Derek Thompson :
(From previous issue)
It is hard for the casual donor to determine on her own which charities do the most good. For example, compare two well-meaning organizations: Charity A accepts $100 and sends $90 to the field to buy better textbooks for Kenyan children. Charity B accepts $100 and sends $45 to the field to buy deworming tablets for Kenyan kids. If you focus on “overhead” costs, as many people do, the choice is clear: Charity A is twice as effective. But randomized controlled trials have shown that while textbooks do little to raise school attendance, medicine for intestinal worms often helps children go back to school. In the end, Charity B might be many times more effective. This is why it’s so important for organizations like GiveWell to track dollars and outcomes.
GiveWell estimates that the cost-per-child-life saved by the Against Malaria Foundation is just $3,340.
But comparing outcomes is tricky. Is it better to avert a death from a tropical disease, or to raise a family from abject poverty? Philosophically, the most difficult task facing GiveWell is putting the vast spectrum of human suffering into numbers. It is, in a way, a math problem, but one laden with value judgments, about which reasonable people can disagree.
For example, to compare suffering across countries, some organizations use a metric called DALYs, or Disability-Adjusted Life-Years. One DALY could equal one year lost to early death, 1.67 years of blindness, or 41.67 years suffering stomach pain from an intestinal parasite. If a program has averted 80 DALYs, it might have saved the death of one infant or cured minor health problems for several adults.
To choose the charity that represented the greatest good as I saw it, I had to choose my values. Disability-Adjusted Life-Years acknowledge no difference between averting fewer deaths and improving many lives, but because my donation had been forged by death and near-death experiences, I was motivated to err on the side of saving lives rather than simply improving them. And because this represented my first major donation, I wanted to donate to a cause whose impact was certain.
It is not obvious to effective altruists that certainty is the right way to think about doing good. Imagine, for example, if you face a 1 percent chance of saving a million lives versus a 100 percent chance of saving ten lives. The certainty thesis might lead one to choose to save the single life. But the expected value of the first option is 10,000 lives saved-a 1,000 times difference in outcomes.
Still, when I expressed my values to Hassenfeld, he had a very specific recommendation. “I think the Against Malaria Foundation is the right choice for you,” he said. “That’s where I gave half of my donations last year, and if I had your values, it’s where I would give now.” That left a final step: calling the founder of the Against Malaria Foundation and learning more about the charity GiveWell has rated the number-one in the world.
IV. The Cause: Against Malaria Foundation
The next morning, I called Robert Mather, the British founder of the Against Malaria Foundation, to find out how a businessman with practically no NGO experience came to run one of the most effective charities in the world. He told me his life was abruptly changed due to a freak fire involving a family of strangers 40 miles outside of London.
“I’m rubbish with a TV remote control, and that led to a major left turn in my life,” he began. “I was trying to turn off the BBC in 2003, and instead, I pressed a button that went to another channel. It was a documentary featuring a child who seemed to have melted in a fire.”
The child was Terri Calvesbert, a one-year-old girl living in Suffolk, England, who lost 90 percent of her skin, including her nose and eyelids, in a fire sparked by her mother’s discarded cigarette. Calvesbert was burned so badly that when firefighters found her, they initially mistook her for a burned doll. “She had been put into an artificial skin body suit,” Mather recalls. “I’m not an emotional person, but my wife and I had two children, and I am not ashamed to say that I was streaming.”
Six months prior, Mather had participated in a charity bicycle ride, and it occurred to him that he could organize a similar event to raise money for the girl. Mather called swimming-event organizers in Sydney, New York, Lima, and elsewhere. His effort resulted in 150 coordinated global swims, with thousands of participants raising hundreds of thousands of dollars for Calvesbert, who is now 18 years old.
The mathematical challenge of finding the greatest good can expand the heart. Empathy opens the mind to suffering, and math keeps it open.
The global success of “Swim for Terri” sent Mather’s cogs whirring. If one girl could inspire $400,000 in donations, what could a truly international cause do? “As you scratch beneath the surface on global health issues, the same disease comes up as the biggest killer of kids in the world and biggest killer of pregnant women,” he said. “Malaria was a no-brainer.”
Approximately 200 million people suffer from malaria each year, and the death estimates range between 400,000 and 800,000. About 90 percent of those mortalities are in sub-Saharan Africa, and three-quarters of them occur in children younger than five. The second-order effects of the disease are vicious: Malaria is a massive impediment to economic growth, since survivors often cannot work, and parents have to devote their lives to caring for their sick children.
I’ve read, and typed, and read again these numbers, and they are so stark to me that they can easily float away into the atmosphere of statistics, escaping true empathy. Understanding one nation’s experience feels more visceral: Every day, more than 500 people die from malaria in the Democratic Republic of Congo, and the majority of these deaths are children under the age of five.
AMF offers a shattering metaphor: Imagine a fully booked 747 airplane and infants strapped into seats A through K of every row of the economy section; their feet cannot reach the floor. Every day, this plane disappears into the Congo River, killing every soul on board. That is malaria-in one country. By GiveWell’s calculations it would cost $1.7 million to save the airplane.
While larger fish like the the Global Fund and the Gates Foundation focus their resources on developing a fast and absolute cure, AMF has a preventative approach: cheap insecticide-treated bed nets (about $7.50 in the DRC) that block and kill the mosquitoes that carry the disease from person to person.
(To be continued)
