Mmm, good point. In the paragraph I was implicitly trying to talk about supporting material changes to the Gaza conflict specifically and the military occupation and forced settlements of Gaza and the West Bank broadly (i.e. not sending offensive military aid to Israel; as opposed to recognition of a Palestinian state represented by the PLO at the U.N.). In general my point was to highlight the tension between:

1. In the U.S., U.K., Australia, (and likely other countries I’m less familiar with), the two largest parties both support continuation of direct military support for Israel’s offensive capabilities (including via providing maintenance and support through the F-35 programme). Opposing this generally gets you directly removed from the party, or ostracised in a way that hurts people’s political careers (although, I’ll note this situation is changing rapidly as starvation kicks in).
2. There is plurality (U.S., 2024), and otherwise broad public support for directly ending or reducing military aid to Israel (U.K.) in Western countries.

(I might delete this post later if it derails the thread, I’m not sure how useful or constructive it is—please let me know!)

I think this inadvertently highlights why an ‘EA’ (utilitarian) framing might downplay the badness of the conflict. I think the badness falls into five buckets (opinions follow; and not claiming that you do or don’t agree with these):

1. The direct number of deaths and ongoing suffering is high.
2. The systematic bombing and killing of civilians, coupled with the eradicationist rhetoric of the Israeli government, almost certainly constitutes a genocide. A genocide carries a quality of horror and depravity to it that, in my opinion, multiplies the harm of the deaths. Even a pure utilitarian may be able to see that a genocide causes fear and suffering well beyond the time, place, and people it affects (for example, Jewish people continue to suffer from the harms of the Holocaust today).
3. Such a genocide being paid for and propped up by Western governments greatly erodes global security and trust (last year alone, the U.S. paid for $17B in military aid to Israel; Israel’s military budget was $47B). It was already difficult, and will get more difficult, for smaller countries to trust that the West will honour their commitments to security, or intervene if attacked by the wrong country (we are already seeing this with Lebanon and Syria). But worse, they can’t trust that the West will not even stay out of it!
4. Similarly, the massive public support for non-intervention in Western countries contradicts the stances of their governments. Every time a democracy fails to produce a democratic outcome, it bends a little. I think it’s safe to say we have seen (U.S. 2024) and will continue to see (U.K. 2029) the electoral consequences of a pattern of these outcomes (but not to pin these results specifically on Gaza).
5. Consequentially, every time the West has behaved like this with another country, they have experienced significant blowback. By its nature, it’s hard to predict what the blowback will be this time, but it’s reasonable to assume that restraining Iran’s nuclear capabilities will now be permanently harder.

Many policy-minded EAs seem directly invested in (3, 4, 5). So I think the issue is tractability, but to be clear, the Western governments paying for this war are the ones with the power to end it. It is telling that non-U.S. Western governments have supported Gaza around the same time as developments in tariff negotiations; it seems pretty clear that the benefits of U.S. trade have been used as a cudgel against trading partners (especially when, in the U.K., France, and Australia, their left-wing leaders have historically supported Palestine up until forming government). I doubt that relationship can be changed by a well-placed EA policy organisation. Nor do I suspect that the U.S.’ relationship with Israel could similarly be changed, as any Democrat or Republican who openly supports Palestine instantly becomes a pariah and loses much of their standing with the party even if all of their other policies are indistinguishable from FDR (see: Zohran, Ilhan Omar).

I’ve spoken to Concentric Policies about this, IIRC they also do a bit of work (less than tobacco) on alcohol

A few loose objections on tractability and neglectedness specifically, not very well thought out:

• Prohibition didn’t work in the U.S. and the U.S. now has similar rates of consumption to other countries (on the other hand, Islam is very effective at this)
• There’s a paradox where countries with high taxation on alcohol also have high consumption—but this might just be correlative
• Alcohol mostly seems to burden specific wealthier countries, so it probably isn’t cheap to focus on. These countries will already have large lobby groups on either side of the debate, and it would get political.
• Sweeping social taboos are unlikely to work when most people experience net positives, or the negative effects are hard to attribute. See veganism for an example here, and tobacco for a counterexample (many people experienced large, visible net harms).

I can see good arguments for policy work in neglected countries, and I like the work that Concentric Policies are doing here. But a broad social taboo in high income countries seems really, really hard.

Broadly, I think the argument might also be somewhat unnuanced. You could achieve similar effects on alcoholism with targeted policies, which makes it different from veganism and tobacco, where almost all incremental units of consumption cause harm.

(But again, super loose thoughts, open to critique on this)

Obviously Global Fund are gonna emphasise the importance of this, but this quote stood out:

For the first time, we have a tool that can fundamentally change the trajectory of the HIV epidemic — but only if we get it to the people who need it most

I don’t really have any knowledge on HIV, but my assumption is that if it’s cheap to deliver high volumes of 6-month protection, you can essentially end the spread of the virus, and if it can be widely funded and generically manufactured, we might be able to permanently end it within a generation. (Would be happy to stand corrected!)

The Global Fund and Gilead have announced that Lenacapavir, the new 6-month PrEP treatment for HIV, will be made available in 120 countries at no profit. Gilead originally agreed to license Lenacapavir, royalty-free, to local manufacturers, but have now also agreed to directly supply doses until those manufacturers reach capacity, likely for up to 2 million at-risk people. The Global Fund will direct resourcing and deliver doses.

Extremely good news, and a possible silver lining after potentially losing PEPFAR.

So for your criteria:

• Locals agree that it would be a good idea
• Can be done using local resources and expertise
• Not currently being done locally
• Not something that local governments should be doing instead

A broad class of interventions that fit this bill are entrepreneurial interventions. The goal would be to build local capacity temporarily in order to prove out the intervention in the eyes of the government (who will want to see local demand and effectiveness), and then hand it over to them. These can be locally informed or have local adaptations (satisfying (1) and (2)), but wouldn’t necessarily be currently done because they’re new ideas.

it seems that would imply that locals would do it or ask their governments to do it

I think this isn’t true for these kinds of interventions. It’s easy to imagine large gaps between ‘I think this would be a good idea’ and ‘I have the resources, funding, and willingness to do this myself’ or ‘My government will do this’. Governments in particular move slowly and often want proof that an intervention works locally before implementing it themselves.

Just on the second point—I do think it would be consistent with EA values and broadly good for EAs to normatively value government partnerships more highly. Mulago also talk a lot about finding a ‘doer at scale’, and are very excited about government in this regard.

I wonder if there are ways of evaluating the economic impact of strengthening local institutions vs trying to implement alone.

(Obviously, in many contexts, this is easier said than done—but I also see lots of EA charities operate in countries with capable governments that don’t consider government as the default long-term doer.)

(FWIW, if you pledge today, your pledger number will be in the 10,200s, as a number of pledgers have rescinded their pledge—so no fun status benefits 😛)

You might be surprised to learn that CEAs of mental health interventions in the EA space (example) don’t count the value of preventing suicide and self-harm. But on a DALY basis, self-harm and suicide have roughly the same burden in total as depression as a whole, precisely because they’re so much worse (this is to say nothing of effects on income).

I think that mental health interventions, and especially direct suicide counselling, might be really underrated, simply because the research hasn’t been done in a lot of depth (that I’m aware of). Part of this is because it’s quite hard to accurately quantify the effects of interventions on long-term suicide rates (you need many years, and access to death records). However, there are a few good studies that I think might point to ways this could at least be estimated, and then we can agree on an appropriate evidence discount.

The theory of change gets quite convoluted. For example, people may report feeling suicidal or having suicidal thoughts, but this may have no real correlation with their attempts. Or we may find that people who report feeling less suicidal commit suicide less often, but it may not be true that reducing their feelings of suicidality actually has any effect on their long-term attempt rate.

Here’s a good paper looking at 84,000 people’s PHQ-9 scores and follow-ups with suicidality. Unfortunately, the evidence isn’t causal, but this study looks at suicide prevention RCTs and finds that, at least, depression interventions reduce ideation, but not suicidality. I’ll be doing a bit more research in this area because I think it’s quite promising!