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Akhil
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Thanks for this post. Apologies I have not had to read through in detail, but I would suggest that perhaps:
The search criteria that you have used has missed a significant number of papers within the field. Looking at the country distribution you posted, this becomes more obvious; I would suggest looking at the What Works papers that were produced several years ago, where quite extensive literature reviews were being conducted
I think you do acknowledge this weakly, but there is such wide-spanning heterogeneity in the studies that you have included (and the programs the use), that I think tighter sub-group analysis is needed to tease out meaningful conclusions
A lot of work in this space has been done in the last 5-6 years; whilst not a specific limitiation of your work, just something to bear in mind!
How much of this decision for the sponsored projects to spin out was at the request of the individual organisations, and to what extent was it initiated by EV?
Added to an existing fund, although there is the option to give specifically to VAWG charities
@Linch this is an unacceptable comment, steeped with condescension and some racism.
Charity Entrepreneurship
Sorry for very short comment Great post , seems like could be amenable to a mass media campaign on it CE are looking to start new mass media charities I think you should get in touch/ happy to introduce
What was the recruitment method for this study? Do you think that could be skewing the data in any way?
As someone who occupies a ‘leadership’ position in EA, what is your mentality and approach to fostering a new generating of EA leaders, and making sure that we have a bigger, stronger and more diverse group of ‘leaders’ within the community?
*I don’t necessarily love the use of the words leader and leadership, but think it is a helpful and simple shorthand in this instance.
I am planning to write a shorter, more speculative examination of AMR as a GCBR/X-risk in the coming weeks :) I will try and address this there, thanks for the great question
Really excellent question, and unfortunately we don’t have a good answer here. We know all the factors that contribute to AMR, but we haven’t as yet been able to quantify their relative contribution. This really constrains impact and investment within the space as it makes impact evaluation difficult, and makes it difficult for governments and other funders to justify the value of AMR interventions and policies that they may be considering. As I mention in the report, this is probably amongst the highest, if not highest, area of need within the space. Part of the difficulty with developing good quantified models of the drivers of AMR is a balance between making sure it is scientifically rigorous enough (which would likely require longitudinal metagenomic data), but also getting answers relatively quickly (and inexpensively).
Any projects or groups working on this idea should be in touch!
Great question. It is true that a lot of antibiotics that are used globally are used in factory farming. What is less clear, however, is how much this contributes to AMR (i.e. just because 70% of antibiotics are used for animals does not mean that 70% of AMR or AMR-attributable mortality is a result of use in animal agriculture). Because the science is unclear on exactly how much factory farming contributes (although it undoubtedly plays some role), this is a tricky question to answer
However, regardless, in expectation and even with conservative estimates of the above, advocacy to limit the use of antibiotics as a growth stimulation or prophylactically in factory farming is a promising thing to do.
There have been successful corporate campaigns and certification standards in this space (e.g. here and here amongst many other examples). From my conversations with folk in the space, there would be a role and scope for new actors in this area.
Hey I have a couple of cost-effectiveness analyses that I can point you to:
The Center for Global Development has released a report on the ROI of the PASTEUR Act, a proposed pull incentive for new antimicrobials. Their calculations are well done: https://www.cgdev.org/blog/world-needs-new-antibiotics-proposed-us-program-develop-them-would-pay-281
I wrote a report for CE on an AMR idea; the cost-effectiveness analyses of which will be released soon and I will post here when they are!
Hi cflexman,
I think these are valuable comments, and you are absolutely correct. Limited time meant that I (1) was very short-hand in how I aggregated effect sizes/results from academic studies, (2) used simplistic point estimates. Ideally, I would have done a meta-analysis style method with risk of bias assessment etc. My main limitation is a frustrating one- time.
I did try and caveat that with trying to make all my shorthands and uncertainties explicit, but I dont think I quite succeeded at that.
One area I would push back on is the comments regarding social interventions and survey data- the methods in most/all these studies are survey effects asking women wehther they have experienced violence in the last year. To me, this seems pretty robust, and as long as the surveys are conducted to a high standard with low risk of bias (which most of the studies have dedicated sections to explain how they tried to do this, to varying degrees of success), think this is credible and internally valid data.
Hey Sanjay, thanks for your comment
Internal validity-I think it is important to bear in mind there are a number of high quality RCT’s conducted with low quality of bias- given that, although this might not feel like it has as strong an evidence as bednets or vaccines, it does have a strong evidence base. You can see the cRCTs here- Abramsky et al (2014), Dunkle et al (2020), Leight et al (2020), Wagman et al (2015), Ogum Alangea et al (2020), Le Roux et al (2020), Chatterji et al (2020).
On surveys- To summarise, the concern you raise is that the programs aim to reduce social acceptability of VAWG, and mostly use local interviewers to assess incidence of violence, which may introduce social acceptability bias. Although this seems plausible, interviews were trained, conducted privately and used validated questionnaires. To quote one paper
The study was conducted in accordance with WHO guidelines for the safe and ethical collection of data on violence against women [[24]]. These guidelines seek to minimize reporting biases and risk of harm to both respondents and interviewers. At both baseline and follow-up, interviewers received at least three weeks of training on the ethical and methodological issues surrounding the conduct of a survey relating to IPV and HIV, as well as ongoing support during the course of the survey. Interviewers were all from the local area, and interviewed respondents of the same sex as themselves. Interviews were conducted in private settings, in Luganda or English, and were concluded by providing information on additional support services in the area. At baseline, interviewers conducting the baseline survey were blinded as to the allocation of the intervention. It was not, however, possible to keep follow-up interviewers blinded.
As a result, I think this risk of bias is quite low. Also, I think that inherently, any impact evaluation of interventions in this space would require surveys.
3. External validity- A valid concern. I have two comments: (1)There are a number of studies in different settings which show positive results, suggesting external validity. (2) Although cultural and social drivers of violence vary, the intervention is co-designed with community and quite locally tailored, which mitigates some of the concern around external validity.
4. Meta-comment- I think that some of my estimates of the persistence of effects were quite conservative, which may counterbalance slightly smaller discounts for external and internal validity
Great questions Joel
1- SO my impression is from looking at : (1) trends in VAWG over time (unfortunately mostly old data here) (2) differences in rates of VAWG depending on level of country economic development, that it seems unlikely that VAWG will decrease (at all, or at least to a moderate extent) by itself.
2- There is a bit of work on policy related interventions in this space, which had mixed results and were harder to map the cost-effectiveness of. My impression is that opportunistic identification of potentially promising policies that are tractable may be cost-effective, but that solely focusing on this may not be (that is purely my thoughts based on a few hours of reading broadly around policy changes in the space, and without a thorough deep dive).
3- Great to hear you are interested in researching this. Always happy to share all my knowledge and information!
Great question Michael, and I have a similar intuition. I have reached out to HLI to see if they would be interesting in working together on this. From a very brief literature search, there is a small but existent body of work that looks at the effect of VAWG on SWB. Here are a few papers I found that you might find interesting:
https://www.cise.uadec.mx/downloads/Publicaciones/ArtGAM-Violence.pdf
https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-020-00950-6
https://journals.sagepub.com/doi/full/10.1177/10778012221099988
https://www.tandfonline.com/doi/abs/10.1080/07399332.2020.1764564?journalCode=uhcw20
Thank you- edited!
Hey Joel, great report- overall, I am also pretty excited about interventions for hypertension. A couple of questions about your report:
You decided to narrow down on sodium policy taxation advocacy- whilst I think this is probably one of the more appealing interventions in this space, I wonder whether you considered other interventions e.g. community salt substitution, which was looked into by Givewell and recently had a very large RCT conducted.
The impact of sodium reduction extends beyond BP effects- Although the majority of the health effect of sodium reduction does seem to be through reducing BP, there are some other causal mechanisms that are suggested e.g. reducing oxidative stress, reducing sympathetic tone. I wonder whether you looked into/considered these
The cost of advocacy- it seems like you have by and large taken the cost of quite a lean charity doing this. I wonder whether it would be worthwhile looking at organisations that have previously successfully helped advocate for taxation policy, and estimated their size/cost. I would imagine this might be a higher cost by several factors
Are there good advocacy groups out there- I would be really interested to know whether there are highly effective organisations advocacy for sodium taxation policy already out there, that funders might be able to look int further + potentially fund!
A great report- thanks Joel!
I am very glad to see more attention on this pressing issue, and very excited about the work of NOVAH.