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Caleb Ontiveros

Peter Singer's The Most Good You Can Do

, is now out in both the US and the UK. Visit the website for the book 

 and take part in the giving game to decide which effective charities the profits from selling the book get donated to - and encourage your friends to do the same - 

 presents the following case: suppose you can choose to visit an art museum. On one option, you will see the museum and visit an enticing new wing while on the other option you will see the museum without visiting the new wing. However, there is an evil demon that despises the new wing and so inflicts fifteen years of blindness on one random person out of every hundred people who visit the new wing. Would you visit the new wing? Definitely not!

If you wouldn’t then you are suggesting that the harm of fifteen years of blindness outweighs the benefit of one hundred people visiting the new wing. Now suppose you can make a donation to a museum that will allow one hundred people to see a new wing or donate to a charity that prevents fifteen years of blindness—which should you donate to?

These questions are of central importance to effective altruists. Effective altruism is a philosophy and social movement which applies evidence and reason to working out the most effective ways to improve the world. Singer’s book 

 serves as a fine introduction to the emerging movement. The book is divided into four sections: the first defines and offers a backdrop for effective altruism, the second considers how to do the most good, the third focuses motivation and justification, and the fourth discusses choosing causes and organizations.

Aiming to do the most good, many effective altruists live fairly modestly and give the rest of their income to effective charities. One may 

, that is, attempt to make a very high income in order to give that income away. For example, by 

 one can save hundreds of lives. Others may 

 that others give and effectively make the world a better place. Promoting or working for groups like Giving What We Can, or even making an effective altruism meet-up could be a fantastic way to spread effective altruist ideas, and so make the world a better place through advocacy. Similarly, one may 

 causes or organizations in order to assess how effective they may be. Other promising routes include working as a 

, directing funds to the most effective projects, or starting an effective organization.

One of the best aspects of the book is that Singer focuses on actual people who carry out these strategies. 

These goals are not unattainable nor do they demand burdensome sacrifices

. Nonetheless, one may worry that behaving as an effective altruist is too much of a sacrifice. Happily, however, 

effective altruists take joy in their altruistic projects

 and find doing good, as do most people, sincerely rewarding and meaningful. As Singer states, “We can regard people as altruists because of the kind of interests they have rather than because they are sacrificing their interests” (103).

Why should one be an effective altruist? Many altruists see it as a moral matter: we can give to others, without damaging our own lives in the process, in order to save lives—shouldn’t we do this? And 

shouldn’t we save as many lives and prevent as much suffering as we can

? Singer and many others have, and continue to, persuasively argue that the answer to both questions is yes. But there are other reasons to be an effective altruist: as mentioned, most people find that doing good promotes meaning and happiness in their lives and others. This is illustrated by the altruists who “walk cheerfully over the world.”

But, if we are to give, where should we give to? What causes or organizations do the most good? Can we make judgements about what charities do more good than others? The initial case involving the new wing of a museum suggests that we can. We can compare the good of donating to a museum or to a charity which prevents blindness.

There will, however, be less clear cases. Effective altruists tend to be concerned about global poverty and health, animal welfare, and existential risk. They want to decrease the suffering of human and nonhuman animals as well as prevent the extinction of sentient life. There is much debate between effective altruists about which of these causes are the most important—where can we do the most good? Singer provides an excellent introduction to the nuances of this debate, though people who are familiar with and active within the community will find little new here.

Those who are not familiar with effective altruism will benefit greatly from this book. It is exceptionally lucid, engaging, and careful. Singer helpfully addresses some of the most prevalent concerns people tend to have about effective altruism and persuasively argues why it is such an important movement. I would encourage anyone who is unfamiliar with or who would like to know more about effective altruism to read this book. Similarly, those who want to peak others interest in effective altruism would do well to recommend or give this book to others.

 largely conveys ideas that many effective altruists will be familiar with. Nonetheless, I would still suggest that people already very familiar with effective altruism read the book. It is 

brilliantly inspiring and provides an excellent model for how to present effective altruist ideas

Effective Altruism makes for an exciting movement and The Most Good You Can Do should propel this excitement as the movement grows.

Coralie Oddy

Why financial education matters for smarter giving

This academic year, financial education was made part of the compulsory national curriculum in the UK for the first time [1].

 This is fantastic news for young people, but also potentially for effective altruism.Most effective altruists that I have met have a good understanding of finance and economics, which is unsurprising in a movement which seeks to do the most good by giving. However, to spread effective altruism on a large scale, we need to be mindful that large numbers of people have a poor understanding of personal finance.

The Financial Capability Report (2013) showed that 16% of people in the UK couldn’t read a bank statement correctly, while 30% of people couldn’t select the best out of three individual savings accounts. Less than half of those surveyed made a personal budget for themselves [1].

If you are worried or confused about your finances, giving is less likely to be on your agenda.

To give regularly and consistently, you need to be able to understand what you are able to give, and have confidence in your ability to manage your money. 

A population that can live well within its means, rather than a population with great wealth, appears vital for creating a culture of giving.

Of course, a good understanding of finance is likely to be beneficial in terms of confidence in the ability to give and in ensuring a potentially larger portion of income to give away in the future.

In one case study, students at sixth form college in Newham, an area of London with high economic deprivation [2], took courses in financial studies alongside their A-Levels. They displayed an awareness of risk and benefit in terms of loans and investments, with some students inspired to start their own business ventures or continue their studies in finance at university level [3].

There were also reports of students taking financial information back to their families, shaping their decisions on personal finance. This meant some families seeking financial advice or shopping around for accounts and insurance for the first time.

Clearly, teaching finance is beneficial on an individual level, but also benefits communities and family groups. While giving itself does not form part of the new curriculum syllabus, making it part of the picture could give these benefits a global reach, too.

With financial education now featuring on the curriculum, this could be an ideal opportunity to talk about how effective altruism can fit into a young person’s life plans.

Effective altruists could consider delivering school workshops and talks, or support young people to create their own effective altruist youth chapters. If you are a teacher, there’s a lot of potential for lively and exciting lessons that incorporate thinking about altruism. Organising debates about ‘how to rule the world well’ or asking students to work out and agree on how they would split their country’s GDP if they were in charge are appealing for young people and support speaking and listening, critical thinking and maths skills, while also helping young people consider their roles and responsibilities as global citizens. With the right facilitation, a debate like this could work even at primary level.

When I worked in education, the vast majority of young people I met were passionate about making a difference and doing something impactful with their lives – it was how to achieve this that posed the difficulty. Education on public spending provides an opportunity to address the inequality present in the world, and promotes active discussion about the most effective ways to change this.

Instead of allowing young people to believe that poverty is an insurmountable problem, we can provide them with the tools for change.

Research suggests that altruism and other sharing behaviours sharply increase during adolescence, but that parochialism – treating members in your own group or circle differently to ‘outsiders’ – also emerges at this time. In our teenage years, we are seeking to form our identity and develop an understanding of which groups we belong to, and therefore, who we should help and support in the future [4]. If we teach young people about their similarities and connection with other young people in the developing world, we promote inclusivity and empathy by extending ‘in group’ status at a time when young people’s ideas about this are still malleable.

talk to children about how their contemporaries in the developing world live, and model giving for them

. As a parent, giving children extra allowance to give to a good cause of their choice and explaining that’s what you do too is a great starting point for getting your kids to think about money management and get into the habit of giving.

Combine these early giving habits with a sound financial education, and we have a strong basis for a generation of potential altruists who are well informed, critical and confident.

if you work with children and young people in any capacity (or are a parent), start talking about giving now

. It really is never too early, and the benefits – an understanding of the value of money, compassion and sharing skills – are what we all want for our children.

If we want young people to make positive, impactful life choices, the best time to bring this up is when they are still in education. If we want them to give effectively in the future, we can give them these skills and values now.

Money advice service: press release on UK money habits

The development of egalitarianism, altruism, spite andparochialism in childhood and adolescence

Raffi Grinberg

How Religion Motivates My Giving

The other patrons at the Chinese restaurant were beginning to stare. Charlotte and I couldn’t help raising our voices as the debate intensified.

“Isn’t the point to pick the charity that does the most good for the least amount of money? Each dollar that doesn’t go there is a dollar that could have done more good,” she asserted.

“Yes, but I guess there are two different values. Doing as much good as possible, and contributing to the survival of the Jewish people.”

We were at an impasse. We had agreed that, rather than using a gift registry for our wedding, we would create a charity registry. “We’ve been blessed by our families with more than enough furniture, clothing, and kitchen supplies to make a home,” we wrote in the invitation. But which charities would make the list?

Both Charlotte and I have become more passionate about advocating charities that are evidence-backed, and whose impacts are proven. To that end, we had identified 

, both recommended by the rigorous charity evaluator 

. It felt strange, though, to exclude Jewish charities—given that we were having an orthodox Jewish wedding.

Being Jewish is what shaped my views on charity in the first place. Growing up in day schools, my classmates and I were instilled with our people’s commitment to tikkun olam (repairing the world). We were encouraged to decorate our own tzedaka (charity) boxes, to take them home and donate a portion of our allowance each week. In Bible class, we learned about the tradition of the tithe, about how one tenth of our income belonged not to us, but to those who needed it most. And in Talmud class, we learned the importance of challenging the majority opinion, of demanding error-proof logical argument.

When I first heard about Giving What We Can—donating 10% of one’s income? using metrics to select the most effective causes?—it sounded like a Jewish organization!

On the other hand, there are ways in which my commitment to Judaism conflicts with my commitment to effective altruism. Most prominently, the fact that I choose to donate a portion of my 10% to Jewish charities that are not as proven as other secular charities.

Plenty of Jews give to non-Jewish charities, but Jews are much more likely to give to specifically Jewish charities. If Jews don’t support their own people, few other people will necessarily prioritize helping Jews over others. True, as Charlotte astutely pointed out, each $1 I give to a Jewish person in need could have helped a non-Jewish person who was more in-need, whose life could have been more improved by that help.

But I see a difference—it’s not just about the individuals. Unfortunately, as has often been the case in history, the existence of the Jewish people is continuously threatened. As a Jew, I feel a strong obligation to contribute however I can to our survival.

I’m able to apply the same standards I’ve learned from the Giving What We Can community to find the more effective Jewish charities. Unfortunately, I’m not yet aware of any large ones that track data through studies and emphasize transparency to the same extent as GiveWell’s top-rated charities, but I still seek those that save the most lives (or have the most positive impact on lives) for the lowest cost.

True, my allocation may feel contradictory, and it is a question I am still working on—by reading, by thinking, by debating with Charlotte and with others. What I’ve concluded is that it’s okay for now. To paraphrase the philosopher Rabbi Harold Kushner: if it were an obvious choice, if all our decisions of right-and-wrong were pre-programmed into us, life would have no meaning. Struggling with questions of morality is what gives us purpose.

John Halstead

The Best Public Health Interventions of the 20th Century

Public health interventions in the 20th century have been responsible for massive improvements in global health. According to the Copenhagen Consensus,

“Life expectancy hardly changed before the late 18th century. Yet it is hard to overstate the magnitude of the improvement since 1900, from a life expectancy of 32 years to 69 now, to 76 in 2050. The biggest factor was the fall in infant mortality.”[1]

68% of the improvement in human health is down to technical improvements, such as vaccines, micronutrient fortification and deworming medicine, while higher income accounts for only 3%. For example, Sub-Saharan Africa’s real per capita income in 2008 was just over half that of England in 1870, and yet child mortality rates are two thirds lower in Africa in 2008 than in England around 1870.[2]

Under five Years of Life Lost (YLL) as a percentage of total YLL 1990 – 2050.[3]

Many critics of aid[4] underestimate the sheer scale of the progress that has been achieved as a result of public health interventions, which are often supported by foreign aid and international bodies such as the World Health Organization (WHO), UNICEF and the World Bank. In this blogpost, I will briefly describe and assess some of the most successful public health interventions of the 20th century.

This research relies to a large extent on the prior work done in this area by the Centre for Global Development, which has been published as Millions Saved. We have selected four of the twenty case studies from Millions Saved, examined the evidence given, and tried to provide reasonable estimates of cost-effectiveness. In addition, we look at an intervention not covered in Millions Saved – reducing tuberculosis in south east Africa.

We have strong reason to believe that that all of the interventions had high impact and very high cost-effectiveness.[5] All of them averted a Disability Adjusted Life Year (DALY)[6] for less than $50, some of them significantly less, with smallpox eradication, for example, saving a life (30-40 years) for $5. For context: the NHS will spend £30,000 to save a Quality-Adjusted Life Year (QALY);[7] and the world’s most effective charities avert a DALY for around $30.[8]

The smallpox eradication campaign (1967-1979) is by some distance the most effective program considered here and is one of the best public health interventions of all time. In 1967, smallpox affected 10-15m people and killed nearly a quarter of them.[9] The eradication campaign, with the help of the WHO, the US government and endemic countries cost only $300m.[10] It has saved at least 50m lives until today and provided enormous non-life-saving health benefits.[11]

Cost per life saved (1967-2014) = $5 per life.

This suggests that the intervention averted a DALY for significantly less than $1. Indeed, the benefits mentioned here do not include non-life-saving health benefits, such as blindness prevented. The eradication of smallpox was a truly extraordinary public health achievement.

2. Guinea worm reduction in Asia and Sub-Saharan Africa

Giving What We Can views interventions against Neglected Tropical Disease (NTDs) as having high cost-effectiveness.[12] One NTD, which until recently blighted much of Africa, is dracunculiasis AKA ‘guinea worm disease’. Guinea worm is contracted by drinking water bearing the guinea worm parasite. The disease is rarely fatal, but it does impose a significant disability and pain burden on those infected. On average, the disease incapacitates people for 8.5 weeks.[13]

In 1986, the WHO passed a resolution to eradicate guinea worm within 10 years.[14] In close collaboration with UNICEF, the US Centres for Disease Control and Prevention (CDC) and the WHO, the Carter Centre led the eradication effort.[15] To reduce the burden of the disease, the campaign encouraged the provision of safe water and water filtering through cloth, health education, surveillance of new cases and case containment.[16]

In 1986, there were around 3.5m cases of guinea worm worldwide. Today, guinea worm is very nearly eliminated, with fewer than 200 reported cases in 2013.[18] We provide the following estimate of cost-effectiveness:

Cost per DALY averted (1986-2004) = $46.20.[19]

According to Givewell, the global program to eradicate guinea worm is ‘one of the success stories of global health’.[20]

In Egypt in 1978 all cause infant mortality was exceptionally high at 100 per 1000 live births, which meant that more than 100,000 infants died every year. At least half of these deaths were diarrhoea associated.[21] In the 1960s, it was discovered that diarrhoea could be treated effectively with a simple combination of salt, sugar and water, called Oral Rehydration Therapy (ORT).[22]

The Egyptian National Control of Diarrheal Disease Project (NCDDP), introduced in 1981, improved case management of diarrhoea through ORT and better feeding, especially breastfeeding.[24]

There is good evidence to show that ORT significantly reduced infant mortality in Egypt. From 1970-77, the reduction in infant mortality attributable to diarrhoea was 4.2%; from 1977-82 it was 7.8%; whereas from 1982-90 – the peak years of the NCDDP – it was 15.9%.[25] The rate of infant diarrhoeal deaths declined faster than the overall rate of infant mortality after the introduction of the NCDDP.

We conservatively estimate that the programme saved 100,000 lives in the 1980s.[26] According to the Centre for Global Development, the program cost $43m. It was funded by USAID and the Egyptian government and with assistance provided by UNICEF and the WHO.[27] So, we estimate that the program saved a life for $43m/100,000.

This is exceptional. According to a paper in the British Medical Journal, ORT saved 50 million lives worldwide in the 20th century.[28]

4. Controlling tuberculosis in south east Africa

In 2012, 8.6m people fell ill with tuberculosis (TB) and 1.3m of them died (including 320,000 deaths from HIV positive people). In Malawi, Tanzania and Mozambique, national tuberculosis control programmes making use of short-course chemotherapy proved a highly cost-effective tool in the battle against TB.

TB is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. It is highly contagious.[29] Efforts to control TB have been significantly setback by the rise of HIV in the 1980s and 90s, as the two infections co-exist in large numbers of people. In the mid 1960s new drugs were discovered which allowed short-course chemotherapy treatment. This was testimony to the wisdom of the British Medical Research Council, which provided long-term support for tuberculosis research.[30]

In the 1980s, short-course chemotherapy was introduced and rapidly expanded in Malawi, Tanzania and Mozambique.[31] In all three countries, the cure rate for short-course chemotherapy ranged from 70% In Mozambique to 87% in Malawi, whereas the average cure rate for standard chemotherapy was 40-50%.[32] Despite the impact of the HIV outbreak on TB death rates, the chemotherapy cure rate remained largely unaffected by the HIV outbreak.[33] According to De Jonghe et al, the average cost-effectiveness of the intervention was:

Cost per year of life saved = <$6< big="">

According to the WHO, an estimated 37m lives were saved by tuberculosis treatment from 2000-2013.[34] As the tuberculosis situation improves in the developed world, it is nonetheless deteriorating in the developing world.[35] We hope that in the future, the poor will be able to afford the same healthcare resources as the rich today.

5. Preventing Iodine Deficiency Disease in China

Iodine Deficiency Disorder (IDD) is the world’s leading, and most easily preventable, cause of mental illness, with around 50m sufferers today.[36] In severe cases, IDD can cause cretinism and in more mild ones causes goitre.

In 1993, 370 million Chinese people lived in IDD endemic areas, which was 40% of the global at-risk population.[37] The economic cost to China is estimated to be $50bn.[38] After becoming aware of the scale of the problem, China launched the National Iodine Deficiency Disorders Elimination Program in 1993. The program made regions aware of the problem of IDD; strengthened the capacity of the salt industry to iodise; improved monitoring of the quality of salt; and banned non-iodised salt.[39] According to Goh, as a result, the rate of goitre (an illness caused by IDD) among children aged 8-10 fell from 20.4% in 1995 to 8.8% in 1999.[40] We have deduced the following cost-effectiveness estimate:

According to The Copenhagen Consensus salt iodisation was the most cost-effective and desirable intervention available to the world in 2012.[41]

The achievements of these public health interventions are enormous. They are all large-scale, national and international programs which have brought massive benefits at very low cost. The focus here has been chiefly historical, but the successes of the past may guide us towards success in the future. Humanity has done a great deal of good. The challenge we now face is to do the most good possible while we can.

Copenhagen Consensus: How much have global problems cost the world?

See William Easterly, The White Man’s Burden : Why the West’s Efforts to Aid the Rest Have Done so Much Ill and so Little Good (New York: Penguin Press, 2006); Dambisa Moyo, Dead Aid : Why Aid Is Not Working and How There Is Another Way for Africa (London: Allen Lane, 2008).

The full report provides a more thorough examination of the evidence.

To determine the number of DALYs lost due to a disease, a weight factor that reflects the severity of the disease on a scale of zero (perfect health) to one (death) is assigned to the disease. See 

Nancy Devlin and David Parkin, “Does NICE Have a Cost-Effectiveness Threshold and What Other Factors Influence Its Decisions? A Binary Choice Analysis,” Health Economics 13, no. 5 (2004): 437–52.

Give Well: a model for cost-effectiveness of interventions

Ruth Levine, Case Studies in Global Health : Millions Saved (Sudbury, Mass; London: Jones and Bartlett, 2007); Frank Fenner et al., 

 1988, 1363, . The individual case study from Millions Saved is available 

Fenner et al., “Smallpox and Its Eradication,” 1365–1366.

[here]( Levine, Case Studies in Global Health; Fenner et al., “Smallpox and Its Eradication,” 1363. The individual case study from Millions Saved is available <a href=).

Giving What We Can: Neglected Tropical Diseases

Ernesto Ruiz-Tiben and Donald R. Hopkins, “Dracunculiasis (Guinea Worm Disease) Eradication,” Advances in Parasitology 61 (2006): 280–282.

“WHO | Dracunculiasis (guinea-Worm Disease),”

“WHO | Dracunculiasis (guinea-Worm Disease).”

For an explanation of how I arrived at this figure, see the full report.

Give Well: Cost-Effectiveness of Guinea-Worm Eradication

. Givewell notes that the cost of completing eradication may be much greater.

M. EI-Rafie et al., “Effect of Diarrhoeal Disease Control on Infant and Childhood Mortality in Egypt: Report from the National Control of Diarrheal Diseases Project,” The Lancet, Originally published as Volume 1, Issue 8685, 335, no. 8685 (February 10, 1990): 334–38, doi:10.1016/0140-6736(90)90616-D.

Miller and Hirschhorn, “The Effect of a National Control of Diarrheal Diseases Program on Mortality.”

EI-Rafie et al., “Effect of Diarrhoeal Disease Control on Infant and Childhood Mortality in Egypt,” 335.

See Miller and Hirschhorn, “The Effect of a National Control of Diarrheal Diseases Program on Mortality”; EI-Rafie et al., “Effect of Diarrhoeal Disease Control on Infant and Childhood Mortality in Egypt.” The CDG case study somewhat misleadingly reports this figure at page 7 of 

 . I have been unable to get my hands on the stated source for the $43m figure. Miller and Hirschhorn say that the grant assistance totalled $32m. See Miller and Hirschhorn, “The Effect of a National Control of Diarrheal Diseases Program on Mortality.”

Eric De Jonghe et al., “Cost-Effectiveness of Chemotherapy for Sputum Smear-Positive Pulmonary Tuberculosis in Malawi, Mozambique and Tanzania,” The International Journal of Health Planning and Management 9, no. 2 (April 1, 1994): 154–155, doi:10.1002/hpm.4740090204.

“WHO | Micronutrient Deficiencies - IDD,” WHO, accessed September 17, 2014, 

http://www.who.int/nutrition/topics/idd/en/

T. Ma, J. Guo, and F. Wang, “The Epidemiology of Iodine-Deficiency Diseases in China,” The American Journal of Clinical Nutrition 57, no. 2 Suppl (February 1993): 264S.

Chor-Ching Goh, “Combating Iodine Deficiency: Lessons from China, Indonesia, and Madagascar,” Food & Nutrition Bulletin 23, no. 3 (September 1, 2002): 280–91.

“Copenhagen Consensus 2012 - Outcome”

 accessed September 17, 2014,. See the assessment paper 

Hauke Hillebrandt

Update on the Against Malaria Foundation

The Against Malaria Foundation (AMF) has been one of our highly recommended charities for several years now. Our colleagues at Givewell have published an extensive update recently that was generally very favourable and they continue to rank among Givewell’s top charities. You can read more on 

 In this blog post, we give you an update about their efforts that we feel complement Givewell’s report. You can find more general information about AMF on our 

. In our opinion, AMF continues to be one of the most effective charities in the world.

Recent Scientific findings that relate to AMF’s effectiveness

There is some evidence that malaria increases HIV transmission

. In 2006, a paper published in Science showed that people who are HIV positive have shown a spike in HIV viral load during a malaria fever episode

. They found that, a malaria fever can increase HIV viral load by almost one log (10 times) - and stay at an increased level for a duration of up to 6 weeks

. A recent systematic review and meta-analysis found that acute malaria increases HIV viral load by only 0·67 log10 (see 

But does this increase in viral load cause increases the risk of transmitting HIV? According to a recent review, this seems to be the case: malaria may increase HIV transmission in communities with high HIV prevalence, but has no effect in areas with low HIV prevalence

How large is the increase? Early modelling data suggested that in Kenya, since 1980, this disease interaction may have caused 8,500 HIV additional infections (and about 1 million extra malaria episodes due to HIV - this co-infection might also have facilitated the geographic expansion of malaria to areas where HIV prevalence is high)

Blog

Peter Singer's The Most Good You Can Do

Why financial education matters for smarter giving

How Religion Motivates My Giving

The Best Public Health Interventions of the 20th Century

Update on the Against Malaria Foundation

Giving What We Can Spring Fundraiser

Ten Swaps to help you get to your Pledge

Living on less than £1.50 a day

Global Priorities Project is looking for a summer intern

Why You Should Make It to Chapters' Day