An outstanding book that has really made me rethink how I consider altruism, which as simple as it sounds, I had never framed in terms of economic principles of comparison as I do my other finances. The concept of "effective altruism" is now ingrained in my head considering the benefit that each dollar I donate has in terms of saving a life, with a QALY as the most quantifiable means of comparison. For someone who thinks as an analytical engineer, this is even difficult for myself to consider the trade-off between saving someone's life who is afflicted by malaria vs. cancer. While my donation will have a much larger QALY impact in terms of saving more life-years among developing countries, can I really compare that vs. saving fewer life-years in developed countries? On paper absolutely, but the human element in my brain prevents me from being able to make an apples-apples comparison. Nonetheless, this book has really made me think about the impact I want to make. I have a strong admiration for MacAskill's truly pragmatic outlook on life, even if I cannot embrace it as fully as he does. Another good example is with the choice of career. While we may salute those who choose to dedicate themselves to philanthropy and on-the-ground efforts in countries like Haiti that are in most need of assistance, an economic pareto comparison of career choice would absolutely validate that I can do much more good by letting those who are better skilled at performing aid go to Haiti, and by working as an engineering manager in the developed world with a high salary, that I can then use to finance effective altruism rather than perform by myself.
Onto a few notes directly that I found memorable:
Story of PlayPumps, a sexy idea to turn water pumps in African villages into a merry-go-round type game for children. Novel and interesting, this idea gained a lot of support and hundreds of millions of investment that otherwise would have gone to more effective causes – ultimately was a failure as it was never used as intended, and ended up making the lives of primary water bearers (women) more difficult given the increased challenge to pump water vs. a conventional pump. “What’s more, no one had asked the local communities if they wanted a PlayPump in the first place.” [p14] – A poor feat of engineering, user experience design, and practicality, as well as fitting the stuffwhitepeoplelike mantra of “knowing what’s best for poor people”.
Story of an out of the box approach to improving childhood education in Kenya – deworming. Parasitic worms were the cause of a huge percentage of school absences that do not garner as much attention since often non-fatal, but have a dramatic impact on long-term future. A small investment for de-worming (treatment costs of pennies per child) reduced absenteeism in Kenya by 25%! A success story of allocating resources efficiently for a large payout.
“One difference between investing in a company and donating to a charity is that the charity world often lacks appropriate feedback mechanisms […] Because we don’t get useful feedback when we try to help others, we can’t get a meaningful sense of whether we’re really making a difference.” [p21]
“Sometimes we look at the size of the problems in the world and think, ‘Anything I do would be just a drop in the bucket. So why bother?’ But in light of the research shown in these graphs, the reasoning doesn’t make any sense. It’s the size of the drop that matters, not the size of the bucket, and if we choose, we can create an enormous drop. We’ve already seen that we have the opportunity to provide a benefit for others that is one hundred times greater than the benefit we could provide for ourselves” [p30] Referencing the impact on lives that a small amount of money would benefit victims of malaria, vs. a much larger sum of money that would impact fewer people when directed towards cancer research.
The concept of quantifying impact made through philanthropic efforts – QALY: Quality-adusted life year, which is used (very stoically) to help make decisions about how to prioritize resources among different health programs. A difficult concept for most emotional humans to swallow, as it does effectively boil down to choosing whose life to save, based on resource efficiency. “When making decisions, whether it’s in volunteering, choosing a career, or deciding to buy ‘ethical’ produce, we should therefore ask: How much does this activity cost, in terms of time or money? How many people does it affect? And, crucially: By how much does it improve people’s lives?” [p42] Parallel to the concept of QALYs, easy to quantify on paper, but difficult to stomach in execution when having to choose who to save vs. who to let die.
As a contrast to Dambisa Moyo’s “Dead Aid”, which claims that philanthropic efforts have stunted development in African countries, while the sociological effects of preventing local companies from growing due to competition from foreign aid is absolutely true, MacAskill vehemently denies that the aid itself has not had a positive impact: “Even among the ‘bottom billion’ […] quality of life has increased dramatically. In 1950, life expectancy in sub-Saharan Africa was just 36.7 years. Now it’s 56 years, a gain of almost 50 percent. The picture that Dambisa Moyo paints is inaccurate. In reality, a tiny amount of aid has been spent, and there have been dramatic increases in the welfare of the world’s poorest people.” [p44] MacAskill has a strong point here, in that the numbers can provide shock value when positioned as $1 trillion in aid given, but when considered over the course of 60 years that is only $17 billion per year which is a pittance compared to $87 trilliion in annual world GDP. Whether the poorest countries could have progressed even better without that aid is a fair speculative what-if, that could never be answered, as the undeniable fact is that aid has had a positive impact. “The eradication of smallpox is one success story from aid, saving five times as many lives as world peace would have done.” [p45] Again back to the QALYs question… on paper we can compare #’s of human lives saved… but can we unemotionally balance fewer deaths of children in Syria from bombings vs. fewer deaths to smallpox in sub-Saharan Africa?
Let’s try to quantify the cost of a life: “Imagine saving a single person’s life […] If you did that, it would stay with you for the rest of your life. If you saved several people’s lives […] you’d think your life was really special. You’d be in the news. You’d be a hero. But we can do far more than that. According to the most rigorous estimates, the cost to save a life in the developing world is about $3,400 (or $100 for one QALY).” [p50]
The natural emotional response to donate is high with natural disasters due to the emotion emoked from images in media – “we think – emergency! We forget there is an emergency happening all the time, because we’ve grown accustomed to everyday emergencies like disease and poverty and oppression […] Ironically, the law of diminishing returns suggest that, if you feel a strong emotional reaction to a story and want to help, you should probably resist this inclination because there are probably many others like you who are also donating […] consider donating to wherever your money will help the most rather than what is getting the most attention.” [p55]
What is the best career to make a difference in the world? Often thought of as being a doctor, but “one additional doctor in the United States provides a benefit equivalent to about four lives saved over the course of their career. That is still awesome. But it’s also less than you probably though before, all because of diminishing returns.” [p60] It’s certainly difficult to compare the impact of saving a life in the developing world vs. developed world, but the QALY quantification earlier suggests that $13,600 is sufficient to save 4 lives in the developing world. Becoming a doctor in a developing country, however, gives the ability to provide 300 QALY’s per year, or to save 300 lives over a 40yr career. This is not to say that a 3rd world doctor is the most resource-efficient occupation, as anyone who makes enough money so as to donate $1MM could also save 300 lives.
“We don’t usually think of achievements in terms of what would have happened otherwise, but we should.” [p63] If you choose not to become a doctor in the US, as a high demand profession you are not decreasing the pool of doctors as someone else who could not have gained admittance to medical school would then take your place. So by choosing not to go become a doctor in a 3rd world country, you are enabling someone else instead to still go and make the same difference that you would have made – while if you have the capability to make a high income, you could indeed make a greater difference in terms of QALYs.
Similarly, a man like Edward Jenner garners a lot of credit for discovering the cure to smallpox which saved 120 million lives. But the reality is that someone would eventually have discovered it. A man like Viktor Zhdanov, Ukrainian virologist, deserves much more credit than he is given, for lobbying the WHO to adopt smallpox eradication early – easily saving 10-20 million more lives than if vaccination had commenced later. “The good I do is not a matter of the direct benefits I cause. Rather, it is the difference I make.” [p63]
Parallel to QALYs is “micromort” – to compare the risks of death from dangerous activities where “one micromort equals a one-in-a-million chance of dying, equivalent to thirty minutes of expected life lost if you’re aged twenty, or fifteen minutes of expected life lost if you’re aged fifty.” [p74]
In consideration of the difference you make vs. the benefit you provide, consider social costs of child labor. “The reason there’s such widespread support among economists for sweatshops is that low-wage, labor intensive manufacfturing is a stepping-stone that helps an economy based around cash crops develop into an industrialized, richer society.” [p109] A good point, as every developed economy had the same manufacturing transition through the industrial revolution. So when you take factories out of countries where labor is low, what then is the impact? Those sweatshop employees are instead left to perform even more dangerous and lower paying tasks in the agricultural sector, which is even more detrimental.
Regarding marketing efforts such as Fairtrade” Though the evidence is limited (which is itself worrying), the consistent finding among the studies that have been performed is that Fairtrade certification does not improve the lives of agricultural workers […] In buying Fairtrade products, you’re at best giving very small amounts of money to people in comparatively well-off countries. You’d do considerably more good by buying cheaper goods and donating the money you save to one of the cost-effective charities” [p112] “the benefits of ethical consumerism are often small compared to the good that well-targeted donations can do.” [p121]
“Some of the top charities I’ve mentioned in this book are Against Malaria Foundation, Cool Earth, Development Media International, Deworm the World Initiative, GiveDirectly, and the Schistosmiasis Control Intiative. Pick whichever you believe to be the best and begin a habit of effective donations. Even a relatively small monthly donation to these charities will have a big impact.” [p159]