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Olga Kuznetsova

Parasitic worm infections are endemic in large parts of the world. Eradication of these worms (deworming) has long been considered a simple and cheap intervention that brings substantial health and education benefits to millions of children worldwide. Many organisations such as the Bill and Melinda Gates Foundation, the World Health Organisation (WHO), and Deworm The World support deworming programs. However in recent years, more data have emerged that cast doubts on the effectiveness of such programmes. Most of these studies have already been discussed by Giving What We Can in 2012, with a focus primarily on the cost-effectiveness of treating worm infections [1]. Here, I will mention the most recent findings, and why we believe that deworming is still a worthwhile cause to support.

Soil-transmitted worm infections are prevalent in the world’s poorest communities and cause symptoms such as anaemia, diarrhoea, abdominal pain, and weakness. The three main types of intestinal worms are roundworms, whipworms (as pictured below) and hookworms, and their eggs pass into the soil through human faeces in regions with poor sanitation. Infection is transmitted when the eggs are ingested via contaminated vegetables or utensils, and hatch in the intestine [2]. According to the WHO, worm infection in children can cause organ damage that exacerbates with age, as well as less direct effects such as reduced productivity, fatigue, and as a result, lower school attendance. It might also worsen other conditions such as tuberculosis and HIV/AIDS [3].

Although deaths from worm infections are rare, worm treatment has long been regarded a cheap and effective health intervention in the developing world. The earliest example of successful deworming was carried out in the early 20th century in the southern states of the USA. After observing that 40% of children suffered from hookworm infections, John D. Rockefeller’s Sanitary Commission sponsored an eradication campaign, which included treatment with thymol and education about good hygiene. The benefits extended beyond health, with improvements seen in school attendance, enrolment, and literacy [4]. Similar observations were made more recently in Kenya, where mass deworming of schoolchildren led to reduced absence from class [5]. Looking at even more long-term benefits, two unpublished studies reported the results of a Primary School Deworming Program in Kenya, which started in 1998. Besides an improvement in height and weight, children treated for worms worked more hours in adulthood due to improved health and earned 20% more than those not treated [6]. However, the fact that the studies have not yet been published has raised concerns about publication bias [7], while the positive studies were treated with significant reservations by the charity evaluator GiveWell, who argue that the results are not necessarily representative of other regions with a lower worm burden [8].

As always, when there are doubts about the efficacy of a treatment, a meta-analysis of published studies can reveal the true effect. The most recent version of the Cochrane review (2012) assessed 42 randomised controlled trials of deworming. In several studies, children were pre-screened for worm infection before treatment, and showed some increase in weight and haemoglobin levels. However, in the trials where the entire community was treated without pre-screening, there was little or no effect on health parameters, growth, cognitive ability, or school attendance. The exception were two trials showing a large positive increase in weight, however both were conducted over 15 years ago in an area with a high worm burden and may not reflect the situation elsewhere [9].

Overall, the Cochrane review has sparked criticism, notably from Innovations for Poverty Action (IPA). In their blog, IPA argues that the review left out three studies showing a positive effect of deworming (one - the early 20th century study and two unpublished). In addition, if deworming following pre-screening improved certain health parameters, the same effects should be seen in infected individuals during mass deworming projects, even if the data from the whole population do not show statistically-significant benefits. On the other hand, GiveWell, while agreeing that the evidence for the benefits of deworming is low, mentioned that the Cochrane review did not include studies on combination treatment for soil-transmitted worms and schistosomiasis (infections of the urinary tract and intestines by the Schistosoma worm). They maintain that combination treatment leads to improvements in health and development, and, like Giving What We Can, continue to recommend the Schistosomiasis Control Initiative (SCI) as a highly effective charity [8, 10, 11].

The largest trial to date, conducted in North India, was published in 2013 eight years after it was completed. It studied one million children who were treated with deworming drugs twice a year over a five-year period. A trial this size was an opportunity to test whether treating worm infections would reduce child mortality (in parallel, the authors examined the effects of Vitamin A supplements on mortality). The results were clear and disappointing: long-term deworming had no significant impact on mortality, weight, height, or haemoglobin levels [12]. However, the validity of the methods and results has been controversial. GiveWell raised the question of why a trial this size was not published for eight years since its completion date, suggesting publication bias [10]. Furthermore, a response published in the Lancet journal claimed that coverage of Vitamin A programme was far lower than the 96% reported in the trial, with less than 10% of children reporting to have received a vitamin tablet within the last 6 months of the study. There were also claims of poor monitoring, reporting bias, and little training and incentive given to the Indian workers who administered the drugs [13]. All these issues raise significant doubts as to whether the Vitamin A (and by extension, deworming) study has been properly planned and executed, and the results are not given much weight in the scientific community.

To conclude, although some recent studies have shown no improvements to health and education after deworming, the data are not always reliable and the studies not always well-executed. The mixed results of the studies in the Cochrane review highlight how trial design and monitoring can affect the conclusion, even when the same drugs are used to treat the disease. Furthermore, the current interventions are very cost-effective even considering the recent adjustment of DCP2’s estimate (see the 2012 GWWC post). Overall, it appears that there can be short-term and long-term health benefits to deworming, especially when schistosomiasis is treated together with soil-transmitted worm infections. As a result, both GiveWell and Giving What We Can continue to recommend deworming and schistosomiasis treatment programs such as SCI and Deworm The World Initiative.

Neglected Tropical Diseases – Are they Cost-Effective to Treat?

Preventive chemotherapy in human helminthiasis

Bleakley H. Disease and Development: Evidence from Hookworm Eradication in the American South. The Quarterly Journal of Economics. 2007;122(1):73-117

Miguel E and Kremer M. Worms: Identifying Impacts on Education and Health in the Presence of Treatment Externalities. Econometrica. 2004;72(1):159-217

Worms at Work: Long-Run Impacts of Child Health Gains.

Hawkes N. Deworming Debunked. BMJ. 2013;345, e8558. doi:10.1136/bmj.e8558

Combination Deworming (Mass Drug Administration Targeting Both Schistosomiasis and Soil-transmitted Helminths).

Taylor-Robinson DC, Maayan N, Soares-Weiser K et al. Deworming Drugs for Soil-Transmitted Intestinal Worms in Children: Effects on Nutritional Indicators, Haemoglobin and School Performance. Cochrane Database Syst Rev. 2012; doi:10.1002/14651858.CD000371.pub5

New Cochrane Review of the Effectiveness of Deworming.

Cochrane’s Incomplete and Misleading Summary of the Evidence of Deworming.

Awasthi S, Peto R, Read S et al. Population Deworming Every 6 Months with Albendazole in 1 Million Pre-school Children in North India: DEVTA, a Cluster-Randomised Trial. The Lancet. 2013;381:1478-1486

Sommer A, West Jr K et al. Vitamin A Supplementation in Indian Children. The Lancet. 2013;382(9892):591

The evidence for deworming

David Goll

: We think our top charities do fantastic work, but we are always interested in other methods for helping the world’s poor. The Copenhagen Consensus and other authors have highlighted the potential of agricultural R&D as a high-leverage opportunity. This was enough to get us interested in understanding the area better, so we asked David Goll, a Giving What We Can member and a professional economist, to investigate how it compares to our existing recommendations.

Owen Cotton-Barratt, Director of Research for Giving What We Can

Around one in every eight people suffers from chronic hunger, according to the Food and Agricultural Organisation’s most recent estimates (FAO, 2013). Two billion suffer from micronutrient deficiencies. One quarter of children are stunted. Increasing agricultural yields and therefore availability of food will be essential in tackling these problems, which are likely to get worse as population and income growth place ever greater pressure on supply. To some extent, yield growth can be achieved through improved use of existing technologies. Access to and use of irrigation, fertilizer and agricultural machinery remains limited in some developing countries. However, targeted research and development will also be required to generate new technologies (seeds, animal vaccines and so on) that allow burgeoning food demand to be met.

Agricultural research and development encompasses an extremely broad range of activities and potential innovations. A 2008 paper issued by Consultative Group on International Agricultural Research (von Braun et al., 2008), an international organization that funds and coordinates agricultural research, identifies 14 ‘best bets’. These include developing hybrid and inbred seeds with improved yield potential, better resistance to wheat rust, increased drought tolerance and added nutritional value, but also encompasses the development new animal vaccines, better fertilizer use and improved processing and management techniques for fisheries.

Notable successes in seed development seem to have generated immense social benefit. The high-yielding varieties that spread through the ‘Green Revolution’ are often credited with driving a doubling of rice and wheat yields in Asia from the late 60s to the 90s, saving hundreds of millions of people people from famine (see, for instance, Economist, 2014). Given the prevalence of hunger and the high proportion of the extremely poor that work as farmers, agricultural research and development seems to offer a potential opportunity for effective altruism.

Existing benefit-cost estimates are promising, though not spectacular. The Copenhagen Consensus project ranked R&D to increase yield enhancements as the sixth most valuable social investment available, behind deworming and micronutrient interventions but ahead of popular programmes such as conditional cash transfers for education (Copenhagen Consensus, 2012).

The calculations that fed into this decision were based on two main categories of benefit. First, higher yield seeds allow production of larger quantities of agricultural output at a lower cost, bolstering the income of farmers. Around 70 per cent of the African labour-force work in agriculture, many in smallholdings that generate little income above subsistence (IFPRI, 2012). Boosting gains from agriculture could clearly provide large benefits for many of the worst off. Second, decreased costs of production lead to lower prices for food, allowing consumers to purchase more or freeing up their income to be spent elsewhere.

Projecting out to 2050, these two types of benefit alone are expected to outweigh the costs of increased R&D by 16 to 1 (Hoddinott et al., 2012). By comparison, the benefit-cost ratios estimated within the same project for salt iodization (a form of micronutrient supplement) range between 15 to 1 and 520 to 1, with the latest estimates finding a benefit-cost ratio of 81 to 1 (Hoddinott et al., 2012), and most of the estimates reported to the Copenhagen Consensus panel for the benefit-cost ratio of conditional cash transfers for education fall between 10 to 1 and 2 to 1 (Orazem, 2012). Using a very crude method, we can also convert the benefit-cost ratios into approximate QALY terms. Using a QALY value of three times annual income and taking the income of the beneficiaries to be $4.50 a day (around average income per capita in Sub-Saharan Africa), agricultural R&D is estimated to generate a benefit equivalent to one QALY for every $304.

Other types of benefit were not tabulated in the Copenhagen Consensus study, but should also be high. Strains that are resistant to drought, for instance, could greatly reduce year-to-year variation in crop yields. More resilient seeds could mitigate the negative effects of climate change on agriculture. Lower food prices may lead to better child nutrition, with life-long improved health and productivity. Finally, higher yields may decrease the potential for conflict due to the pressure on limited land, food and water resources resulting from climate change and population growth. Each of these benefits alone may justify the costs of research and development but, with our limited knowledge, they are not easily quantified.

The high benefit-cost ratio found by the Copenhagen Consensus team is broadly consistent with other literature. Meta-analysis of 292 academic studies on this topic has found that the median rate of return of agricultural R&D is around 44% (Alston et al., 2000). A rate of return, in this sense, indicates the discount rate at which the costs of an investment are equal to the benefits – rather like the interest rate on a bank account. More recent studies, focusing on research in Sub-Saharan Africa, have found aggregate returns of 55% (Alene, 2008).

Unfortunately, the rate of return on investment is not directly comparable to a benefit-cost ratio; the methodology applied often deviates from the welfare based approach applied by the Copenhagen Consensus team and the two numbers cannot be accurately converted into similar terms. Nonetheless, a crude conversion method can be applied to reach a ballpark estimate of the benefit-cost ratio implied by these studies. Assuming a marginal increase in spending on research is borne upfront and that research generates a constant stream of equal benefits each year from then on, the benefit-cost ratio for an investment with a 44% rate of return at a 5% discount rate is 9 to 1.

There are, however, at least two reasons to treat these high benefit-cost estimates with skepticism.

First, estimating the effect of research and development is difficult. One problem is attribution. Growth in yields can be observed as can spending on research and development, but it is much more difficult to observe which spending on research led to which increase in yields. If yields grew last year in Ethiopia, was this the result of research that occurred two years ago or ten years ago? Were the improved yields driven by spending on research within Ethiopia, or was it a spillover from research conducted elsewhere in the region or, even, research conducted on another continent? Estimating the effect of R&D spend requires researchers to adopt a specific temporal and spatial model dictating which expenditures can effect which yields in which countries. Teasing out causality can therefore be tricky, and some studies have suggested that inappropriate attribution may have led to systematic bias in the available estimates (e.g. Alston et al., 2009).

Another problem is cherry picking. Estimates garnered from meta-analysis are likely to be upwardly biased because studies are much more likely to be conducted on R&D programmes that are perceived to be successful. Failed programmes, on the other hand, are likely to be ignored and, as a result, the research may paint an overly optimistic picture of the potential impact of R&D.

Second, for new technologies to have an impact on the poor, they need to be widely adopted. This step should not be taken for granted. Adoption rates for improved varieties of crops remain low throughout Africa; farmer-saved seeds, which are unlikely to be improved, account for around 80 per cent of planted seeds in Africa compared to a global average of 35 per cent (AGRA, 2013). To some extent, this is because previous research has been poorly targeted at regional needs. The high-yield varieties developed during the Green Revolution require irrigation or very high levels of rainfall. New seed development was focused on wheat and rice, rather than alternative crops such as sorghum, cassava and millet. High yielding varieties required extensive fertilizer use. All of these features rendered them unsuitable for the African context, and explain why it was not easy to replicate the Asian success story elsewhere (Elliot, 2010).

However, there are more structural features of many developing countries that will limit adoption. Lack of available markets for surplus production can mean that smallholders can see limited benefit from larger harvests, especially when new seeds are costly and require additional labour and expensive fertilizer. Weak property rights undermine incentives to invest, given that farmers may be unable to hold on to their surplus crop or sell it at a fair price. Unavailability of credit means that, even when it makes good economic sense for farmers to invest in improved seeds, they may not be able to raise the initial capital required. The benefit-cost estimates discussed above, based on a synthesis of evidence from a diverse set of contexts, may underestimate the difficulties with adoption in more challenging countries.

Even in Asia during the Green Revolution, high-yield varieties were adopted first and foremost by large agricultural interests rather than smallholders (Wiggins et al., 2013). If this was the case for newly developed seeds, the impact on the poorest would be more limited than suggested in the Copenhagen Consensus study. They could still benefit from lower food prices and increased employment in the agricultural sector, but in extreme scenarios smallholders may even lose out due to low cost competition from larger farms that adopt new seeds.

In combination, the difficulties with estimating the effects of R&D and the potential barriers to adoption suggest that the estimated benefit-cost ratios reported earlier are likely to be upwardly biased. The benefit-cost ratios estimated are also lower than those associated with Giving What We Can’s currently recommended charities. For instance, the $304 per QALY estimate based on the Copenhagen Consensus benefit-cost ratio, which appears to be at the higher end of the literature, compares unfavourably to GiveWell’s baseline estimate of $45 to $115 per DALY for insecticide treated bednets (GiveWell, 2013). The benefit-cost ratios also appear to be lower than those associated with micronutrient supplements, as discussed earlier. While there are significant benefits that remain unquantified within agricultural R&D, the same is also true for interventions based on bednet distribution, deworming and micronutrient supplements. As a result, while this area could yield individual high impact opportunities, the literature as it stands does not seem to support the claim that agricultural R&D is likely to be more effective than the best other interventions.

Food and Agricultural Organisation,’The State of Food and Agriculture 2013’ (2013)

von Braun, J., Fan, S., Meinzen-Dick, R., Rosegrant, M. and Nin Pratt, A., ‘What to Expect from Scaling Up CGIAR Investments and ‘Best Bet’ Programs’ (2008)

Copenhagen Consensus, ‘Expert Panel Findings’ (2012)

Hoddinott, J., Rosegrant, M. and Torero, M. ‘Investments to reduce hunger and undernutrition’ (2012)

Orazem, P. ‘The Case for Improving School Quality and Student Health as a Development Strategy’ (2012)

Alliance for Green Revolution in Africa, ‘Africa Agriculture Status Report 2013: Focus on Staple Crops’, (2013)

International Food Policy Research Institute, ‘2012 Global Food Policy Report’, (2012)

Elliot, K., ‘Pulling Agricultural Innovation and the Market Together’, (2010)

Wiggins, S., Farrington, J., Henley, G., Grist, N. and Locke, A. ‘Agricultural development policy: a contemporary agenda’ (2013)

Givewell, ‘Mass distribution of long-lasting insecticide-treated nets (LLINs)’, 2013, 

http://www.givewell.org/international/technical/programs/insecticide-treated-nets

The Economist, ‘A bigger rice bowl’, May 10th 2014

Agricultural research and development

Josh Goldenberg

Microfinance is the provision of financial services to those in poverty. This has generally taken three forms. First, there is microcredit – the provision of loans - which is the dominant and best-known form of microfinance. There is also microsavings, the provision of savings accounts, and microinsurance, the provision of insurance.

While there appears to be some reason to think microsavings and microinsurance are more effective at relieving poverty than microcredit, this post will focus on microcredit due to its greater popularity and the appearance of a recent World Bank working paper that promises to shed light on its long-term benefits.

Microcredit has received considerable public attention, much more so than many other development interventions. Despite this, there has been relatively little high-quality research on the intervention. In particular there is a lack of randomised control trials (RCTs) compared to many medical interventions; research has relied on methods which give a less accurate idea of how much good microcredit does.

From the current research, we believe that the effects of microcredit are 

. Until now, however, available studies have been done over a period of a couple of years. This has left open the possibility that, while microcredit has an unclear effect over a couple of years, there may be longer-term benefits that make microcredit a more effective intervention.

, released in March this year by Shahidur Khandker and Hussain Samad, begins to try to answer this question. Conducted over a period of 20 years in Bangladesh, the research investigates the effect of both past and current microcredit borrowing on outcomes like poverty and income. On top of being done over a considerably longer time period, the current study is also quite large, investigating over 3,000 households. The Economist has 

greeted its results with considerable enthusiasm

, writing: “Bangladesh’s government should look at the study—and stop interfering with Grameen’s efforts to cut poverty.”

The data was gathered in 3 rounds – one in 1991/2, one in 1998/9, one in 2010/11 – by the World Bank and partners BIDS (Bangladesh Institute of Development Studies) and InM (Institute of Microfinance). Households were surveyed to see which microfinance programs they were a part of, for their background (how many people in the household, gender balance, etc.) and for outcomes (household income, labour supply, school enrolment, poverty, etc.).

Then a regression analysis was performed – examining the correlation between microfinance program participation and outcomes like extreme poverty. To isolate causation in a study of this kind, one tries to account for all potential confounding factors and determine the strength of the remaining correlation.

In this study, past credit was considered separately to current credit, so as to isolate the correlation of e.g. past credit and net worth, as opposed to just credit and net worth. This allows us to then see how much of the effect on net worth is down to participants’ having loaned in the past, and how much is down to them having loans out now. If we then observe that the effect of past credit is much higher than current credit, we have evidence that microfinance’s effects take a long time, so the other studies in the area – which are done over a year or two – might be too pessimistic due to their inability to account for the true benefits of microfinance.

One potential confounding factor is attrition: 7.4% of households surveyed in 1991/2 couldn’t be traced in 1998/9, and 10% of households surveyed in 1998/9 couldn’t be traced in 2010/11. This is an issue if attrition is not random: for example, if the households that can’t be traced are ones whose homes were repossessed since they failed to pay off a loan. The authors accounted for this by using ‘inverse probability weights’: roughly, if two households are similar and are surveyed in the first round, and one drops out, then the one that’s left in is weighed twice as much in the second round.The study’s authors also tried to account for household split-off, where some members of a household split off to make their own (e.g. when household members grow up and marry). They only included the households which were surveyed in all 3 rounds, so that the new households that arise from a split-off are ignored.

This seems somewhat problematic, and indeed is different to the method done when only the first two rounds were considered (Khandker 2005), where the two households were aggregated (having checked this wouldn’t bias the outcome). For example, household income per capita will appear to go up in these households simply because some people have left the household, rather than because income has actually gone up. Equally, household net worth may go down because the household members who split off may take some of the worth to start the new household. If either of these happen more commonly to those who take part in microfinance programs then it will look like microfinance increases household income per capita or decreases net worth, even though that is not down to the microfinance program (or at least should not be attributed to it). The reverse could also be observed if these happen less commonly for those who take part in microfinance programs.

, is that those who take part in microfinance programs may be more entrepreneurial or better able to use resources, and so would do better than any control group even without microfinance. One way to get around this is to randomise the trial, so that there is no way for people who are disproportionately entrepreneurial to be more or less likely to receive microfinance. However, that is not done here and means the results of the paper must be interpreted with some caution.

Firstly, the authors found that increasing loans to women reduced extreme poverty, and increased assets and school enrolment of both boys and girls, though it did not increase income or expenditure. This is not uncommon; past research of microcredit has given a mix of papers showing a positive effect and papers showing no effect. This research, while showing a positive effect, is relatively in line with the consensus, as the statistically significant effects are small: for example, an increase of loans to women by 10% increased non-land assets by a mere 0.25% (though still large enough to be statistically significant).

What is more interesting in this paper is how much of the change in outcomes is down to current borrowing, and how much is down to past borrowing. In particular, several outcomes were (statistically significantly) bettered by past loans. An increase of 10% in past loans to women increased per capita income by 0.16%, whereas a 10% increase in current loans to women increased per capita income by only 0.04% - too small to be statistically significant. Similarly, extreme poverty was reduced by both past and current loans, suggesting that microcredit brings some people out of extreme poverty in the short-run, and brings further people out of poverty in the long-run.

However, the research suggests microcredit does not have a positive effect on all outcomes over the long-run. A 10% increase in past loans to women decreases non-land assets by 0.12%, and school enrolment by 4-5%. In these outcomes, current loans have a bigger effect than past loans. A 10% increase in both past and current loans will still increase non-land assets and school enrolment. However, borrowing may not increase non-land assets considerably over the long-term and holdings could revert to pre-loan levels if one doesn’t continue to take out further loans.

The new paper gives us a first insight into the long-term effects of microcredit. It suggests that there is some reason to be optimistic about the long-term effects of microcredit on poverty and household income, but equally some reason to think that short-run increases in school enrolment or assets may be short-lived. This assumes that the paper is methodologically sound. Given the small effects, and concerns over the non-randomized methodology noted earlier, perhaps the best thing to conclude from the paper is that there is weak evidence that microcredit has some benefits and some costs over the long-term, but certainly not enough to be convinced of the effectiveness of microfinance to the extent The Economist is. David Roodman goes so far as to say that he is “surprised by how weak [the article] is”.

Still, this is just one paper, and there is plenty of scope for more research to change the picture, and it is encouraging to see more research in this area. Research would at this point likely be better done on microsavings and microinsurance. There is greater scope to expanding savings and insurance coverage and higher potential effectiveness. It remains unlikely, however, that microcredit will be recommended by us in the near future, due to research showing either small or no effects, unlike our current recommended charities. David Roodman in Due Diligence agrees, writing: “less money for microcredit and more for bed nets would be a double win.”

Long run effects of microcredit: a first glimpse

Andreas Mogensen

This July saw the first academic conference on effective altruism. The three-day event took place at All Souls College, one of the constituent colleges of the University of Oxford. The conference featured a diverse range of speakers addressing issues related to effective altruism in a shared setting. It was a fantastic opportunity to share insights and ideas from some of the best minds working on these issues.

I’m very pleased to announce that audio recordings from most of the talks are now available on 

, alongside speakers’ slides (where applicable). I’m very grateful to all of the participants for their fantastic presentations, and to All Souls College and the Centre for Effective Altruism for supporting the conference.

Good Done Right: A conference on effective altruism

Sashika Coxhead

‘1.2 billion people live in extreme poverty.’

I think what happens to a lot of us when presented with a statistic like this is the following: we have a fleeting thought about how awful it is, and we then carry on with our lives: worrying about an exam, choosing between cereals at the supermarket, scrolling through our Facebook newsfeeds.

Just over a year ago, I decided this statistic needed more than just a fleeting thought. 1.2 billion people live 

without enough money to meet their basic needs

 – their needs for things like food, sanitation, healthcare, and shelter. It didn’t seem right that just because I was born in the right place, at the right time, I have easy access to all these things and much, much more.

After I decided this was a problem I’d like to do something about, the next question was whether it was possible to help. Should I volunteer? Raise awareness? Donate to charity? Would any of these actually do any good? I think there’s a bit of a misconception within the world of ‘doing good’ that giving money is 

. For something to really make an impact, it has to be hard, right? Well… no, actually.

Something that’s really exciting to me is the opportunity we have to alleviate the suffering of others through our donations. The most effective charities can significantly and quantifiably improve people’s lives for astonishingly small amounts of money. Giving What We Can’s recommended charities work in developing countries as there, our money goes further and problems can be very cheap to tackle [1]. For example, less than $0.50 per year treats a child for intestinal worms [2], which benefits their development, education and general health. It costs around $6 to purchase and deliver one malaria net, an intervention that is proven to reduce malaria cases and child mortality [3].

That’s not to say other ways of helping the poor, like volunteering and raising awareness, aren’t valuable. Furthermore, the two aren’t mutually exclusive: giving money doesn’t mean I can’t give my time too. However, there’s no escaping the fact that money can make a huge impact: buying 10 years of deworming treatment for the cost of a latte seems like an unrivalled opportunity to me.

After I decided it made sense to donate to the most cost effective charities, I then had to ask myself how much I should donate. I’ve now pledged to give 10% of my earned income throughout my career. People often ask how I donate 10% when I’m a student, but if you’re not earning, Giving What We Can only requires you to give 1% of your disposable income. I’m glad I’ve taken the pledge before I start earning, as it means I won’t notice the drop in income when I start giving more and can form good giving habits right from the start of my career.

10% may seem like a lot, but I’m confident that living on 90% of my income will enable me to live a happy, healthy and comfortable life, whilst saving for the future. I don’t believe that extra 10% will increase my happiness significantly, and I certainly don’t think I will spend it on anything as valuable as multiple years of healthy life for another person. Furthermore, being part of Giving What We Can is a really fun and exciting part of my life: I get to hang out with friendly, like-minded people who are continually questioning and improving on the knowledge we have about the best ways to help others.

The last question I had to ask myself was why pledge, and why so publicly? Although I’m relatively young, I want to make sure I live up to the values I hold strongly today. Pledging ensures that my fleeting thoughts about the suffering of others are, and continue to be, more than just thoughts.

Talking openly about giving is not something that’s widely done in our culture; in fact, I still find myself a little shy when talking to friends about Giving What We Can. However, we’re more likely to give if we know others are doing the same, so it doesn’t really make sense to keep quiet about it, as inspiring one other person to do the same doubles my impact. Finally, I’d like to see a world where using significant amounts of our wealth to help others is a completely normal thing to do, and being part of this community takes us one step closer to that.

http://www.givewell.org/giving101/Your-dollar-goes-further-overseas

“Deworming: A Best Buy for Development.” J-PAL Policy Bulletin, March 2012

http://www.givewell.org/international/top-charities/AMF#Costperlifesaved

Why I joined Giving What We Can as a student

Raffi Grinberg

Although my friend has not yet found the love of his life, he once sought counsel from a female friend on his idea for a future marriage proposal: “Would you find it romantic if we met at an empty field in a poor African village, I got down on one knee and said, ‘With the money I could have used to buy you a beautiful diamond ring, instead I funded the construction of a new school in this empty field’?”

She responded: “If you got down on one knee and said, ‘With the money I could have used to fund the construction of a new school in this empty field, instead I bought you this beautiful diamond ring’—now 

I often joked about my friend’s plan, but somehow the idea always sparked interesting conversations with my fiancée Charlotte. When we decided to become engaged this year, we decided to forego an expensive diamond. Instead, I bought a more affordable ring from a vintage store, and donated the difference between that and one month’s salary to GiveDirectly, one of GiveWell’s highest-ranked charities.

Most friends and family supported the decision, but it was met with some hesitations. I hope that by answering the most common questions we’ve received, I can explain the reasoning behind this decision—and hopefully convince you that a “donation diamond” could be the right decision for other couples as well.

If you don’t spend at least one month’s salary on a ring, won’t everyone think you’re cheap?

Money is no substitute for love. Somehow the archaic idea that “the more someone spends on you, the more he or she loves you” is still commonplace—even though once a couple gets married, they will often share their finances. (So that expensive gift your spouse-to-be just bought you is actually coming out of 

Isn’t a diamond ring the traditional way to show your love for your future wife?

Yes and no. Different cultures use varying types of jewelry to symbolize betrothal and marriage. The popularity of engagement rings (as a primary symbol of commitment) has traded back and forth with wedding band numerous times through history.

In 1930s America, when the use of diamond engagement rings was falling, the DeBeers cartel launched a pervasive advertising campaign to re-popularize them. Their slogan of “a diamond is forever” and the notion of spending one month’s salary were a part of that campaign.

Because of DeBeers’ global monopoly, they were also able to artificially inflate the prices of otherwise not-so-scarce diamonds.

If the premise of an engagement ring is so artificial, why bother with one at all?

Most cultural norms were invented by someone at some point in time, and the more important question is whether it’s worth buying into them in order to be a part of that culture. Mother’s Day may have been manufactured by the greeting card industry to increase their revenue, but I still think it’s nice that everyone gets their mother a card on the same day. (And when I say everyone, I’m forgiving my occasional lapses in calendar memory.)

Charlotte and I believe in the value of commitment, and in the ability of symbols to enhance that commitment by putting it on display for others to see. There’s something beautiful about observing a type of ring and automatically knowing that its wearer will soon vow to preserve her love.

In other words, it’s certainly worth investing some money for a durable symbol of our commitment. We just decided that hundreds of dollars was a more reasonable price range than thousands for that particular symbol—then used the remainder for something more valuable than a signifier.

And maybe, if enough people take on the idea, charity can become the new signifier.

Why is charity so valuable, if most charities use their money ineffectively?

Luckily, there has been a lot of research on this topic (check out the rest of the Giving What We Can Blog).

Each year, GiveWell ranks the world’s most transparent, cost-effective charities. As an example, GiveDirectly aims to deliver almost 90 cents of every dollar you give directly to the people who need it most.

Isn’t it impossible to find a ring that is both beautiful and durable for less than one month’s salary?

Not only is it possible, it’s actually pretty easy. Many vintage stores sell previously-worn jewelry at great prices, including diamonds. Our particular ring is from the 1900’s. If it’s already lasted one hundred years and still looks great, we figure it can go a hundred more.

And Charlotte often reminds me that “vintage is in now,” or something like that.

So should I not buy a new iPhone, because that’s also a “waste” of money?

I’m not trying to convince you to donate every spare dollar you have. I have an iPhone, too. I “waste” my money on take-out meals, on an online subscription to Netflix, and most recently on a battery-powered perpetual motion machine entitled 

 that spins in mesmerizing circles. However, I would hardly qualify these things as waste—even though other people might be able to spend that money on more essential items, they make me happy. (How can one put a price on 

It’s not worth doubting and questioning every purchase you make, because that takes a lot of fun out of life. If an engagement ring makes you happy, I’m not asking you to deny yourself that pleasure.

I’m just asking you to think about whether it’s the expensive diamond that makes you happy, or what it signifies. And if it’s the latter, to think about whether there might be a better way to signify the same thing.

Show each other what your love can do for the world.

Why I spent a month's wages on charity, not an engagement ring

Allan Saldanha

As someone fortunate enough to have never wanted for anything all my life, I've always struggled with the degree of absolute poverty of so many people in the developing world. The world bank's poverty line is just $1.25 a day (adjusted for purchasing power that too), but there are still an estimated 600 million people below this line.

Blog

The evidence for deworming

Agricultural research and development

Long run effects of microcredit: a first glimpse

Good Done Right: A conference on effective altruism

Why I joined Giving What We Can as a student

Why I spent a month's wages on charity, not an engagement ring

How to double your donation to AMF

Child marriage: Why does it happen and what can we do?

Difficult decisions: How I'm using my life to help others

Where do the extremely poor work?