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Michelle Hutchinson

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.

Ben Clifford

What Live Below the Line did to Ben Clifford

, a fundraising challenge to live on a food budget of £1 a day for five days. The aim of the fundraiser is to draw attention to the lives of 1.2 billion people who live on less than a £1 a day and raise money for charities that help some of these people. I fundraised for SCI, a 

, which creates and scales deworming programs with impressive cost-effectiveness.

I was surprised at how difficult I found the challenge. First of all, it was very time consuming. Thankfully I had lots of advice from other people who had done the challenge before, but even so, planning out my weekly shop took up a lot of time and poor planning meant I had to do an extra shopping trip in search of cheaper oats. Second, the food was very boring. I didn't expect this to bother me but I found myself craving variety and a bite of my friends' tastier food. But the biggest difficulty for me was how restrictive the food budget was on my decisions. I couldn't do anything out of routine, for example, forgetting my lunch for work became a stressful scenario. But I also had to miss out on social experiences as simple as having a drink with friends. All of this sounds relatively trivial but when compressed into a week has an impact on your life experience. To claim that this was anything like as difficult as the situations people actually living in extreme poverty face would be preposterous, but I do feel I gained a better appreciation of the power of money and the role it has in our lives.

One of the hardest things I find about challenges such as Live Below the Line is how to react to such an experience. What should my take away be? There's something grotesque about realising how difficult it is to live on a restricted budget and then blowing the equivalent of my week's food budget on a breakfast of French pastries, without changing my actions.

What do I do with the realisation that I undervalue the experiences I have and that most of life involves a cost which is a luxury on a global scale? I'm not sure there is any completely appropriate way to respond.

The most important thing for me is not to let this realisation result in inaction. It is easy to feel overwhelmed by the scale of inequality and not do anything. For me capturing that passion to help and make sure something really tangible happens involves doing something practical, easy, but powerful. It's also something anyone can do:

 to charities like SCI that dramatically improve lives.

Review your percentage at a later stage if you wish.

This doesn't radically change my way of life, I still eat croissants, but it does have a huge impact on the lives of other people.

You can still donate to my campaign here.

 I reached my target of £2,000, but the more donations to SCI the better!

Live Below the Line

Most of us don't like talking about money, but a crucial part of taking compassion for others seriously involves appreciating the power of wealth.

There are two facts about money that motivate me to help:

1. I am rich. From putting my intern expenses into the 

 I know that I am in the richest 14% of people in the world. This isn't because I have crazy expenses, I can expect to be much richer in the future. The average person in the UK is in the top 3% of earners in the world. We can get a better understanding of why this is the case when we consider that 1.2 billion people live on a pound a day.

2. Our money can do an incredible amount to help people living below the poverty line. I can provide a pill that will cure someone of intestinal worms at a cost of 50 cents, by donating to the Schistosomiasis Control Initiative (SCI). It is incredible to think just how many people I can help when I give to the most effective charities.

 challenge to draw attention to these facts. Live Below the Line is a challenge to live on a food budget of a £1 a day for 5 days. This is the amount that 1.2 billion people around the globe live on for food, travel, shelter, everything, everyday. You might think that a pound will go further in developing countries but this figure is adjusted for purchasing power parity, meaning that 1.2 billion are living on the equivalent of what £1 would buy in the UK.

The challenge I am taking part in won't come close to the everyday struggle involved in living in extreme poverty but I hope to highlight the disparity in wealth and the comfort that having excess money provides. I am also donating the savings I will make during the week (plus some more to round up to £100) to SCI and I am hoping to raise £2000 in total. This will fund the equivalent of 4000 tablets to rid kids of parasitic worms. Keeping this in mind puts in perspective the real value of our money.

I hope others will join me in making a donation and having a huge impact. If you'd like to sponsor me you can donate at 

https://www.livebelowtheline.com/me/benclifford

Stephanie Crampin

World Malaria Day

Today is World Malaria Day 2014. It’s a day for gathering support and spreading the word about combating malaria. Malaria is a huge drain on developing economies, and rates of the disease are intimately related with rates of poverty throughout the developing world. It affects development in many ways, including premature mortality, school absenteeism, fertility, population growth and medical costs. Mosquitoes transmit malaria parasites, and symptoms of the disease are flu-like, including headaches, fever and vomiting.

The economic benefits of combating malaria are huge. Whilst it is estimated that each year, US$5.1 billion is needed to fight malaria, the annual cost to Africa of lost GDP due to malaria is at least $12 billion - over double. And yet there is currently a lack of help in this area. In 2012, only US$2.5 billion was available for programmes to fight malaria worldwide.

That’s where we come in. Malaria can be prevented, simply by purchasing and distributing bed nets in areas that need them most. The Against Malaria Foundation (AMF), one of Giving What We Can’s top charities, does just this. At $3 per net, and with an expectation of saving a child’s life per $3,600, they are an extremely cost-effective giving opportunity. AMF currently have plans to make their largest ever distribution in the Democratic Republic of Congo, and we are hoping to see more from them soon. Please help us combat this deadly disease - donate a net today!

http://www.theglobalfund.org/special/2014-World-Malaria-Day/

http://www.rbm.who.int/cmc_upload/0/000/015/330/415680a_r.pdf

A conversation with Alix Zwane of Evidence Action

We had a chance to catch up with Alix Zwane of 

, who was in Oxford for the Skoll World Forum, on the 10th April. She gave us an update on what Evidence Action is up to.

It’s always a pleasure to touch base with the Executive Directors of our recommended charities, not just because of their dedication to work that we find so important and interesting, but because they are all lovely people to get on with. This was the first time we’d met Alix in person, and we enjoyed catching up in the cafe of Modern Art Oxford.

We were particularly interested to hear about the 

’s progress, the importance of which was summed up neatly by Alix: a great measure of a country’s equity in health services is progress against neglected tropical diseases, as these affect the poorest and most marginalized. The DtW Initiative is as strong as ever and still expanding. DtWI is exploring beginning work in additional states in India, and beginning work in Vietnam with new partners. Another of their potential new projects involves a collaboration with 

- it’s great to hear that two such effective charities are working together!

We also chatted about other, broader work being done in the field. Currently there is new scientific interest in the potential to break transmission of soil transmitted helminths via mass drug administration. There have been some big wins for deworming recently, including a new $120 million commitment to control STH’s, spearheaded by the Children’s Investment Fund Foundation and the Bill & Melinda Gates Foundation.

Evidence Action is also exploring a range of new projects less focused around water or NTDs. These include a remedial education programme for young children in Kenya, in partnership with the government there. The evidence base for this work has been documented by the 

 (J-PAL), which advocates for “teaching at the right level” as a cost effective education approach in developing countries.

Evidence Action remains focused on projects in health and development that work, and we can look to them and their sister organizations, J-PAL and 

 (IPA) for first-hand knowledge of how to effectively tackle some of the world’s most pressing, preventable and lingering problems.

Carolina Flores

Celebrity endorsement: the curse of good causes?

A recent article in the Guardian [1] calls celebrity endorsement ‘the curse of good causes’. The article comes across as a personal attack on celebrity culture as ‘a dystopia seething with hypocrisy and soaked with vanity’ transferred to its relation to charitable causes. The arguments for disdaining celebrity involvement in charity are surely familiar:

1. Celebrities are not sincere in their support of good causes: all they care about is getting positive publicity and feeding their narcissistic impulses;

2. Celebrity endorsement trivialises the important causes it is related to;

3. People will only pay attention to the cause because of the celebrity’s association with it, and not because of its importance;

4. Celebrity endorsement sometimes goes badly wrong – for example, when a celebrity’s actions go directly against the ethos of the charity they are supporting;

5.�� Celebrity culture is narcissistic and shallow in itself, and celebrity endorsement of charities is a part of it.

I believe that these fail to establish that celebrity endorsement should be avoided. In fact, my aim it to show that there are good grounds on which to support it.

**First of all, what is the value of celebrity endorsement? **

Argument 1. seems to be based on the assumption that the value of someone’s involvement in a cause comes from the motivation behind it. If their motivation is selfish or insincere, then their involvement is worthless. This seems very implausible. If someone chooses to donate to charity because it makes them happier, or because it will improve their public image, the money they donate will still have a valuable impact: it could save lives, prevent suffering, decrease inequality, or improve someone’s chances of success in life. All of these things seem very valuable.

Celebrities’ motivations for supporting a charity are irrelevant to the impact they have. Furthermore, even if in some cases they are driven exclusively by self-interest, it seems unlikely that that is always the case. Celebrities like Angelina Jolie, Bono, or Elton John, who have shown a long-term commitment to a cause accompanied by generous donations and knowledge about it, are probably driven at least in part by a serious concern for the causes they engage with.

If it isn’t their motivation, what is the value of celebrity endorsement? Like any individual’s support of a charity, it lies in raising awareness of a problem – which may in the long term contribute to social or political change regarding the issue – and in moving donations to the charity – both from the individual and from people she reaches out to. Due to celebrities’ public presence, access to media platforms, and the admiration people often have for them, their support of a cause stands the chance of scoring highly both in raising awareness and in driving donations. If people only pay attention to the cause because of the celebrity, it is still good that they are paying attention to the cause (so argument 3. does not carry much weight). There is some evidence for celebrities’ involvement increasing donations: researchers at Rutgers-Camden looked at a sample of 500 non-profit organisations and concluded that donors gave 1.4% more to charities associated with celebrities than to those without celebrity endorsement. As celebrity endorsement can also reduce the resources a non-profit needs to allocate to fundraising, this means that a lot more can be invested in the charities’ goals. The positive impact of celebrity endorsement on support for a cause seems to indicate that people learn more about it and take it more seriously, not that it becomes trivial, as stated in argument 2. above. [2, 3]

It is true that sometimes celebrity endorsement goes wrong, as argument 4 states. If a celebrity is incoherent in her support of a cause – for example, when Naomi Campbell wore a fur coat while supporting PETA – this will make her lose credibility and appear hypocritical, which won’t have a good effect on the charity. But this only means that celebrity endorsement needs to be done well, as does any activity to help a charity. Ideally, the celebrities involved will have knowledge and interest in the cause: this will make them more persuasive and effective in reaching their aims.

The case for celebrity endorsement of charities is much the same as for any other marketing campaign. To address point 5., whatever one thinks of celebrity culture, it is part of the society we live in, and we must work with what there is to bring change. If celebrity endorsement is a good way of reaching more people and getting more funds, as it seems to be, one may make the case that it should be encouraged and celebrated.

http://www.theguardian.com/commentisfree/2014/apr/02/angelina-jolie-celebrity-endorsement-curse-good-causes?commentpage=1

http://news.rutgers.edu/news-release/celebrity-endorsements-lead-increases-charitable-donations-public/20130926#.U0Z212RdU64

http://trendandtonic.thefuturescompany.com/celebrity-attached-charity-actually-bring-dollars/

Peter Hurford

The Failures of Foreign Aid (And Some Potential Fixes) Part 1

 that individuals can make a large difference in the lives of others through donations, as long as they choose very cost-effective charities. However, while our donation does make a difference to a few people, there are also massive institutions working to make much bigger differences in the well-being of those in other countries — through 

Foreign aid aims to eliminate extreme hunger, extreme poverty, and disease from the world altogether and usher everyone into lives in which they can be happy and live to their potential. Because foreign aid is perhaps the biggest attempt to make the world a better place, it is important to me that we get this right.

Unfortunately, we haven’t gotten it right quite yet. Fifty years of foreign aid efforts later, and extreme poverty, extreme hunger, and disease still exist. While it may seem wildly idealistic to believe that extreme poverty, extreme hunger, and disease can be eliminated soon, Peter Singer in his book 

 argues that the elimination of all three plights is within our reach if only we studied foreign aid, looked at its failures, and made some modifications. In this essay, I explore his chapter on foreign aid.

Peter Singer starts off by quoting a prominent foreign aid critic, William Easterly, who makes the following argument:

The West spent $2.3 trillion on foreign aid over the last five decades and still had not managed to get twelve cent medications to children to prevent half of all malaria deaths. The West spent $2.3 trillion and still had not managed to get four-dollar bed nets to poor families….It’s a tragedy that so much well-meaning compassion did not bring these results for needy people.

However, as Peter Singer notes, $2.3 trillion on foreign aid over five decades is $46 billion a year, which distributed over all developed nations works out to $60 per person per year, or 0.3% of the economic output of these nations (30 cents per $100). In 2011, America was one of the least generous developed nations, giving 0.18% of GDP — though America still gave the most at the dollar by dollar level, sending $32 billion overseas. Other nations, like Sweden, give closer to 1% of their GDP.

Still, billions of dollars a year sounds like an awful lot, though it’s also equally fair to describe it as $90 per person, per year — less than people tend to typically donate on their own from their after tax income, and much less than people give up in taxes.

Interestingly, the American population feels like a lot more goes to foreign aid than 0.18% of the GDP. Peter Singer quotes a poll done by the University of Maryland, which asked 848 respondents “What percentage of the federal budget goes to foreign aid?”. 

, or $900 billion annually (the US budget has typically been $3.6 trillion per year), or $3000 per person — more than 33 times larger than the actual budget.

More interestingly, these same respondents were asked how much they thought the government should spend on aid. Here, the median response was for the government to 

, or 13 times larger than it actually is. At 10% of GDP, the aid budget would work out to $360 billion annually, or $1200 per person.

Whether $900 billion annually or $27 billion annually, these numbers for aid — both potential and actual — mean little without a baseline to compare them to. Just how much would it actually cost to do what William Easterly suggests — use medications and bednets to prevent half of all malaria deaths?

To consider the cost, Peter Singer looks to a more broad initiative — the 

, a UN-lead project to “Eradicate extreme poverty and hunger; Achieve universal primary education; Promote gender equality and empower women; Reduce child mortality rates; Achieve universal access to reproductive health; Combat HIV/AIDS, malaria, and other disease; Ensure environmental sustainability; and Develop a global partnership for development”. One of these subgoals is to prevent half of all malaria deaths.

The World Bank has estimated that in order to meet these goals, it would require around an additional $60 billion per year for twenty-five years, though this is a rough guess. However, for the United States to do this alone, this would work out to $200 per person per year, or require roughly 0.4% of US’s GDP. This is even more doable when we internationalize the issue -- for all nations in the 

Organization for Economic Cooperation and Development

, it would be $50.36 per person per year, or roughly 0.13% of the combined GDP.

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 

Andreas Mogensen

An update on AMF

At the end of the last year, concerns were raised by GiveWell regarding AMF’s room for additional funding. Although we took GiveWell’s concerns seriously, 

we chose to keep AMF on our list of recommended charities

. AMF were known to be involved in negotiations for three major distributions in Sub-Saharan Africa that could in principle create a significant funding gap in early 2014. In light of AMF’s outstanding qualities as a charity and the open nature of these negotiations, we didn’t feel there was a sufficient case for overturning our recommendation. In light of the expected time of completion on the negotiations mentioned earlier, we hoped to have a better picture of AMF’s position by April of this year and would review our position at this time. That’s what this blog-post is intended to do.

We were very pleased to learn, at the end of March, that AMF has secured its largest distribution to date, worth nearly $2,000,000. 676,000 nets will go to the Democratic Republic of Congo (DRC), to be distributed between July and October 2014. A distribution in the DRC is challenging but also especially needed, as it is one of the worst affected countries.

We feel that this recent distribution goes some way to vindicating the confidence we placed in AMF in December. Not only is this the largest distribution to date for AMF, it also preserves core features of the AMF model, such as a commitment to rigorous monitoring and to partnering with other organisations to fund non-net costs. In light of past failures to secure distributions, these features of AMF’s programme came under critical scrutiny. It is encouraging to see they have posed no significant obstacle in securing a large distribution in a country that otherwise poses significant logistical challenges.

While this constitutes a significant success for AMF, we should note that this is only one of the three potential distributions mentioned earlier. In fact, it is the smallest of the three. We had reasonably hoped to see each distribution having reached a decision by the end of March 2014. However, the other distributions are still progressing and have yet to be concluded. The next largest is a potential distribution of 680,000 nets, and the largest is a potential distribution of 3.1 – 4.6 million nets. AMF is still hoping to raise additional funds to cover these distributions, as they would require more funds than are currently available. AMF’s policy is to agree to distributions only if they are already fully funded, which is why they need to raise money prior to commitment.

Although we note that the largest of these distributions is being planned for 2015 and therefore can run on a longer timeframe, we are disappointed that these negotiations have not advanced to the same extent. Nonetheless, in light of their recent success in the DRC, we will continue to recommend AMF as a top charity. We wish them the best of luck with their current negotiations. And we encourage all of you to continue supporting AMF through your donations.

Welcome to our new website!

Welcome to the brand new Giving What We Can website! It has a new look, new structure and new features. Have look around, and 

The new website aims to be more accessible than the previous one. We’ve tried to give a new reader a clear pathway to follow through it, ending in a call to action – joining Giving What We Can. Since joining Giving What We Can is a substantial commitment, which not everyone is ready to take right away, the new website puts more emphasis on 

. Try Giving allows people to choose the percentage they’d like to donate, and over what period they’ll do that. People can use it to trial donating 10% for a short period, or to build up their giving gradually towards 10%. The website also makes it easier to donate through the Giving What We Can Trust (having that option always available in the top bar), in keeping with our core mission to move money to the most effective charities.

Building this website has been an immense project, for the successful completion of which we’re grateful to a great number of people. The largest share of the credit goes to our Director of Communications, Steph (regardless of how much she’ll try to deny it!). She oversaw the project from its beginnings, and managed the large number of people all working on different parts. She made sure that everything ran smoothly and that the result was the polished product you’re now looking at. Our Webmaster, Jacob, has been working tirelessly on the project alongside his PhD. As well as building new features and pages, he’s been responsible for bug fixing – a task which has at times led to anguished cries, (tame) swearing, and head banging. Thankfully, he’s survived to this point.

We’re also very grateful to the designers, and to Peter Orr who wrote all the new copy for the website. A large amount of the coding was expertly done by our Director of Operations, Tom. We are also incredibly grateful to and Adam Malone and Aurelien Navarre- two highly skilled volunteers from Drupal, who we met through ‘.impact’. Finally, we have been fortunate enough to have received help on coding, editing and bug finding from many dedicated and talented volunteers – thank you all very much!

I hope you’ll enjoy exploring the new website. I particularly recommend checking out the 

. A page you might like to look over, as providing what we hope is a useful call to action, is 

. The page to keep an eye on in the future is 

. It allows you to track your giving and shows you the impact you’re having on people’s lives. We hope you’ll find it to be a useful resource!

Call for registration – GOOD DONE RIGHT: a conference on effective altruism

 at All Souls College, one of the constituent colleges of the University of Oxford. We’re very pleased to announce that registration for the conference is now open. The conference will be from the 7th to the 9th of July. It seeks to bring together leading thinkers to address issues related to effective altruism in a shared setting. Speakers will include Derek Parfit (Oxford), Thomas Pogge (Yale), Rachel Glennerster (MIT Poverty Action Lab), Nick Bostrom (Oxford), Norman Daniels (Harvard), Toby Ord (Oxford), Jeremy Lauer (WHO), William MacAskill (Cambridge), Larissa MacFarquhar (the New Yorker), Nick Beckstead (Oxford), and Owen Cotton-Barratt (Oxford). The speakers are drawn primarily from within moral philosophy, but there will also be academics who specialize in development and health economics. There will also be a conference dinner on the 8th in the Hall at All Souls. You can learn more about the conference at 

 , which also contains instructions for how to register and suggestions for finding accommodation. We very much hope to see you at the event.