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NickLaing

CEO and Co-Founder @ OneDay Health
11011 karmaJoined Working (6-15 years)Gulu, Ugandaonedayhealth.org

Bio

Participation
1

I'm a doctor working towards the dream that every human will have access to high quality healthcare.  I'm a medic and director of OneDay Health, which has launched 53 simple but comprehensive nurse-led health centers in remote rural Ugandan Villages. A huge thanks to the EA Cambridge student community  in 2018 for helping me realise that I could do more good by focusing on providing healthcare in remote places.

How I can help others

Understanding the NGO industrial complex, and how aid really works (or doesn't) in Northern Uganda 
Global health knowledge
 

Comments
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NickLaing
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I really like this take on EA as an intellectual movement, and agree that EA could focus more on “the mission of making the transition to a post-AGI society go well.”

As important as intellectual progress is, I don’t think it defines EA as a movement. The EA movement is not (and should not be) dependent on continuous intellectual advancement and breakthrough for success. When I look at your 3 categories for the “future” of EA, they seem to refer more to our relevance as thought leaders, rather than what we actually achieve in the world. Not everything needs to be intellectually cutting edge to be doing-lots-of-good. I agree that EA might be somewhat “intellectually adrift”, and yes the forum could be more vibrant, but I don’t think these are the only metric for EA success or progress - and maybe not even the most important.

Intellectual progress moves in waves and spikes - times of excitement and rapid progress, then lulls. EA made exciting leaps over 15 years in the thought worlds of development, ETG, animal welfare, AI and biorisk. Your post-AGI ideas could herald a new spike which would be great. My positive spin is that in the meantime, EAs are “doing” large scale good in many areas, often without quite the peaks and troughs of intellectual progress.

My response to your “EA as a legacy movement set to fade away;” would be that only so far as legacy depends on intellectual progress. Which it does, but also depends on how your output machine is cranking. I don't think we have stalled to the degree your article seems to make out. On the “doer” front I think EA is progressing OK, and it could be misleading/disheartening to leave that out of the picture. 



 
Here’s a scattergun of examples which came to mind where I think the EA/EA adjacent doing machine is cranking pretty well in both real world progress and the public sphere over the past year or two. They probably aren't even the most important.

1. Rutger Bregman going viral with “The school for Moral ambition” launch
2. Lewis Bollard’s Dwarkesh podcast, Ted talk and public fundraising.
3. Anthropic at the frontier of AI building and public sphere, with ongoing EA influence
4. The shrimp Daily show thing…
5. GiveWell raised $310 million dollars last year NOT from OpenPhil, the most ever. 
6.  Impressive progress on reducing factory farming
7. 80,000 hours AI video reaching 7 million views
8. Lead stuff
9.  CE incubated charities gaining increasing prominence and funding outside of EA, with many sporting multi-million dollar budgets and producing huge impact
10. Everyone should have a number 10....

Yes we need to looking for the next big cause areas and intellectual leaps forward, while we also need thousands of people committed to doing good in areas they have already invested, in behind this. There will often be years of lagtime between ideas and doers implementing them. And building takes time. Most of the biggest NGOs in the world are over 50 years old. Even Open AI in a fast-moving field was founded 10 years ago. Once people have built career capital in AI/Animal welfare/ETG or whatever, I think we should be cautious about encouraging those people on to the next thing too quickly, lest we give up hard fought leverage and progress. In saying that, your new cause areas might be a relatively easy pivot especially for philosophers/AI practitioners.

I appreciate your comment “Are you saying that EA should just become an intellectual club? What about building things!” Definitely not - let’s build, too!” 

But I think building/doing is more important than a short comment as we assess EA progress.

I agree with your overall framing and I know you can’t be too balanced or have too many caveats in a short post, but I think as well as considering the intellectual frontier we should keep “how are our doers doing” front and center in any assessment of the general progress/decline of EA.

I agree with this comment in general, and think $100 would be a relatively small amount. For both EV and PR reasons though, I would think $1000ish would be reasonable.

If we were looking for PR firms to compete for a logo or a brand or similar then 10k might make sense, or even more. But the competition is labeled as a "Meme" prize which signals to me at least rougher, lower effort work with less longevity and sticking power than a fun and thought-provoking meme.

I really doubt a competition with any prize pool has more than a 5% chance of producing a meme with close to the strength of p(doom) or 1984, but am happy to be pointed to examples which might show otherwise.

Thanks for the wonderful insight. I'm 38 and have lived with my wife for the last 12 years in the EA hub of Northern Uganda. Although yes it's the perfect place to deeply understand and work on solving tricky development issues (come live with us!), I'll admit there are a few reasons why people might not want to move here permanently, including most you listed ;).

Although our experience has been that if you live somewhere long enough, the place can become home and then you get some of the best of both worlds....

yep potential change of PR disaster was my first thought here. 500 dollars or even 1000 would be safe on the PR front i think, and i doubt there is much to be gained in the quality meme to front between offering 1k or 10k

Oh sorry - yeah that was my laziness I didn't even read your explanation properly. I'm used to the "risky bet" terminology in global health. And yes I understand your narrative framing better now.

People interested in global health will benefit from subscribing to  @David Nash's amazing monthly Roundup of the best writing on global development. He has an uncanny knack of selecting quality stuff, and I always find an interesting article I wouldn't have seen otherwise. 

He also does a great job of breaking the topics up so we can focus on our own area of interest (aid/growth/governance/trade/health/education etc.)

https://gdea.substack.com/subscribe

My only criticism might be that there's a slightly disproportionate focus on economic growth, but hey we've all got our hobby horses ;)

Completely unsolicited plug BTW. Even when I did meet up with David in person he didn't even pay for my coffee ;)

This comment surprised me "Advocacy is riskier than the average grant". 

Yes, it might be riskier than the average GHD or Animal welfare grant, but I would have guessed that advocacy would be less risky than than technical AI safety grants. You've illustrated some ways that advocacy may have caused real world changes. I doubt many technical AI safety can concretely point to a way that they may have made the world even a little safer from AI. 

Is MIRI now not largely an advocacy organisation as well now, emerging from previous technical work?

Strong upvote great job (unusual for me for an AI safety post ha). I think within very specific domains like this, there's no reason at all why you can't do cost-effectiveness comparisons for AI safety. I would loosely estimate this to have similarish validity to many global health comparisons.

I love rational animations and show my friends their videos in groups - very subjectively I think you might have underrated their quality adjuster. But still I'm gobsmacked they have spent over 4 million dollars. If 80k can continue to produce videos even 1/10th as good as their first one for 100k though (about the same cost as each rational animations video), I would probably rather put my money there. 

I also think 12x quality adjustment might be a bit of an overshoot for Robert Miles. Subjectively adjusting each view on one channel as being over 10x the value of another is a pretty big call and I can imagine if I was another video producer I might squint a bit....

(Check @Lauren Gilbert's substack for further conversation on this thread)

Thank you for these wonderful stories @Lauren Gilbert. I love these brief bios, these conversations feel authentic and reflect the kinds of things I've heard from Ugandan immigrants before. I know stories like this probably shouldn't update me in favour of a program like this, but they have. 

Overall I do think the program is probably good, and possibly one of the best, but it does (along with high skilled immigration in general) have some of the highest potential downsides of any GHD intervention that remain largely unacknowledged, which irks me a little. I've harped on these 2  potentially large downsides a few times, and have yet to receive any response. 

1. The best country-builders leaving the country. "You know when you meet someone and you can just tell they’re a leader? That’s how I felt meeting Jasmine". Often the best and most enterprising people take the opportunites to leave. People that could have been country-changing business leaders, civil society leaders and politicians end up working an office job in Germany. There are potentially large down sides from pulling abroad even a few irreplacable potential country-builders.

Its debatable whether Malengo targets the "merely good, rather than the exceptional". About 7.7% of Ugandans complete high school and about 2/3 of these get the 2x principal passes needed for the program. I would guess Malengo would then selects above-average candidates, so perhaps the top 1-4% of Ugandans academically are selected for this program. Whether that percent counts as exceptional or not I'm not sure. I do like though that Malengo makes an effort not to select the best students. 

2. Remainer dissatisfaction could cause large scale reductions in wellbeing. Talking to West Africans I've felt a deep restlessness dissatisfaction when they know friends who have left and done better, while they still remain. In Nigeria it even has a name, "Japa" syndrome. Large numbers of people people spend much  time, money and energy trying to leave the country. When everyone is trying to leave, no-one is trying to build their country In Nigeria they call it "Japa" In Uganda , mass emigration is not yet a reality yet so this. If more programs like Mulago grow and immigration becomes more possible, a similar situation could happen in East Africa.

Because of no. 1 above, I'm a bigger fan of low/mid skilled immigration like the Malengo Kenyan nurse program, as remittances will likely be similar-ish and that downside disappears.

A few other points. 

1. It's impossible that these families of kids on this program were making only $42 a month on average as Malengo stated. How was this calculated? If they just asked the families they could have given this absurd number to increase their chances I suppose. For family income I would conservatively guess these families would average 5x-10x this. Unless their kids are sponsored, almost no-one in Uganda who sends kids to high school would earn only $42 Each year of high school in Uganda costs minimum $700 a year for one person. University is $1500+. Both your first and third case here managed/would have managed university- and that's just fees for one family member. 

Even most families in the poorest, most remote places where OneDay Health works earn more than $42 a month. The World Bank has revised their "extreme poverty" line to $90 a month. I doubt many (if any) of these families that have managed to send their kids to high school earn that little. Its not the biggest deal, but Malengo should probably fox this $42 number as its a long way from the truth.

2. I absolutely love that Malengo have embedded an RCT into this. I suspect the differences will be staggering between incomes and opportunities - there's no real reason to think otherwise. A small caveat is that Ugandan incomes are often extremely low 0-55 years after graduating university, then many can increase quite steeply after that (often 4x - 10x_ more than after university graduation). Many friends here worked for $60 a month after graduating then moved on to $600+ a month NGO/Government/Business jobs later. On the other hand German salaries will likely incrementally improve. Despite this there will still obviously be huge differences 5-10 years after graduation.

3. if the first cohort was 2021 then shouldn't some have graduated by now and be working?

This could well be true. Although When it comes to "cost-effectiveness" of income gains through directly for the beneficiary (Kremers point) the early gains will have a much bigger effect on well-being. There's decent evidence that each doubling of income seems to have a similar effect on well-being. So "Cost per doubling of income" might be more useful metric than Kremer's cost per extra dollar generated. These studies also assume that they are living in the same economy, obviously things cost a lot more in Germany so we wouldn't expect well-being increases to be as big as if that income increase has happened in Uganda 

https://forum.effectivealtruism.org/posts/coryFCkmcMKdJb7Pz/does-economic-growth-meaningfully-improve-well-being-a

So if they were going to earn 500 euros a month in Uganda and they now earn 4000 in Germany, that might be better seen as a direct 3x increase in wellbeing pointes rather than 8x income.

Even on the doubling-income front the program might still look very good (haven't looked into it). And I'm not touching on the other potential  benefits (remittances), just responding directly to Kremers comment.

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