Thanks James I think this is a great initiative. instinctively 3 of those policy areas seem tractable and at least somewhat neglected. I’ve seen first hand through my wife’s work in Northern Uganda (albeit on a small scale) the power of alcohol legislation .
Air pollution on the other hand has large amounts of academic research and advocacy attached to it, and is also getting increasing funding through climate change mitigation money bags. Clean air fund estimates around 4 billion (ish) spent annually in aid towards clean air, which may still be not enough but is similar to malaria funding, with cleaning the air arguably far less tractable than malaria.
One of your numbers here does look like it could be a bit of misleading strawman, the “10-20 million” spent in aid on clean are in India. Its true that India isn’t getting much philanthropic aid here, possibly because their government is already spending quite a lot on cleaning the air. There may also be political reasons why they aren’t getting more funding. India has pledged 1.7 billion over the next 5 years to clean up their air, which may not be nearly enough but dwarfs aid funding. The World Bank are also supporting this program logistically, which at a wild guess might be 5-30 million dollars of support??? Also the World Bank has dedicated 1.5 billion dollars towards greening India’s energy supply, which is a relatively small contributor to the clean air problem, but still significant—OpenPhil estimated around 15% of the problem in their report. Looking at aid money alone can be misleading and make causes seem more neglected than they are.
If you had picked “China” rather than “India” to display, then clean air aid funding would have been around 1.5 billion dollars a year which paints a different picture. Picking India as your example seems potentially like misleading cherry picking, and I’m interested to hear why you chose India as your example here, rather than another country, or the world combined like for other examples?
As a final very uncertain side note I’m a little dubious about the death estimates from things like clean air and lead. There is far more uncertainty around them compared with deaths from the big 3 infectious diseases (where uncertainty is still surprisingly high), and given the motivations of the people researching them they are at risk of being inflated.
At least I think it’s good where possible to display uncertainty around these estimates, although I’m guilty of not doing this myself at times as I know it makes graphics look messy.
Also I think DALYs lost is a better metric than “deaths”, as it captures more meaningful information, but I get using the easier to understand metric. Using DALYs lost, malaria and lead poisoning would likely look like bigger problems comparatively than they do using only the death metric.
In addition, I’m confused about the figure of $5-10m for spending on alcohol. This is roughly how much is spent by just two alcohol charities in the UK (Drinkaware and Alcohol Research UK). So global philanthropic spending on alcohol is presumably much higher—and then there’s also any government spending.
Perhaps the $5-10m figure is supposed to only apply to low and middle income countries, or money moved as part of development assistance for health?
The $5-10M for alcohol work is indeed LMIC only—GiveWell document from 2021 here. I think the main funder missed from that is the DG Murray Trust in South Africa, whose alcohol harms reduction work is exclusively South Africa oriented.
There isn’t a development assistance for health estimate from the IHME for alcohol policy work, lead exposure, or suicide prevention through means restriction in the way that there is for tobacco. One reason for displaying these funding estimates as a range is that they are very uncertain and vulnerable to questions of what gets included or not.
Interesting point about Drinkaware—I didn’t know it was partly industry-funded. Given this, even though I’d hope the information they provide is broadly accurate, I’m assuming it is more likely to be framed through the lens of personal choice rather than advocating for government action (e.g. higher taxes on alcohol).
I presume the $5-10M also only refers to alcohol-specific philanthropy? I would expect there to be some funding for it via adjacent topics, such as organisations that work on drugs/addiction more broadly, or ones that focus on promoting nutrition and healthy lifestyles.
That’s very true, and after a 30 second google search here’s a 15 million GiveWell grant recommended in December 2021 given to a bunch of Orgs in the space—Actually I think this may have been funded by OpenPhil directly but then does it count or not? Unsure.
(I don’t lead on the air quality work, so be more careful with this comment that the others that I’ve left here).
India wasn’t picked as an example to illustrate the importance and neglectedness of air quality work. Rather, India has been the dominant setting for Open Philanthropy’s air quality work to date—it even has its own updated web page. You can read more about why Open Philanthropy launched the work on South Asian air quality here and here. Santosh Harish, the Program Officer who leads that work, recently gave an excellent interview to the 80,000 hours podcast—transcript and recording here.
I agree domestic financing complicates relative neglectedness—the effort here was to be as consistent as reasonably possible between the risk factors. Neglectedness comparisons are very tricky to nail down in general (e.g. how to attribute non-specific health systems spending across both causes and risks, whether to include treatment for linked health conditions like lung cancer or cirrhosis, how to think about relatively ineffective uses of money like e.g. biofuel subsidies for climate change, or a more relevant example here would be smog towers for air quality). One nod to the uncertainty of both measurement and scope here is the use of ranges; but yeah, we’re trading off a bunch of different considerations here.
There’s a lot of internal research stress testing the IHME burden estimates for lead and air quality, and some on alcohol—I’m doing more on alcohol specifically at the moment. Here we’re pointing to the IHME GBD study for several reasons: it’s widely recognized, easy to interact with, has a largely consistent / common methodology between different causes of death and disease, and importantly doesn’t allow for deaths to be attributed to more than one cause. This works well for problems where the Open Philanthropy way of conceptualizing the problem (e.g. malaria, lead exposure) matches a GBD cause (e.g. malaria) or risk (e.g. lead exposure). This doesn’t mean we uncritically use the GBD in all of our own decision making—but this set of reasons make it very helpful to refer to when communicating externally. It might be that we publish more of our internal research on this in the future, but honestly it’s a serious time investment and I don’t want to over promise.
DALYs sit behind the framework but can be understandably offputting for many audiences. The BOTECs / grant decisions are in line with our usual GHW cause prioritization framework of valuing increases in healthy life and log-income.
Thanks heaps for the reply Chris! Yes I have read the OpenPhil work on air quality. That explains to some extent the India choice, although I still feel like its a misleading graphic.
I would be interested to hear what you found interesting and compelling about the 80,000 hours interview? Maybe though you can’t say much (or anything) given your position at GiveWell. I was impressed by his knowledge and passion about the issue, but found his arguments about potentially tractable interventions somewhat unconvincing. I struggled to see a clear theory of change in his proposed interventions. I can definitely be convinced, but just aren’t right now. think its likely India will greatly reduce air pollution over the next 20 years, but its hard for me right now to envisage how marginal funding will make a difference. Obviously I’m not an expert at all though so could easily just be dead wrong.
If anything the interview made me a bit less convinced than I was before that air quality in India was likely to be a cost-effective cause area. I was also surprised that he didn’t talk about the significant domestic funding going towards cleaning the air as well.
I agree air quality is meaningfully different from the other areas we highlight in terms of domestic salience (at least in India). But it’s not clear to me whether the existence of nascent government funding (and the consequent opportunity to improve the allocation of that funding) make philanthropic opportunities better or worse.
Efforts like the NCAP framework and 15th Finance Commission budget allocations in India are fairly new, and there aren’t well-developed playbooks for prioritizing and addressing sources of air pollution in this context. So we think there are large potential benefits to helping improve the effectiveness of those efforts. Among other things, we’re doing that by supporting organizations to help governments develop and implement specific action plans (e.g.), developing better models to enable cost-effectiveness analysis (e.g.), and providing independent assessment of progress against policy goals (e.g.). We think these are areas where philanthropic funding may be able to have an outsized impact. Santosh gives some more examples of grants he’s made in this part of his podcast. We’re also exploring working in other countries in South Asia with fewer government resources allocated to air quality than India. The program hasn’t been running long enough to make confident claims of impact yet.
Thanks so much for your great explanation James and the other ones on the post. Great to see direct engagement from the people running the program.
the theory of change of trying to change the government’s current allocation of makes some sense (I didn’t pick it up in the podcast, but reading back it is there to some degree), but its very difficult. Its always a difficult task influence governments to spend their money in more impactful directions—especially just with science and logic. Advocacy skills might be at least as important to your cause as the data the projects you fund produce.
I would be interested to see if you have examples of philanthropies with small amounts of money and no real carrot or stick, influencing governments with larger amounts of money on the issue. Here in Uganda philanthropies can definitely influence the direction of healthcare for example (HIV, Malaria national programs. etc.), but its largely through pouring significant resources into that area, often more than the government can even which gives them hard power and carrots and sticks to wield.
I’m also interested if Indian governments have shown in any practical way that they might be genuinely interested in cost-effectiveness analysis driving fund allocation? As far as I know in East Africa here cost-effectiveness analysis is almost completely unutilised by governments, I’ve certainly never heard it referred to from any level of government in any intervention here, health or otherwise. I hope India is more switched on than that and might pay more attention. I know nothing about the region really so maybe they do already use it.
Anyway we will see what happens! Obvious clean air is wildly important and causes ludicrous amnounts of suffering and death. It may well be a hard thing to judge the impact on—a rough one for the grantmaker and those doing the interventions. If the quality doesn’t improve obviously that will be a fail, but if it does (as is likely) its going to be hard to pin down the counterfactual impact of the grants. If they do allocate more efforts to rural areas that’s a win you could tick up I’d imagine, but if air quality gets better in general it may well be hard to figure out what portion of it was due to your guys work—even if most of it was.
Anyway thanks again for the reply and all the best with the project!
Thanks James I think this is a great initiative. instinctively 3 of those policy areas seem tractable and at least somewhat neglected. I’ve seen first hand through my wife’s work in Northern Uganda (albeit on a small scale) the power of alcohol legislation .
Air pollution on the other hand has large amounts of academic research and advocacy attached to it, and is also getting increasing funding through climate change mitigation money bags. Clean air fund estimates around 4 billion (ish) spent annually in aid towards clean air, which may still be not enough but is similar to malaria funding, with cleaning the air arguably far less tractable than malaria.
One of your numbers here does look like it could be a bit of misleading strawman, the “10-20 million” spent in aid on clean are in India. Its true that India isn’t getting much philanthropic aid here, possibly because their government is already spending quite a lot on cleaning the air. There may also be political reasons why they aren’t getting more funding. India has pledged 1.7 billion over the next 5 years to clean up their air, which may not be nearly enough but dwarfs aid funding. The World Bank are also supporting this program logistically, which at a wild guess might be 5-30 million dollars of support??? Also the World Bank has dedicated 1.5 billion dollars towards greening India’s energy supply, which is a relatively small contributor to the clean air problem, but still significant—OpenPhil estimated around 15% of the problem in their report. Looking at aid money alone can be misleading and make causes seem more neglected than they are.
https://www.worldbank.org/en/news/press-release/2023/06/29/world-bank-approves-1-5-billion-in-financing-to-support-india-s-low-carbon-transition
https://www.worldbank.org/en/country/india/publication/catalyzing-clean-air-in-india
If you had picked “China” rather than “India” to display, then clean air aid funding would have been around 1.5 billion dollars a year which paints a different picture. Picking India as your example seems potentially like misleading cherry picking, and I’m interested to hear why you chose India as your example here, rather than another country, or the world combined like for other examples?
As a final very uncertain side note I’m a little dubious about the death estimates from things like clean air and lead. There is far more uncertainty around them compared with deaths from the big 3 infectious diseases (where uncertainty is still surprisingly high), and given the motivations of the people researching them they are at risk of being inflated.
At least I think it’s good where possible to display uncertainty around these estimates, although I’m guilty of not doing this myself at times as I know it makes graphics look messy.
Also I think DALYs lost is a better metric than “deaths”, as it captures more meaningful information, but I get using the easier to understand metric. Using DALYs lost, malaria and lead poisoning would likely look like bigger problems comparatively than they do using only the death metric.
Some excellent points.
In addition, I’m confused about the figure of $5-10m for spending on alcohol. This is roughly how much is spent by just two alcohol charities in the UK (Drinkaware and Alcohol Research UK). So global philanthropic spending on alcohol is presumably much higher—and then there’s also any government spending.
Perhaps the $5-10m figure is supposed to only apply to low and middle income countries, or money moved as part of development assistance for health?
The $5-10M for alcohol work is indeed LMIC only—GiveWell document from 2021 here. I think the main funder missed from that is the DG Murray Trust in South Africa, whose alcohol harms reduction work is exclusively South Africa oriented.
There isn’t a development assistance for health estimate from the IHME for alcohol policy work, lead exposure, or suicide prevention through means restriction in the way that there is for tobacco. One reason for displaying these funding estimates as a range is that they are very uncertain and vulnerable to questions of what gets included or not.
There is some HIC alcohol policy funding. I’d personally be leery of including Drinkaware, since it is funded by alcoholic beverage manufacturers (and some other broader industry participants) and so I think sits in quite a different category.
Thanks for clarifying!
Interesting point about Drinkaware—I didn’t know it was partly industry-funded. Given this, even though I’d hope the information they provide is broadly accurate, I’m assuming it is more likely to be framed through the lens of personal choice rather than advocating for government action (e.g. higher taxes on alcohol).
I presume the $5-10M also only refers to alcohol-specific philanthropy? I would expect there to be some funding for it via adjacent topics, such as organisations that work on drugs/addiction more broadly, or ones that focus on promoting nutrition and healthy lifestyles.
That’s very true, and after a 30 second google search here’s a 15 million GiveWell grant recommended in December 2021 given to a bunch of Orgs in the space—Actually I think this may have been funded by OpenPhil directly but then does it count or not? Unsure.
https://www.givewell.org/research/grants/RESET-alcohol-December-2021
The $5-10M figure is inclusive of $5M per year from that grant, which was recommended by GiveWell but funded by Open Philanthropy.
(I don’t lead on the air quality work, so be more careful with this comment that the others that I’ve left here).
India wasn’t picked as an example to illustrate the importance and neglectedness of air quality work. Rather, India has been the dominant setting for Open Philanthropy’s air quality work to date—it even has its own updated web page. You can read more about why Open Philanthropy launched the work on South Asian air quality here and here. Santosh Harish, the Program Officer who leads that work, recently gave an excellent interview to the 80,000 hours podcast—transcript and recording here.
I agree domestic financing complicates relative neglectedness—the effort here was to be as consistent as reasonably possible between the risk factors. Neglectedness comparisons are very tricky to nail down in general (e.g. how to attribute non-specific health systems spending across both causes and risks, whether to include treatment for linked health conditions like lung cancer or cirrhosis, how to think about relatively ineffective uses of money like e.g. biofuel subsidies for climate change, or a more relevant example here would be smog towers for air quality). One nod to the uncertainty of both measurement and scope here is the use of ranges; but yeah, we’re trading off a bunch of different considerations here.
There’s a lot of internal research stress testing the IHME burden estimates for lead and air quality, and some on alcohol—I’m doing more on alcohol specifically at the moment. Here we’re pointing to the IHME GBD study for several reasons: it’s widely recognized, easy to interact with, has a largely consistent / common methodology between different causes of death and disease, and importantly doesn’t allow for deaths to be attributed to more than one cause. This works well for problems where the Open Philanthropy way of conceptualizing the problem (e.g. malaria, lead exposure) matches a GBD cause (e.g. malaria) or risk (e.g. lead exposure). This doesn’t mean we uncritically use the GBD in all of our own decision making—but this set of reasons make it very helpful to refer to when communicating externally. It might be that we publish more of our internal research on this in the future, but honestly it’s a serious time investment and I don’t want to over promise.
DALYs sit behind the framework but can be understandably offputting for many audiences. The BOTECs / grant decisions are in line with our usual GHW cause prioritization framework of valuing increases in healthy life and log-income.
Thanks heaps for the reply Chris! Yes I have read the OpenPhil work on air quality. That explains to some extent the India choice, although I still feel like its a misleading graphic.
I would be interested to hear what you found interesting and compelling about the 80,000 hours interview? Maybe though you can’t say much (or anything) given your position at GiveWell. I was impressed by his knowledge and passion about the issue, but found his arguments about potentially tractable interventions somewhat unconvincing. I struggled to see a clear theory of change in his proposed interventions. I can definitely be convinced, but just aren’t right now. think its likely India will greatly reduce air pollution over the next 20 years, but its hard for me right now to envisage how marginal funding will make a difference. Obviously I’m not an expert at all though so could easily just be dead wrong.
If anything the interview made me a bit less convinced than I was before that air quality in India was likely to be a cost-effective cause area. I was also surprised that he didn’t talk about the significant domestic funding going towards cleaning the air as well.
Hi Nick, thanks for your thoughts.
I agree air quality is meaningfully different from the other areas we highlight in terms of domestic salience (at least in India). But it’s not clear to me whether the existence of nascent government funding (and the consequent opportunity to improve the allocation of that funding) make philanthropic opportunities better or worse.
Efforts like the NCAP framework and 15th Finance Commission budget allocations in India are fairly new, and there aren’t well-developed playbooks for prioritizing and addressing sources of air pollution in this context. So we think there are large potential benefits to helping improve the effectiveness of those efforts. Among other things, we’re doing that by supporting organizations to help governments develop and implement specific action plans (e.g.), developing better models to enable cost-effectiveness analysis (e.g.), and providing independent assessment of progress against policy goals (e.g.). We think these are areas where philanthropic funding may be able to have an outsized impact. Santosh gives some more examples of grants he’s made in this part of his podcast. We’re also exploring working in other countries in South Asia with fewer government resources allocated to air quality than India. The program hasn’t been running long enough to make confident claims of impact yet.
Thanks so much for your great explanation James and the other ones on the post. Great to see direct engagement from the people running the program.
the theory of change of trying to change the government’s current allocation of makes some sense (I didn’t pick it up in the podcast, but reading back it is there to some degree), but its very difficult. Its always a difficult task influence governments to spend their money in more impactful directions—especially just with science and logic. Advocacy skills might be at least as important to your cause as the data the projects you fund produce.
I would be interested to see if you have examples of philanthropies with small amounts of money and no real carrot or stick, influencing governments with larger amounts of money on the issue. Here in Uganda philanthropies can definitely influence the direction of healthcare for example (HIV, Malaria national programs. etc.), but its largely through pouring significant resources into that area, often more than the government can even which gives them hard power and carrots and sticks to wield.
I’m also interested if Indian governments have shown in any practical way that they might be genuinely interested in cost-effectiveness analysis driving fund allocation? As far as I know in East Africa here cost-effectiveness analysis is almost completely unutilised by governments, I’ve certainly never heard it referred to from any level of government in any intervention here, health or otherwise. I hope India is more switched on than that and might pay more attention. I know nothing about the region really so maybe they do already use it.
Anyway we will see what happens! Obvious clean air is wildly important and causes ludicrous amnounts of suffering and death. It may well be a hard thing to judge the impact on—a rough one for the grantmaker and those doing the interventions. If the quality doesn’t improve obviously that will be a fail, but if it does (as is likely) its going to be hard to pin down the counterfactual impact of the grants. If they do allocate more efforts to rural areas that’s a win you could tick up I’d imagine, but if air quality gets better in general it may well be hard to figure out what portion of it was due to your guys work—even if most of it was.
Anyway thanks again for the reply and all the best with the project!