I appreciate your thoughtfulness and shared goals of addressing anemia in India. Please see my response to critiques of fortification efforts here.
e19brendan
Karma: 145
I appreciate your thoughtfulness and shared goals of addressing anemia in India. Please see my response to critiques of fortification efforts here.
Responding to recent critiques of iron fortification in India
Thanks!
I decided to go down this path by carefully examining my priorities for what work I might do after a fellowship wrapped up, first considering how I might best approach the following year with respect to my values and goals. Having been quite interested in doing EA-aligned work, I surveyed some opportunities to work within EA organizations. Along the way, I spoke with Joey Savoie, who encouraged me to cofound my own charity startup rather than joining his (Charity Science Health). I was tentative given my limited experience, but as I considered the counterfactual impact of various alternatives, I grew more interested and took initial steps to find a cofounder (after speaking with a number of people within and outside of EA who encouraged me to proceed). There was a lot of interest; I interviewed a number of qualified candidates; and I was quite happy to find Nikita.
In parallel, I developed a shortlist of the jobs/kinds of jobs I might start this year, and applied to some. I considered factors such as learning/career capital, earning potential, lifestyle, and direct impact, consisting of quite a few weighted subfactors across a variety of opportunities I was considering. If anyone is particularly interested, I am happy to share this model, but I’m not sure I want it posted publicly at this point. This process left me with two rather different “best opportunities.” After much deliberation and many conversations with mentors, I took the plunge into charity entrepreneurship. I’ll let you know in a few months whether I think that was the right choice. Below is a non-exhaustive list of questions I’d recommend someone considering EA entrepreneurship ask themselves:
How should my values and long-term goals influence what I do next?
What alternative opportunities exist (including maintaining the status quo)?
How well do these opportunities and EA entrepreneurship align with the conclusions of the first point?
What qualities should an EA entrepreneur have? (This point may require a longer post, with some input from others)
What degree of expertise is necessary to have a decent shot at positive counterfactual impact? (Many EAs might suggest this bar is lower than your first instinct.)
Do I think I’d be relatively well-suited for EA entrepreneurship?
How much will what I’d learn and how I’d grow from such an initiative make my future endeavors more impactful?
Do other EAs think I’d be well-suited for EA entrepreneurship?
Are there somewhat specific projects identified (by others or myself) to be potentially high impact that appear feasible, interesting, and fulfilling?
Will somebody fund me, or am I confident enough and financially able enough to fund myself?
Do others outside EA think this is a good idea?
Is this the right time to do this?
Are the structures around me supportive of success? Will they guide me well? Will they complement my strengths and compensate for my weaknesses? Will I know whether I’m on the right track, when to re-evaluate, and when to move on?
Can I imagine a reasonable path forward, build a tentative plan, convince the appropriate critical people, and commit?
Do I have an exit strategy, and how much better or worse is it compared with alternative opportunities/exits?
Do I believe that people’s lives may be better if we try this?
Do I still want to do this?
If it’s of value, I could address my own answers to these questions and others, but it may be best to have more of a conversation—I’d be happy to skype (just email me). The answer to the last question on the list is still yes!
fortify hEAlth is the actual name, for now. We’ll have to decide how we like seeming cute. For non-EA correspondences, we can just avoid the capitalization, but it may be worth changing this on our website or universally for the sake of the non-EA community (which may take more convincing than all of you supportive folks). Feel free to email us suggestions, but this is where we’re at for now.
It is pretty hard for me to know now just how impactful we should expect this venture to be. Considering the counterfactuals, the expected value does seem worthwhile, but I’ll humbly admit that the most likely outcome is nearly no direct impact, i.e. if we learn that we should stop before actually improving anyone’s access to iron. So, please don’t mistake risk tolerance for heroism. However, the scale of direct impact may be quite large if successful, and it so far doesn’t seem too infeasible to advise against continuing. We need to learn more in order to assess the value of continuing or desisting.
Other factors influencing my own justification of this risk of failure include the value of motivating or deterring others in pursuit of EA entrepreneurship; my buy in to “doing good together,” which might include a portfolio of activities with varying levels or risk across the movement; and the counterfactual learning possible here compared with alternatives. Plus, I’m excited about what we’re trying to accomplish! Nikita may have a somewhat separate framework, so do reach out to her as well!
Thanks!
can you elaborate more on why you think the space is uncrowded enough for a new charity?
This question is a key consideration about which we hope to become more certain in the next couple of months. This is to say, we don’t know that the space is sufficiently uncrowded. However, we have a few reasons to believe this very well could be the case:
The prevalence, particularly of iron deficiency anemia, is geographically diffuse.
Implementing an impactful strategy likely needs to be reiterated independently across geographic borders, and existing organizations may be limited in the number of high-intensity projects they can/decide to manage at one time.
Large organizations working on this issue may systematically neglect working in certain populations or employing certain strategies that a new EA-aligned organization may not.
Large organizations’ impact may depend on an abundance of specific projects to support, the lack of which may bottleneck their efforts.
The marginal impact of funds to their efforts compared to specific implementation projects may be relatively weak.
The burden of disease associated with iron deficiency anemia remains quite high, and in absolute terms and in terms of percent of all cause DALYs is actually growing (although the rate accounting for population growth is in fact declining). This suggests that what has already been done has not been sufficient so far, and that accelerating the gains existing organizations will eventually bring about may have a substantial impact.
Over the next month or so, our priority is to interview experts within the large global institutions involved in iron fortification as well as local implementors within locations we might work in order to better understand whether our assumptions are reasonable, what gaps they see in the field, and whether those gaps could be met by EAs like ourselves.
Can you also elaborate on why you decided to create a new charity rather than join an existing one?
The brief answer is that it is reasonably possible that forming a new charity has greater counterfactual impact than joining an existing charity operating in this space. We assume that the existing charities are able to hire competent people to carry out their agenda, and that the positions for which they would hire us would likely provide little opportunity to redirect their efforts towards higher-impact opportunities identified through an EA approach. That said, we would almost certainly be partnering with those existing organizations in carrying out any sort of intervention. They are the experts! Projects in micronutrient fortification in the past and present have been highly collaborative across institutions. We would work together, or even within existing organizations if that emerged to be the most impactful step forward.
We would also consider this venture to be worthwhile even if we later recognize that this space is too crowded for a new charity or that we are the wrong people to start it. We think there is a somewhat low, hard to quantify, but meaningful probability that there is a gap in iron fortification that EAs like us would be able to fill. If we fail, we won’t be overwhelmingly surprised, but the value of success would be high. Charity Science (more specifically, Peter Hurford, the comment’s author) modeled the impact of creating new GiveWell Charity here. We’re also evaluating the feasibility of EA entrepreneurship more generally and hope that what we learn can support the movement.
Nikita and I determined that our time was worth even a low probability chance of having such substantial impact. We also believe that this effort will strongly improve our ability to improve the lives of others in future endeavors.
Introducing fortify hEAlth: an EA-aligned charity startup
This is an interesting point, though I wonder whether EAs have the right attitude about tractability. Tractability and neglectedness tend to be inversely related, and the relationship is imperfect—I think EAs can make reasonable bets about when society as a whole overly neglects low-tractability problems, making it worthwhile to disrupt complacency. Sea-changes are apparent even in recent history, say in treating HIV in sub-saharan Africa—something that many argued was impossible, unfeasible, and too costly. A similar transformation is apparent in TB care, especially in the treatment of drug resistant tuberculosis. Although these may not be priority areas for EAs, the global health community has majorly updated over the last 20 years about how tractable they are and at what cost these interventions could effectively improve people’s lives. I think it’s worth learning from these lessons.
Can you say more about the “revealed constraints” here? What would be the appropriate preconditions for “starting the party?” I think it can and should be done—we’ve embraced frontline cost-effectiveness in doing good today, and we’ve embraced initiatives oriented towards good in the far future even in the absence of clear interventions; even so, global mental health hasn’t quite fit into either of those EA approaches, despite being a high-burden problem that is extremely neglected and arguably tractable.
Mental health interventions will become more cost-effective on an absolute scale, as we advance knowledge and implement better, and on a relative scale, as we largely overcome the burden of communicable diseases like malaria. The EA community should rally around the possibility of accelerating the development and dissemination of mental health interventions. It is quite exciting to see the work of some EAs in this space, and I think EAs could bring real value to the academic and nonprofit leaders involved in global mental health. It may be that working on this issue is more valuable at this point than merely funding this cause, but that’s a broader strategy discussion. I’m excited to join other EAs in building the case for the relevance of mental health to the movement.
I wonder if there are good ways to transform a tribalism of “us versus them” into an “us versus it,” aligning joint interest in overcoming the constraints of amoral causes of suffering. This is framing is somewhat commonplace when we talk about combatting malaria on a global scale and fighting cancer in individual care. There are countless examples in the medical world of this personification of amoral disease “agents.” It seems like it may be a way to repurpose our tribalistic cognitive mechanisms for good.
I’ve written a bit about this for a course with Josh Greene a few years back, and I’d be happy to share if anyone is interested.
How about a podcast that sheds light of unanswered critiques of the EA movement? They’d have to be fairly knowledgeable about EA in order to pass the “Ideological Turing Test,” and you’d have to make sure that the editing/framing doesn’t unfairly give EA ideas an edge, but I think we could learn a lot from thoughtful critique!
What could have made applications/applicants in the global health & development space stronger?
Fantastic! Will these be livecast on the web?
Pasha & Austen, fantastic suggestions. Pasha, I’d be happy to do some research on effectiveness of hotlines or brainstorm proxies with you. Austen, I’m really excited to hear more about what you’re doing with PPP. I’m quite interested in suicide prevention and I think the neglectedness and avertable suffering and death make it an essential focus for our time and effort. I think that most in the EA community (as well as global health more broadly) question tractability, which is all the more reasons to demonstrate pathways to effective reduction in suicide. I would love to hear more about what you’re doing, and potentially get involved. I’m hoping to get together folks in EA who are interested in global mental health. Please let me know if you’d be willing to chat!
Gladly. I’m also looking forward to learning from others on the forum, and I’m happy to speak 1:1 if you’d like!