Some thoughts for future development—I recognize, of course, that you were working within the confines of a blog post:
On difference 1: Would it be more accurate to describe this as a continuum? E.g., EA organizations tend to invest significantly fewer resources into translating and adapting cost-effectiveness work in Country A before applying it in Country B than organizations applying HTA. Although giving no thought to emergent properties like differences in disease burden would be really unwise, I am not aware of any evidence that major EA funders are missing the super-low-hanging fruit there. (Of course, I could be underinformed, in which case some concrete examples of serious misses would help me update on their methodology!)
The idea of the suggested reframing is to paint investing in cost-effectiveness translation as a tradeoff—one can do more extensive work in this area (HTA) or relatively less (EA), and both approaches have their benefits and downsides. It intuitively seems that best approach would depend on the resources that would be going into the intervention in a new location, the costs of additional translation efforts, and the likelihood that the results of those efforts would either shape the intervention-as-deployed or change funding decisions. Indeed, my hunch is that—in general—your suggestions grow stronger as the amount of money EA is putting into global health increases, and the odds of EA funders being able to influence other funders through their actions increases.
On difference 2: I think the crux here is about the effect of other donors and the likelihood of successfully coordinating with them. If one views the decisions of other donors as essentially fixed, then it likely makes sense to allocate one’s own funds in a way that seeks to gives cost-effectiveness (or other atttributes one thought undervalued by the broader funding ecosystem) the appropriate amount of emphasis in the global health ecosystem as a whole—rather than weighing a basket of attributes in the way the donor would if they controlled how all donors spent their monies on global health.
For longer pieces (not blog posts), it would be worth considering that “someone should do X,” “EA as a whole should do X,” and “Specific Organization C should do X” are different claims. I think the kind of thinking in your blog post has a lot to offer EA organizations, but at later stages of development would need to be actionable by specific people and organizations in light of their particular constraints to achieve impact. In particular, I see GiveWell as acting more as a pure advisor to donors, so it faces the constraint of keeping those donors (which it has attracted with a goal of finding “charities that save or improve lives the most per dollar”) happy. Much more so than Open Phil and Founders Pledge, it is also built around the Unix-like philosophy of (mostly) doing one thing and doing it very well and may experience adverse outcomes from even well-intentioned mission creep by funding more “meta” work like your recommendation 4.
So I am not sure how actionable recommendations 2, 3, and 4 (maybe even 1) are for an organization in the style of GiveWell. On the other hand, I think they are quite actionable for OpenPhil. Given that GiveWell alone is a significant part of the ecosystem, a suggestion for longer pieces would be to offer more action items that clearly fit within its operating philosophy and constraints.
Yes I essentially agree—though the other option available is to decide to work more through local institutions to prioritise and fund health services. Again yes this may be better done at scale. Though with the rate of growth in EA funding, I wouldn’t rule out a role for this kind of EA engagement. Or perhaps there is a role for EA as a kind of catalytic funder, investing in frameworks/platforms for more effective aid policy from states and major multilaterals.
I think you mean that if there are gaps for highly cost-effective services that aren’t being delivered by other donors (or indeed the national health system, we should remember that even in the very poorest countries, national institutions are still likely to be the main healthcare funder and provider, not the donors) then it makes sense for EA to fill those gaps. I think gap-filling and prioritisation are separate steps. With the additional criteria we’re still trying to assess value and therefore in a sense a certain kind of more broadly conceived assessment of cost-effectiveness. For example, if intervention A has a better cost per DALY than intervention B but equity considerations mean the HTA committee strongly prefers intervention B, then B is rightly considered a higher priority. We could then look at the practical issues of gaps, organisations that can deliver etc.
On specificity of recommendations, yes that’s fair. As you say this is just a blog so perhaps for future work. I also considered working out a clearer taxonomy of what is being prioritised (causes/programmes/interventions/charities etc). But this one was on the long side for a blog as it is
Thanks for sharing this, Tom!
Some thoughts for future development—I recognize, of course, that you were working within the confines of a blog post:
On difference 1: Would it be more accurate to describe this as a continuum? E.g., EA organizations tend to invest significantly fewer resources into translating and adapting cost-effectiveness work in Country A before applying it in Country B than organizations applying HTA. Although giving no thought to emergent properties like differences in disease burden would be really unwise, I am not aware of any evidence that major EA funders are missing the super-low-hanging fruit there. (Of course, I could be underinformed, in which case some concrete examples of serious misses would help me update on their methodology!)
The idea of the suggested reframing is to paint investing in cost-effectiveness translation as a tradeoff—one can do more extensive work in this area (HTA) or relatively less (EA), and both approaches have their benefits and downsides. It intuitively seems that best approach would depend on the resources that would be going into the intervention in a new location, the costs of additional translation efforts, and the likelihood that the results of those efforts would either shape the intervention-as-deployed or change funding decisions. Indeed, my hunch is that—in general—your suggestions grow stronger as the amount of money EA is putting into global health increases, and the odds of EA funders being able to influence other funders through their actions increases.
On difference 2: I think the crux here is about the effect of other donors and the likelihood of successfully coordinating with them. If one views the decisions of other donors as essentially fixed, then it likely makes sense to allocate one’s own funds in a way that seeks to gives cost-effectiveness (or other atttributes one thought undervalued by the broader funding ecosystem) the appropriate amount of emphasis in the global health ecosystem as a whole—rather than weighing a basket of attributes in the way the donor would if they controlled how all donors spent their monies on global health.
For longer pieces (not blog posts), it would be worth considering that “someone should do X,” “EA as a whole should do X,” and “Specific Organization C should do X” are different claims. I think the kind of thinking in your blog post has a lot to offer EA organizations, but at later stages of development would need to be actionable by specific people and organizations in light of their particular constraints to achieve impact. In particular, I see GiveWell as acting more as a pure advisor to donors, so it faces the constraint of keeping those donors (which it has attracted with a goal of finding “charities that save or improve lives the most per dollar”) happy. Much more so than Open Phil and Founders Pledge, it is also built around the Unix-like philosophy of (mostly) doing one thing and doing it very well and may experience adverse outcomes from even well-intentioned mission creep by funding more “meta” work like your recommendation 4.
So I am not sure how actionable recommendations 2, 3, and 4 (maybe even 1) are for an organization in the style of GiveWell. On the other hand, I think they are quite actionable for OpenPhil. Given that GiveWell alone is a significant part of the ecosystem, a suggestion for longer pieces would be to offer more action items that clearly fit within its operating philosophy and constraints.
Thanks Jason, appreciate your thoughts.
Taking your points in order
Yes I essentially agree—though the other option available is to decide to work more through local institutions to prioritise and fund health services. Again yes this may be better done at scale. Though with the rate of growth in EA funding, I wouldn’t rule out a role for this kind of EA engagement. Or perhaps there is a role for EA as a kind of catalytic funder, investing in frameworks/platforms for more effective aid policy from states and major multilaterals.
I think you mean that if there are gaps for highly cost-effective services that aren’t being delivered by other donors (or indeed the national health system, we should remember that even in the very poorest countries, national institutions are still likely to be the main healthcare funder and provider, not the donors) then it makes sense for EA to fill those gaps. I think gap-filling and prioritisation are separate steps. With the additional criteria we’re still trying to assess value and therefore in a sense a certain kind of more broadly conceived assessment of cost-effectiveness. For example, if intervention A has a better cost per DALY than intervention B but equity considerations mean the HTA committee strongly prefers intervention B, then B is rightly considered a higher priority. We could then look at the practical issues of gaps, organisations that can deliver etc.
On specificity of recommendations, yes that’s fair. As you say this is just a blog so perhaps for future work. I also considered working out a clearer taxonomy of what is being prioritised (causes/programmes/interventions/charities etc). But this one was on the long side for a blog as it is