Part of the problem is that in countries like mine there is next to no data, and the data produced by international organizations is often wrong or grossly misleading. It is culturally inappropriate to even ask simple questions like, how many people live here, or how old is that child, and most locals will lie and tell you whatever you want to hear to give a donation, not because they are bad people, but because lying, especially to strangers, is culturally acceptable here, if not outright expected. Part of the reason is that these communities have been living off of harmful aid like this for so long that they understand the only way that they can survive is to convince the donors that they need money. In this culture of dependence, accurate statistics about populations are next to impossible to come by unless you live in that community for a significant period of time.
If you want specific data on the harm of these programs on a larger scale, check out William Easterly’s book White Man’s Burden, or Dambisa Moyo’s book, Dead Aid. Personally I can only offer anecdotes of so many people that I have seen hurt by aid. Really, my best advice is to come live here, you will see first-hand the harm of programs like this and frankly there is no accurate data, even the stuff that AMF puts out.
If there is an absence of accurate data, why should we believe that supporting AMF destroys more jobs than it creates?
It sounds like it is (anecdotally) easy to point to some people who have been hurt by distribution of free bed nets (local producers), but if there are economic benefits from reducing malaria, then any job gains will likely be spread amongst many sectors. You won’t be able to identify such job gains through anecdotal evidence.
On a side-note, there is a blog post on the AMF website from 5 years ago discussing this issue of where they buy their nets. It would be interesting to hear if anything has changed since then.
It’s worth noting that AMF supplies long-lasting insecticide-treated bednets, which appear to be the most-effective type. If local producers are not producing this type, then the absence of AMF et al may lead to greater local jobs, but only in the production of bednets that aren’t as good at reducing malaria.
It is a good question, why, if the data is flawed or dubious, should you believe that there is economic harm taking place? I would return to the point of choice. If foreigners do not have sufficient data to determine that a particular intervention would do more good than harm, I see no reason that they should have the right to override the will of the community. If we cannot get correct data as to which interventions would help a community the most, why can we not instead simply ask the community what they want? If anyone knows what they need, it would seem that the community would. I’m not certain that more harm than good is being done, but I have seen enough anecdotal evidence of poorly conducted studies and visible harm, that I am quite concerned. It seems that in the absence of sufficient evidence we should revert to the will of the community.
As for benefits unidentifiable in anecdotal evidence, if we go under the assumption that studies here are inherently flawed, then these benefits will not be able to be measured until the society develops to a point where such studies provide accurate and useful data. Therefore all we have to go on are questionable studies and anecdotal evidence. Once again leading to an impasse and it seems that the tie should go to what the communities themselves actually want. In terms of the question about the economic benefits of reducing malaria, certainly they exist, the question we are asking is which benefits are greater, reducing rates slowly by supporting the sustainable growth of local businesses which are combating malaria, or reducing rates quickly while harming local businesses, limiting the choices of local populations, and increasing dependency on foreign aid? I think a strong case can be made for the former, but if we fail to analyze charities based on the amount of choice they give to populations and the level of dependency they create, we won’t even be asking this question.
As for the question of where AMF buys their nets, in my mind it is less about the fact that they are buying them in foreign countries, and more about the fact that they are using money to buy goods instead of train individuals and build capacity. If they wanted to help out a net import and distribution business which employs, perhaps fewer people than a factory, but still is providing sustainable income to families, to distribute to a wider populous, or train them how to run educational programs about bed net use to increase demand, that would be helpful, because when AMF left, the infrastructure would remain and the people on the ground could keep doing the work themselves. The problem is that their current practices do not employ locals or leave in place any sustainable systems so that when they are gone, the people are left with no income, nets that will fail in at most five years, and no way to replace them. If they believe that the long lasting nets could not be made in country, that does not mean they should donate them, simply that they should help train an import business to bring in the higher quality nets, and educate the people about the importance of using those particular nets. There are so many better ways they could be spending their money, which comes back to the original point, Effective Altruism should focus on sustainable solutions which get the local communities to run and implement them, not one time fixes which fall apart as soon as the organization leaves.
“It is a good question, why, if the data is flawed or dubious, should you believe that there is economic harm taking place? I would return to the point of choice. If foreigners do not have sufficient data to determine that a particular intervention would do more good than harm, I see no reason that they should have the right to override the will of the community.”
We have good evidence and reason to believe that bednets reduce the incidence and burden of malaria. The big question is over the economic impact, not so much the health impact.
So it seems we can be confident we’re improving health, but less confident of the impact on jobs. We have two scenarios:
(a)Without bednets/AMF: people will die and suffer from malaria and there is an uncertain impact on jobs.
(b)With bednets/AMF: fewer people will die and suffer from malaria and there is an uncertain impact on jobs.
But ok: let’s consider your anecdotal evidence. Based on this, how many jobs do you think have been displaced by the existence of AMF within a given country? How many people do you realistically think need to be employed to produce the bednets needed by a country? Do you have any figures, estimates, or even guesses for the number of people employed as bednet manufacturers in any country?
“We have good evidence and reason to believe that bednets reduce the incidence and burden of malaria. The big question is over the economic impact, not so much the health impact.”
But we don’t have good evidence that bednets are in fact being used in these communities and are actually actively reducing malaria rates, and I have experiential evidence that communities are not using these nets, and both families and health workers are lying to researchers when they come through about net use and malaria prevalence. Are some families using them, possibly. Is it significantly fewer than what AMF claims, I would argue yes.
To conflate AMF and bednets is to miss the whole point. There will be bednets without AMF. Those bednets will go to communities that actually want them and would pay for them, and support local jobs either in factories or import businesses. With AMF, the communities that want bednets will still get them, so there’s no impact there, and communities that don’t want them will not use them, so there’s no impact there. The only appreciable impact is the loss of jobs and infrastructure to get nets to those that want them without AMF’s help.
As for the claim about reduced malaria rates increasing household income, the study you quote claims that shocks like drastic malaria reduction would reduce household incomes for 30 years and significantly increase populations. In a country like this where there are already too few jobs and most people are barely getting by, that could be catastrophic. Most communities might not survive to see the eventual increase in household income, which comes as much from higher rates of education as anything else according to the study.
To the final point, I don’t have the statistics, as noted above, I’m skeptical of any statistics that are coming out of this part of the world, because of the culture around telling strangers what they want to hear. Without accurate information, I feel, once again we must default to what the people actually want, as if anyone knows what they need, they do.
Which brings up a concern. You, and it seems most of the interlocutors here have failed to address to question of choice. The question of freedom. There is no dispute that AMF ignores the requests of communities. That they insist on top down development initiative instead of systematically bottom up initiatives. This is harmful because it does not give people a voice in what is done to them. It destroys the ideals of democracy and self determination. And it is the reason that people don’t use the bed nets, because they don’t care about what you think is valuable, because you never asked them what they want. Interventions which come from the community will be more effective, period. Because the community will actually need them and use them. Effective Altruism fails because it does not realize that the effectiveness of a program is contingent on how invested a community is in that program, and the community’s investment is contingent on you actually asking them what they need.
Note the difference in outcomes between insecticide-treated nets and untreated nets. Locally-produced nets are likely to be untreated, which aren’t very effective.
Let’s back up, because you are continuing to ignore two of my arguments against AMF, that they create dependency, and that they limit freedom. I’m skeptical of the studies for many reasons, everything from a lack of professional ethics of local translators and surveyors, to the troubles of conducting longitudinal studies with children in compounds which often have different children staying in them from day to day, to dissimilarities between what AMF does and what is done in these studies, to philosophical concerns that I have with any such studies that I have from a methodological standpoint. However, the claim I make at the top of the article is that we need to reassess the criteria that we use for determining an effective charity, while debating whether or not the interventions of AMF do what they claim to do may help us to determine if it is inevitably effective, it misses the central point, that effective altruists ignore metrics like job creation, freedom and dependence when evaluating charities.
You still have failed to address the problem of choice. Why can you not care less about what the people want? Why do you think that money gives someone the right to determine how others live their lives? Should we live in a world where only those with money have the right to choose what happens to everyone? That’s the world AMF promotes. By giving to charities that ignore the voices of the populations on the ground you perpetuate the culture of corruption, ubiquitous in modern politics (especially here). People here feel powerless to change their own destinies, because you decided their destiny for them. You condemn them to a generation of poverty with the hope that their economy will recover, when maybe they don’t want that. If I told you that you could live in poverty for 30 years and based on some economic models which may or may not apply you can improve in your income modestly afterward would you agree? If someone you had never met decided that you should live in poverty for 30 years to eventually see a possible increase in income, do you think that they would be right to make that decision for you?
Please stop cheery picking one or two points which are tangential to the actual argument, and answer this: why should we ignore the will of the people? What gives you the right to decide for them? Did they elect you? Do you know them? Have you ever even visited the places that you are making choices for? Why does wealth give you the right to dictate how people you have never met overcome poverty?
“Please stop cheery picking one or two points which are tangential to the actual argument”
Your argument is only based on anecdotal evidence. I’m happy to address many of your points, but if you’re not actually willing to accept a significant amount of evidence as to the health benefits, I don’t see why you expect us to accept your anecdotal evidence concerning jobs.
I’m happy to discuss the question of choice, though you seem to also oppose Give Directly, which precisely provides people with more choice.
I expect you to write an unnecessarily long response to this.
Part of the problem is that in countries like mine there is next to no data, and the data produced by international organizations is often wrong or grossly misleading. It is culturally inappropriate to even ask simple questions like, how many people live here, or how old is that child, and most locals will lie and tell you whatever you want to hear to give a donation, not because they are bad people, but because lying, especially to strangers, is culturally acceptable here, if not outright expected. Part of the reason is that these communities have been living off of harmful aid like this for so long that they understand the only way that they can survive is to convince the donors that they need money. In this culture of dependence, accurate statistics about populations are next to impossible to come by unless you live in that community for a significant period of time.
If you want specific data on the harm of these programs on a larger scale, check out William Easterly’s book White Man’s Burden, or Dambisa Moyo’s book, Dead Aid. Personally I can only offer anecdotes of so many people that I have seen hurt by aid. Really, my best advice is to come live here, you will see first-hand the harm of programs like this and frankly there is no accurate data, even the stuff that AMF puts out.
If there is an absence of accurate data, why should we believe that supporting AMF destroys more jobs than it creates?
It sounds like it is (anecdotally) easy to point to some people who have been hurt by distribution of free bed nets (local producers), but if there are economic benefits from reducing malaria, then any job gains will likely be spread amongst many sectors. You won’t be able to identify such job gains through anecdotal evidence.
On a side-note, there is a blog post on the AMF website from 5 years ago discussing this issue of where they buy their nets. It would be interesting to hear if anything has changed since then.
https://www.againstmalaria.com/Newsitem.aspx?newsitem=Where-do-we-buy-our-nets-from
It’s worth noting that AMF supplies long-lasting insecticide-treated bednets, which appear to be the most-effective type. If local producers are not producing this type, then the absence of AMF et al may lead to greater local jobs, but only in the production of bednets that aren’t as good at reducing malaria.
It is a good question, why, if the data is flawed or dubious, should you believe that there is economic harm taking place? I would return to the point of choice. If foreigners do not have sufficient data to determine that a particular intervention would do more good than harm, I see no reason that they should have the right to override the will of the community. If we cannot get correct data as to which interventions would help a community the most, why can we not instead simply ask the community what they want? If anyone knows what they need, it would seem that the community would. I’m not certain that more harm than good is being done, but I have seen enough anecdotal evidence of poorly conducted studies and visible harm, that I am quite concerned. It seems that in the absence of sufficient evidence we should revert to the will of the community.
As for benefits unidentifiable in anecdotal evidence, if we go under the assumption that studies here are inherently flawed, then these benefits will not be able to be measured until the society develops to a point where such studies provide accurate and useful data. Therefore all we have to go on are questionable studies and anecdotal evidence. Once again leading to an impasse and it seems that the tie should go to what the communities themselves actually want. In terms of the question about the economic benefits of reducing malaria, certainly they exist, the question we are asking is which benefits are greater, reducing rates slowly by supporting the sustainable growth of local businesses which are combating malaria, or reducing rates quickly while harming local businesses, limiting the choices of local populations, and increasing dependency on foreign aid? I think a strong case can be made for the former, but if we fail to analyze charities based on the amount of choice they give to populations and the level of dependency they create, we won’t even be asking this question.
As for the question of where AMF buys their nets, in my mind it is less about the fact that they are buying them in foreign countries, and more about the fact that they are using money to buy goods instead of train individuals and build capacity. If they wanted to help out a net import and distribution business which employs, perhaps fewer people than a factory, but still is providing sustainable income to families, to distribute to a wider populous, or train them how to run educational programs about bed net use to increase demand, that would be helpful, because when AMF left, the infrastructure would remain and the people on the ground could keep doing the work themselves. The problem is that their current practices do not employ locals or leave in place any sustainable systems so that when they are gone, the people are left with no income, nets that will fail in at most five years, and no way to replace them. If they believe that the long lasting nets could not be made in country, that does not mean they should donate them, simply that they should help train an import business to bring in the higher quality nets, and educate the people about the importance of using those particular nets. There are so many better ways they could be spending their money, which comes back to the original point, Effective Altruism should focus on sustainable solutions which get the local communities to run and implement them, not one time fixes which fall apart as soon as the organization leaves.
“It is a good question, why, if the data is flawed or dubious, should you believe that there is economic harm taking place? I would return to the point of choice. If foreigners do not have sufficient data to determine that a particular intervention would do more good than harm, I see no reason that they should have the right to override the will of the community.”
We have good evidence and reason to believe that bednets reduce the incidence and burden of malaria. The big question is over the economic impact, not so much the health impact.
So it seems we can be confident we’re improving health, but less confident of the impact on jobs. We have two scenarios:
(a)Without bednets/AMF: people will die and suffer from malaria and there is an uncertain impact on jobs.
(b)With bednets/AMF: fewer people will die and suffer from malaria and there is an uncertain impact on jobs.
In fact, there is some evidence to suggest reducing malaria can boost economic growth and productivity: http://effective-altruism.com/ea/pd/longterms_effects_of_malaria_on_labour/
But ok: let’s consider your anecdotal evidence. Based on this, how many jobs do you think have been displaced by the existence of AMF within a given country? How many people do you realistically think need to be employed to produce the bednets needed by a country? Do you have any figures, estimates, or even guesses for the number of people employed as bednet manufacturers in any country?
“We have good evidence and reason to believe that bednets reduce the incidence and burden of malaria. The big question is over the economic impact, not so much the health impact.”
But we don’t have good evidence that bednets are in fact being used in these communities and are actually actively reducing malaria rates, and I have experiential evidence that communities are not using these nets, and both families and health workers are lying to researchers when they come through about net use and malaria prevalence. Are some families using them, possibly. Is it significantly fewer than what AMF claims, I would argue yes.
To conflate AMF and bednets is to miss the whole point. There will be bednets without AMF. Those bednets will go to communities that actually want them and would pay for them, and support local jobs either in factories or import businesses. With AMF, the communities that want bednets will still get them, so there’s no impact there, and communities that don’t want them will not use them, so there’s no impact there. The only appreciable impact is the loss of jobs and infrastructure to get nets to those that want them without AMF’s help.
As for the claim about reduced malaria rates increasing household income, the study you quote claims that shocks like drastic malaria reduction would reduce household incomes for 30 years and significantly increase populations. In a country like this where there are already too few jobs and most people are barely getting by, that could be catastrophic. Most communities might not survive to see the eventual increase in household income, which comes as much from higher rates of education as anything else according to the study.
To the final point, I don’t have the statistics, as noted above, I’m skeptical of any statistics that are coming out of this part of the world, because of the culture around telling strangers what they want to hear. Without accurate information, I feel, once again we must default to what the people actually want, as if anyone knows what they need, they do.
Which brings up a concern. You, and it seems most of the interlocutors here have failed to address to question of choice. The question of freedom. There is no dispute that AMF ignores the requests of communities. That they insist on top down development initiative instead of systematically bottom up initiatives. This is harmful because it does not give people a voice in what is done to them. It destroys the ideals of democracy and self determination. And it is the reason that people don’t use the bed nets, because they don’t care about what you think is valuable, because you never asked them what they want. Interventions which come from the community will be more effective, period. Because the community will actually need them and use them. Effective Altruism fails because it does not realize that the effectiveness of a program is contingent on how invested a community is in that program, and the community’s investment is contingent on you actually asking them what they need.
“But we don’t have good evidence that bednets are in fact being used in these communities and are actually actively reducing malaria rates”
Yes we do. For example, this systematic review considers 22 randomised controlled trials which look at morbidity and mortality from malaria: https://www.ncbi.nlm.nih.gov/pubmed/15106149
Note the difference in outcomes between insecticide-treated nets and untreated nets. Locally-produced nets are likely to be untreated, which aren’t very effective.
This study finds that the impact of scaling-up supply of bednets across several countries is consistent with the findings of previous trials: https://www.ncbi.nlm.nih.gov/pubmed/21909249
Are you happy to accept this evidence?
“Are some families using them, possibly. Is it significantly fewer than what AMF claims, I would argue yes.”
What claims do AMF make about use?
Let’s back up, because you are continuing to ignore two of my arguments against AMF, that they create dependency, and that they limit freedom. I’m skeptical of the studies for many reasons, everything from a lack of professional ethics of local translators and surveyors, to the troubles of conducting longitudinal studies with children in compounds which often have different children staying in them from day to day, to dissimilarities between what AMF does and what is done in these studies, to philosophical concerns that I have with any such studies that I have from a methodological standpoint. However, the claim I make at the top of the article is that we need to reassess the criteria that we use for determining an effective charity, while debating whether or not the interventions of AMF do what they claim to do may help us to determine if it is inevitably effective, it misses the central point, that effective altruists ignore metrics like job creation, freedom and dependence when evaluating charities.
You still have failed to address the problem of choice. Why can you not care less about what the people want? Why do you think that money gives someone the right to determine how others live their lives? Should we live in a world where only those with money have the right to choose what happens to everyone? That’s the world AMF promotes. By giving to charities that ignore the voices of the populations on the ground you perpetuate the culture of corruption, ubiquitous in modern politics (especially here). People here feel powerless to change their own destinies, because you decided their destiny for them. You condemn them to a generation of poverty with the hope that their economy will recover, when maybe they don’t want that. If I told you that you could live in poverty for 30 years and based on some economic models which may or may not apply you can improve in your income modestly afterward would you agree? If someone you had never met decided that you should live in poverty for 30 years to eventually see a possible increase in income, do you think that they would be right to make that decision for you?
Please stop cheery picking one or two points which are tangential to the actual argument, and answer this: why should we ignore the will of the people? What gives you the right to decide for them? Did they elect you? Do you know them? Have you ever even visited the places that you are making choices for? Why does wealth give you the right to dictate how people you have never met overcome poverty?
“Please stop cheery picking one or two points which are tangential to the actual argument”
Your argument is only based on anecdotal evidence. I’m happy to address many of your points, but if you’re not actually willing to accept a significant amount of evidence as to the health benefits, I don’t see why you expect us to accept your anecdotal evidence concerning jobs.
I’m happy to discuss the question of choice, though you seem to also oppose Give Directly, which precisely provides people with more choice.
I expect you to write an unnecessarily long response to this.