I’m the Director of the Happier Lives Institute and Postdoctoral Research Fellow at Oxford’s Wellbeing Research Centre. I’m a philosopher by background and did my DPhil at Oxford, primarily under the supervision of Peter Singer and Hilary Greaves. I’ve previously worked for an MP and failed to start a start-up.
MichaelPlant
Karma: 9,064
I’m pleased and surprised to hear you say this. I’d thought that the default EA metric was QALYs: I’ve had more conversations than I can count with EAs saying that QALYs are probably not the best metric overall or even for health itself. A couple of points.
There no common sense understanding of the term—unlike ‘health’ - there are also three different and incompatible accounts of well-being (hedonism, desire-satisfaction, objective list).Saying “we’re in favour of well-being” can be equally mysterious.
I think there’s something a bit weird about saying “this is what we actually mean, but don’t tell anyone in case they think we’re weird”. I worry it’s getting a bit, well, Scientological, if you’re at the stage where you have various versions of the truth: one for the public, another for those in the know.
My suggestions is to talk about “HALYs”—Happiness adjusted life years. Not only is this what we actually care about (if we’re utilitarians, though I presume any view should value happiness, all other things being equal), happiness is much more intuitive than well-being and it sounds less silly.
Ah, I see. I do think that makes sense: we stress the value of things besides health but shy away from using terms which make us look silly.
And yet whilst ‘well-being’ and ‘flourishing’ are good names, they seem problematically vague to my ears: I imagine a conversation where I say “I want to help people lead flourishing lives” and they pause before saying “I agree, QALYs sounds too narrow … but what exactly do you mean about leading a flourishing life? How are you defining/measuring that?” I think there’s an advantage, if you want to do cost-effectiveness, to having a clear, if slightly wrong, measure. QALYs have the virtue of providing a uniform score sheet.
On your last point, I think that reveals a problem about word use. I don’t see ‘happiness’ being used narrowly in ordinary language at all. It describes a whole host of things: the good life, well-being, life satisfaction, emotions, etc.
Thanks for the comments Tom.
On 1. I agree that the broadness of leaving ‘well-being’ unspecified looks like an advantage, but I think that’s someone illusory. If I ask you “okay, so if you want to help people do better, what do you mean by ‘better’?” then you’ve got to specify an account of well-being unless you want to give a circular answer. If you just say “well, I want to do what’s good for them” that wouldn’t tell me what you meant..
This might seem picky, but depending on you view of well-being you get quite sharply different policy/EA decisions. I’m doing some research on this now and hope to write it up soon.
On 2. I should probably reveal my cards and say i’m a hedonist about well-being. I’m not interested in any intervention which doesn’t make people experience more joy and less suffering. To make the point by contrast, lots of thinks which make people richer do nothing to increase happiness. I’m very happy for other EAs to choose their own accounts of well-being of course. As it happens, lots of EAs seem to be implicit or explicit hedonists too.
Nice post. Can I suggest you’re missing the most obvious one from your test?
How about “making people happier”?
which you could rephrase as
“reducing suffering/connecting people/empowering people to life the lives they want.”
I’m one of those (controversial?) people who thinks most economic and technological development is morally neutral and does surprisingly little to make people’s lives better, largely because people adapt to it and doesn’t make a difference over the long run. I’m actually planning to make this argument in a longer post soon as I also think it’s something of a neglected issue.
Dear Joey,
I’ve recently written the following paper you might find interesting. It’s the first essay I’ve written for my PhD and, as the title suggests, I try to understand what a billionaire EA should do to maximise happiness. In brief, my conclusion is that mental health and happiness interventions look a lot more promising that our present anti-poverty and anti-malaria ones.
I’ve been meaning to put something on the EA forum on this topic for a while but haven’t got around to it (because I don’t really use/understand the EA Forum and saw this on facebook).
Regarding the conclusions you reach:
-I’m actually sceptical that Conditional Cash Transfers increase happiness at all and it’s therefore questionable how useful they are. I don’t think we have enough evidence yet to know: we’d need to track people’s experiences of happiness over at least 6 months. (I’ve previously discussed this with Rob Wiblin and there might be an argument about the long-run economic benefits of CCTs that I’d like to see in made in writing).
-So, I think research in the effectiveness of poverty looks very good!
-I didn’t consider tobacco taxation or micro-nutrient fortification but my guess is that these are unlikely to change people’s experiences of happiness by much either. I’d suppose that a smoking reduction would help people live longer but there’s a further value question of how much you weight helping people live longer (I take the epicurean view on death, which means I’m uncertain there’s any value in prolonging life, but feel free to ignore this).
-I didn’t consider anything about SMS immunisation reminders. Intuitively that does look quite promising from the modules I took into behavioural econ a couple of years back, but I’m sure your knowledge is much more up to do that mine and you’ve harvested everything you can from the Behavioural Insights Team and so on. If you would like to talk to some (more) behavioural economists I have at least one friend working in the area I could put in touch with.
I hope that’s helpful. If you have any questions I’m best reached via the facebook or michael.plant@philosophy.ox.ac.uk
Is effective altruism overlooking human happiness and mental health? I argue it is.
Hello Ben.
A couple of comments:
I wouldn’t expect people to be able to adapt to severe pain, not when you consider the evolutionary advantages of always taking your hand out of the fire. I’d expect people to die before they got used to pain.
What is going on is that mental pain may have a bigger impact on your happiness then physical pain and more than we imagine it does. I.e. chronic depression is worse than chronic lower back pain.
(You might reply that this is unfair because mental pain and happiness are basically the same thing: i.e. it’s obvious being unhappy has a bigger impact on happiness than just being in pain, so you’ve just measured the same thing twice. What you’d really want is data which showed the impact different health states have on people’s emotional experience/moods (which is what I take happiness to be). Nevertheless given that depression/anxiety seems to be lots of negative mental states, whereas chronic pain isn’t, that’s still a point in favour of depression/anxiety being where the unhappiness is.)
And yes, so I think depression, which already looks bad on DALYs, is much worse even than that.
Also, it seems that mental health issues are all over the world in a way that, say, malaria is quite concentrated. That’s why I say it’s possible mental health interventions may be more effective in developed rather than developing countries—people have more technology are greater familiar with mental health.
I can’t tell you what the ‘in the wild’ effect size is because I don’t know it and I don’t think it’s been tried. That’s why I suggest a billionaire tests it to find out! The evidence is the CBT works (remedies about 50% of cases of depression) so I’d say the challenge is more getting it to people and getting them to use it.
Developed world happiness interventions? I’m not sure what you mean. Some people in some governments are beginning to think explicitly in terms of happiness, but it hasn’t really caught on.
On the death thing, we have different intuitions. In your parlance, I’d say you adapt totally to being dead: there’s no you after death for anything to be good or bad for! So all this analysis is very sensitive to philosophical issues.
Thanks for the comments. I was wondering how long it would be before someone said this! I’m slightly sympathetic to the ‘this is bad for PR’ argument. But two points on that:
this is mostly a question of framing. It’s not ‘poverty is great’ it’s ‘mental health is really bad, even worse than poverty’.
I think there are virtues to honesty. If we self-censor and don’t try to work out how to do the most good just because we think somehow, somewhere, somebody is going to disagree, then we’re almost certainly not going to work out how to do the most good.
More generally, I don’t think your “Extreme poverty is pretty bad and causes mental health problems” version is true. As you can see from this: (http://cep.lse.ac.uk/layard/thriveannex.pdf) there’s only slightly more depression in poor countries in low-income countries (7%) than high-income countries (6.5%). Layard calculates the averages in his book Thrive (p.41). So that undermines the idea that poverty causes mental health issues and removing people from poverty would fix them. Mental health seems to be a problem of being a human anywhere.
I think a more promising argument, which I make in the paper, is that it might just be a lot cheaper to treat mental health in poorer countries. I also take the utilitarian view that misery, not injustice or anything is, just is the problem. There’s some discussion about whether teaching people to be happy is the right long-term solution even in terms of happiness, but that’s an empirical question that needs investigation.
You also seemed to have merged mental health, poverty and failed states. I’m not sure how to respond to that one.
In response to Behind the Beautiful Forever, you might want to check out this paper—Making the Best of a Bad Situation: Satisfaction in the Slums of Calcutta (http://www.jstor.org/stable/27526958?seq=1#page_scan_tab_contents) which shows those in slums “experience a lower sense of life satisfaction than the more affluent groups, but are more satisfied than one might expect”. I’m somewhat disinclined to take anecdotes or stories as serious evidence: they tend to focus on the interesting parts of life, whereas the upshot from the happiness literature I’ve seen in that most people’s lives are, well, pretty ordinary. That is, unless you’ve got a mental health disorder. Then your life sucks.
Hello Ben and thanks for your comments!
I think I’m substantially more pessimistic than you are about the role economic growth has in making people happier (‘happiness’ conceived either as life satisfaction or emotional experiences). So I buy the story that Give Well charities make people healthier, this allows them to get an education, this helps them become richer and so help their children, but I’m sceptical that any of this increases happiness.
For instance I came across this analysis of the Easterlin Paradox yesterday (http://bit.ly/28XXisi) which looked at GDP and life satisfaction scores of European countries over the last 40 years. I emailed the author for some clarification and he explained “if long run growth increased by 1%[per year], then life satisfaction would rise from 3 to 3.0027” (life satisfaction was measured on a 1-4 scale). So he thought economic growth was statistically significant but not interesting as far as life satisfaction is concerned.
All this seems quite surprising. As far as I know there is lots of evidence suggesting economic growth doesn’t do much/anything for happiness—including the Haushofer (2015) paper into Give Directly, but almost none indicating growth would increase happiness. If you know of any, please send it to me, because this seems strange.
As a debunking explanation for why we think money matters when it doesn’t, I think it helps to remember we’re not very good at affective forecasting. When we think about wealth it seems important (“I’d be so much happier if I were on a yacht right now”) but we forget we’ll adapt to whatever it is, focus on other things, and that our being wealthier will make other people feel comparatively less wealthy.
I agree there’s more work to be done in terms of comparing the flow-through effects (I’m still not really sure what these are—is this just about economic growth? Could you provide a link to where I can read about them?) of mental health to physical health. A quick scan suggest the former is also bad, but I’m not sure how bad. This is probably the most relevant point for those concerned about the very long run. On this one, I think I’m probably more optimistic than you about how low the low-hanging mental health fruit are. AFAIK, no one has really tried to pick them and find out.
Regarding your last paragraph I’m not sure physical health interventions do a whole lot better than mental health ones. I think physical health is a lot easier to imagine and show progress on because you can see it. One of my general concerns is I don’t think we currently do a very good job of measuring human suffering (i.e. via QALYs) and we’re relying too heavily on our intuitions about the imagined badness of various things. I’m also hopeful that, with digital technology, we may find it’s much easier to treat mental health because those often receive cognitive rather than physical interventions. Maybe at some point in the future we’re consider physical health problems, which require a real human to help you, as the complicated ones.
In terms of badness: my guess is they are also bad, although I don’t know what research has been done with happiness measures. Speaking to some psychiatrists, I gather it’s possible that some cases of schizophrenia don’t have to be bad (e.g. you hear voices but it doesn’t bother you) but often they are.
In terms of treatment: different. I gather schizophrenia requires at least different types of CBT from those used to treat depression, and typically anti-psychotics, so it might be quite a lot less susceptible to the approach I suggest, but I’m not really sure.
Thanks for this. I’m already aware of this stuff and, in fact that was written my Konstantin Sietzy, who has worked with me on this and helped co-write an earlier unpublished report into this problem.
Are you saying you didn’t check footnote 45 of my paper? Outrageous! The $1000/DALY figure comes from
“Patel, V et al. (2015). Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities. The Lancet. These figures should be treated with caution. As the authors note, p1681 “hardly any published evidence exists on the cost-effectiveness of population-based or community-level strategies in or for low-income and middle-income settings” ”
I’m afraid I don’t know exactly who conducted the studies they refer to.
My criticism of MH intervention is more in terms of the way QALYs don’t seem to capture YLD in the same way a happiness-based approach would. I’m afraid I don’t, but probably should, know how Givewell’s $100 malaria figure is split between YLD and YLL and how the $1000 depression figure is split between YLD and YLL. I actually found it incredibly hard to find that sort of information, maybe because I’m a health economist and don’t know where to find it. If you know, please tell me!
In retrospect, I’m probably not careful enough in the paper and I’ll have to re-write it for the next draft. I say that QALYs underrate mental health by quite a bit, and on DALY estimates malaria is 10x cheaper, so maybe mental health treatments are in the right sort of ballpark already. Really I’d want to know how much depression and malaria each reduce happiness (‘happiness’ to be more carefully specified) whilst sufferers as still alive, and how much they increase mortality. Then you can do a more principled cost-effective analysis where you plug in how bad you think being dead is for someone. Unfortunately no one seems to be in the business of measuring health in terms of experienced happiness, so we may not be able to try and answer this question for some time.
Good suggestion. I’ve edited my original post slightly.
I don’t think my own experiences are terribly important and I’m much more interested in arguing about the points themselves.
I’m not sure how you can disagree with the statement that mental health disorders are worse than poverty in terms of happiness; that’s true simply in virtue of what they are. Being depressed means you experience lots of negative mental states (i.e. are unhappy). Being poor doesn’t mean that. Actually being unhappy has to be worse than being a state that is likely to make you unhappy.
Putting this the other way round, you could say “depression is bad for your income, but being in poverty is worse”. Depression might cause you to earn less, but if you’re looking at income, then the state of having a low income has to be worse than having something liable to cause you to have low income. It’s also not true that all people in poverty are depressed. So I think it makes more sense to target misery, not poverty.
Do you think I’ve misunderstood your point? Sorry if I have.
I’m also very much in favour in targeting violence, crime, etc. as those seem obviously bad for happiness. However I’m not sure how bad, nor do I have a potential solution. On that note, the problem of adaptive preferences, as discussed by Sen, etc. is quite interesting. He argues that the poor adapt to their terrible condition and thus they seem surprisingly happy—they are making the best of a bad lot—and that is an additional reason to do something.
I take the other line: if I could save person X who will be made happier, or person Y who won’t be because person Y will adapt to the new condition, I’d want to treat X, not Y.
I’m not sure what an absolutely comparable number would be: people would have to be comparing themselves to the same unchanging criteria over time. The evidence, from the Easterlin Paradox etc. is that people do change their standards over time and largely seem work out how they are doing my comparing themselves against others. As such it looks like increasingly worldwide life satisfaction would be very hard.
I take these sorts of argument as reasons to move away from life satisfaction towards direct measures of people’s experience in the moment. I want to know how good or bad the person actually feels, not how well they they are doing against an arbitrary and changing standard.
I’m not sure what you think this meta-analysis contradicts. Could you please be more precise?
Card on the table, I’m more interested in ‘affective well-being’ than ‘cognitive well-being’ as they call it—i.e. ‘happiness’ rather than ’life satisfaction—and I take the meta-analysis as being broadly in my favour.
I’ve discussed this briefly with Julian Savelescu, a philosophy professor here at Oxford, and I think he said he was working on it. I don’t know much about the topic and it’s sort of a different problem from the one I’m looking at here (dealing with one’s own emotions). i’m sceptical but happy to be proved wrong.
hello Keiran and thanks for your comment.
I don’t discuss the Easterlin Paradox in any depth in the paper because it was largely tangential to the point I was making. It’s really interesting and something I’ve thought about a lot.
Whether you think the Easterlin Paradox is correct or not somewhat depends on what you think it shows in the first place. There are different formulations of this. My reconstruction is that the Easterlin Paradox makes three claims:
Richer people within a country more satisfied than poorer people.
Richer countries more satisfied than poorer countries
As countries have got richer, life satisfaction has remained broadly flat.
What makes the Easterlin Paradox interesting is that the lack of evidence for 3 seems weird given the truth of 1 and 2. That’s the paradoxical part: if being richer than other people at particular moments makes us more satisfied, why don’t countries get more satisfied if they get richer? Isn’t more money always better?
Now, I should point out that no one doubts the truth of 1 or 2. To my eyes, the battle ground is about the 3rd point: does growth increase life satisfaction? There’s some dispute over whether it does, but at best economists only find there is a tiny difference e.g see Stevenson and Wolfers. Perspectives can disagree, but I take that a victory for the Easterlin side: if growth does matter, it seems pretty trivial, so lets focus on increasing satisfaction by other means.
(You can also get into a tedious quagmire of how to best assess 3 given the data available. Stevenson and Wolfers look at growth, but it’s not really a surprise that growing/shrinking GDP increase/decrease satisfaction. What you really want is long-run growth, which Beja 2015 looks at and concludes that, if long run growth increased by 1%[per year], then life satisfaction would rise from 3 to 3.0027″ (life satisfaction was measured on a 1-4 scale) which I mention in reply to Ben Todd below)
So I’m not doubting
It seems that the literature now suggests that the relationship between income and life satisfaction is one of diminishing returns but that an increase in income is correlated with an increase in life satisfaction.
But that refers to point 1, not point 3. What seems to be going on is that income has a large relative effect and a small absolute effect on life satisfaction. The fact that richer people are more satisfied than poorer people doesn’t allow you to infer than making those poor people richer would increase their happiness. Analogously, if I change who wins a 100m sprint so yesterday’s loser becomes today’s winner then it’s not obvious (but still possible) I’ve increase overall satisfaction with the result.
Anyway, this is all analysis in terms of cognitive, not affective well-being. I think the latter is what really matters. The Kahneman and Deaton 2010 paper is really interesting because it shows life satisfaction (cognitive well-being) goes up with income but ‘happiness’ (affective well-being) plateaus at $40,000ish for household (not individual) income. Given that’s a survey conducted in America we might suppose this figure would be far lower elsewhere. It seems unlikely to be the case that $40,000/year/household is the figure beyond which incomes stop affecting happiness for all times and all places. If you conceptualise the relevant figure as “the ability to shameless participate in society” then you’d expect that to change.
As a result, I think more work is required to find out what the level of absolute income is that people require. As the Give Directly study shows, it may be incredibly low and so low that cash transfers do surprisingly little.
I’m not sure how you’ve reached your conclusion on the basis of what I’ve said. I’m taking ‘depression’ to be a mental health disorder with certain symptoms, including substantially lowered mood. I’m not using ‘depression’ as a synonym for ‘feeling a bit bad’.
I’m making the claim that depression, which is constituted by lots of negative emotional states (i.e. states that feel bad to the person) is probably worse that many, if not all, other forms of suffering in terms of happiness (your ‘happiness’ = the sum total of momentary positive mental states less your negative ones). In part this is because depression induces intense negative states, in part because we don’t seem to be able to hedonically adapt to the condition in a way we can to, say, becoming paraplegic.
I’m not glibly dismissing other cases of suffering. I think you seem to be objecting to doing all things considered evaluations of how bad various things are. If you don’t want to do all things considered evaluations it’s quite hard, if not impossible, to make important moral choices.
Depression is just one of a range of mental health disorders, that’s true. Where I’ve used them synonymously that was simply careless and definitely my mistake.
And I don’t have solution for schizophrenia, nor did I realise I was supposed to! I’m a philosopher who researches happiness, not a psychiatrist.
I really like this. It did make me wonder how bad life really was for those in what the graph calls ‘absolute poverty’
My initial response is ‘quite bad’ and, quoting Hobbes, that life was ‘nasty, brutish and short’.
By then I thought about it a bit more and number of considerations occurred to me:
Most people adapt to most things that happen. There’s evidence lottery winners and those who get disabled return to their pre-event level of life satisfaction after 6 months.
People make mistakes when imagining their future lives or the lives of others. There’s also evidence we engage in a ‘focusing illusion’ and only consider the differences between our life and some other life, rather than the similarities or how it would be to actually live that life. For example, Bill Gates (probably) doesn’t wake up every morning and shout “I’m the richest man in the world!” he gets up, has coffee, gets stuck in traffic, goes to meetings, etc..
Most people report being happy (or, more specifically, about 7⁄10 say they are satisfied with their lives). I’m critical of this sort of data, as well as the fact it’s mostly from people outside of poverty, but it’s still striking, at least to me, how pervasive this is.
The preceding three points make evolutionary sense: if we didn’t want to be alive, we probably wouldn’t try to be. It also follows changes, rather than objective conditions, are often most relevant (think about how you’re sensitive to small noises when alone at night, but not in a night club). Natures fits creatures to receive pleasure from that which is essential to their survival. I now wonder if, actually, day to day, hour by hour, Agricola would probably have reasonably happy unless he were cold, hungry or unwell. I’m not saying I would chose his life over mine, only that it probably wasn’t as bad I automatically thought it was.
What do others think?
I can provide references for anyone who wants to quibble with my empirical claims