Casually, the Lancet article is making a very big claim—that general health spending on kids has led to averted deaths at $4205 each across the board since 2000. This is a simple average of the association between spending and reduced deaths. So it attributes 100% of the progress in this area to the amount of spending in each country. As they point out, the correlation is not tight. So it would not be sensible to attribute 100% of the improvement to the spending. Which is in a way disappointing because we can’t then just throw more money at the problem and expect this return. But in another way isn’t such a surprise that all Givewell found was a very slight improvement on that average. Education, culture, the economy, general efficiency of public services, declining fertility probably all had quite a lot to do with each country’s story. So the Lancet article isn’t that useful in this way?
The analysis is a bit more sophisticated than that:
“To avoid overestimation of the number of child deaths averted through health intervention, we take advantage of the analysis published by Wang et al (1), which examined the component of changes in child mortality that can be linked to changes in income per capita and educational attainment. Based on the econometric model used by Wang et al (1), we estimate counterfactual deaths in a scenario where income, education, and number of live births change with time but everything else is set at its year 2000 value.”
See supplemental material: http://www.thelancet.com/cms/attachment/2033982751/2049751458/mmc1.pdf
OK, so then either it is surprising that givewell hasn’t found better, there are some harder to observe links between child health spending and child health, or there are other variables that probably aren’t covered off properly in the model?
Big development organisations (Gates, UNICEF, etc) can do certain things that are very effective, such as vaccinations, and might also enjoy economies of scale. It’s actually quite surprising that individual donors can do significantly better ($3340 per life saved by donating to AMF vs. $4205 per life saved). Note also, that the $4205 figure is a biased sample of any big development organisations programme—because most are not only active in low income countries.
Individual donors cannot donate in a ringfenced fashion to development organisation through big organisations such as UNICEF unfortunately.
Casually, the Lancet article is making a very big claim—that general health spending on kids has led to averted deaths at $4205 each across the board since 2000. This is a simple average of the association between spending and reduced deaths. So it attributes 100% of the progress in this area to the amount of spending in each country. As they point out, the correlation is not tight. So it would not be sensible to attribute 100% of the improvement to the spending. Which is in a way disappointing because we can’t then just throw more money at the problem and expect this return. But in another way isn’t such a surprise that all Givewell found was a very slight improvement on that average. Education, culture, the economy, general efficiency of public services, declining fertility probably all had quite a lot to do with each country’s story. So the Lancet article isn’t that useful in this way?
The analysis is a bit more sophisticated than that:
“To avoid overestimation of the number of child deaths averted through health intervention, we take advantage of the analysis published by Wang et al (1), which examined the component of changes in child mortality that can be linked to changes in income per capita and educational attainment. Based on the econometric model used by Wang et al (1), we estimate counterfactual deaths in a scenario where income, education, and number of live births change with time but everything else is set at its year 2000 value.” See supplemental material: http://www.thelancet.com/cms/attachment/2033982751/2049751458/mmc1.pdf
OK, so then either it is surprising that givewell hasn’t found better, there are some harder to observe links between child health spending and child health, or there are other variables that probably aren’t covered off properly in the model?
Big development organisations (Gates, UNICEF, etc) can do certain things that are very effective, such as vaccinations, and might also enjoy economies of scale. It’s actually quite surprising that individual donors can do significantly better ($3340 per life saved by donating to AMF vs. $4205 per life saved). Note also, that the $4205 figure is a biased sample of any big development organisations programme—because most are not only active in low income countries. Individual donors cannot donate in a ringfenced fashion to development organisation through big organisations such as UNICEF unfortunately.