Global Health and Development

This report is a “shallow” investigation commissioned by GiveWell. The primary focus of the report is to provide an overview of what is currently known about the exposure to lead paints in low- and middle-income countries.

Researcher Ruby Dickson and Senior Environmental Economist Greer Gosnell investigated various interventions that may help very poor people to increase their income and earning potential in the short and medium term. Their goal in this report is to provide a foundational overview of the potential for particular income-improving livelihood interventions with a focus on sub-Saharan Africa (SSA).

The first of a two-part series on anti-deforestation initiatives, this report examines the feasibility and cost-effectiveness of the REDD+ framework for reducing forest loss and degradation and for abating CO2 emissions that contribute to climate change.

This report is a “shallow” investigation and was commissioned by Open Philanthropy and produced by Rethink Priorities. Open Philanthropy does not necessarily endorse our conclusions. The primary focus of the report is a literature review of the effectiveness of prizes in spurring innovation and what design features of prizes are most effective in doing so. We also spoke to one expert. We hope this report galvanizes a productive conversation about the effectiveness of prizes within the effective altruism community. We are open to revising our views as more information is uncovered.

Agricultural land redistribution is a type of agrarian reform in which large farms are broken up and distributed to tenants or landless peasants. Land redistribution typically requires exceptional circumstances to succeed. Past redistributive efforts have been most successful in the aftermath of revolution, war, or independence. When redistribution has succeeded, it has been accompanied by extensive agricultural support, such as rural infrastructure development, subsidies for fertilizers and high-yield seeds, agronomic training, and cheap credit. The main value of redistribution appears to be improved agricultural yields, but redistribution is neither a necessary nor sufficient condition for improved yields.

The value of charter cities can be divided into three main buckets: (1) direct benefits from providing an engine of growth that increase the incomes and wellbeing of people living in and around the city, (2) domestic indirect benefits from scaling up successful charter city policies across the host country, and (3) global indirect benefits from providing a laboratory to experiment with new policies, regulations, and governance structures. We think it is unlikely that charter cities will be more cost-effective than GiveWell top charities in terms of directly improving wellbeing.

Lead exposure is a large problem with social costs on the order of $5-10 trillion annually, most of which come through neurological damages and losses in IQ causing lost income later in life. Lead exposure is diverse both in terms of sources and geography, with there being many different pathways for environmental lead to enter the human body and exposure being common across nearly all low- and middle-income countries. Although the proportion of the lead burden attributable to different sources is unclear, important exposure pathways include informal recycling of lead acid batteries, residential use of lead-based paint, consumption of lead-adulterated foodstuffs, and cookware manufactured with scrap lead. Rough initial cost-effectiveness estimates suggest that some strategies for dealing with lead exposure could be as or more cost-effective than GiveWell top charities.

The sHALY (subjective wellbeing-based health-adjusted life-year) describes health states using a conventional QALY or DALY classification system, or ideally a broader “HALY+” system described in Part 2. But it assigns values (“weights”) to those states according to their effect on life satisfaction and/or hedonic wellbeing. This helps avoid some problems with hypothetical preferences, such as the difficulty of imagining what it’s like to be in a different health state and the neglect of non-health consequences of health conditions.

The most widely-used HALYs are the quality-adjusted life-year (QALY) and disability-adjusted life-year (DALY). For reasons covered in Part 1, they tend to inaccurately estimate the overall wellbeing impact of many conditions, leading to serious misallocation of resources. The (hypothetical) HALY+ incorporates incremental improvements to the most common versions of the QALY and DALY, so that they more closely track subjective wellbeing (and perhaps other things people care about) while avoiding some potential problems with pure wellbeing measures. The extent to which they would resolve each of my core concerns with current HALYs is summarized in the conclusion.

This series of posts describes some of the metrics commonly used to evaluate health interventions and estimate the burden of disease, explains some problems with them, presents some alternatives, and suggests some potentially fruitful areas for further research.[1] It is primarily aimed at members of the effective altruism (EA) community who may wish to carry out one of the projects. Many of the topics would be suitable for student dissertations (especially in health economics, public health, psychology, and perhaps philosophy), but some of the most promising ideas would require major financial investment. Parts of the sequence—particularly the first and last posts—may also be worth reading for EAs with a general interest in evaluation methodology, global health, mental health, social care, and related fields.

We investigated the cost-effectiveness of vaccine research and development to learn about how cost-effectiveness estimates are made and where they might go wrong. By doing this, we became far more wary of taking these estimates literally. Many people will do things like reducing their cost-effectiveness estimate by a factor of 10x and call this a conservative estimate, but in light of this exercise and other examples, this is not enough. Furthermore, our research underscored that donating to the Against Malaria Foundation (AMF) may be a really hard baseline to beat and that it is important to do some degree of investigation before assuming things beat AMF. Lastly, our research has some implications for biosecurity that merit further exploration.