Hi carneades, thank you for your post! It is great to see a post by an international development professional on effective altruism. As someone who did field work in Africa during PhD, I am sympathetic to what you conclude from your own observation. However, it is important to see what rigorous studies conclude and based on my reading of the literature I have some disagreements.
On job creation, taking into account the environment in most poor countries in terms of infrastructure, legal environment and productivity of the labor force, it would be much more costly to produce bed nets there than importing from somewhere that can make it cheaper. So given the choices of (A) importing cheaper bed nets that can save many more children in the poor country, and (B) producing bed nets locally at much higher cost (and by the way one would need to sell it at much higher price, or put in large subsidy for its production, neither of which makes much sense) while creating not that many jobs, (A) seems much better. (And I said “creating not that many jobs” because you are talking about simply setting up a bed net factory to meet local demand; for significant job creation the country would need China-type export manufacturing but that would require transforming the whole economy in terms of the points mentioned above — infrastructure, legal environment and productivity of the labor force — rather than setting up and probably subsidizing a few unproductive bed net factories which seems like bad industrial policy.)
On need vs. demand for insecticide-treated bed nets, see this article linked to by Fluttershy, especially the 2nd point under “Points of possible disagreement”: “irrationality about one’s health is common in the developed world. In the developing world, there are substantial additional obstacles to properly valuing medical interventions such as lack of the education and access necessary to even review the evidence. The effects of something like bed nets (estimated at one child death averted for every ~200 children protected) aren’t necessarily easy for recipients to notice or quantify.” There is a chapter in the book “Poor Economics” that argues that poor people fail to implement health practices with high returns like treating their drinking water or getting vaccinated, not because they are less rational than people in rich countries. People in rich countries may do no better under the same circumstances, but governments in rich countries provide the infrastructure, nudges or mandatory requirements to make these practices much less costly or even compulsory. Also, there is not only evidence that free distribution of bed nets does not lead to decreased usage, but also that it increases demand and usage in the first year (initial demand is very sensitive to price) which causes people to learn about its benefits and demand more in the future.
On Give Directly, see this study on how people use the money they get. It’s ex ante unclear how people would use the money, but the study shows that credit (and savings) constraint is a really big problem in these people’s lives and people end up using their money to improve food security, invest in durable goods or businesses etc. There was no significant increase on alcohol or tobacco consumption (the study tried to rule out desirability bias including using list randomization questionnaire) or decrease in labor supply.
Of course the studies cited here aren’t perfect but they seem pretty well done to me (and many experts in the field), so I would trust them more than anecdotal evidence which could vary a lot from place to place.
Hey, thanks for the thoughtful response. Here are my thoughts:
A may seem better from an international perspective, but if you ask the people here if they would rather have a factory and more jobs, something they could be proud of, a reason for young people to not leave the country in droves, and the feeling that they are able to solve their own problems, or more bed nets, they would pick A every time. I have asked many communities across the country in Community Analysis surveys what they need, they often say electricity, clean water, better roads, and consistently the most popular answer is more jobs. But I have never seen a community ask for bed nets, or a cure for malaria. To them, it is like the flu. The point is that, just because it seems better to you, it does not mean that it is what people want, and who are you to tell people in countries that you have never visited what they need? I agree that it would be more work to subsidize a factory, but the benefits to the morale of the people, (something which is hard to quantify beyond the percent of people that die trying to illegally immigrate to Europe) would drastically outweigh the costs, and you would be listening to what the people actually want instead of deciding for them.
But why do governments in richer countries implement these kinds of programs? Surely it is because the people in that country are more educated, and vote in leaders, or vote for initiatives which inevitably improve their health. Programs like AMF which cut the voter out of the loop do significant damage to democracies. When politicians are beholden to foreign companies and governments for aid instead of their people for votes, they will serve the interests of the foreign organizations, not the people. If the appeal is made to the government, not the people, then he people fail to see the importance of the intervention, and it is not sustainable. We should be educating people so that they ask their government to implement these changes, not cutting the people out of the equation for the sake of saving costs, and thereby cutting young democracies off at the knees. I would be surprised if bed net distributions would actively decrease use of nets, but I have seen many communities actively attempt to deceive researchers about their use of bed nets because they know what “the right answer” is and they know what they need to say to get the foreigners to give them more things. So while I doubt that use decreased, I’m skeptical that it increased at the rates touted by these organizations. My question is, why could we not instead do campaigns solely focused on increasing demand, so that people would actually ask their governments for these interventions. This might lead to people holding their officials (who are actually, at least in principle answerable to the people) responsible for health interventions, as opposed to foreign organizations who are answerable to their donors.
I do not live somewhere where Give Directly works, but there are similar programs where I live. Though the study was interesting, my central concern is that, at least here, lying to strangers is not merely culturally acceptable, it is expected, especially when those strangers are foreigners. Therefore any answers given by families on the baseline or endline surveys are certainly in question (especially since people here simply tell you what they think you want to hear). To give you a sense, we have local staff here who conduct surveys in villages, and it is difficult for them to even accurately find out the primary language of the village, without spending several weeks there since everyone just speaks to you in the language you start speaking to them in until they trust you more. Simply, if the people there are anything like the people here, I would be surprised if they took sufficient precautions to rule out desirability bias. The point about labor supply is interesting, but the study does note that it was unable to study true long term effects of these interventions. Give Directly is promoting providing villages money for ten years, from my understanding, the study did not analyze the effects of such actions over long periods of time anything more than four months “this variation in the present study is not sufficient to obtain reliable estimates for the evolution of the treatment effect over time” those are the interventions that I am concerned with, and those are the ones which could do more harm.
In your concluding sentence you make three points that I would like to address. First you claim that the studies are well done, second you claim that they should be trusted over anecdotal evidence, and third you claim that this may vary from place to place.
4) To the first point, simply because a study is well done, it does not make it true. You can do everything in your power to stop someone from lying to you, or telling you just what they think you want them to hear, but, at least where I am unless you live for weeks with a community, they will lie to you. I have seen so many researchers get survey answers from families that I am aware are false, simply because that is the culture here. Just because something is well done, it does not mean that it is true.
5) Yes, the information that I present is anecdotal, but in a culture where it is expected that you lie to strangers, that is all that we have. The problem is that so few donors actually come and experience the reality of what the organizations they support are doing, and even when they do, it is often for such a short time, or they are sufficiently insulted from the community that they fail to experience the catastrophic failures of the programs they are supporting (especially since they are often there seeing only what the program wants them to see). Due to the culture of lying to strangers here, I would trust an anecdote form someone that knows a community well over a well thought out study any day. Maybe that is just because I have seen so many studies here get things so wrong. How long were you here? Where? What kind of research did you do?
6) I would like to end in agreement, so to your last point, I think you are correct. My experience is limited to where I live, and West Africa is certainly different from East Africa in many ways. Problems that we face here, may not be significant concerns over there. I share these concerns and experiences because it seems to me that the majority of the people in this forum have spent little time in the actual communities that receive donations from these organizations. Those communities are unable to speak for themselves (usually no internet), so I am simply trying to give them a voice and explain why they would disagree so drastically with many of the proposed interventions. Thanks for sharing these articles and views. I have committed my life to doing the most good in the world, and from my experience organizations promoted by Give Well are not the best way. All the best!
Hi carneades, in reply I just want to make 2 general points here:
Many things need to be done in the developing world, e.g.the ones you mentioned: protecting people against malaria, creating jobs, improving the quality of governments… The most effective intervention for one purpose could be not very useful for another, but that’s still okay because it would be better than trying to do something that serves multiple purposes but is ineffective in all of them. (e.g. for protecting people against malaria, the most effective intervention could be distributing bed nets for free; for job creating, it could be improving the infrastructure and legal system; for improving the quality of governments it could be educating voters—though for this to affect government provision of bed nets down the road would take many years and if we solely rely on this to protect people against malaria we would miss the opportunity to save many lives now compared to using the most effective intervention on this)
By saying the studies are good I mean the researchers take into account that respondents may not report the truth and seem to manage to find out the truth despite that. This is not just because I trust these famous economists to do a good job or I know some of them personally and know that they care about doing a good job, but I also find evidence from the papers. For instance in the Cohen and Dupas paper on free distribution of bed nets, it says (on p14, under “III.C Data”) “During the home visits, respondents were asked to show the net, whether they had started using it, and who was sleeping under it. Surveyors checked to see whether the net had been taken out of the packaging, whether it was hanging, and the condition of the net.” In the Haushofer and Shapiro paper on Give Directly, on p28 they talk about potential desirability bias on alcohol and tobacco and how they address it, and on p32 they mention assets including metal roofs and livestocks which surveyors could easily check (I don’t think they mentioned surveyors checking this but the study is done by IPA in the same region I work in Kenya so I imagine it should have the high standard of work done by this organization and surveyors should check things when they can). In general economists don’t like to rely on survey data precisely because people may lie, and in developing countries when this is often inevitable we try hard to get around the problem and mention how we address them in papers (otherwise you would get a lot of questioning from presentation audience, referees, etc. so there’s plenty of incentive in academia to do that; e.g. I can imagine these two studies having survived such scrutiny).
Also regarding your point of how things on the ground could appear to be completely different from the truth if you don’t know the community well enough, in my experience typically local surveyors understand the context well enough to be able to explain to us foreigners what is happening. I agree that this could be a problem for some donors/organizations/studies that aren’t very careful, so I can only say that this won’t be a big problem if things are done well (which should be the case for charities recommended by GiveWell but I don’t know about others).
(I spent 5 months in a town in western Kenya, not super integrated into the local community or fluent in the local language so take this with a grain of salt if you want, but I do know very well how this kind of studies and surveys work since I did one myself.)
Thanks again. Here are my thoughts.
Certainly there are many different kinds of interventions that we can implement. Some interventions are mutually exclusive, others are not. Toms shoes comes and donates shoes to a community, where another organization is attempting to improve small businesses, particularly tailors, some of the few professionals in very small communities. The donation puts many local tailors out of business. Therefore, we either need to develop interventions which are not mutually exclusive or choose between interventions. If we want to do the first, organizations like AMF should help local businesses instead of destroying them. If we want to do the second, we should choose between interventions by asking the people what they need, not deciding what we think is best without ever talking to the people on the ground. If they don’t want us to save their lives at the expense of job opportunities, we should not. People should have the right to choose their own interventions, especially when those interventions can do their communities harm. If you want to go in without the community’s consent, the least that you can do first is do no harm.
As for the studies, at the end of the day I’m a philosophical skeptic all the way down (which means that I have so serious concerns about the relation between truth and the scientific method, for legitimate philosophical reasons, such as the problem of induction , and the problem of underdetermination, check out the Stanford Encyclopedia of Philosophy for more on that) but we can put that aside for now. As for the trust, I trust the people that live here about what they need, and what they are doing more than I trust foreigners who don’t spend much time with the people, famous economists or not. Your quote about nets fails to address a number of concerns, such as communities that put up nets whenever they see the inspectors coming (you would be surprise how many people do this), and the fact that most people here hang out outside until well after peak mosquito biting time, so even if they sleep under a mosquito net, and are fully truthful in an interview, since they don’t actually understand or appreciate the importance of bed nets, and someone values something much less when they get it for free. Checking for a metal roof seems like a clear method, but there are so many more which could be lied about. Livestock wanders freely here, and is rarely kept in any kind of pen, and only the people that live in a village really know who owns what. I’m not saying that all of their metrics are necessarily off, I’m saying that I’m not convinced that they are correct. As for the academic criticism, I’m concerned that the people that provide the scrutiny are, unfortunately, not the people with an in-depth experiential understanding of the cultural practices of these communities. I am also concerned that there is a gap between something being able to survive academic criticism, and providing a fully accurate picture of the state of affairs here.
As for the final point, why do you think that the local surveyors are able to solicit truthful responses any more than foreigners? If those local surveyors did not grow up in the same tiny area of the village, the families will lie through their teeth. I have lived here for years, and I am close to fluent in a local language and I have seen families lie to every census worker that comes through, local or foreign. I have also seen translators blatantly lie to researchers about what respondents say. Truth is not valued here. Unless you do speak the language and have lived with a family for quite some time, there’s no way for you to know if they actually sleep under a bed net, if they actually exclusively breast feed, or if they really own that goat. As noted before, I cannot say that this happens everywhere as Africa is a big place, and cultures differ drastically. Perhaps in East Africa there are different cultural practices which make it easier to conduct research, but here even the Government cannot correctly take a census.
Thanks for taking the time to engage in in this discussion. I hope that you reconsider donating to charities which ignore what communities actually want in favor of providing cheap, but ultimately harmful interventions.
Want to add this to #1:
a) Death & sickness are bad for the economy. It’s pretty uncontested that more people use malaria nets than when they are provided for free (can link research on this if necessary). When someone is sick, it’s time that they can’t spend in the labor force. When someone gets sick a lot as a child, it affects them so that they are a less productive worker in the future. When your child is sick, you have to spend time taking care of them that could have otherwise been hours you earned a wage, spent on goods, etc. So in that regard, this is probably an outweighing factor to a couple jobs.
b) Even if malaria nets don’t effect wages and productivity at all, the money that would have gone to the malaria net maker doesn’t just disappear, it’s simply spent somewhere else. So jobs don’t go away, they are just created in other areas.
So it’s not just weighing job creation vs. malaria prevention, it’s that malaria prevention probably helps job creation.
So jobs don’t go away, they are just created in other areas.
So jobs don’t go away, they are just created in other areas.
This isn’t really true. Yes, probably there is some job replacement so that the jobs don’t literally disappear 1-for-1. But there will probably be fewer jobs, and I don’t think it’s easy to say (without doing some research) whether it’s 0.1 or 0.5 or 0.9 fewer jobs for each malaria net maker that goes away.
Mostly agree, though it’s worth noting that the multiplier can also be greater than one if money gets shifted to an industry that creates more jobs per dollar than the malaria nets.
The question then is why don’t we, instead of ignoring what the people actually want, invest in companies which could create jobs for them (because that’s what they are asking for)? Why does effective altruism care so much about saving lives that it would rather many people live in abject dependence, where their only purpose in life is to have all of their problems solved by foreigners, than to have fewer people pull themselves up by their bootstraps and solve their problems themselves? If what we care about is actually giving jobs, why not promote charities which do create jobs and fight health problems at the same time? Why not build the capacity of local workers to tackle their own challenges? By promoting charities which care about number of people saved over actually getting those people out of poverty, EA only perpetuates the cycle that they claim to be fighting against. If you are really concerned about job creation, the charities promoted here are not the best. But if you only care about saving people and keeping them dependent so that the effective altruists of tomorrow can save them again, donate away.
I apologize for being harsh, but these interventions are hurting real people. I see it every day. And people who have absolutely no stake in it keep donating to these harmful organizations thinking that they are doing good, when in fact they are doing harm. Come to Africa, listen to the people. Ask them what they want. You will increase more happiness by giving them jobs to better their own health, than you will by keeping them dependent and keeping more alive.
a) But malaria really kills about as many people as the flu every year, but I doubt anyone would say that flu vaccines are the best way to improve the economy, or even that they have an appreciable effect. Everyone here considers malaria another version of the flu. Professionals don’t call in sick with the flu for a few days, they call in sick with Malaria, and most of them are fine. Do you think that any American politician would advocate closing down several factories in the Midwest (which are the sole means of support for towns there, if it would mean that slightly fewer people would get the flu? Not a chance. Politicians in democracies that are not flooded with aid actually listen to their people (at least more than politicians where I live do).
b) The problem is that, since countries like mine have absolutely no industry (because aid organizations like AMF run them all out of business) it is not spent in a way that every cent goes back to the local population. It is spent on imports, where certainly some money is going to the distributor, but most of the money is going overseas, away from the people that most need it. The jobs are created, in other countries. This might be great for the corporation that makes AMF’s nets, but it is horrible for the people on the ground.
Malaria prevention helps job creation about as much as having foreigners give out flu vaccines helps job creation at home. Sure you might prevent a couple of cases of the flu, but it is nothing compared to closing down a factory and destroying the livelihood of many people.
“have absolutely no industry (because aid organizations like AMF run them all out of business)”
This is not why they have no industry. Trade does not cost jobs overall, at most it relocates who does what between and within countries. I’d read a book like Why Nations Fail for a better explanation of why some countries struggle to develop complex industries (governance and economic institutions).
In any case, importing nets results in people manufacturing them using proper economies of scale in countries like Vietnam, Thailand, China and Tanzania (where AMF buys its nets), which is also valuable.
Closing yourself off to foreign inputs is no path to economic development.
Two thoughts, there’s a difference between trade, where the consumers get to choose what they are buying and aid, where they have no choice whatsoever. If you start, say an import business to provide people with a certain good that they can only get abroad, you are certainly providing jobs, and you are catering to the needs and wants of the people. Instead of having jobs producing the goods, people have jobs storing and selling them. Perhaps fewer jobs, but jobs nonetheless. I’m not talking about trade, I’m talking about aid. The difference is that aid is temporary, AMF goes in, employs a lot of people to help distribute nets, and then leaves them to cut costs. They don’t give the same long term employment that an import business or local factory might provide. I’m not arguing against trade, I’m arguing against unsustainable aid like AMF.
As for economic development, if we consent to the thesis that it is based on the strength of institutions, aid does not help those either. Aid does several things, it makes politicians beholden to foreign donors instead of the people, by tying conditions to money or goods to come into the country. This harms political institutions since the laws of the country are based not on what the people actually want, but on what foreigners think is good. This leads to laws that are on the books solely to appease international donors, but which are never enforced on the ground. Furthermore, and more appropriate to AMF, it leads to the perception of the people that it is the responsibility of foreign organizations to solve problems, not the government. This means that they do not hold their elected officials accountable, which inevitably weakens these institutions.
I’m not saying we should close ourselves off to foreign imports, which provide steady jobs, I’m saying we should stop giving money to organizations which donate goods and take away local jobs, of people who could either be working in a factory, or simply importing those same goods. If we supported these businesses instead, we could get similar outcomes without hurting the communities.