I am an applied researcher at Founders Pledge, specialising in Global Health and Development. Before that, I did a PhD on cognitive evolution (which involved running around after monkeys a lot).
Rosie_Bettle
Karma: 549
Mass media interventions probably deserve more attention (Founders Pledge)
A systematic framework for assessing discounts [Founders Pledge]
Oral healthcare in LMIC is a promising new cause area: Founders Pledge (Medium Investigation)
[Linkpost] Founders Pledge: how we use (and sometimes don’t use) DALYs
Thanks for this post, fascinating stuff!
My quick-ish question: is it possible that you are underestimating the WELLBY effect of grief, for AMF? My understanding (from referring back to the ‘elephant in the bednet’ post, but totally possible that I’ve missed something) is that these estimates are coming from Oswald and Powdthavee (2008), and then assuming a 5 year duration from Clark et al. (2018). Hence getting an estimate of ~ 7 WELLBYs.
The reason I’m a little skeptical of this is first that it seems likely to me (disclaimer that I have not done a deep dive) that losing a child would increase the likelihood of depression and other mental illnesses, alongside other things like marriage disruption (e.g. Rogers et al. 2008, which highlights effects lasting to the 18 year mark). I don’t think these effects will be accounted for by pulling out the estimate coming from Oswald & Powdthavee according to the Clark paper.
Along similar lines, I also think the spillover effects of AMF might be underestimated; my intuition is that losing a child is inherently especially shocking, and that the spillover effects might larger than the spillover effects from things like cash transfers/ therapy- e.g. everyone in the community feels sad (to some degree) about it. Am I correct that the spillover for AMF is calculated only for family members, not for friends and other members of the community?
Thank you for posting this, really interesting! I am pretty excited for malaria vaccine roll-out, but think that posts which go against current thinking are valuable, and I appreciate this being posted.
Three things that I’d be super curious about (and i think might have the effect of being more optimistic);
(1) IIRC the WHO found a 13% reduction in all-cause mortality (!) with a vaccination coverage rate of ~65%. This was in Ghana/ Kenya and Malawi, I think. I assume these areas already had some availability of SMC/ bednets, and this makes me think that there’s likely quite a substantial impact beyond nets/ SMC?
(2) Beyond immediate impacts of the vaccine- will the malaria vaccine likely bring eradication forward beyond the impact of nets/ SMC? (my current understanding is yes, and I think that bringing eradication forward is super important.)(3) As you already point out, where would money have otherwise been spent. My impression here is that the money which funds malaria vax roll-out would likely come from a mix of sources, rather than nescessarily pulling from SMC/ bednets (but I still have some concern/ uncertainty here).
Hi Joel, thanks for this detailed + helpful response! To put in context for anyone skimming comments, I found this report fascinating, and I personally think StrongMinds are awesome (and plan to donate there myself).
Yep, my primary concern is that I’m not sure the longterm effects of grief from the loss of a child have been accounted for. I don’t have access to the Clark book that I think the 5 year estimate comes from- maybe there is really strong evidence here supporting the 5 year mark (are they estimating for spouse loss in particular?). But 5 years for child loss intuitively seems wrong to me, for a few reasons:
Again, idk how good the Clark 5 year finding is so I could be wrong! But the data that I’m aware of suggests that the effect of childhood bereavement is considerably longer than this. Rogers et al (2008) finds that parents still report poorer wellbeing at the 18 year mark, Song et al. (2011) finds that older bereaved couples still had lower quality of lives in their 60s relative to unbereaved couples, etc. From a quick scan (just from looking up ‘long term effects child berevement’) the estimates that I’m seeing pop up are higher than 5 years.
People may develop depression/ anxiety etc in response to the loss of a child. From a quick look (there may well be a better data source than this) there’s an NEJM article from Li et al. 2005 that puts the relative risk ratio (for psychiatric hospitalisation, relative to unbereaved parents) at 1.67. I assume that’s going to be a longlasting effect, and I see an argument to ‘treat key sources of depression’.
I do realise there may be confounding variables in the analyses above (aka so they’re overestimating grief as a result)- this might be where i’m mistaken. However, this does fit with my general sense that people tend to view the death of a child as being *especially* bad.
My secondary concern is that I think the spillover effects here might go considerably beyond immediate household members. In response to your points;
Thanks, that makes sense to me! I do think there’s some way in which this is an overestimate (aka maybe v young children are less affected by the death of a sibling). However, idk if this enough to compensate for not having accounted for non-household spillover effects; my sense is that the friends of the kid would be affected, plus other members of the village, parents who get rightly scared that their kid will fall ill, and so on. Aka I could see effects along the line of ‘my childhood best friend died, this adverse childhood experience contributed to my adult battle with depression’.
That also makes sense to me, cheers. I don’t have a strong sense either way on this.
This would make sense to me if it was adult versus adult deaths, but it seems worse to me for a parent to lose a kid (relative to counterfactual). I can see how this is a super thorny issue! Maybe it ameliorates the problem somewhat?
I do want to highlight the potential ‘duration of effect’ plus ‘negative spillover might be higher than (positive) spillover effects from GD’ issues because I think those might change the numbers around a fair bit. I.e. if we assume that effects last 10 years rather than 5 (and I see an argument that child bereavement could be like 20+) , and spillover is maybe 1.5X as big as assumed here, that would presumably make AMF 3X as good.
Hey Vasco,
RE: most of the funding going to groups which are already in the EA ecosystem- yep, I think this is correct. I still think this is compatible with the statement of ‘being especially interested in stuff falling outside the main GHD ecosystem’ though, and that the grantmaking focus has changed somewhat in the last year or two.
* r.i.c.e we granted to an early stage (before they were GiveWell supported) when they were having a severe funding crunch.
* FEM, Suvita and LEEP we evaluated and granted to at an early stage. I think there’s value here in ‘identifying promising charities and getting up to scale asap’.
* Our most recent grants aren’t up on the website yet: I don’t think (? could be wrong) 1daysooner’s malaria stuff has gotten EA funding yet, Ubongo isn’t EA supported afaik, or Essential.
It’s true though that a lot of FP GHD grantmaking is stuff that’s already supported by the EA community. I could have been clearer here; our guiding principle is just ‘whatever we think is most cost-effective’ and many of the existing EA-supported orgs still have funding gaps that are highly cost-effective. Aka I wouldn’t want to prioritise something that sounds cool on a ‘this is new basis’ over something that is already known in EA, and is more cost-effective. Most of the decisions that I really agonise over are ‘does this really beat bednets? Most things don’t beat bednets, and I’m aware that most things seem less cost-effective as more researcher hours go into probing them’. I do think it is possible though to to find funding opportunities in the ‘falling outside the current GHD ecosystem and >10X in expectation’ space though, and these have been some of my favourite grants.
RE: the scope of Founders Pledge’s global health and development fund being different in the past. This was before my time (I joined FP maybe 1.5 years ago) but yes, I would say that our scope has changed a little to be somewhat more risk tolerant (while still focusing on evidence base) and figuring out where our comparative advantages are (speed being one of them).
RE: being more open with evaluations; yeah I totally agree with you, and think you’re right that explaining when we depart from GiveWell is esp important. (Some places where we’ve just started to do this: Vadim’s education work, my mass media stuff. But I haven’t published actual FO evals as often). IMO our evals are rigorous, without being as in-depth as GiveWell; there’s a process of understanding the area (some of our cause area reports are on the EA forum), then a ~25 page ish eval & CEA, and red-teaming. Our rapid grants are shorter, but still have an eval, CEA/ BOTEC + red-teaming.
Hi David, thanks making these points. I totally agree that there’s likely to be a lot of variation between campaigns, and that examining this is a critical step before making funding decisions- I don’t think (for instance) we should just fund mass media campaigns in general.
I did find it helpful to focus upon mass media campaigns (well, global health related mass media campaigns) as a whole to start with. This is because I think that there are methodological reasons to expect that the evidence for mass media will be somewhat weak (even if these interventions work) relative to the general standard of evidence that we tend to expect for global health interventions- namely, RCTs. This is because of problems in randomising, and of achieving sufficiently high power, for an RCT examining a mass media campaign. I think this factor is generally true of mass media campaigns (and perhaps not especially well-known), hence the fairly broad focus at the start of this report.
I agree with you though that ascertaining which programs tend to work is hugely important. I’ve pointed to a few factors (cultural relevance, media coverage etc), but this section is currently pretty introductory. The examples I’ve focused upon here are the ones where there is existing RCT evidence in LMICs (e.g. family planning is Glennerster et al., child survival from recognition of symptoms is Sarassat et al., HIV prevention is Banerjee et al.) Some things that stand out to me as being crucial (note that I’m focusing upon global health mass media campaigns in LMIC) include the communities at hand having the resources to successfully change their behavior, there being a current ‘information gap’ that people are motivated to learn about (e.g. the Sarassat one focuses on getting parents to recognise particular symptoms of diseases that could effect their children, and the Glennerster one provides info about the availability and usage of modern contraceptives), cultural relevance (i.e. through the design of the media) and media coverage.
I am obviously biased (I co-manage the fund), so please bear that in mind. But I’d like to throw in Founders Pledge GHD fund as another GHD option- it’s not the case that you have to be an FP member to donate to this fund.
We tend to fund GiveWell-style recs (e.g. AMF) alongside things that we think are higher risk but potentially more impactful/ younger orgs that we want to get up to scale quickly. Recent grants have included: 1DaySooner to try and speed up malaria vaccine roll-out, Essential for research into producing low-cost proteins in East Africa, Ubongo, Suvita, LEEP, r.i.c.e for kangeroo mothercare, Family Empowerment Media, Taimaka. Some stuff that we’re currently checking out include Pure Earth, other lead research-y things, and some anti-corruption stuff via my colleague Vadim.
I’m especially interested in things which could be very good, but might fall outside the bounds of the current GHD funding ecosystem (e.g. things that are not super amenable to RCTs, orgs that are too young to get mainstream funders but too old for seed funding, urgent things that require a very quick turnaround).
Full disclosure that we haven’t been the best at publicly publishing evaluations- due to capacity, but still. I hope to improve this/ generally provide more resources about how we do grantmaking from the fund over the next year or so.
Hey Christian, thanks for your comment! I totally agree that ML has great potential for diagnosis (in dentistry but also within the field of medical care more broadly– e.g. I was reading about this grant from Gates the other day, it’s a diagnostic ultrasound for maternal conditions). Caveat that I’m not sure that the average person would trust an ML diagnosis over a ‘real person’ diagnosis (at least, not yet), and I think it would be a while until roll-out in an LMIC type context. Nonetheless, I think this is a promising area which I want to check out in more detail.
Within the field of oral health though, I think that investing in preventative treatment is currently more promising than diagnostics/ curative treatment: i.e. while I think that training up local dentists may be cost-effective, it seems a little borderline. However, preventative treatment (aka fluoride) seems to be extremely cost-effective, and we already know how to do it. This is mainly because salt and milk fluoridation appear to work and are insanely cheap—that’s where my $2 WELLBY/ $9 DALY figures are coming from.
correct: to be absolutely clear, CE and the orgs themselves definitely incubated and developed the first CEAs for the CE charities (not us!). Thanks for this, will edit my comment. What I meant was is that evaluating and supporting orgs in the ‘no longer a seed stage charity but also not yet at scale’ stage is a key role that I see for the FP GHD fund, and I think we’ve had previous success here.
Yep, 1DS’ pandemic preparedness has been supported by OP. And thanks, I will mention to our comms team. FYI that our impact report is upcoming onto the website, which will list all recent grantmaking.
(also cheers for this post, and making the subtleties & differences between different GHD funds etc clearer!)
Hullo, this report is fascinating! Upvoted. Just a quick note that Founders Pledge estimate of DMI’s child survival program is out of date (which totally makes sense, as we haven’t published our full eval of DMI’s child survival program).
We currently rate this program at 4x GD, not 12x GD- this is after applying a really strong adjustment (16%; internal valdity adjustment of 30%, external of 54%), to try and deal with the uncertainty from the Sarrassat et al. RCT. thanks!
Hi Akhil, I really like this report: thank you for writing it up here!
Something that I think could additionally add to the impact of VAWG (although clearly difficult to estimate/ maybe not worth it for a shallow dive) is the somewhat cascading/ generational nature of domestic violence and associated trauma– e.g. that if you experience more Adverse Childhood Experiences, your children are also more at risk for ACEs, etc.
It also has struck me before that social norms about VAWG/ intimate partner violence vary strongly across regions. I think social norms are very powerful; do you know of any charities aiming to shift social norms regarding VAWG/ intimate partner violence? (E.g. I’m thinking along the lines of narrative stories over the radio, but there may be other alternatives in this area).
Thanks Stan! This is really helpful- agreed with you that they should be combined as multipliers rather than added together (I’ve now edited accordingly). I’m still mulling a bit over whether using the word ‘discount’ or ‘adjustment’ or something else might help improve clarity.
Thank you Joel! Hope that you had a nice flight.
Hi Christian,
Thanks for this comment, I am happy someone drew attention to this!
I did check out various papers (such as the one you linked, and some other papers proposing a link between fluoride exposure and adhd). I didn’t find them convincing enough to add in a non-monetary cost to fluoride (bear in mind that I also left out various potential net-benefits, such as increased attendance at school and work).
To give a bit more detail (because I think this important), I found that the evidence linking fluoride to neurological outcomes was pretty low quality. I could only mainly find ecological studies, where i judge the risk of confounds to be very high- plus other issues that make me suspicious such as exclusion of outliers (without clear justification). That being said, I do think it’s important to be cognisant of these theories, even if the available evidence is poor— I quite like this review, which basically argues that low to adequate levels of fluoride don’t appear to be associated with any neurological conditions, but there is ‘low level’ evidence that they are at high concentrations.
To me, this gets at the point that fluoride should only be used in communities that have low levels of fluoride already— apart the speculation about neurological disorders, we know that fluoride can cause fluorosis (weakening of tooth enamel) in levels with high levels of fluoride. I have put the ‘costs’ of fluoride at zero, but have highlighted in the report that I think these kinds of interventions should only be used in area with low fluoride (for instance, not areas with high levels of groundwater fluoride). In areas with high fluoride, I agree with you that there might be ‘costs’ to be accounted for .
Totally agree with you on the point about trust! I quite like the salt/ milk interventions since they are more ‘opt in’ than water fluoridation (aka you could just buy the other salt/ milk), as well as being more practical in areas with lower levels of piped water access. I’d hope that this would mean less pushback.
Yep! I do think flossing is good, but I suspect it’s less impactful/ helpful than fluoride (especially fluoride added to water/ milk/ salt).
Thanks! I didn’t especially look into tongue scraping, but I’ll check it out a bit more. My general sense would be that it would be tricky to persuade people to do regularly, in comparison to something ‘automatic’ like fluoridated salt.
‘The structure of academia rewards people for developing one theory and sticking to it. There are few academic incentives for reaching a consensus or even hashing out the relative probabilities of different views.’
I agree with this, but I just wanted to link out to a new paradigm that I think gets good traction against this problem (and also highlights some ongoing consciousness research). This is being funded by the Templeton Foundation (a large philanthropic science funder), and essentially they’ve got leading advocates of two leading consciousness theories (global workspace theory and integrated information theory; see here) to go head-to-head in a kind of structured adversarial experiment. That is, they’ve together developed a series of experiments, and together agreed beforehand that ‘if the results go [x] way, this supports [x] theory’. Afaik, the results haven’t been published yet.
Disclaimer that in a previous life I was a comparative psychologist, so I am nerdily interested in consciousness. But I do think that there is a tension between taking a strong view that AI is not conscious/ will not be conscious for a long time, versus assuming that animals with very different brain structures do have conscious experience. (A debate that I have seen play out in comparative cognition research, e.g. are animals all using ‘chinese room’ type computations). Perhaps that will turn out to be justified (e.g. maybe consciousness is an inherent property of living systems, and not of non-living ones), but I am a little skeptical that it’s that simple.
Hello, I’ve been researching modern slavery at Founders Pledge recently. (Also oops, pressed send before I meant to- hence the edit!)
I really respect the Freedom Fund for pushing forward with evaluative work, esp in an area where there aren’t many published evaluations (you can see one of their evaluations here). At the same time, I think the $657 figure is very optimistic. My understanding is that the figure GWWC are pulling from (the $657 amount) is based on weaker, observational evidence—and doesn’t really account for the marginal funding amount. By this, I mean that I expect that most high-quality programs would be funded within the next few years (so this is really the cost to speed this process up).
My general sense is that this is an area where the evidence basis for direct work is suprisingly weak; there are hardly any RCTs, or strong quasi-experiments. It’s true that modern slavery interventions are difficult to test, but nonetheless this is pretty striking given that modern slavery is an area that’s of increasing interest to many policy makers (e.g. movement towards an EU ban on products made with forced labor, SDG goal 8.7).
I suspect the lack of RCT-style evidence, and the sense that it’s not super neglected, might be why there hasn’t been much EA focus here. Nonetheless, I think focusing on interventions around advocacy, tech and research may be promising here (and I’d probably argue for prioritising this over direct work, given current funding patterns).
Advocacy in this area can push for things like strengthening existing Modern Slavery Acts (e.g. by adding sanctions, existing legislature is very weak) and bringing in ‘floor wages’ for workers (e.g. see this video from the Asia Floor Wage Alliance). Tech developments to actually be able to locate modern slavery seem critical to me, and like a key bottleneck in this area: to NGOs (who need to be able to prioritise their efforts, measure the impact of their work and so on), to multi-national companies (who need to be able to locate modern slavery within their supply chains, in order to choose contractors who do not use modern slavery), to consumers (to know which products are at risk of modern slavery and apply consumer pressure), and to strengthening legislation (it seems difficult to impose sanctions on multi-national companies, if companies can genuinely argue that they don’t have the ability to locate modern slavery in their supply chains). I’m also interested in tech work that helps workers stay safe as they migrate (e.g. apps that provide accurate job info, tell people their work rights, etc etc). So I’d probably lean to charities with a strong focus on this; afraid I don’t have a one-stop recommendation yet as work is still in progress, but you might want to check out the Asia Floor Wage Alliance, Global Fund to End modern Slavery, Anti-Slavery International and International Justice Mission as well as the Freedom Fund (for groups that also have an advocacy/ tech focus).