Based on this kind of observation, it seems to me that most people want to live. My personal, subjective, moral view is that it would be wrong to assign a different moral weight to their lives.
Let me challenge you here. Suppose that in a community inspired by Tsangano, Malawi, where people used 71% of nets which they freely received, the quality of life is −0.2 with an SD of 0.3 (normally distributed). 60 km away, in a place visually similar to Namisu, Malawi (where people used 95% of nets), the quality of life is 0.3 with an SD of 0.2. Each community has 2,000 people (who need about 1,000 nets). You have only 500 nets.
Who are you going to give the nets to?
Further challenge: You also have a pre-recorded radio show that improves farmers’ agricultural productivity by coaching them to place only 1 grain 75 cm apart and cover with a few cm of soil rather than scattering the grain. This can increase people’s productivity by an average of 20%. The airtime for the show in one community costs as much as 500 nets.
Are you going to forgo any nets and buy the show?
Are you subjectively assigning equivalent moral weights to the lives of the people in the two hypothetical communities?
(disclaimer: I work for AMF, but this is my personal opinion)
Yes, we have to prioritize. No, life quality seems the wrong metric for prioritization.
A few practical responses to the challenge first: AMF funds bednets at the scale of countries or provinces, that is, a few million nets at a time. This allows for efficient distributions that leverage economies of scale. Prioritization takes a number of factors into account, such as malaria prevalence (which might have an effect on the bednet use rate). Life quality metrics are currently not a factor for prioritization, as far as I know.
Re the challenge: I think you’d have to consider that life quality goes up as a result of the intervention. It might go up more in areas that start from a lower baseline than in areas where people are already better off. It’s important to note that bednets (or, for that matter, most interventions) are not purely life-extending interventions. They have a variety of other benefits:
Economic improvements: Fink and Masiye 2015 found that free bednets increased the average annual harvest value for a farmer by $76, about 12% of the group’s average annual harvest value at baseline.
Education improvements: since children cannot go to school when they are ill
General welfare improvements since people don’t have to care for sick children, don’t have to mourn them or organize funerals so often, …
Health improvements from averting long-term effects of malaria infections
A final question: you keep using net-negative lives in your examples, yet people are accepting help, voluntarily. This seems to indicate net-positive life quality. How do you think about that?
Thank you. This actually makes a lot of sense. The farming improvements (although could be different in different areas and studies) are astounding. For example, One Acre Fund increases farmers’ annual income by about $100 or 50%, for the cost of about $25/farmer in 2021. Bednets have an equivalent nominal impact for about a fifth ($5) of the price.
Sidenote: the lower % improvement suggests that AMF serves relatively affluent farmers (with average annual incomes of $633 ($76/12%*100%), which can have twice to five times the real value) (unless the $76 is real value).
The agricultural productivity can increase because people are less sick and more productive. Also people could have a greater capacity to seek better farming practice information, livestock could be less ill (if bednets are used to cover livestock), and fishers could have better equipment.
Also, children could be able to help with chores rather than occupy parents or older siblings to care for them. Reduced treatment spending can be also substantial. Assuming that malaria treatment costs $4 and a bednet prevents 2 cases of malaria per year, then a family with 5 children (who would be treated if they get malaria) can save $40/year, which can a substantial proportion of their income.
In terms of attendance, bednets can have limited effects (about an additional week of school per year?).
In Kenya, primary school students were considered to miss 11% of the school year (20 school days missed per child per year) due to malaria, while in Nigeria the figure varied between 2% and 6% of the school year (3 to 12 days per year per student). Kimbi et al. (2005) estimated that in the Muea area in Cameroon, 53 out of 144 (36.8%) malaria-infected children lose 0.5 to 14 days of school (averaging 1.53 schooldays). (Thuilliez, 2009)
That is about 10 days/year. If a bednet prevents half of the cases, that is 5 days or a week.
The impacts on enrollment can be relatively larger due to the increased farming income and reduced treatment cost if education expenses are substantial. For example, if education costs $100/year, then an additional child can be educated. If education expenses are close to zero, then malaria does not affect enrollment.
The quality of education or its relevance to employment is not directly addressed but can be addressed indirectly by enrolling a child in a better (higher paid) school.
Reducing mortality can have positive impact on savings and investments due to the reduction of funeral costs, which can constitute a large proportion of a family’s annual income.
I am not familiar with the research on long-term health improvements. I imagine that early treatment of cases that would be more severe, especially for young children, is a key factor. Prevention reduces the rate when this would be needed.
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Ah hah hah, yes, it is “net-positive life” but perhaps not life quality. Let me show you some of these videos:
These are just arbitrary examples that show abuse, neglect, and addiction, mostly from countries that AMF does not operate in. It is possible that similar situations exist in some areas of countries of AMF operation.
The argument that in these situations, people can feel worse than if they were dead.
Although currently you do not consider life quality factors, you could use these factors to put pressure on governments to advance legislation and governance that prevents dissatisfied lives, such as by banning FGM, forced marriage, or ritual servitude.
Even if additional measures are needed to improve life quality, considering these factors can be a statement that AMF, a large player, communicates. Implementing an somewhat sophisticated metric (such as a weighted average with some exponents) can engage officials in calculating what legislation and agreements would net them the most nets (haha), rather than using blame or other negative motivation to achieve the same result.
Preferring life satisfaction (or its proxies) statistics and expert estimates can have positive effects on governance/institutional decisionmaking of AMF partner countries and regions, such as the development of government networks of people familiar with the concepts (and interested in the improvements) of life quality measures and the government’s interest in quantifiable impact.
Not to bother you anymore, but if a government decides to give its 1 million nets to its worst slum and leaves the people who seem to have all they need (except maybe bednets) uncovered, that’s actually equally great as vice versa, and better if malaria rates in the slum are 10% higher than those in the countryside, because more children will be able to survive and people will have more for daily spending. Right.
Let me challenge you here. Suppose that in a community inspired by Tsangano, Malawi, where people used 71% of nets which they freely received, the quality of life is −0.2 with an SD of 0.3 (normally distributed). 60 km away, in a place visually similar to Namisu, Malawi (where people used 95% of nets), the quality of life is 0.3 with an SD of 0.2. Each community has 2,000 people (who need about 1,000 nets). You have only 500 nets.
Who are you going to give the nets to?
Further challenge: You also have a pre-recorded radio show that improves farmers’ agricultural productivity by coaching them to place only 1 grain 75 cm apart and cover with a few cm of soil rather than scattering the grain. This can increase people’s productivity by an average of 20%. The airtime for the show in one community costs as much as 500 nets.
Are you going to forgo any nets and buy the show?
Are you subjectively assigning equivalent moral weights to the lives of the people in the two hypothetical communities?
(disclaimer: I work for AMF, but this is my personal opinion)
Yes, we have to prioritize. No, life quality seems the wrong metric for prioritization.
A few practical responses to the challenge first: AMF funds bednets at the scale of countries or provinces, that is, a few million nets at a time. This allows for efficient distributions that leverage economies of scale. Prioritization takes a number of factors into account, such as malaria prevalence (which might have an effect on the bednet use rate). Life quality metrics are currently not a factor for prioritization, as far as I know.
Re the challenge: I think you’d have to consider that life quality goes up as a result of the intervention. It might go up more in areas that start from a lower baseline than in areas where people are already better off. It’s important to note that bednets (or, for that matter, most interventions) are not purely life-extending interventions. They have a variety of other benefits:
Economic improvements: Fink and Masiye 2015 found that free bednets increased the average annual harvest value for a farmer by $76, about 12% of the group’s average annual harvest value at baseline.
Education improvements: since children cannot go to school when they are ill
General welfare improvements since people don’t have to care for sick children, don’t have to mourn them or organize funerals so often, …
Health improvements from averting long-term effects of malaria infections
A final question: you keep using net-negative lives in your examples, yet people are accepting help, voluntarily. This seems to indicate net-positive life quality. How do you think about that?
Thank you. This actually makes a lot of sense. The farming improvements (although could be different in different areas and studies) are astounding. For example, One Acre Fund increases farmers’ annual income by about $100 or 50%, for the cost of about $25/farmer in 2021. Bednets have an equivalent nominal impact for about a fifth ($5) of the price.
Sidenote: the lower % improvement suggests that AMF serves relatively affluent farmers (with average annual incomes of $633 ($76/12%*100%), which can have twice to five times the real value) (unless the $76 is real value).
The agricultural productivity can increase because people are less sick and more productive. Also people could have a greater capacity to seek better farming practice information, livestock could be less ill (if bednets are used to cover livestock), and fishers could have better equipment.
Also, children could be able to help with chores rather than occupy parents or older siblings to care for them. Reduced treatment spending can be also substantial. Assuming that malaria treatment costs $4 and a bednet prevents 2 cases of malaria per year, then a family with 5 children (who would be treated if they get malaria) can save $40/year, which can a substantial proportion of their income.
In terms of attendance, bednets can have limited effects (about an additional week of school per year?).
That is about 10 days/year. If a bednet prevents half of the cases, that is 5 days or a week.
The impacts on enrollment can be relatively larger due to the increased farming income and reduced treatment cost if education expenses are substantial. For example, if education costs $100/year, then an additional child can be educated. If education expenses are close to zero, then malaria does not affect enrollment.
The quality of education or its relevance to employment is not directly addressed but can be addressed indirectly by enrolling a child in a better (higher paid) school.
Reducing mortality can have positive impact on savings and investments due to the reduction of funeral costs, which can constitute a large proportion of a family’s annual income.
I am not familiar with the research on long-term health improvements. I imagine that early treatment of cases that would be more severe, especially for young children, is a key factor. Prevention reduces the rate when this would be needed.
--
Ah hah hah, yes, it is “net-positive life” but perhaps not life quality. Let me show you some of these videos:
People in a slum, possible abuse and neglect in spousal relationships, FGM, FGM and family, some parents decide that their child cannot live, and sending family members for life-long shrine work.
These are just arbitrary examples that show abuse, neglect, and addiction, mostly from countries that AMF does not operate in. It is possible that similar situations exist in some areas of countries of AMF operation.
The argument that in these situations, people can feel worse than if they were dead.
On a positive note, there are also very chilled environments where lovers get married as well as officials who support consideration based on reasoning.
Although currently you do not consider life quality factors, you could use these factors to put pressure on governments to advance legislation and governance that prevents dissatisfied lives, such as by banning FGM, forced marriage, or ritual servitude.
Even if additional measures are needed to improve life quality, considering these factors can be a statement that AMF, a large player, communicates. Implementing an somewhat sophisticated metric (such as a weighted average with some exponents) can engage officials in calculating what legislation and agreements would net them the most nets (haha), rather than using blame or other negative motivation to achieve the same result.
Preferring life satisfaction (or its proxies) statistics and expert estimates can have positive effects on governance/institutional decisionmaking of AMF partner countries and regions, such as the development of government networks of people familiar with the concepts (and interested in the improvements) of life quality measures and the government’s interest in quantifiable impact.
Not to bother you anymore, but if a government decides to give its 1 million nets to its worst slum and leaves the people who seem to have all they need (except maybe bednets) uncovered, that’s actually equally great as vice versa, and better if malaria rates in the slum are 10% higher than those in the countryside, because more children will be able to survive and people will have more for daily spending. Right.