Effective Altruists Agree That It's Hard To Help People In The Developing World

sorry regular readers I'm writing this because I want to be able to link it on X

A remarkably common criticism I see of effective altruism is that effective altruists say you should help people in the developing world, but don’t they know that helping people in the developing world is very hard?

This criticism baffled me so greatly that I didn’t know how to respond the first twenty times I saw it. But I have finally seen it enough times that I’m going to write up this post.

Effective altruists agree that it is difficult to help people in the developing world. The “effective” in effective altruism refers to exactly this insight. It’s not enough to want to do good; you also have to do good well.

One important early effective altruist paper is Toby Ord’s The Moral Imperative toward Cost-Effectiveness In Global Health. Ord talks about Disease Control Priorities in Developing Countries, a book which lists various health interventions, how much they cost, and how much good they do. He writes:

The least effective intervention analyzed is still the treatment for Kaposi’s sarcoma, but there are also interventions up to ten times more cost-effective than education for high-risk groups. In total, the interventions are spread over more than four orders of magnitude, ranging from 0.02 to 300 DALYs per $1,000, with a median of 5. Thus, moving money from the least effective intervention to the most effective would produce about 15,000 times the benefit, and even moving it from the median intervention to the most effective would produce about 60 times the benefit…

Moreover, there have been health interventions that are even more effective than any of those studied in the DCP2… For instance in the case of smallpox, the total cost of eradication was about US$(2013)1.5 billion.67 Since more than 100 million lives have been saved so far, this has come to less than US$15 per life saved—significantly superior to all interventions in the DCP2. Moreover, the eradication also saved significant amounts of money. Approximately US$500 million was being spent across developing countries per year in routine vaccination and treatment for smallpox, and more than US$7 billion was lost per year in reduced productivity. Even just in the United States, smallpox vaccination and vigilance cost US$1 billion per year before eradication. The eradication program thus saved more lives per year than are lost due to war, while saving money for both donors and recipients, paying back its entire costs every few months.

Ord concludes:

If we can save one thousand lives with one intervention and ten thousand with another at an equal price, then merely moving our funding from the first to the second saves nine thousand lives. Thus merely moving funding from one intervention to a more cost-effective one can produce almost as much benefit as adding an equal amount of additional funding.

Of course, Ord’s paper is talking only about providing healthcare. If you look at the whole space of ways people try to help the global poor, you see many programs which are far worse than treatment for Kaposi’s sarcoma, which at least usually cures the cancer. For example, the water pump charity PlayPumps claimed to provide water pumps powered by children playing on merry-go-rounds—but unfortunately the creators flunked high school physics:

Most merry-go-rounds build up momentum and then spin freely — this is why they are fun for kids. But if they're being used to pump water, they require constant force. Applying such force would be exhausting for any adult, let alone a child.

PlayPumps turned out to be a dangerous, ineffective, and expensive alternative to a traditional hand pump — inferior in almost every possible way. They were a chore rather than a source of enjoyment for children. Kids didn't want to play with them, so the women of the local village ended up pushing the merry-go-round themselves, which was tiring and not an activity the women signed up for.

Just trying to help isn’t good enough. If you don’t know what you’re doing, you can easily leave people worse off.

The largest effective altruist organization that specializes in global poverty is GiveWell.

GiveWell has a staff of more than seventy people and spends ten million dollars a year researching charities that help people in the developing world, because figuring out which charities work is very hard—especially when they’re on the other side of the globe.

You never have to take GiveWell’s word for anything. All the information they have about their top charities is extensively explained on their website. You can even enter your own numbers into their cost-effectiveness spreadsheets if you’re skeptical of some part of their reasoning.

You might notice that all of GiveWell’s top charities are health charities: they prevent malaria, provide vitamin A supplements, or help people get vaccines. When GiveWell makes grants that aren’t to its top charities, through its All Grants Fund, the grants also usually go to health charities. There’s a reason for that (and here I’m speaking for myself, not GiveWell).

Job training programs, microfinance, food aid, agricultural extension programs, and other ways of helping the world’s poor depend a lot on context. For example, you might train people to be carpenters—but maybe there are already too many carpenters for the jobs available, or all the wood products are imported, or carpentry companies are controlled by a small number of families who refuse to employ anyone outside the family, or small-engine repair pays better anyway. You need to know a lot of specific details to know whether the program will work.

On the other hand, seasonal malaria chemoprevention works basically the same way everywhere there’s malaria. We know how likely people are to die from malaria and the extent to which malaria keeps them from working. And we know that no one likes being sick, being unable to work, dying, or watching their children die. Some contextual knowledge is required—the prevalence of malaria, the effectiveness of the local healthcare system—but ultimately you can roll out the same program and get basically the same results.

And—as Ord points out—not all health programs are created equal. GiveWell uses extensive research to make sure that they recommend only the most cost-effective programs: the ones that are 15,000 times better than other programs.

I sometimes say I’m 80% an aid skeptic. I have deep misgivings about the ability of rich people in the developed world to save poor people far away. Ultimately, many valuable things—economic development, civil liberties, democracy—can only come from the actions of the people affected. Being rich doesn’t mean you can save everyone.

But rich people from foreign countries can provide the global poor one valuable thing: medicine. Medicine that costs a trivial amount of money for us is far out of the reach of the global poor. We can’t turn other people’s countries into rich, capitalist liberal democracies. But we can make sure that they don’t have malaria or vitamin A deficiency or HIV/AIDS —and thus that they’re in the best possible position to solve their own problems.

I believe in a humble approach to helping the developed world. We must be aware of our limitations. We must know what we can and can’t help with. That is precisely why I am an effective altruist. And if you’d give to the global poor except that you’re worried that you don’t know how your money would help, I’d be happy to have you on the team.