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Ahimza Thirunavukarasu

Confessions of a Giving What We Can member - how the pledge saves lives

Unlike most hobbies and pastimes picked up in my university years, Giving What We Can has become a bigger part of my life over time. I first learnt of the organization when, as a frustrated medical student, I was browsing the web looking for a forum or community which would empathise with how I felt about the world. Even though I was studying to be a doctor, I felt that there was so much more I could be doing with my time and money that could actually save lives.

Giving What We Can appealed to me as a pragmatic and genuine way to do this. The standards they set for both charities and individuals who are serious about making a difference in the world, could have a huge impact on how the future of aid and development looks. The ethical arguments behind these standards are compelling, and so by joining Giving What We Can and attempting to live by the moral principle of 'doing the most good', I feel more comfortable in my decision making.

In this post, I will address some questions that you might have about the reasons for taking the pledge, and the impact of doing so on your life.

Since taking the pledge over a year ago, I have not told many people about it. This is mostly because I don’t really like talking about myself, fear coming across as self-righteous, and bringing up charity during social conversation can be a pretty difficult thing to do.

However, putting my own issues aside, and in the spirit of getting more people thinking about these issues, I finally wrote a post about Giving What We Can on my personal blog a few months ago. This received a mixed response. I know a lot of my friends read it, but did not comment or broach the subject with me afterwards. Some asked me more about my giving habits but left it at that. The positive comments I did receive were from people who either already knew about Giving What We Can, or those who liked me enough to say nice things.

Spurred on by the confidence I’d earned from writing about it, I later managed to bring up the topic with a hospital Consultant I work with. Her reaction was of utter horror – that I was giving away money instead of saving it for my family and future. Even though I hadn’t prescribed my values to her, she became defensive, gave me her views on the nature of charity, and then listed off all of the voluntary work she does in her spare time.

This simply confirmed what I already knew about the inherent beliefs that make people back away from such a pledge. When presented with the vision and mission statement of Giving What We Can, it is difficult to disagree with the basic premises behind them. [Extreme poverty should be eliminated. Supporting charities that do this in the most effective way ensures a much greater impact. We should be seeking out effective charities, and encouraging others to follow suit.]

Where people shut down is when a 10% pledge is mentioned. How can this organisation be suggesting that we all part with 10% of our income – on top of the outgoing expenses already seeping away in rent, bills and tax? How is anyone supposed to save up for a mortgage, or have any kind of social life? And actually, on second thought (because this is the point at which people start having second thoughts), doesn’t using ‘evidence’ and trying to be ‘effective’ seem like a rather cold and calculated way of being charitable?

When personal finances come under threat, people often forget their beliefs about justice and equality. These knee-jerk responses may arise because we live in a society in which, knowingly or unknowingly, we measure our happiness, freedom and success based upon our financial freedom. We value having the choice of what to spend our money on, and how much we’ll spend; even if we know that we don’t necessarily make the wisest decisions in that process. Often, the decisions we make with respect to charitable giving are actually very poorly thought out, yet we never bear the consequences of those decisions and so still congratulate ourselves on the good we’ve done.

The money we spend can indicate something about what we value. If I buy a cappuccino for £2, I am stating that I place the value of the caffeine hit and foamy milk, and the absence of time cost of making my own coffee, as greater than £2. However, that is also the same cost of giving someone at risk of malaria a long-lasting insecticidal net, which could reduce that risk and contribute to an overall improvement of their life. Knowing this doesn't mean I always stop myself from buying non-essential items, but it does help put into context how little it can cost to make real impact. In the developed world, we don’t have to be heroes to save lives; we can in fact save lives in the developing world at a fairly low expense to ourselves.

The ugly truth that surfaces when we start thinking in these terms is that we place a greater value on our lifestyle than on other people’s lives. We can only do this because we happen to be on the right side of the poverty line, and hence seemingly exist in an entirely different world from those on the other side.

We sidestep this problem using some common excuses. For example, some people argue that foreign aid isn’t efficacious – which is a reasonable concern, but one that should lead one to investigate how to maximise effectiveness, rather than closing that door completely. As illustrated by Giving What We Can, there are plenty of options available.

Others argue that charity should begin at home; either by being generous with those in your circle, or by giving to local charities. Whilst it is understandable that emotional bonds might lead you to make certain value judgements, this does not mean you have no moral responsibility to the wider world. People often assume that they only have finite resources to spend on others; but in our personal lives, we can usually find extra time and money to spend on new family members, friends, or local charity initiatives. The fact that 

the potential impact of giving to charities in the developing world is far greater than when giving locally

 means that we should be expanding our circles to include those who need this generosity the most.

Thinking about effectiveness doesn’t need to be cold-hearted – in fact it takes a great deal more empathy to be caring about people on the other side of the world, who lead such different lives.

Many young people decide that it’s more sensible to save up as much money as possible in the early part of their careers when their income is probably at its lowest. They argue that it makes more sense to first invest in their own future and then give to charity later, when they will have a larger bank balance and the financial security to be able to do so.

Although this sounds reasonable, I believe that, for people who are genuinely interested in giving money to charity, it is not the best strategy. I’ve set out a few reasons below, but if you’re interested, 

 highlights more points from both sides of the argument pretty well.

you never know how your priorities will change

. You might decide to have children, or acquire responsibilities that require money to be set aside. As possibilities increase, giving to charity may no longer feature high up on your radar. Getting into the practice of giving to charity early on makes it easier to smoothly incorporate it into your routine, such that having a baby or a mortgage later on doesn't become another excuse not to give. It's perfectly possible to combine charity with these other commitments if it's made into enough of a priority.

an increase in earnings over time is usually accompanied by a more extravagant lifestyle and set of needs

. Society expects people to adapt to their salary so that there is always a need to continue striving for a higher pay. Although this is a pretty good way of motivating people to work harder, it means that the deadline to start giving to charity gets pushed further and further away. Setting proportionate charitable giving as a part of lifestyle early on, means that, alongside the motivation to earn more for oneself, there is an added motivation of earning to also give more.

being part of the movement whilst young can provide many opportunities for personal growth and improvement of skills

, I have met a variety of motivated, intelligent and hard-working people with a passion to make the world a better place. I agree wholeheartedly with entrepreneur Jim Rohn when he said, “You are the average of the five people you spend the most time with.”

I have made a resolution to try and attend more events organised by effective altruists, and take part in the debates and conversations that allow us all to grow and improve individually and collectively. I had the chance to attend the 

 conference on 28th-30th August 2015, where I met people from various disciplines who had become interested in ‘doing good’, and hence were using their backgrounds to contribute to a better future. Not only did I learn about the range of problems that the world faced (being a medic can be rather isolating), but I also learnt a bit more about how my own skills and ideas could fit into this.

The 10% suggestion is simply a target value for those who are serious about giving. If that seems too high, a more easily digestible 1% starting point is recommended. The idea is that once you start allocating a portion of your money to charity, you stop seeing it as a ‘big deal’, and slowly realise that it doesn’t eat away at your lifestyle nearly as much as you’d have expected it to.

If every month you were making a conscious decision to give away £300, this could seem like a pretty big sacrifice. Once you’ve made the pledge, on the other hand, you can set up your charitable donation to leave your account automatically, and continue to budget for a lifestyle that never included that portion of money. 

There’s less of a sense of giving your money away, and more of a sense of setting some aside for a cause larger than your own wants and desires.

Why 10%? It’s an amount that’s enough to require a certain degree of commitment, without being too difficult to achieve. Many Giving What We Can members pledge a higher percentage than this; or choose to always give anything they earn above a certain value.

Once you start giving, it becomes a good kind of addictive habit, and you are more likely to continue to give larger and larger amounts over your lifetime

 - another reason to start early. This is not only because through giving effectively, you learn how far the money can go, but also because the return on your own personal satisfaction usually leads to more motivation to keep on giving. Don’t underestimate the impact of charitable giving on one’s baseline amount of happiness – it’s been 

 to be a lot more powerful than spending on oneself.

By joining Giving What We Can and identifying yourself as part of a larger group, it is easier to maintain motivation to act in the way you believe you should.

 Whilst living in the expensive city of London, where it can sometimes feel like most people are striving towards a lifestyle they don’t yet have, I’ve found it a lot easier to stay committed to this idea by having the knowledge that over 1000 people throughout the world buy into it. Many are actively involved in ways others than donating; some are actively involved in 

the growth of the charity and its research

; many go into high-paying careers in order to contribute huge portions of their income, and others are spreading the word through 

This year, I set aside £6000 of my earnings to charity; about 20% of what I have received from my junior doctor salary. I can’t say that in this first year as a doctor, my presence has been enough to ‘save’ any lives, but I believe that my charity donations may well have.

By stating this fact, I am not attempting to show off – I feel that I can be doing a lot better – but rather showing that it can be done. 

I am not struggling financially as a result, and have added to my quality of life rather than detracted from it. It has also given me more sense of perspective on what matters.

 Rather than feeling guilty when I spend on myself or my family, I feel happier knowing that I have contributed to the lives of others as well.

Currently, Giving What We Can recommends global health charities, which they believe to be the most effective at improving lives. Many other types of charities are difficult to evaluate due to difficult follow-up, uncertain outcomes and very long term aims. This can seem problematic for people who feel very strongly about particular causes, such as climate change or female empowerment.

 (the top recommended charities by GWWC) as two of my main recipient charities, I also distribute my money to causes I have reason to believe are effective, but more difficult to evaluate due to the nature of their work.

For example, the neglect of psychiatric conditions as a global health priority despite 

 it causes means that this area needs a lot more attention – but cannot be treated simply with a pill or a bednet. Giving money to causes that aren’t as ‘direct’ at saving lives needn’t make my giving less effective – as long as I feel that I have sufficiently researched them and am confident about the possible gains that they might produce.

For people fortunate enough to be working in a well-paid job in the developed world, the principles of this movement are worth considering. Indeed, 

I believe that the biggest benefit of being part of Giving What We Can is the exposure to a refreshing way of thinking about the world

. To think about what your impact is every time you put £10 towards charity, rather than a pizza. To ask yourself what kind of world you want to live in, and how you’re going to contribute towards that. 

By a small shift in our perspectives regarding the value of our money, we can make a huge impact. Through this shift, we can galvanise other people, charities and global organizations to become leaner and more effective – making the value of one’s contribution much greater than the purely financial effect.

Larissa Hesketh-Rowe

Would you save two strangers or your partner? A review of 'Strangers Drowning'

It all started well. The writing style is very vivid, very intimate. It draws you in. You peer through the window into these people’s lives, they invite you in and you become friends. Together you share in their triumphs and their pain.

Strangers Drowning: Voyages to the Brink of Moral Extremity

 profiles a few extraordinary individuals living lives of extreme ethical commitment. We meet a family that founded a leper colony out in the wilderness in India, despite the risk to their children. We share in the hardships of a couple who adopt twenty children alongside two biological children because they keep finding young people in need. We follow a nurse on an incredible journey of hunger strikes and self-sacrifice to bring about change for her people and protect some of the most vulnerable women during conflicts in Central America. And we get to know people who donate large percentages of their money to the most worthwhile causes.

They push themselves to the brink of their own moral standards. For them, unlike for most of us, there is little discord between their own beliefs and their actions. They are in many ways “more free, because [they] can control [themselves], so [their] intentions aren’t frustrated by weaknesses [they’d] rather not have”.

Yet these people are not heroes. They are “do-gooders”. A term chosen deliberately for its provocative nature. “Ordinary” people do not like do-gooders, there is something provoking about them. 

Is it their holier-than-thou attitude? Is it our guilt at not doing more ourselves?

Heroes are for wartime, we learn. They are ordinary people doing extraordinary things because the situation calls for it. Those people we admire. We imagine we could be them, if disaster ever struck our neighbourhood.

For “do-gooders” it is always wartime.

These people go beyond your average “part-time, normal do-gooder - someone who has a worthy job, or volunteers at a charity, and returns to an ordinary family life in the evenings”. Their work is never done. The people they need to save include not just their family, their community or victims of a particular illness, but all victims of all suffering throughout our entire world.

Between these intimate stories of do-gooders Larissa weaves the history of our conception of do-gooders through developments in psychology, political theory and philosophy.

Why is society so suspicious of do-gooders? Looking at our cultural history suggests some answers. Misreadings of Darwin make only selfishness natural, and thus altruism a form of deviant behaviour. The need for consumerism within Capitalism sets as the norm the egotistical consumer. Even the sacrosanct nature we attribute to human frailty, the love within fiction for the flawed, complex hero battling her own imperfection can lead to an idealisation of the selfish.

It seems society is against our do-gooders. Somehow, they are not to be trusted.

Questions over whether they are truly doing the right thing, the moral thing, the human thing, are left hanging. Larissa seems purposefully quiet in her own book. She makes no argument, only carves a path through history and leads us to extraordinary - if disconcerting - people.

As we dig deeper into their lives our do-gooders’ stories stray into the darker realities of committing your entire existence to a higher calling.

Our caring parents of twenty-two children struggle with children with terminal conditions and are almost torn apart by tragedies under their roof. We find our nurse’s abusive past keeps her too long with a stifling husband and we hear “do-gooders” compared with codependents, interfering in problems and in countries they do not understand for their own moral satisfaction.

Our do-gooders are driven to work without sleep, without comforts and without friends. Many question their every action, feel alone in the world and drive themselves to despair.

The children of the founders of the leper colony survive, but what if they hadn’t? Would one twist of fate have converted them from local celebrities to cruel and terrible parents abandoning their parental duties and putting their children at risk?

This question is asked but never answered in the book. What judgement do we make of these people who seemingly put their own happiness and that of their nearest and dearest at risk for strangers? The reader is left to decide.

Would you save two strangers or your partner?

The title of the book ‘strangers drowning’ links with a question Larissa asks her subjects; would you save two strangers from drowning or your partner? How many strangers would outweigh the life of your partner?

Neither Larissa, nor her subjects, nor the book answers this question.

 in the Globe and Mail does give one answer:

“This dilemma is false. I do not have to choose between my mother and two strangers, and I will not.” Perhaps it’s about saying to the person setting the problem, “Hey, if you jump in with me, maybe we can save all three.”

Despite the inspiration I take from many of these stories, this is what makes me sad about Strangers Drowning: the book does not invite us to jump in and save all three. There is no call to action to changes any of the injustices we see. I feel endlessly beaten by the weight of suffering in the world and yet am not encouraged to fight back. I’ve always felt positive about the giving I do and that it makes a difference. In Stranger’s Drowning you either leave your wife to drown or you do nothing. The middle ground I and so many people I know occupy – who, together, make a huge difference in the world – are dismissed in one sentence at the beginning of the book as every day do-gooders and volunteers.

As I grew more frustrated with a societal narrative that seemed to discourage a truly ethical life and felt more and more sorry for the individuals Larissa profiled I raced towards the end of the book, reaching for the ultimate conclusion.

Would we be happier if we could all shake off this group narrative celebrating selfishness?

If we all took on some more of the burden perhaps the few would not need to drive themselves so far to pick up the slack of the rest of us?

Were we all to become “do-gooders” she states, then the world would be “so utterly different as to be nearly unimaginable.” Whether this would be a good thing or not is left hanging.

Yet without do-gooders “showing what a person can do for strangers if he sets himself to do it fewer would try”.

But with burdens and pasts that seem to make our do-gooders miserable, in a world suspicious of them, Strangers Drowning leaves little inspiration to try.

In Strangers Drowning there is no call for us to leap in and help save strangers from drowning. We are left entirely as we were. We are still “us”, the do-gooders are still “them”. With this divide still intact I am saddened to find we are free to continue our lives just as before.

Perhaps this is precisely why doing good seems like such a burden to many of our do-gooders.

The burden falls unequally on them alone while we are free to sit back. That’s too much weight for a few but if we each lifted a bit more each individual burden would be light.

I am fortunate to have many wonderful friends in the Effective Altruism movement with which to share the load and through which I was able to reach out to Julia Wise. She, along with her husband Jeff, is one of the do-gooders in Strangers Drowning. I asked her if this was really a true portrayal of what giving was like for her.

“It's funny for me now reading back on how things were at the time Larissa MacFarquhar began interviewing us in 2010. At the time I did feel that helping was a struggle, and that I didn't know other people who were really trying. Five years later I feel very differently! Seeing the growth of the effective altruism community, and having friendship and support from that community, has made a world of difference to me. Instead of feeling isolated and downtrodden, I feel invigorated by being part of a worldwide effort to change how we help others. I'm also glad Jeff and I did decide to have children, as I think it's easier to forge ahead whole-heartedly with our work in effective altruism when we feel satisfied that we have the important things in our personal lives.”

 about her experiences, and this feels like a reflection of what giving could be like if we all took on a little more.

We need more stories like Julia’s. Stories of people who do “save all three”, but not through great sacrifice nor unusual achievement but simply by living an ethical life that balances the needs of others with theirs.

We often seem to focus on the most extraordinarily effective givers. People like Bill Gates, Elon Musk or clever graduates who go on to be bankers earning six figures to give away most. Reading Strangers Drowning reinforced in my mind that the voice that is missing from these narratives is that of the ordinary person.

People who give their extra income to buy antimalarial bednets and try to eat less meat. People who run local groups to fundraise for top charities. People who volunteer on promising projects, speak to their MP or simply just try to encourage others.

These role models remind us that we - the ordinary “us” in Strangers Drowning - can also make important positive changes in the world, especially when we act together.

Larissa’s portrayal of the do-gooders moved me, yes. Julia’s story fills me with hope and inspires me to action. I will not leave two strangers, my partner or the do-gooders drowning.

Scott Weathers

Reaching for Greater Impact Through US Legislation

The United States Senate is currently considering 

, a bill that USAID argues could save the lives of 15 million children and 500,000 mothers – Effective Altruists should take note.

At its core, the Reach Act would create a Maternal and Child Health Survival Coordinator position at USAID, who would prioritize spending on the most cost-effective, evidence-based interventions. The Reach Act builds on 

, a report commissioned to identify the most high-impact interventions in maternal and child health.

 gives a benchmark for the impact scaling up maternal mortality interventions could have through 2020.

Raj Shah, the previous administrator at USAID, instituted a number of reforms that has allowed USAID to save more lives. This legislation is about codifying and institutionalizing those reforms through future administrations.

An important distinction that Effective Altruists will notice is that this legislation (at least in the short run) will save lives primarily by prioritizing the best interventions, rather than summoning up new resources for global health. This means that the true number of lives saved by the Reach Act will be the difference between the impact of the interventions USAID funded before and after the reforms are enacted.

USAID does not specify which interventions will be de-prioritized, possibly because this involves upsetting constituencies within USAID. It’s impossible to tell exactly how many lives this legislation could save because this number hinges on decisions that future Maternal and Child Survival Coordinators will make.

USAID’s priorities affect billions of dollars of aid every year.

However it is very clear that USAID’s intentions under Raj Shah align nearly perfectly with EA values. The interventions USAID has prioritized are highly cost-effective – vaccinations, micronutrient supplementation, breastfeeding, and other priority interventions 

 feature prominently in Acting on the Call. Under Raj Shah, USAID has made allocation decisions to prioritize funding within 24 focus countries that have 70% of global maternal and child deaths and scaled up evidence-based and cost-effective interventions.

Ultimately, the Reach Act will also elevate the profile of global health and create favorable conditions that could deliver more overall funding for cost-effective interventions. This will happen through 3 major reforms: the Reach Act will 1) create an inter-agency working group to produce a “whole of government” 10-year plan for ending maternal and child deaths by 2035, 2) obligate the White House to report to Congress on this plan, and 3) establish a public-private partnership to generate more financial resources.

In India, USAID’s focus on several interventions could save tens of thousands of lives.

It is also likely that USAID will be able to demonstrate much greater impact through Reach Act reforms, making the case for increased funding much easier. Together, these reforms would 

generate resources and create accountability mechanisms

 for political actors that are not currently using their power to improve global health as much as they could.

Effective Altruists bemoan the lack of opportunities to effectively do good in the world beyond cost-effective charitable giving. Let’s be clear: giving to GWWC-recommended charities represents the clearest and easiest way to improve the world for individuals in the developed world. But supporting the Reach Act offers the potential to improve millions of lives and refine US efforts to save lives in the developing world.

James Snowden

Explain like I'm five: Essential surgeries

This post is intended as a quick overview and primer on essential surgeries for those of us who care deeply about the relief of poverty in the developing world, but don’t actually know much about it.

Surgical interventions, until recently the “neglected stepchild” of public health, are getting increasing attention from public health professionals as new evidence emerges of their cost-effectiveness. While it may still be too early to say if there are any specific charities which are as cost effective as Giving What We Can’s recommendations, essential surgeries should definitely be on our collective radar.

Much of the information in this post comes from the 

Disease Control Priorities 3 (DCP3) report on essential surgeries

Essential surgeries, as defined in Disease Control Priorities 3, are 44 surgical procedures which have been selected because they:

Some examples of essential surgeries are caesarean births and cleft palate repair.

To the contrary, organ transplants (too expensive), and most cosmetic surgery (which does not address substantial need) count as non-essential surgeries.

Surgery is a ‘horizontal’ healthcare service provision, defined by the healthcare capabilities it requires rather than by the condition treated. Horizontal provisions tend to be provided by publicly funded health systems (i.e. government, not charity).

The required capabilities to perform surgery are:

Although surgery itself is a horizontal provision, many charitable interventions use a ‘vertical’ approach, treating particular conditions; either by sending surgical missions, or by employing/training local surgeons. Different types of essential surgery have different costs and benefits. Donors may therefore prefer to fund types of surgery which are particularly cost-effective. There may be significant benefits to both 

It is estimated that universal provision of essential surgical procedures would avert about 1.5 million deaths per annum. This represents 

6-7% of all avertable deaths in lower and middle-income countries

Much of the disease burden associated with essential surgery results in severe disability rather than death. For example, cataracts is a leading cause of blindness in the developing world but can be easily fixed with a simple surgery. 

The total avertable DALY burden for essential surgical procedures is 87 million.

Essential surgeries treat conditions across the spectrum of healthcare but most can be split into 5 categories.

The first three are generally treated at first-level hospitals (which have about 50-200 beds and basic surgical capabilities) and treatment is often urgent:

 C-sections and other birth-related surgeries

The remaining two categories generally have to be treated at specialised facilities but as they tend to be elective rather than urgent, patients can be scheduled efficiently, improving cost-effectiveness:

Essential surgeries can also be carried out by short-term surgical missions or on self-contained mobile platforms.

Much of the charitable contribution to treating essential surgeries is through running surgical missions to address these more 

Increasingly, essential surgery is viewed as cost effective.

Historically, surgery has been regarded by experts in public health as a luxury which only the relatively wealthy can afford. This is no longer the case. There is an increasing body of evidence which demonstrates that essential surgery is within the range of interventions which should be considered the most effective available. In some cases, the cost per DALY averted seems to be in a comparable range to interventions recommended by Giving What We Can.

Conditions requiring surgical treatment are an increasing proportion of the disease burden in developing countries.

DCP3 indicates a large part of the surgically treatable disease burden comes from injuries. As injuries, particularly road traffic accidents, increase in low income countries as an unfortunate consequence of development, there is a greater need to 

 conducted a review of studies on the cost-effectiveness of surgical interventions. This yielded 121 cost-effectiveness studies in seven categories of surgical intervention.

The most effective surgical interventions were:

Adult male circumcision (median of $14 per DALY)

With the exception of male circumcision (which reduces the risk of HIV infection), for which only three datapoints were available, and for which the estimates are probably most unreliable (because of the epidemiological factors), surgical interventions cost-effectiveness estimates could be more robust than those of horizontal health interventions. This is because when a patient comes into a hospital for surgery, there is low uncertainty about the cost of the hospital and the surgery, the associated disease burden, and the health outcome can be measured quite exactly. Nevertheless, these figures might be an overestimate of the true cost. But these estimates are in the same range of the cost effective interventions for infectious diseases:

Blog

Confessions of a Giving What We Can member - how the pledge saves lives

Would you save two strangers or your partner? A review of 'Strangers Drowning'

Reaching for Greater Impact Through US Legislation

Explain like I'm five: Essential surgeries

A Statement from Giving What We Can

The scourge of women's health you've never heard of

Why I choose to give now

Action on the refugee crisis and action on global poverty: thoughts, facts and ways to do good better.

Should we give to SCI or fund research into schistosomiasis?

Giving What We Can is Hiring! Director of Growth.