% of that to my estimate of Lafiya Nigeria's cost-effectiveness of $4.50 per DALY, that results in about $10-$15 per DALY, approximately doubling or tripling the cost per DALY.
And it seems like GiveWell's cost-effectiveness analyses doesn't account for these kinds of costs. I understand why they wouldn't want to, since most people looking at their cost-effectiveness analyses are trying to compare one charity to another, not trying to figure out the total cost. But, still I want to try to account for it in my calculations.
Thanks for elaborating David, I think I better understand where you're coming from now. I still don't buy the need to incorporate these costs though, so in the interest of potentially changing my mind and to prevent talking past each other let me try to be concrete.
Approach-wise, I think froolow got the accounting right when he was looking into GiveWell's older (2022) CEAs (emphasis mine):
Applying this approach to (say) Lafiya Nigeria's figures, Rethink Priorities estimates that if you donated $361 and Lafiya spent it in Q1 '25 you would have averted one additional death in expectation. Supposing you included costs from other orgs like WHO etc, sure the total cost may increase, but it's still the case that your $361 helped avert one additional death in expectation! You could think of those other overhead costs as "leveraged funding" or "other people's money moved by your money" or whatever, but why would any of that be relevant to the fact that an additional death was averted because you decided to donate $361? Shouldn't that averted death be what ultimately matters?
Maybe you're thinking from a credit attribution perspective? e.g. you want to say "yes a life was spared, but I shouldn't get all the credit, since my money moved WHO's money etc, so if we did proper accounting (maybe using Shapley values) maybe I can only get 40% credit for averting that neonatal death or averting that woman from dying in childbirth, whereas WHO gets 30% credit and other actors get 30% credit". But in that case I don't see where this over-focus on credit attribution is coming from, instead of just wanting to avert the death of that child or mother and knowing that you the donor can do so by giving Lafiya $361?
I think I understand your perspective, but I think there are two different ways of looking at any particular charity opportunity, and that is only one of them. I think each applies in different circumstances to different extents, and it can be difficult to tell how much each applies, depending on circumstances.
The first way of looking at it is the one that you described, where some other organization has already paid for its part of the health intervention, and would have paid for it regardless of if the donor donated any money. In that case, it might seem reasonable to me to mostly ignore the costs from the other organization, and only look at the cost paid by the donor when doing the CEA.
One example of where I think this would be applicable is when looking at a health intervention that has diminishing returns. For example, looking at AMF, probably the places where the LLINs will be most effective and least costly to distribute tend to receive them first. This could easily result in later LLINs being less cost-effective than earlier LLINs, so it might make sense to just look at what kind of impacting the donor is adding rather than looking at the total cost and impact of AMF.
The second way of looking at it is that the costs paid by the other organization were necessary for the health intervention, so we should account for those costs, although we would also need to somehow account for any other impacts from what the other organization spent. I think this way of looking at it is particularly valid if the money from the other organization will only be spent if the donor makes the donor's donation, but I don't think that's a requirement.
For example, on the AMF website, it says "100% of public donations buys long-lasting insecticidal nets (LLINs). An LLIN costs US$2.00." But there are actually many other necessary costs that need to be paid in order for LLINs to be effective, like the costs of distribution and the costs of figuring out where additional LLINs are needed. So, if we assumed that $2/LLIN was the only cost being paid, we would end up with incorrect cost-effectiveness numbers.
One thing that I think can help decide which perspective to use is the relative cost-effectiveness of the other organization's impact alone vs. the donor's donation alone. If the cost-effectiveness of the other organization's donations is a lot better than the one for the primary donor's donation, then I think it might be safe not to account for the costs of the other organization's donations. But, if not, I think it might make sense to account for the other organization's costs.
For example, let's say an organization spends $100 on a health intervention that saves one life. Then the donor comes along and pays another $10 to save a second life, but that donor can only do it because of the $100 that the organization already paid. In this case I think the more accurate cost-effectiveness for saving a life would be ($100 + $10) / 2 = $55, rather than just $10. However, if someone is just looking at which charity to donate to rather than trying to figure out realistically how many lives will be saved by a given donation, I could see the applicable number being $10/life. That's because I could see someone from the charity saying, "Hey, somebody else made this $100 donation, but didn't give us the other $10, even though it would make the intervention a lot more cost-effective, and it would be great if you could make up the difference." That seems like a good donation to make. But if someone asked, "How many lives do your donations tend to save?", I think the $55/life number would be more accurate.
In my case, I think the cost-effectiveness of Lafiya Nigeria is dramatically better than the cost-effectiveness of most global health interventions, even GiveWell's top charities, so I think accounting for the overhead costs from other organizations might make sense. Although, maybe only in the context of figuring out how far the money will actually go, not necessarily in the context of trying to figure out which charity to donate to.
Also, to some extent, my cost-effectiveness number for Lafiya Nigeria just seems too low to be possible, so I'm trying to figure out what might be wrong with it. Trying to account for costs from organizations like the WHO seems like a promising path for doing that.
Thanks for all the feedback on this. I think I've done a lot more useful thinking regarding this as a result.
You're welcome :) Apologies in advance if I've come across as too nitpicky and inadvertently confrontational by the way!
No problem. I probably seem that way also.