Summary

The Disease Control Priorities (DCP3) collection overviews the DALY cost-effectiveness of global health interventions in the following areas: 1) Essential Surgery; 2) Reproductive, Maternal, Newborn, and Child Health; 3) Cancer; 4) Mental, Neurological, and Substance Use Disorders; 5) Cardiovascular, Respiratory, and Related Disorders; 6) Major Infectious Diseases; 7) Injury Prevention and Environmental Health; and 8) Child and Adolescent Health and Development. 

Top causes in these areas can be covered by one highly cost-effective and three profitable projects: 1) Sliding-scheme health facility consultancy, 2) Complex family issues shows, 3) Health product advertisements on social media, and 4) Government policy consultancy. Relatively cost-ineffective interventions currently funded by Open Philanthropy include bednet distribution and preventive deworming. The first section of this post overviews these investment and divestment opportunities. The second part notes cost-effective interventions in individual areas.

This essay is for the Cause Exploration Prizes contest. I would most appreciate if you let me know about organizations that are already running programs similar to the four that I mention or those that provide any of the outcomes under $20/DALY that are not popular in EA.

Synthesis

Four projects that collectively cover cost-effective global health interventions

These projects are based on (Black et al., 2016; Bundy et al., 2017; Debas et al., 2015; Gelband et al., 2015; Holmes et al., 2017; Jamison et al., 2017; Mock et al., 2017; Patel et al., 2016; Prabhakaran et al., 2017). See volume and page references further below and in Appendix 1: DCP3 volumes notes.

1) Sliding-scheme health facility consultancy (profitable, high impact)

Medical consultancy details

DCP3 identifies the below listed interventions and practices as cost-saving to highly cost-effective (<$20/DALY). A consultancy could address all improvement opportunities in a global health facility, taking the advantage of low marginal cost of any individual advice. 

• Prioritization
  • Drugs provision: hepatitis B, tetanus toxoid, pneumococcus, and rotavirus vs. less cost-effective human papillomavirus (HPV) vaccines; aspirin and beta-blockers for acute management of ischemic heart disease; misoprostol distribution through community health workers (CHWs), distributing NTD chemotherapy (onchocerciasis, lymphatic filariasis, visceral leishmaniasis, trypanosomiasis, etc vs. slightly less cost-effective schistosomiasis), treating smear positive tuberculosis with first-line drugs, blood pressure management in upper middle-income countries (UMICs), polypill for high absolute risk of cardiovascular disease in UMICs, angiotensin-converting enzyme (ACE) inhibitor for heart failure
  • Screening: hypertension and cholesterol screening in areas where treatment is affordable; adding syphilis to HIV screen (with syphilis treatment); mother to child transmission of syphilis screen and treatment with penicillin; mental health diagnostics and referrals to self-care and informal community care resources
  • Updating practices: new drugs and diagnostics equipment for tuberculosis, artesunate rather than quinine for severe malaria, zinc addition to oral rehydration solutions (ORS), task-sharing for surgeries (appendicitis; hernia repair; first-level and obstetric surgeries in settings with little specialized care, such as post-conflict; cleft lip and palate repair), case management decisionmaking diagrams for CHWs, clinical standards compliance
• Preventive healthcare information
  • Detailed information: early childhood development practices; healthy diet; aflatoxin exposure mitigation; hazardous substances education
  • Concise information and reminders: handwashing, family planning, physical activity, voluntary male circumcision, stoves that decrease indoor air pollution, kerosene alternatives, female genital mutilation (FGM) prevention
  • Prevention and cessation programs: tobacco, alcohol, and areca nut use; violence

Partnerships consultancy

Facilities should develop partnerships to finance some of their services. Local institutions and businesses could invest in cost-saving opportunities, academic institutions benefit from research partnerships, and pharmaceutical companies gain affordable manufacturing and R&D capacity. Consultants should advise on the strategy of approaching these stakeholders in order to maximize impact, while finding mutually beneficial solutions.

Profitability

The scheme could be profitable in industrialized economies where healthcare costs are high, since a relatively small percentage improvement could significantly reduce total costs. The cost of training could be reduced by higher purchasing power in developing countries.

2) Complex family issues shows (profitable, high impact)

Shows details

Radio and TV shows should engage wide audiences in gossiping about health-related practices recommended by DCP3. These channels should complement or emphasize information shared by healthcare providers and emphasize key messages. Covered topics can include:

• All ages: abuse, neglect, returns to education, nutrition, mental health and support, helminthiases, safe driving, indoor air pollution and solutions, gender norms, physical activity, hazardous task training and OSH, sugar-sweetened beverages risks
• Early childhood: various play activities and materials
• Ages 5–9: WASH practices, FGM prevention
• Ages 10–14: self-regulation; tobacco, alcohol, areca nut, and drugs use prevention
• Ages 15–19: social skills development, family planning, sexually transmitted infection (STI) prevention, value of innovative problem solving
• Parents: breastfeeding, ORS with zinc, postnatal hygiene, child stool disposal, maternal nutrition, child underweight and overweight, reducing aflatoxin exposure, vaccinations, hazardous substances child poisoning prevention

Profitability

• The shows can be sold to larger radio and TV stations, while provided for free to smaller and remote outlets

3) Health product advertisements on social media (profitable, high impact)

Advertisement details

Targeted health product advertisements should be displayed to various audiences. The products include:

• Soap; ORS sachets with zinc; condoms; voluntary male circumcision centers, healthy drinks and snacks (unsweetened; no trans fat; low sodium; low bad cholesterol content); insecticide-treated nets (ITNs); pellet stoves; swim lessons; kerosene alternatives (such as solar lamps); education loans; micronutrient powder; alcohol, tobacco, and areca nut cessation therapies and no-risk substitutes

Profitability

Advertising profit can be gained by social media platforms.

4) Government policy consultancy (low-cost, very high impact)

Consultancy details

Policies recommended by DCP3 not implemented by nations should be suggested to the relevant actors. The positive impact maximization objective shared by this consultancy could indirectly benefit the government. The policy recommendations can include:

• Taxation: tobacco, areca nut, sugar-sweetened beverages, alcohol
• Bans: trans fat, kerosene, corporal punishment, asbestos, mercury, trash burning
• Regulation: salt content in food; arsenic in water; (EU) fuel standards; street dust cleaning; OSH; industrial air pollution (including SO₂, NO₂, and dust); unhealthy drug, food, and beverage product marketing scientific-basis regulation and labeling; surrogate alcohol
• School programs: swimming basics, social skills, gender norms, self-regulation, WASH practices, stress management, optimal nutrition, value of performing an impactful task, FGM, alcohol use prevention, self- and community-based mental health, family planning
• Procurement-related: speed bumps at high-risk intersections, coal and diesel alternatives investment
• Information: OSH practices, hazardous site locations
• Training: teachers to pass tests and continuously upskill, cost-effectiveness-based prioritization and bottleneck-resource prevention for health centers, high ROI health products and practices knowledge of CHWs

Cost-effectiveness

The cost of advising policy drafts should be relatively low, since information is already available and similar policies enacted elsewhere. The policies should have a very high impact due to large scale. The institutionalization of impact cost-effectiveness consideration can provide additional long-term benefits for a high number of individuals at any time. Thus, cost-effectiveness of this program should be very high.

Divestment recommendations

DCP3 finds more cost-effective programs (from cost-saving and $1/DALY) than the following ones that Open Philanthropy funds or has previously invested in. Divestment from these programs should finance more cost-effective projects, unless these are fully financed.

1. Insecticide treated bednet programs ($20–150/DALY) (Black et al., 2016, p. 277) or ($90–100/DALY) (Holmes et al., 2017, p. 21)
2. South Asian Air Quality if DALY unit pollution decrease by clean stoves is more cost-effective (Gelband et al., 2015, p. 38)
3. Campaigns (Patel et al., 2016, p. 112) of Development Media International that would normalize alcohol use (p. 110), for example (Angelin in the Doghouse, n.d.)
4. Preventive deworming drugs for schistosomiasis and soil-transmitted helminthiases ($70–105/DALY) (Holmes et al., 2017, p. 21)
5. Treatment of severe malaria ($5–$220/DALY) (Mock et al., 2017, p. 14) at the upper end of the range

Further, these relatively cost-ineffective programs should be avoided:

• Non-specialized school feeding programs ($52–84/child/year) instead of micronutrient powder provision ($2.92/child/year) that can have comparable outcomes (Bundy et al., 2017, pp. 156–158)
• Unrestricted funding to GAVI (Karnofsky, 2013) if this is invested in human papillomavirus (HPV) vaccination programs ($4,500–8,890/DALY) (Bundy et al., 2017, p. 358)

More cost-effective interventions in similar areas include:

1. and 5. Treatment of severe malaria with artesunate where that is cost-effective ($6–8/DALY) (Black et al., 2016, pp. 322–323; Holmes et al., 2017, p. 21)

2. Loans for pellet stoves (providing free clean fuel for poor households in India costs $25/DALY (Mock et al., 2017, pp. 14, 136); loans for cleaner-burning stoves can have greater DALY cost-effectiveness)

4. Chemoprevention of other neglected tropical diseases (NTDs), such as onchocerciasis ($3–15/DALY) but not lymphatic filariasis ($4–30/DALY) which is funded by GlaxoSmithKline (GSK) (GSK Announces £1 Billion, 2022), unless the distribution of lymphatic filariasis drugs is bottlenecking the effectiveness of the GSK's drugs provision commitment

Individual volumes notes

1: Essential Surgery

Investment

• Task-sharing consultancy for appendicitis, obstetrics, and hernia repair (~$202–402/death averted) (pp. 343–345)
  • Neighboring country skills sharing seems possible due to large mortality rate differences. Local consultancy capacity was not specified
  • Other operations, including hydrocelectomy (p. 164), hydrocephalus (p. 140), obstetric fistula (p. 101), and cleft lip and palate repair (p. 324) could be task-shared if the marginal per DALY cost of consulting these units is comparable to the total per DALY cost of the initial consultancies
• First-level hospitals ($11–223/DALY) (p. 222) and emergency obstetrics ($9.2–15/DALY) (pp. 84, 322)
  • Including in conflict and post-conflict settings where other care is limited and prices low
• Cesarean delivery repayment schemes in Oman (profitable) (p. 374)
  • Benefit-cost ratio was 75.7, so customers could be able to repay. Profits could finance other programs
• Operation Smile partnership (surgery: $9–108/DALY) (p. 324)
  • Inclusion of an OPP link on this widely advertised charity materials can grow the longtermism community

2: Reproductive, Maternal, Newborn, and Child Health

Investment

• Pneumococcus ($1–20/death averted) and rotavirus ($20–40/death averted) vaccines (pp. 15, 323)
  • In especially neglected settings (such as conflict zones) since elsewhere could be covered, or increased uptake (such as community leaders endorsement)
• Treatment of severe malaria with artesunate ($90–200/death averted or $8/DALY) (pp. 15, 323)
  • Including rather than quinine; where not yet covered
• FGM prevention programs in countries with >80% rates (p. 42)
  • FGM can cause obstetric conditions including fistulas and can reflect and reinforce decreased subjective wellbeing of females and males
• Integrated community case management algorithm sheets to community health workers (p. 152)
  • Facilitates task-sharing in all areas of healthcare and thus increases the resource-effectiveness of the healthcare system
• Prophylactic zinc addition to ORS ($10–50/DALY) (pp. 177, 324)
  • Existing ORS programs that distribute packets should add zinc
• Info on locally-available play materials and activities variety (p. 243)
  • Most effective in early childhood development, which significantly influences the child’s developmental potential
• Continue vitamin A supplementation ($4–9/DALY) (p. 277)
  • Unless other actors can cover the need
• Community-based distribution of misoprostol where cost-effective ($9–200/DALY) (p. 277)
  • Where postpartum hemorrhage risk is high and prices can be low and other care limited, such as conflict-affected areas of Somalia
• Improved compliance with clinical standards (return–$0.5/DALY) (p. 294)
  • Use existing government and healthcare network connections to distribute useful material
• Info on handwashing with soap, ORS, breastfeeding, clean postnatal practices, and hygienic child stool disposal (total of 529,000 deaths averted per year) (p. 10)
  • Cost-effective well-received info sharing, such as share-with-5 WhatsApp messages or community leaders on radio (especially if airtime is provided for free)

Divestment

• Divest from insecticide treated bednet programs ($20–150/DALY) (p. 277) unless all more cost-effective programs are fully funded
  • For example, if pneumococcus and rotavirus vaccine and artesunate for severe malaria at the above cost-effectiveness are not fully funded
• Avoid maternal and child health programs in India if these are funded by development banks (p. 310)
  • Social return on investment in India is 15–53 so these programs could be funded by development banks
  • Possibly, increasing the demand for these programs could be complementary to the banks’ programs, if these are focused on infrastructure development but not demand

3: Cancer

Investment

• School programs that build habits that reduce cancer risk (p. 9)
• Education on tobacco hazards (p. 9)
• Healthy diets promotion in the Arab Peninsula and former Soviet republics (pp. 30, 37)
• Reduced alcohol consumption in South Asia (pp. 30, 37)
• Persistent infections in sub-Saharan Africa and China programs (p. 36)
• Hepatitis, tobacco, and alcohol prevention awareness in West Africa and Mongolia (p. 30)
• Smokeless tobacco and harmful and safe alternatives awareness in India and safe alternatives producer support (p. 89)
  • “More than 50 percent of oral cancers in India … are attributable to smokeless tobacco … [harmful betel quid substitutes] often claiming to be safer products, have become … increasingly used by young people, particularly in India”
• Reducing aflatoxin exposure (pp. 153–157)
  • Improved storage, maize liming, risk information, HBV patients and high aflatoxin risk areas targeting, fungus-resistant strains and fungicide marketing
• Raw fish consumption risks education in high prevalence areas (p. 157)
• Hepatitis B virus (HBV) vaccination, priority in endemic countries (≥$13.22/QALY) (pp. 158, 30)
  • Hepatitis B prevalence and liver cancer caused by longer-term infections is the highest in West Africa and Mongolia
• Tobacco taxation in LMICs (income gain–$195/DALY averted) (p. 187)
  • Especially in countries with rising middle class, such as BRICS nations
• Tobacco advertisement (p. 185) critique with healthier alternatives introduction
  • $9 billion is spent on advertisement and promotion in the US annually – shifting this to healthier products can have high impact
• Non-harmful cigarette and e-cigarette (p. 186) alternatives for teenagers with marketing that makes tobacco products uncool
  • Such as sugar-free herbal skill bubble gum
• Shifting global cancer funding from relatively cost-ineffective to 1,000× more cost-effective programs, including prevention

Divestment

• Divest from South Asian Air Quality if (DALY) unit pollution decrease by clean stoves is more cost-effective (p. 38)
  • “[H]ousehold air pollution may account for about 2.4 percent [in LMICs] …  3.6 percent of cancer deaths in LMICs are attributed to ambient air pollution”

4: Mental, Neurological, and Substance Use Disorders

Investment

• Mental disorders and substance use prevention programs and skills and psychosocial interventions for primary school children (pp. 31, 115)
• Limiting surrogate alcohol (p. 127) use
  • Surrogate alcohol is “nonbeverage alcohol not officially intended for human consumption”
  • Its use may be limited most cost-effectively by mandating very bad taste flavors
• Improve parental care, reduce exposure to trauma, improve group social skills, and decrease early or unwanted pregnancy rates (pp. 148, 156)
  • These comprise risk factors for mental and developmental disorders
• Provide existing mental health and social skills resources to educators and mandate universal coverage (pp. 149–150, 190)
  • “Manuals … enabled non-mental health professionals in areas with limited resources to deliver the [mental health] interventions … ‘The Incredible Years’ (The Incredible Years, n.d.) … children’s mental health program led to significant reductions in conduct problems … and increased friendship skills,” both with relatively large effect sizes
  • “[social and emotional learning] interventions are considered as best-practice interventions for LMICs”
• Voluntary sector child mental health services program evaluation research support in high marginality countries (p. 150)
  • “In some countries, the voluntary sector provides the bulk of child mental health services. However, the evidence base for such interventions is poor, largely because of the absence of research support for program evaluation”
  • Local volunteer work could be highly cost-effective due to low cost and context-relevant emotional skills or cost-ineffective if volunteers make little or negative difference
  • Most impactful volunteers could be offered a stipend to reduce their alternative work commitments
• Scale up no-cost population-based alcohol control measures (p. 229)

Divestment

• Divestment from campaigns (p. 112) of Development Media International that would normalize (p. 110) alcohol use (example: (Angelin in the Doghouse, n.d.))
  • Illicit drug dependence risk factors include “social norms that are tolerant of alcohol and other drug use”
  • “Mass media campaigns [can have] negative and others positive impacts on drug attitudes and use”

5: Cardiovascular, Respiratory, and Related Disorders

Investment

• Tobacco taxation, labeling and advertisement regulation, cessation therapy, and mass media programs (p. 5)
• Optimal nutrition education (pp. 104, 111, 119–120, 130)
  • “Suboptimal diet is the single-largest risk factor for poor health globally”
  • “The prevalence of obesity correlates positively with the initial stages of economic growth and development, as populations of rapidly developing LMICs undergo nutritional and lifestyle transitions while having little access to health services and education”
  • “Some demographics consider being underweight to be the epitome of beauty”
  • Fiscal measures to prevent obesity are cost-saving in all listed countries (p. 130)
• Unhealthy food marketing regulation and its analysis and nutritionally adequate meals with explanations in schools [type of a school feeding program] (p. 125)
• Physical activity promotion (p. 93)
  • “[B]etween 3 percent and 6 percent of national health care costs are attributable to physical inactivity.” Thus, government promotion of healthy exercise can be cost-saving.
• Salt content regulation ($2.60–3.74/DALY) (pp. 5, 110)
• Trans fatty acid bans and sugar-sweetened beverages taxation (p. 5)
• Aspirin and beta-blockers for acute management of ischemic heart disease ($11–22/DALY averted) (p. 12, 141)
• Prevent fetal undernutrition and overnutrition (p. 39)
  • Including by nutrition supplementation for undernourished pregnant women (especially in South Asia where average child birth weight is low) or risk awareness programs
• Child obesity prevention programs for ages 6–12 (pp. 44–45)
  • In LMICs, where costs should be lower and about ¾ of overweight under age five children are: “[I]n India and many LMICs, there is a general misconception that an obese child is a healthy child
• Stress reduction in rapidly urbanizing LMICs (p. 120)
  • Such as occupational demands management training and social support promotion
• Screening for hypertension and cholesterol in areas where treatment is affordable ($4/QALY) (p. 397)

6: Major Infectious Diseases

Investment

• Voluntary male circumcision ($1–10/DALY) (p. 21)
• Treating severe malaria with artesunate ($6/DALY) (p. 21)
  • This was identified by volume 2 at $8/DALY (p. 323)
• Preventive chemotherapy for onchocerciasis ($3–15/DALY) (p. 21)
• Adding syphilis screen to HIV screen and syphilis treatment ($9–10/DALY) (p. 21)
• Preventive chemotherapy for lymphatic filariasis ($4–30/DALY) (p. 21)
• Treating smear positive tuberculosis with first-line drugs ($8–40/DALY) (p. 21)
• Detecting and treating visceral leishmaniasis ($15–20/DALY) (p. 21)
• RPR prevention of mother to child transmission of syphilis screen and treatment with penicillin in high-prevalence areas (cost-saving) and switching ICS screen where that is more cost-effective than RPR (p. 128)
• Relatively new tuberculosis drugs (can be cost-saving) (p. 286)
• Investigate the cost-effectiveness of malaria elimination by eliminating mosquitoes (p. 332) considering impact on human and mosquito generations
  • “Costs for [malaria-carrying mosquitoes] elimination have varied but have generally been low” (332)
  • Include insect welfare metrics and r-selected species’ experiences
• Voluntary counseling and testing for HIV ($2.75–1,900/DALY) (pp. 71–74) in low-cost areas

Divestment

• Supplying ITNs for malaria ($90–100/DALY) (p. 21)
  • Volume 2 mentions a range of $20–150/DALY (vol. 2, p. 277)
• Preventive chemotherapy for schistosomiasis and soil-transmitted helminthiases ($70–105/DALY) (p. 21)
  • Instead of into the popular deworming (2019 Nobel Laureate Michael Kremer Emphasizes WASH and Deworming Benefits, 2021; Alexander, 2012; Fiennes, 2015; Sean, 2016) invest into the chemoprevention of more neglected NTDs, such as onchocerciasis ($3–15/DALY) and lymphatic filariasis ($4–30/DALY) (but GSK recently announced its commitment to eradicating lymphatic filariasis (GSK Announces £1 Billion, 2022))

7: Injury Prevention and Environmental Health

Investment

• Speed bumps at high-risk junctions ($12/DALY) (p. 11)
• Swimming lessons for children ($27/DALY) (pp. 11, 65, 201)
• Clean fuel for poor households in India (public-private subsidy) ($825/death averted ($25/DALY) impact for up to 44,000 individuals) (pp. 14, 136)
  • Such as three-stone stove replacement with a pellet stove: “Pellet stove has the lowest particulate matter with an aerodynamic diameter of less than 2.5 micrometers (about 0.1), while three-stone stove the highest (3.25–7.5)”
• Parental education on hazardous substances to prevent poisoning (p. 16)
• High-risk families parental support to prevent violence (p. 16)
• School-based social skills and gender norms programs (p. 16)
• Corporal punishment bans (p. 16)
  • Enforced/reportable in schools and with a fine range from zero to a relatively large proportion of a parent’s (or household’s, if parent has no income) income where any reporting is not fined but used as a learning opportunity for the entire community while alternatives are offered (e. g. via a WhatsApp video)
• Mitigating drinkers’ abuse and harmful alcohol use programs (p. 16)
  • Such as low-disturbance and low-violence fair drinking games with the norm of showcasing good time with friends
• Engineering controls to decrease release of silica and other toxins (p. 16)
  • Such as using respirators or wet methods to reduce dust (Choosing and Implementing Control Measures for Silica Dust, n.d.)
• Safe injection devices, such as blunt-tip suture needle (p. 16), acquisition where marginal cost is minimal
• Informal sector OSH (p. 16) regulation, especially dusting payments (p. 17)
• Formal sector OSH, emissions regulation, asbestos and mercury bans (p. 17)
  • Such as dust and SO₂ and NO₂ emissions control
  • Asbestos and mercury bans with offering alternatives and an achievable phase-out timeline
• Trash burning and new kerosene devices bans (p. 17)
  • With fines relatively low as a proportion of one’s income but enforceable anytime someone reports trash burning
• Community street dust cleaning (p. 17) schedule
  • With a possibility to pay a professional cleaner
• Senior skilled staff training for hazardous tasks and effective use of available personal protective equipment (p. 16)
  • For example, encouragement by an entertaining radio/TV show
• Marketing-competitive less-alcoholic but tastier and cheaper liquor plastic (p. 16) sachets
  • That is marketed for aggressive people as showcasing ‘being smart and drinking big’ with friends where any fighting is a safety-first imitation that engages one in navigating dynamics among close ones
• Coal and diesel alternatives investment (p. 17)
  • To make subsidies to these sectors more long-term profitable than coal subsidies
  • Possibly, interpreting international law that prohibits subsidies as having a health (I. (b)) (Article XX General Exceptions, 1994) exception for clean technologies
• Monitoring and reducing arsenic in water (p. 17)
• Developing and sharing a public resource on hazardous sites locations (p. 17)
• EU fuel standards (p. 17)
• Occupational health training (p. 29) videos database
  • “[Occupational health in LMICs] knowledge is limited; regulations are either nonexistent or unenforceable because of lack of trained personnel; and the research community has focused on more salient health issues, such as infectious diseases”
• Abuse and neglect prevention parental care programs (p. 74)
  • “[W]orldwide, 11 percent to 22 percent of girls and 4 percent to 19 percent of boys have experienced child sexual abuse, 14 percent to 55 percent have experienced child physical abuse, 12 percent to 22 percent have experienced physical neglect, and 13 percent to 25 percent have experienced emotional neglect”
• Violence reduction programs can be sold to governments with large proportions of violence-related GDP spending (pp. 78–80)
  • In El Salvador, violence-associated costs are 24.9% of GDP, in Colombia 24.7%, and in Morocco 22.0%

Divestment

• Treatment of severe malaria ($5–$220/DALY) (p. 14) at the upper end of the range

8: Child and Adolescent Health and Development

Investment

• Condom use promotion in Madagascar, DRC, and India (p. 64)
  • Condom use rates are in Madagascar (below 10%), DRC (10–20%), and India (20–30%)
  • Such as by profitable marketing
• No-cost contraception methods information in the Sahel region and sub-Saharan Africa (p. 64)
  • Such as traditional and fertility sign methods (vol. 1, p. 117)
  • The highest percentage of married females ages 15–24 with unmet contraception need is in the Sahel Region and sub-Saharan Africa (about 25%) (p. 64)
• Teen family planning option awareness in West and Central Africa (p. 64)
  • 30% of West African and 20% of Central African females gave birth by 18
  • Option rather than expectation; can be joined with parental responsibility program (if a teenage female or male wants to have children and these would be well taken care of, that is great)
• Smoking prevention programs for pre-teens in high prevalence and increase countries (pp. 65–66)
  • Smoking prevalence for ages 10–24 is highest in the former Soviet republics and Papua New Guinea (more than 20%) and increasing the most (more than 2% per year) in Egypt, Saudi Arabia, and Mongolia (p. 65–66)
• Binge drinking prevention for 14-year-olds in highest increase countries (p. 67)
  • The highest increase in binge drinking for ages 15–24 is in Egypt, Mauritania, Nigeria, Angola, Botswana, Cambodia, and Vietnam
• Show peer adolescent groups the value of performing a task (p. 110)
• Engage adolescents in impactful and innovative problem solving (pp. 110–111)
  • “[A]dolescents [can] respond in novel and adaptive ways. Thus, specific learning or training experiences during adolescence may guide the final connectivity patterns in some of these long-range cognitive control networks”
• Attachment bond brain and behavior development information for primary caregivers (p. 125)
  • “[If the] attachment bond between children and significant others— mothers, fathers, or primary caregivers—is disrupted [that is] extremely detrimental for brain and behavior development” (p. 125)
• Self-regulation course scale-up in LMICs (pp. 127–128)
• Health-related social media ads for adolescents targeted to their interests (p. 300)
  • “Media and social marketing have the potential to target the health-related attitudes and values of adolescents as well as those of their families and the broader community. … Social media and marketing have greater capacity than traditional media to target actions according to adolescents’ interests.”
• Tetanus toxoid vaccine ($3.61/DALY) (p. 358)
• Sliding scheme for HPV vaccination to save funding for other vaccines, such as tetanus toxoid (pp. 358, 205)
• Education loans promotion (p. 424)
  • Due to returns on education
• Encouraging divestment from relative cost-ineffective interventions on pp. 150–151 instead of the cost-effective ones on p. 149, until these are fully funded

Divestment

• Avoid non-specialized school feeding programs ($52–84/child/year) instead of micronutrient powder provision ($2.92/child/year) that has comparable outcomes (pp. 156–158)
  • Micronutrient powder can have comparable outcomes on height, weight, and micronutrient status as in-school meals
• Avoid GAVI’s HPV vaccination programs ($4,500–8,890/DALY) (p. 358)

9: Improving Health and Reducing Poverty

Investment

• Cost-effective components of health packages otherwise covered by the Gates Foundation (p. 13)
• Cost-saving regulations that address intersectoral priorities: WASH, tobacco, drugs, air pollution, OSH, physical activity, and diet (pp. 26–29)
• Target $1/DALY interventions, if these are still available: blood pressure management (UMICs), polypill for high absolute risk CVD (UMICs), female condoms to sex workers in South Africa, and angiotensin converting enzyme (ACE) inhibitor for heart failure (p. 149)
• Detecting and treating human African trypanosomiasis ($20/DALY) (p. 149)
• Sugar-sweetened beverages taxation in India (tax income and $27.3 million annual health expenditure decrease) (p. 366)
• More accurate competitively-priced tuberculosis diagnostics in India (5.4 million years of life gained and $105 million private health expenditure saved per one million sputum smear tests replaced annually) (p. 367)

Divestment

• Infectious diseases if these are or would be fully covered by the Gates Foundation and other funders (p. x)

Conclusion

A variety of cost-effective global health and development opportunities is available. Open Philanthropy should consider funding a few organizations that cover the majority of the easiest-achievable health outcomes at low marginal cost. The DALY cost-effectiveness of global health grants can be estimated with the DCP3 collection.

Appendix

Appendix 1: DCP3 volumes notes

My notes include the collection quotes which I noticed and some of my reactions. Thus, these notes can show my biases.

References

2019 Nobel laureate Michael Kremer emphasizes WASH and deworming benefits. (2021, October 6). https://www.who.int/news/item/06-10-2021-2019-nobel-laureate-michael-kremer-emphasizes-wash-and-deworming-benefits

Alexander. (2012, December 5). Revisiting the case for developmental effects of deworming. The GiveWell Blog. https://blog.givewell.org/2012/12/05/revisiting-the-case-for-developmental-effects-of-deworming/

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Black, R., Laxminarayan, R., Temmerman, M., & Walker, N. (2016). Disease Control Priorities, Third Edition: Volume 2. Reproductive, Maternal, Newborn, and Child Health. World Bank. https://doi.org/10.1596/978-1-4648-0348-2

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