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Stephanie Crampin

Struggle for survival

On the 16th July in London, Giving What We Can will be co-hosting an event "Struggle for Survival" with 

. This is a chance for interested people to experience a little of what it's like to experience some of the challenges faced, and choices made by those living in extreme poverty. The event has been put on at the World Economic Forum, with the aim of getting businesses to get them to do more for the communities where they are based.

. One of our members, Jacob Williamson has attended the last such event we put on, and to give you an idea of what it's like, here is his recollection of what happened:

"I took part in a poverty simulation event organised by Global Hand this evening. I think the offer reached my inbox through the Giving What We Can mailing list, and little detail was given in advance other than beaming endorsements from Ban Ki-Moon and Richard Branson. It seems these folks shook up Davos slightly by attempting to demonstrate to millionaires how the Bottom Billion get by.

"There are, of course, inevitable limits to the realism any such project could achieve. It certainly seems a stretch to think people will immediately imagine anything resembling despair or degradation – nevermind hunger – when the tasks at hand are made into practical, competitive games. It seems to me that the project is instead still promising for different reasons. It is plausible that by learning the facts about the obscenely scarce economic conditions so many people must operate in by playing them out first-hand, people will process and appreciate them more.

"There just is a real sense in which when we’re supplied with photos of people living this in a certain lifestyle and struggling to achieve certain goals, actually proceeding to simulate such goals and actions yourelf, and see how little they go to succeeding in the context of the game – that does bring things to life in a way simply reading such facts might not. So the groundwork for achieving empathy later might be laid, rather than that emotion actually arriving in the course of the experience.

"Supplement it with sufficient information of the kind Giving What We Can tends to provide, not only about how comparatively rich we all are, but also just how much good as individuals we can do, and there could be potential for persuasion there."

Emma Howard

A first glance at Development Media International

The literature on economic development has begun to study the potential for mass media in development (Roy, 2014). Information can support citizens to make more informed decisions in many areas of their lives, including health and politics. However, research shows that changing attitudes and knowledge does not necessarily translate into the desired behaviour changes (Nag, 2011). Any successful development media campaign will need to overcome barriers to impact, such as a failure to understand the underlying reasons for existing practices.

 is attempting to realise the potential of mass media to 

 in useful ways in the developing world. DMI is a UK-based NGO that delivers radio and TV campaigns in the developing world (see more 

, with plans to reach 10 African countries. DMI’s current focus is reducing child mortality and morbidity in children under five. The reason for this focus is that the majority of child deaths in this age bracket are the result of a lack of basic practices such as early breastfeeding or diarrhoeal treatment.

In conjunction with the London School of Hygiene & Tropical Medicine (LSHTM), DMI is the first organisation to combine mass media campaigns with scientific modelling to predict health outcomes. Initial estimates from such modelling predict a potential 10-16% reduction in child mortality, at an estimated cost of $60-$300 per life saved, potentially making this the most effective lifesaving intervention available. According to the 

, 6.9 million children under 5 perish each year as a result of the issues DMI is addressing. Assuming a high coverage rate, and given the estimated cost-effectiveness of this project, DMI’s potential annual impact on child mortality is striking. Of course we should be cautious about such estimates, but they do justify further investigation.

DMI has designed its campaigns to address 3 key main aims concerned with:

Behaviour change to save the most lives in a given country and context;

Tackling key barriers such as cultural norms and religious beliefs that commonly impede behavioural change;

Reaching the largest number of people in the most effective way based on carefully selected media partnerships, demographic profiles, geographical locations and language preferences of their target audience at the most effective times of day over a sustained period.

Whilst child survival remains the main focus of DMI, DMI is also targeting a range of other related 

 issues such as sexual and reproductive health, nutrition, hygiene, environmental health and both communicable and non-communicable diseases. This puts them in a good position to make an impact on four of the eight Millennium Development Goals, improving gender equality, child survival, maternal health, and HIV/Aids and malaria.

 frequently attributed to existing studies in development media by conducting a randomised controlled trial of one of their radio health projects in Burkina Faso to evidence their impact. They have attracted the attention of GiveWell, who have described the preliminary results from their trial 

. Although preliminary midline results from a randomized controlled trial appear promising, GiveWell expects to conduct a more thorough evaluation of DMI this year, and will withhold judgement until this is complete.

Using research gathered, DMI have found that their target audiences are most likely to have access to and actively listen to the radio as opposed to the television. In Uganda, as many as 74% of the population listen to the radio at least weekly, compared with only 11% watching television in the same period. Audiences are most receptive to emotionally evocative stories rooted in everyday life delivered in a narrative form. Using a 3-part dramatic structure delivered in the local language, DMI uses the power and perseveration of emotional responses on memory to enact behaviour change in its audience. This 3-part structure lends itself to the intentions of behaviour change, as the dramatic character is forced to overcome an obstacle through behaviour change before he/she can achieve resolution.

The countries chosen for DMI’s current campaigns have been designed to achieve maximum efficacy, by combining those countries with high maternal and child mortality rates that also stand to benefit most from mass media intervention due to average to high media penetration. 

 is implemented “at three levels: in households, in the wider community, and in people’s use of health facilities and services”.

The versatility of DMI’s story development enables multiple interconnected health issues to be addressed, leading to improved health outcomes not necessarily restricted to any one domain. For example, campaigns centred around child health can also serve to reduce neonatal mortality, maternal health, hygiene and nutrition via the promotion of health facilities to give birth or monitor pregnancy. Rather than diluting the focus of a given intervention, evidence suggests that there is only a small reduction of impact on each issue, and because adding another issue to an existing campaign only fractionally increases the cost, the cost-effectiveness is much greater.

In conclusion, a preliminary examination of DMI shows promising results in the development and delivery of mass media public health interventions towards reducing child mortality, morbidity and maternal health via an extremely cost effective medium. It remains to be seen whether the initial results of DMI’s study are statistically significant at closer examination, as the self-reported nature of the initial assessment has raised 

 concern. Development Media International aims to address these concerns in their later endline study results, which will specifically measure child mortality statistics as opposed to subjective self reports. You can expect a later blog post from us reporting on these findings, but so far we are excited by the efforts of DMI in targeting hard-to-reach audiences in a cost-effective way, as well as their unique potential to effect behaviour change on a population level.

If mass media interventions prove socially desirable merit goods in the development process, then a strong case should be made for their wide diffusion among the populace in order to reach the most technologically alienated audiences (Nag, 2011). If they are to act as tools of social inclusion, economic opportunity and empowerment, targeted efforts need to be made to provide access to content, opportunities and tools geared towards the priority needs of a given community. On a broader level, both governmental and non governmental organisations should form a collaborative effort towards the provision of technology to safeguard against the marginalisation of traditionally excluded and disadvantaged groups from effective public health campaigns, such as those employed by DMI (Nag, 2011).

Nag, B. (2011). Mass Media and ICT in Development Communication: Comparison & Convergence. 

Roy, S. (2011). Media Development and Political Stability: An Analysis of Sub-Saharan Africa. 

. MediaMapResource. org (Accessed May 25, 2014).

Katja Grace

Apples and oranges? Some initial thoughts on comparing diverse benefits

An important part of effective altruism is comparing the value of different altruistic endeavours. Many altruistic endeavours bring about different kinds of good things, for instance protection of children from incapacitating diseases, and extra years of quality education. To find the best causes, we need some way of evaluating these next to one another. How much extra education in the developing world is worth the same as an extra year of healthy life?

Answering such questions is notoriously tricky, and Giving What We Can faces an even harder problem of answering them in such a way that other people are happy to use our judgements, and thus our recommendations. One can't just opt out of answering them, for the same reason one 

 choose one’s partner by their social security number just because it's hard to weigh up a good sense of humour against kind eyes.

So how can we make such evaluations? Giving What We Can research has been looking into it a bit, and this blog post will tell you some of what we think. We’ll look at various methods from economics and the social sciences, and discuss the advantages and disadvantages of different approaches.

Any attempt to compare the value of two things has two basic parts. The first step is often to parcel out all of the main ways each item might have benefits. For instance, if a person in Malawi doesn’t contract malaria next year, this will translate to various good things: less suffering and more joy for that person, less stress for their family, less congestion at the local hospital, a few thousand dollars of productive work, slightly different expectations among people nearby about how well their lives are likely to go.

This can go on for more steps - a few thousand dollars of productive work might be factored out in terms of increased prosperity for the family, and more prosperity spread among the wider world. Prosperity for the family might in turn be factored out as better nutrition for them, more education for their children, some investments that will bring them further prosperity, etc.

Another thing that often happens at this stage is that items are made more abstract. For instance one particular girl’s recovery from schistosomiasis might be equated to some number of ‘quality adjusted life years’ or ‘QALYs’. This makes evaluation more tractable. Now we can evaluate many similar things at once, a little bit inaccurately, instead of doing thousands of different evaluations. For instance if we convert many different health interventions into QALYs saved, then we can compare a QALY to a year of school, and we automatically have a comparison of lots of different health interventions.

The second step is to actually compare the value of the items you end up with. This might involve for instance seeing how money much a person is willing to pay to avoid some suffering. You could do this by observing how much money and effort they invest in avoiding the flu, in flu season. Or you might ask them directly, ‘if you could pay $1000 to avoid this surgery, would you take that offer?’. Or instead of looking at money they will sacrifice, you might just ask about how they feel. For instance you might ask a blind person repeatedly over a period how satisfied they are with their life, and do the same with a person who is not blind.

Comparing value can be done immediately without the previous step of converting things, or after so many iterations of the previous step as to turn health and education into unrecognizable buckets of value. Many ways of comparing the value of A against B have been developed, especially in the social sciences. I have collected some of them into a 

, which describes their upsides and downsides, and suggests when we might expect them to be most appropriate.

Note that the methods in the menu are generally comparing benefits to identifiable groups of people. We may care about people for whom it’s hard to make these measurements, such as future generations, but we’ll need different or further methodology to know how to compare these effects to the direct benefits we can measure. Nonetheless it’s valuable to understand how we should compare diverse benefits today, and this may be a key component in a more general analysis.

Also, we won't usually be able to choose freely from the list of methods. Giving What We Can will probably not have the resources to go and find out how much an additional parent improves the life outcomes for a person in rural China. The hope is rather that this list might help guide choices of comparison when a few different methods happen to be available. I’ll give you a few examples of evaluation methods on the list, then in the rest of this post I'll describe some of key choices it offers and mention some of the factors that might suggest one choice over another.

To give you a concrete idea of what we are talking about, here are some examples of how we might use different methods from the list to figure out how good something is for a person:

 if a person is willing to pay $100 for a textbook, you can infer that they prefer having the textbook to having $100, and therefore to other things they could buy for $100.

Instantaneous reports of subjective wellbeing:

 a person’s phone pings them throughout the day and and asks something like, ‘zero to ten, how good do you feel right now?’ Using this method, we can build a hedonic profile for different individuals and (hopefully) discover the correlates and causes of happiness, as well as their relative importance.

 A person is asked what probability of dying they would be willing to accept for an intervention that would improve their health in some way.

 Use the total costs people pay to avoid extra sunburn as a lower bound for how much a healthy ozone layer is worth to them.

What to elicit: preferences, happiness, or another proxy of good?

Whether you ultimately care to optimize for good feelings, people getting what they want, or something else is a controversial moral question. I won't address this question here except to note that different answers can lead us to prefer different measurement techniques. For instance, it is relatively easy to observe a person's preference by looking at which things they choose. Their happiness in different situations is harder to observe, so you might do better just asking them directly if that's what you care about. On the other hand, there are many reasons to suspect people's answers to 'how happy are you' across time and between people don't exactly correspond to the true landscape of happiness, so even if you cared about happiness you might take a person's preferences seriously, if you thought they liked to be happy.

When the situation you want to evaluate will have ramifications for other people than the one(s) directly affected, the preferences and feelings of the people involved will be a poor proxy for the overall good or bad done. For instance, suppose you are considering educating a young woman in a developing country. This should help her, but it is thought to also have large effects on her children and others in her community. If you are hoping to eventually lift her region out of poverty through this type of action, you are relying mostly on good from such indirect effects. In this case, discovering how much the woman would like to be educated is not very useful. Even if she wouldn't like to be educated at all it may be a good intervention. Similarly, if a person does not understand or care very much about their own future, their views on the value of improving it are not very useful. Asking a child how much they would like to be dewormed is not very useful.

One might deal with this in the earlier step, by equating 'one child dewormed' into a small amount of health, education, and physical development. A child might know better how much they dislike being sick, or adults may be able to shed light on the long term costs of malnourishment. Or you might just abstract a child's illness to be generic illness, and ask how much better informed people wish to avoid such illness.

In many situations what people think or say they value differs from what they choose given the opportunity. There are many possible reasons for this, from hypocrisy to difficulty envisaging the situation of interest accurately and without a biased focus. To the extent one believes a person's behaviour better indicates their 'real' preferences, observing choices will be more accurate than asking. However a person's speech may better reflect their preferences on reflection than their behaviour, which usually comprises a combination of considered preferences and unendorsed urges. If you wish to respect only the former, this is some reason to ask instead of observing.

Asking also has the benefit of making it relatively easy to isolate the issue of interest; natural situations rarely allow one to pin a preference to a specific factor, as so many factors change. For instance, if you see that parents choose to send their children to school at substantial cost, you might like to infer that they expect the education to benefit their children substantially. But it could also be that they expect their children to look poor if they don't go to school, and be treated worse. Then if the school didn't exist their children would not be worse off - they are just worse off if the school does exist, and they don't go to it.

The best people to evaluate A and B would seem to be people who have experienced both, and are currently either experiencing both or neither. This way they will hopefully be familiar with both items, and not too biased by the details of one being more salient at the moment.

Often it will be hard to find people in exactly that situation though. You will often have a trade off between people who are familiar with one item and not the other (so know more but might be biased) and people who are not familiar with either (so know little, but probably less biased).

This is all only an issue if you are interested in evaluating A and B for the person directly involved. If you want to know about the overall social benefits of fewer people being blind for instance, compared to fewer people being crippled, you may be better off asking someone who is neither blind nor crippled.

Suppose you want to know whether it is better to get a five year old to go to school for an extra year, or to avoid them getting malaria for one year, and you intend to figure it out by asking their parents. One way you could do it is to ask each parent 'do you think your child will be better off if she goes to school this year and gets malaria, or if she doesn't go to school or get malaria this year?'. Another is to ask some parents how valuable they think going to school is, and other parents how valuable they think avoiding malaria is, then comparing those values.

If you ask a person to compare two things at once, you will often get different answers to if you get them to just compare one or the other. One reason is that when they can see things side by side, they compare on the characteristics that seem salient. When they can only see one thing, they tend to ignore characteristics if they don't feel like they can get any grasp on how good the actual number for the characteristic is, even if it seems important. In our earlier example, suppose that for both the school and the health interventions, the parents are told how much extra income their child is likely to have in the future as a result of the project, and zero-to-ten how much their child will like it at the time. Suppose education will bring about much more future income than the health intervention on offer, but makes the child 2/10 happy instead of 8/10 happy. Then when the parents look at both interventions together, they might weigh up the present costs and future gains and choose the education intervention. When they look at the projects separately though, they might have fairly similar mental images of two different largish gains in future income, whereas happiness looks quite different on the given scale. So implicitly they focus more on the difference in happiness, and so the comparison could come out the other way.

These have been several of the considerations which make some evaluation methods more appropriate than others, at different times. The social science literature has a lot more to say. Hopefully our menu nonetheless summarizes enough important points to strengthen our research comparing interventions, and can be built upon in the future as we carry out such comparisons.

Peter Hurford

The Failures of Foreign Aid (and some potential solutions) Part 2

So even if our aid was solely focused on the Millenium Development Goals, it still would fail because it is simply not large enough. However, Peter Singer does spend some of his chapter arguing that the way America picks its foreign aid targets isn’t really all about aid. Instead, it’s all about… 

During the Cold War, the politics of aid was at its height — money was spent on other countries not to reduce poverty or fight disease, but rather to tilt countries away from Soviet influence. Peter Singer writes about hundreds of millions of dollars that was given directly to a Congolese dictator, all of which was included in Easterly’s $2.3 trillion figure. Obviously, those hundreds of millions did little to help meet the Millenium Development Goals. The fact that this spending did nothing to help people in poverty is no evidence at all for the criticism of aid that is sincerely directed at eliminating poverty.

Likewise, in 2011, Afghanistan, Israel, Iraq, Pakistan, Egypt and Afghanistan received $21.3B of the 

, or 66.3% of the total aid budget. Again, it’s clear that these nations are the target of aid not because they are the most poor or most in need, but because — even though they have more than a fair share of legitimate humanitarian problems — they are key countries in the War on Terror. It’s no coincidence that all these nations are near or in the Middle East.

Now, the point that Peter Singer and I are making is not that it’s necessarily for nations to offer aid to achieve political goals. It’s just to point out that such politically motivated aid should not be criticized for failing to achieve humanitarian goals — because humanitarian goals are just not what we have in mind. 

Less than 5% of aid spending is on health

 -- things like “twelve cent medications” are funded much less frequently than Easterly seems to claim. And that’s something we need to own up to. The humanitarian goals need more work, and they won’t be achieve with the kind of spending we currently have.

Another political problem with US foreign aid that Singer points out is that our aid is focused on indirectly benefitting the US. Congress requires that US aid be in the form of US goods transported on US ships. A government agency that intends to stop the spread of AIDS in Africa by distributing condoms must buy these condoms from American manufacturers and load them onto American ships — even though this would cost more than twice as much as doing the same with Asian manufacturers and Asian ships, or by building the necessary industries in Africa and using those industries to employ Africans themselves.

It gets worse when you consider food aid. Politics requires that food aid be in the form of government subsidized US goods shipped on US ships. This results in food being dumped in Africa at great shipping expense and displacing the local market, resulting in less income for African farmers. The need to transport food from far away also delays the arrival of urgently needed supplies. Furthermore, as 

70% of the cost of aid is tied up in shipping and logistic costs

, changing the system could allow for nearly three times more aid per dollar.

Instead, the same corn could have been bought in Africa without shipping costs and other overhead costs, providing income directly to African farmers instead of taking it away from them. While a boost to American business, inefficient regulations like these can mean that spending $27 billion a year is often the equivalent of $7 billion a year or less. While these regulations help a few specific American businesses, in particular shipping, they require higher taxes for everyone else to fund unnecessarily expensive programs. When economic and political goals are substituted in place of humanitarian goals, its no wonder the humanitarian goals suffer.

Corruption, Dependence, Institutions, and Millennium Villages

While Singer points out that aid is insufficient at cutting extreme poverty, extreme hunger, and disease because it is (1) too small, (2) badly directed, and (3) badly structured, he also argues that aid critics go too far by suggesting that all aid is caught up by corrupt governments and/or that it just creates dependency. The reason for this is that it is ignorant of how aid actually works.

Sure, giving money directly to the poor might breed dependency (though 

) and giving money directly to certain governments might enrich only their corrupt leaders. That’s why foreign aid money is mostly neither given directly to the people or the government (though a lot of money in the past certainly was, which is more reason why Easterly’s $2.3 trillion over fifty years figure failed to eradicate poverty).

As an example of effective foreign aid, Singer points us to the 

United Nations Millenium Villages Project

. This was a project to provide simple interventions to put extremely poor people on paths to sustainable growth that would continue even after the Millenium Villages Project stopped. Some of these interventions involve the creation of village-run institutions to decide how aid is spent that must involve the input of women, programmes to purify drinking water, vitamin and mineral supplements, immunization, bed nets to prevent malaria, new technology like stoves and energy production, and deworming to rid people of internal parasites.

Another example programme Singer mentions is offering fertilizer and better seeds to farmers that will improve their agricultural productivity, and farmers in return are required to give a portion of their increased harvest to a programme that would feed school-children — continuing the cycle to improve nourishment and school attendance. The project makes sure to require village buy-in, focuses on the long-run, focuses on changing things at the institution-level, and works to create sustainable change. It’s very different from the drop money and run approach that would create dependency and corruption.

Singer points to several failures in foreign aid with humanitarian goals — not enough money is being spent, and the money that is being spent is not on the countries that need it the most or on the most effective methods. Instead, too little money is being spent on wildly ineffective measures. Yet, Singer offers foreign aid a way out to meet its humanitarian mission: work on funding more proven interventions at much higher rates, and end the counterproductive regulations and food subsidies.

Singer, being consistent with a more politically liberal tradition, even suggests an easy place foreign aid money could come from: slightly higher taxes. Consider the proposed 

, a 5.4% additional tax on all incomes over a million dollars in the US.

The Joint Committee on Taxation has estimated this would bring in roughly an extra $42 billion per year, which combined with the current aid budget would be enough to fully fund the Millenium Development Goals with an extra $9 billion annually left over. Another way to get the $60 billion per year would be to just cut the US Defense Budget by 10%. A large share of this money (something like $20 billion) could immediately be raised just by redirecting US Aid’s funding from politically oriented projects, towards development projects.

Now, I don’t suggest that any of these specific changes would be wise — I just do this to suggest that making very serious and significant strides toward eliminating extreme poverty, extreme hunger, and disease is possible, with equally serious and significant changes in our priorities. Remember that $60 billion annually is a simple $200 per person per year in the United States. Such an amount is hardly out of our reach.

Michelle Hutchinson

Giving What We Can in 2014

Giving What We Can carries out reviews of its progress and plans every six months. This post describes what we are working on over the current period, the first half of 2014. It is a summary of our 

. Having successfully improved the journey to membership over the previous period, we’re now concentrating on how to increase the number of people starting out on it. We’re doing that by testing various approaches developed following research over the last period. These include individual outreach on social media, a variety of events and a new website with a clearer pathway through it towards taking action.

Giving What We Can is working towards a world without extreme poverty. We’re doing that by inspiring donations to the organisations which are most effective in helping those in the developing world. Our key metric is our number of members, each of whom have pledged at least 10% of their lifetime income to the most effective charities. Over the first half of this year, we aimed to get 90 new members, which would take us to 497 members. That’s the same number as we gained over the second half of 2013, and about double the number of new members for each of the two previous periods. This target stems from two facts: Many of the people who joined over the last period were people who heard about us earlier, but we didn’t have a chance to follow-up with until Ben joined us on Community. On the other hand, we will be trying out new ways to interest people in effective giving.

Over the past year, our experience has been that the most promising strategy for increasing membership is to engage people personally, and provide a gradual pathway for people to join. Two possible ways to provide this are by running events, and by engaging people on social media. Both these allow for a more personal interaction and better follow-up than the mass media approach we had previously been using. Over the second half of 2013 we did market research, we tried reaching out individually to various groups on Facebook and via email and we tested whether we were able to run a few different types of events.

Following up on what we learned on the individual outreach side, we are engaging with the groups which seemed the most promising. By doing this over a more prolonged period, we hope to gather enough data to know how effective this is as a way of getting people involved. With regard to events, joint events seemed promising based on our running events with both YTFN and Global Hand, so we would like to run more of those. They also allow us to learn from groups who have more experience running events. Events at workplaces also seem promising, since they are convenient for young professionals who are typically very busy.

We have just launched our new website. It aims to be clearer to navigate, and to lead more directly to people getting involved and ultimately joining. We will be testing three immediate action points for the website, since we don’t yet know which of these would be popular: Try Giving, personal dashboards (which allow people to track their donations), and donating to the Giving What We Can Trust.

Over the last period, we talked to people who had already done Try Giving. Their impressions were positive, and most of those whose Try Giving period ended signed up again or joined. Therefore, we are promoting it to a great extent on the website (

https://www.givingwhatwecan.org/get-involved/join-us

). We aim to have 85 people sign up to Try Giving by the end of June.

The dashboards, called My Giving, are launching with the new site, so we will be testing them in this period. They provide a way for people to set themselves a giving goal and track their impact. We will test them as a good way for members and Try Givers to track their giving, and also advertise it directly as a way for people new to effective giving to engage with us.

In this period, we’re organising two exciting events – our annual Weekend Away, and the Effective Altruism conference Good Done Right. This will be the third year the Centre for Effective Altruism holds a weekend away. Over the last two years it has been predominantly team members and volunteers from Giving What We Can, 80,000 Hours and The Life You Can Save who came. This year we will encourage Giving What We Can members to come too, since it’s such a good opportunity for people to get to know others interested in effective giving.

Good Done Right is the first interdisciplinary conference on Effective Altruism, and is a great opportunity to get Effective Altruism recognised in academia. Speakers include Derek Parfit, arguably the most significant moral philosopher of the 20th Century, Rachel Glennerster who runs the Abdul Jameel Poverty Action Lab and Larissa MacFacquhar, a journalist for the New Yorker who has a book forthcoming on extreme morality. Following the conference, selected lectures will be published as a book by Oxford University Press.

The first half of 2013 is an exciting time of trying out different approaches – social media outreach, events and different pathways to membership through the website. Our aim is to find out which are the best ways to reach out to people and to encourage them to donate long-term to the most effective charities.

Between 1990 and 2010 the world succeeded in halving the proportion of people living in extreme poverty. Eradicating extreme poverty is going to be still more difficult. But those of us in the developed world are in the fortunate position of having 

. By committing ourselves to sustained giving, and by using evidence to determine which charities to support, we really can 

have a significant impact on the lives of others

Toby Ord and DCP3

The Disease Control Priorities in Developing Countries publications are a World Bank initiative to produce evidence-based analysis of what health policy priorities should be. They are one of the best sources of information for comparing the cost-effectiveness of different health-based interventions. The newest edition, DCP3, will be published volume by volume over the next two years. Giving What We Can’s President, 

, is on the advisory panel to the editors of DCP3. He recently attended a meeting of the advisors, in which they reviewed the two volumes which are nearly ready for publication. We thought you might be interested in hearing a little about the progress of DCP3, and Toby’s role in it.

The most exciting development in the plan for DCP3 is that it will now include an overall comparison of health interventions across all areas, in terms of cost-effectiveness. That comparison will form part of the 1st volume, which will be published last, since it draws the other volumes together. Although there was a comparison of this type 

, the initial plan was not to include one in DCP3. The reason was that comparing numerical cost-effectiveness of interventions across areas might give a feeling of spurious precision. In many cases, the estimate of the cost-effectiveness of a particular intervention has a large error margin, which makes people hesitant to compare it to the estimate for a very different intervention. It’s important to be clear that the estimates are uncertain and vary by region. On the other hand, these estimates are our 

. We cannot be certain that the interventions will have the impact these estimates predict; but these are the best indication we have and so acting on them gives us the best chance of helping people as much as we can. The challenge is presenting them without giving a false sense of precision.

This week’s meeting of the advisory panel was to discuss the two volumes of DCP3 which will be published first: those on surgery and on cancer. These two areas aren’t ones that we usually think of as particularly cost-effective, but the current drafts do contain some promising intentions. One of these is the current estimate for training first responders in first aid (in the surgery volume), which is just $7 per DALY. This is in keeping with findings in DCP2 that health education is often very cost-effective. The current estimate for providing essential surgical facilities at a first level (district) hospital is also very cost-effective, at $11-223 per DALY.

Cancer treatments are sometimes given as paradigm examples of hugely expensive interventions which serve only to marginally extend the lives of the elderly. Although in the developed world we do spend large sums on cancer drugs, some cancer treatments are extremely cost-effective. This is sometimes obscured by the fact that improving cancer treatments has a high diminishing marginal return. An example given in DCP3 is that for a childhood cancer we used to prescribe a $50 treatment, which had a 50% survival rate. We now prescribe a $100,000 treatment, for which the survival rate is over 90%. We should strive for a world in which all children can receive the latter. But in the mean time, the former can be used to help many more children.

Also in the cancer volume is information about tobacco, which is still causing more than a million deaths per annum. The current draft of the volume estimates that doubling the price of cigarettes in low and middle income countries could reduce by a third the number of people who smoke, and that that would prevent over a 100 million deaths (meaning averting deaths before 70). Unfortunately, increasing tax on cigarettes by that amount is politically difficult. If it was possible, it would not only save lives, but also generate government revenue that could be used to help people in other ways.

Going forward, Toby will be primarily concerned with the 1st (summary) volume of DCP3, for which he may write a chapter. He is also on the technical advisory group, which discusses the best ways to disseminate the information in DCP3 – for example, what kinds of executive summaries should be provided. The estimated time for the 1st volume appearing is early 2016. In the mean time, look out for the volumes on cancer and surgery, which will be coming out in a few months time.

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