Famine, Affluence and Mortality

  • In 1971, in East Bengal, millions are dying from lack of food, shelter and medical care
  • These deaths are avoidable
  • However, people have not taken the necessary decisions to avoid these deaths
  • No government has given the sort of massive aid that is necessary to enable the refugees to survive for more than a few days
    • Britain, among the top givers of aid to East Bengal will spend more than 30 times as much on the Concorde
    • Australia, another top giver, will spend more than 12 times as much on the Sydney Opera House
  • The way that people in affluent countries react to situations like the East Bengal crisis cannot be justified
  • First assumption: death from lack of food, shelter, medical care, or other basic necessities are morally wrong
  • Second assumption: if it is in our power to prevent this moral wrong from occuring, without sacrificing something of equal or greater moral importance, we ought take necessary actions to prevent that moral wrong
  • These principles seem uncontroversial, but if acted upon they would change the world radically
    • Distance doesn’t matter – helping a person 10,000 miles away is as important as helping a person 10 yards away
    • Doesn’t matter if you’re the only person who can help or if there are millions of others who could also be helping
  • Why should we refuse to take distance into account?
    • If we accept the principles of impartiality and universalizability, we cannot discriminate against someone merely because they are far away
    • It used to be possible to argue that you know the needs of the person who is close to you better, and thus are better prepared to help that person
    • However, swift communication and transportation have obviated that argument
  • Why shouldn’t it matter that there are millions of others in the same position?
    • The fact that others have done nothing says nothing about our own moral obligation
    • If everyone gave 5 pounds sterling to the Bengal Refugees Relief Fund, there would be no crisis in Bengal
    • The fact that others won’t give 5 pounds means that you’re obligated to give more; by giving more, you’re doing more good
    • Why doesn’t this become an infinite obligation?
      • The infinite obligation paradox only arises if the act of sending money is simultaneous and unexpected
      • If we build an expectation of giving, then no one has to give the maximum they’re able
  • The outcome of this argument is that traditional moral categories are upset
    • Normally, giving to international food aid is considered a “charitable” donation
    • Charitable donations are “superogatory” acts – it’s good if you do them, but you’re not an immoral person for not doing them
    • Singer redraws the boundary, making donating to food aid an obligatory act
  • Is this too big a revision of our moral code?
    • In the past, society drew a distinction between duties and superogatory acts in order to draw a line between behavior required for society to function and other other good behaviors
    • However, the moral point of view requires us to look beyond our own society – the prevention of the starvation of millions is at least as important as the upholding of property norms within our society
  • Is this moral code one that people are actually capable of upholding?
    • Sidgwick and Urmson argue that we need to have a moral code that is not too far beyond the capacities of ordinary people
    • Otherwise there will be a general breakdown in compliance with the moral code
    • However, this ignores the amount of influence that moral codes have on social norms and personal behavior
      • If the expected amount that one donates is 5% of one’s income, then the thought of giving away half of one’s income is absurd
      • If there is a norm that no one can accumulate wealth until the least well-off are provided for, then only giving away 5% of your income will seem extremely narrow-minded
    • Finally, this consideration only applies to what we expect from others, not what we should expect from ourselves
  • There are number of other points, more practical than moral which have bearing on this issue
    • Aid ought to be given by governments, not private charity
      • Why not both?
      • No evidence that private charitable donations reduce the probability of government aid
      • Even if one is lobbying for government intervention, one should practice what they preach and give direlctlso
    • Famine relief only increases the chance of starvation later, due to population growth
      • This only means that aid should be targeted at population control, rather than famine relief
      • The total aid donated should be the same
  • How much should we be giving away?
    • The strong version of Singer’s principle is that one should give until one has lowered themselves to the position of the person that they are giving to
    • The weak version of this argument is that one should give until further giving would cause the loss of something morally significant
    • Even the weak version of the argument requires a massive shifting lifestyles
    • However, these considerations are academic, given that the amount we give is so far below even the threshold of the weak form of the claim
  • Do philosophers have a role to play in public affairs?
    • It is sometimes arguemd that public policy depends on assessments of facts, and because philosophers have no specific expertise, they aren’t qualified to comment on public policy
    • However, the famine is not one of these issues
      • The existence of the famine is not in doubt
      • Nor is it disputed that Western societies can help, either through direct food aid or investment in population control
    • Therefore, this is an issue in which philosophers can take a position
    • The issue is one that is faced by anyone who makes more money than is necessary to support themselves
    • It is not enough to discuss; one must also act to bring the practice of their lives more in line with philosophical theories
  • Postscript
    • While the famine in Bangladesh has ended, the world food crisis is, if anything even more serious
      • US no longer has huge grain reserves
      • Increases in the price of oil have made fertilizer and transportation more expensive
    • The case for aid remains just as great in 1972 as it does in 1971
    • However, instead of targeting direct food aid, we should target population growth reduction
    • The important is to choose the most effective target and direct a massive amount of aid at that

Global Health and Development

  • Introduction
    • In 2013, nearly 800 million people were living under the international poverty line
    • Living in poverty has a significant negative impact on health
    • People die of easily preventable illnesses, such as malaria tuberculosis and diarrhoea
    • This suffering is preventable but neglected
  • The case for global health and development as an important cause area
    • Global poverty creates a great deal of suffering for a great number of people
      • In 2013, 10.7% of the global population lived under the global poverty line of $1.90 a day
      • This line is the minimum level of income required to fulfill basic food, shelter and clothing needs
      • These people are especially vulnerable to preventable diseases
      • The damage done by these diseases runs into the millions of DALYs per year
    • There are well documented ways of reducing poverty
      • Poverty is relatively tractable if we focus on immediate costs to health and quality of life
      • Relatively simple and cheap interventions can prevent infectious disease and parasitic illnesses
    • Additional resources would do a great deal more in this area
      • Global poverty gets a great deal of attention but the actual funding level is relatively small
      • Both government and individuals allocate a relatively small number of donations to alleviating global poverty
    • We have stronger evidence for interventions in global poverty being effective than in almost any other area
      • Measurable outcomes
      • Robust record of successes
      • Certainty about actual benefit
    • Cost-effectiveness analyses and RCTs
      • Cost-effectiveness analyses attempt to quantify how much good can be done with a given amount of money
      • For example: the eradication of smallpox saved at least 60 million lives at a cost of 1.6 billion dollars
      • This works out to roughly $25 per life saved, which is amazingly cost effective
      • The most highly recommended charities today save a life for $900 – $7,000, which is still pretty cost effective given that we spend far more to just add a couple of years to our lives in the developed world
      • Cost-effectiveness estimates are based on randomized controlled trials (RCTs)
        • Give intervention to half of the population, and have the other half as a control group
        • Compare outcomes
      • Interventions in global health are backed up by more RCTs than any othe cause area
    • In summary, it’s possible to have a large impact on global health and development because:
      • The problem is large in scale
      • Many of the subproblems are highly tractable
      • The problem is relatively neglected, given its scale
      • The evidence for interventions is very strong
  • Concerns about prioritizing global health as a cause area
    • Does foreign aid really work?
      • While some foreign aid interventions are wasted, the average dollar of foreign aid does a lot of good
      • Even if all other foreign aid was wasted the eradiction of smallpox would have been worth it
    • Charity “beings at home”
      • Additional resources can do a lot more good per unit in the developing world than in the developed world
      • Developing countries lack resources and their problems are ones that we’ve solved at home
    • Who are we to say what poor people need
      • It’s possible to intervene without being paternalistic
      • Concerns about paternalism seem less pressing when people have clear and pressing needs
  • Why you might not choose to prioritize this cause area
    • There might be better ways to improve the lives of people living today
      • Mental health problems might be causing more suffering than poverty
      • Investing in a broader cause area might improve the decision-making of all humanity, improving our ability to solve not just this problem, but all problems
      • We need to avoid the “streetlight fallacy” of investing in cause areas simply because it’s easy to build RCTs around their interventions
    • We should prioritize reducing the suffering of non-human animals
      • Over 50 billion animals currently live in conditions of extreme suffering before being slaughtered in factory farms
      • There is even less spent on this than is spent on fighting global poverty
      • Comparing the two depends on the following judgment calls
        • The significance of animal suffering compared to human suffering – is human suffering more morally significant
        • The indirect effects of poverty interventions vs. animal suffering interventions – do efforts to reduce poverty have more positive spillover effects?
        • Importance of a strong evidence base – we have far more evidence that efforts to alleviate human poverty work
    • We should prioritize the long-run survival of humanity
      • If we think we can affect the long run future, focusing on that might have a higher impact than focusing on more immediate problems
      • How much moral weight should we give future people
      • How much weight should we give the “non-identity problem”
        • Policies enacted today will determine what jobs and lives people have, who they marry, etc
        • These policies will affect how good the lives of future people are
        • How can we balance policies that cause future people to come into existence, but make them worse off?
      • Can our actions have any impact on the far future
      • Maybe the best way of fixing long-term problems is by fixing the short-term problems first?
    • We might want to focus on systemic change
      • Poverty reduction only addresses the symptoms of poverty, not its root causes
      • Not clear whether focusing on the immediate issues will help us end poverty altogether
      • Current marginal efforts are probably best spent helping the poor directly, rather than on politics
  • Summary
    • Global poverty causes a huge amount of suffering
    • One of the worse consequences of this is preventable disease
    • We have a number of highly effective interventions for treating diseases
    • We have strong evidence that these interventions work and are cost effective
    • It’s plausible that we should further systemic change to solve these issues
    • However, systemic change might be best effected by giving local participants the ability to better influence their own futures
    • Whether you believe this to be the most important cause depends on
      • Whether you believe there are other better ways to improve human lives
      • How much marginal value you give to reducing human suffering
      • Whether you believe it more important to focus on the long-term future of humanity

GiveWell’s Criteria for Top Charities

  • The top charities GiveWell recommends to donors are characterized by:
    • Evidence of effectiveness
      • Programs should be studied rigorously and repeatedly
      • Benefits should be expected to generalize
      • Can the charity execute?
    • Cost effectiveness
      • Estimate cost required to accomplish a particular benefit
      • People in the developing world have a dramatically lower standard of living, so a single dollar can help them more
    • Room for more funding
      • Top charities receive a significant number of donations as a result of GiveWell’s recommendations
      • Will these additional funds be well spent?
    • Transparency
      • Potential top charities are examined thoroughly and skeptically
      • Charities must be open to this investigative process
  • Why these criteria?
    • Effectiveness
      • Most information about charities is simplified, exaggerated or incomplete
      • In order to judge what donation will do the most good, one needs to answer the following questions:
        • What will the donation permit that would not have otherwise have happened?
        • Will this activity change people’s lives for the better, or will it run into challenges
        • Will it accomplish a large amount of good, relative to other possible donations
      • While one can make an informed assessment of these questions by examining charities in detail, not everyone has the time to do this
      • GiveWell focuses on charities that are verifiably outstanding, for whom a case can be made without relying on judgment calls
    • Global poverty
      • Developing world poverty is far more severe than developed world poverty
      • Each dollar goes farther in the developing world
    • Direct causes over root causes
      • Root cause efforts require far more donor engagement
      • Addressing direct causes can empower people to address root causes themselves
      • Donors should focus on areas that they’re best able to help
  • Why so few charities
    • GiveWell focuses on a relatively small sector of the charitable sector
    • Only assesses charities that publish the statistics that allow them to be assessed
    • Evaluation is time-intensive
  • The process for identifying top charities
    • Find eligible charities
      • Search for charities
      • Look at applications
    • Examine charities
      • Deeply examine charity’s impact
      • Find out strengths and weaknesses of charity
    • Follow up
      • Track performance over time
      • Write about both positive and negative outcomes

GiveWell’s Update Top Charities For Giving Season 2018

  • 3 top charities whose goal is reducing deaths
    • Malaria Consortium’s Seasonal Malaria Chemoprevention (SMC) program
    • Helen Keller International’s Vitamin A Supplementation (VAS) program
    • Against Malaria Foundation (AMF)
  • 5 charities implementing programs to increase income
    • Evidence Actions’ Deworm The World Initiative
    • Schistosomiaisis Control Initiative
    • Sightsavers’ Deworming Program
    • EDN Fund’s Deworming Program
    • GiveDirectly