As December rolls in, my inbox is filled with requests for donations, often from organizations I have given to in the past. This holiday season is also bittersweet because I cannot visit Delhi, where I was born and my parents still live, because of the air pollution and smog during the winter months. In Delhi, I find it hard to breathe, and usually lose my voice because of inflammation caused by particulate matter pollution. This year, I am under doctor’s orders to avoid travelling to Delhi in the winter; I’ve been struggling with respiratory problems from long Covid.
With air pollution dominating my thoughts and nudges for charitable giving in my inbox, my first instinct is to give to causes that help mitigate pollution in Delhi. But I am also aware of the literature on emotional giving or ineffective altruism. In their 2021 paper, Caviola, Schubert and Greene explain why both effective and ineffective causes may attract dollars. People often give emotionally to a cause that has personally impacted them in some way.
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This paper resonated with me because I am exactly the sort of irrational dog lover likely to support the best training programs for guide dogs. These super dogs have my lifelong admiration. My Labrador retrievers can barely fetch a ball.
We all know air pollution is bad. But how bad? And compared to what?
As an alternative, I looked up the top charities recommended by GiveWell—the top two work on reducing Malaria deaths. Malaria kills between 600,000 and 700,000 each year. And GiveWell is considered one of the most credible evaluators in the philanthropic space. Should I be thinking less about air pollution in Delhi and more about malaria in Africa?
So, I thought it best to evaluate 1) my priors on air pollution, 2) whether air pollution mitigation in Delhi merits my dollars/rupees. And if Delhi air pollution merits intervention, then it would be good to 3) identify the reasons air pollution became such a big problem in Delhi (you would be surprised), which would lead to uncovering 4) how to mitigate the problem of air pollution so I can decide where to send my dollars. And since I got to #4, to understand 5) why people think that giving to malaria charities is “higher impact” than solving air pollution.
6. Back to Malaria—Is It Really That Simple?
While writing this post, I also thought more about malaria and whether malaria prevention is more complex than impact evaluations lead us to believe. If legibility is the consequence of a narrowing of vision to make a complex problem tractable, then are these malaria mitigation interventions too simple?
95% of all malaria deaths are in Africa, and that malaria disproportionately kills children.
This is probably why the effective altruism community, which believes in helping those far removed from one’s situation, measures by lives saved per dollar when thinking about long-term and high-impact efforts, and rates malaria prevention charities so highly. In his latest column, Ezra Klein defends the basic principles of effective altruism and separates it from the SBF-FTX mess.
It is impossible not to feel for the children in Africa dying from malaria. But suggesting that distributing nets and antimalarial medication is the best way to save lives and prevent illness compared to anything else we know is narrow. Regions outside Africa only account for 4% of malaria deaths. But I don’t see high use of mosquito nets and antimalarial medication in Europe and the U.S. Outside of camping equipment stores, I don’t think I have seen any mosquito nets bought or sold in the U.S. These countries don’t have malaria deaths because they have access to good public sanitation, clean water, electricity and healthcare. Malaria hits children in poor regions with low state capacity.
Common sense tells us that the best way to save lives and prevent illness is economic growth. But then how do we know for sure that economic growth in Africa will help reduce malaria incidence?
Look at the decline in malaria deaths in India since the big bang reforms in 1991, which placed India on a higher growth trajectory averaging about 6 percent annual growth for almost three decades. Malaria deaths declined because Indians could afford better sanitation preventing illness and greater access to healthcare in case they contracted malaria. India did not witness a sudden surge in producing, importing or distributing mosquito nets. I grew up in India, in an area that is even today hit by dengue during the monsoon, but I have never seen the shortage of mosquito nets driving the surge in dengue patients. On the contrary, a surge in cases is caused by the municipal government allowing water logging and not maintaining appropriate levels of public sanitation. Or because of overcrowded hospitals that cannot save the lives of dengue patients in time.
So, it seems bizarre to claim that these impact studies on distributing malaria nets prove “that they save lives and prevent illness at lower cost than pretty much anything else we know of.” Economic growth and high state capacity saves lives at a much higher scale, not just from malaria but from all infectious diseases. And malaria-affected individuals can be saved and illness can be prevented at very low marginal cost if we embrace the idea of economic growth and prosperity for all of humanity.
Economic growth helped save lives and prevent illness from ALL infectious diseases.
Sustained economic growth in India has saved an additional 405 lives per 100,000 in a country with 1.4 billion people. If India had the 1990 death rate from infectious diseases in 2019, an additional 5 million Indians would die each year. That’s the total estimated excess death toll from Covid in India. Economic growth in India has saved those lives every year. And as Indians become prosperous, the number of lives saved will increase without any additional spending on mosquito nets.
Perhaps I am focusing on the wrong part of GiveWell and Ezra Klein’s claim. I should focus on “at a lower cost than pretty much anything else we know.” Perhaps those recommending these charities as having the highest impact are doing so because they can be implemented and evaluated with confidence at a lower cost relative to efforts to improve state capacity and boost economic growth. Giving to charities that work on state capacity, institutions, public sanitation policy, economic growth, etc. is not a sure thing. Maybe they only increase the chances of economic growth by 5%. But with enough diligence and evaluation, we can be 90% sure that our dollars buy the additional mosquito net, and that mosquito net has a 70-80% chance of saving a life. So, this is less about the overall impact and more about “impact we know” or better phrased as “impact we can count and take credit for.” The Against Malaria Consortium’s website says they have raised $488,628,184, funded 223,421,135 nets and protected 402,158,043 people. Contributing to this institution a donor can calculate the number of lives they saved with their contribution. This is not just about legibility but also attribution. Each dollar donated will not just save lives but also assuage guilt, signal virtue and make one feel good during the holidays. Telling people about investments in clean construction technology hardly has the same effect at the holiday party.
It is not just philanthropy. In my conversations with Lant Pritchett (1 and 2) he argued that development policy and aid has been infected by attribution. We have long known that the first step to development in poor regions of the world is economic growth. But economic growth is neither easy to achieve, and when achieved not easily attributable to a single intervention.
India’s development trajectory changed when the reforms in 1991 ended the worst parts of socialist command and control, opened India to global trade and put in place several institutional changes for currency and macroeconomic stability, pushing India into higher growth for the next three decades. As a result, GDP per capita increased sevenfold, and about 250 million Indians—more than the total population of Brazil—were lifted out of poverty. All socioeconomic groups prospered because of sustained economic growth. India added approximately $3.6 trillion to its economy as a direct consequence of these reforms.
Lant Pritchett writes about the Ford Foundation investing in the Indian Council for Research on International Economic Relations (ICRIER) in 1982. ICRIER is a nonprofit research center created “to foster improved understanding of policy choices for India in an era of growing international economic integration and interdependence.”
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The need for attribution in philanthropy has led to “rigorous impact evaluation,” and to conduct these impact evaluations necessarily requires narrowing and simplifying the problem into legible and calculable forms. The end result is claims that distributing malaria nets is the best way to save lives and prevent illness. Common sense tells us otherwise.
Interesting post! If I understand you correctly, you're arguing that we should evaluate other possible uses for charity money, like pursuing economic growth, which might be better than e.g. GiveWells analysis?
I think this part is the most important one
There's 3 points that come to mind here.
First of all, pursuing economic growth sounds great - what concrete options would you imagine though?
Second of all, if you ask 2 different economists how to boost the economy you'll likely get 3 different answers. It's extremely hard to get any facts in this field, due to interconnectedness of economies and so many factors having an impact on economic reality. So to me, measuring the effectiveness of any intervention would basically be an impossible task. Contrast this to giving out things (bednets or anything else really), where you can easily compare populations/neighborhoods/communities that received them with those that didn't.
Third, regarding the current funding levels. Ultimately, growing the economy is the goal of any government, business and to some extent many private individuals in a country. It doesn't seem obvious to me that e.g. a few million by a charity will meaningfully move the scale here. Again, compared to e.g. efforts against malaria, which have way less funding and way less powerful proponents.
This was a link post so it's probably best to add a comment to the original - https://srajagopalan.substack.com/p/altruism-and-development-its-complicated/comments