Unpacking Vitamin A's Impact on Child Mortality

GiveWell is one of the world's best-known charity evaluators, with the goal of "searching for the charities that save or improve lives the most per dollar." It mostly recommends projects that help the world's poorest people avoid easily prevented diseases, like intestinal worms or vitamin A deficiency.

But should GiveWell, as some critics argue, take a totally different approach to its search, focusing instead on directly increasing subjective wellbeing, or alternatively, raising economic growth?

Today's guest — cofounder and CEO of GiveWell, Elie Hassenfeld — is proud of how much GiveWell has grown in the last five years. Its 'money moved' has quadrupled to around $600 million a year.

Its research team has also more than doubled, enabling them to investigate a far broader range of interventions that could plausibly help people an enormous amount for each dollar spent. That work has led GiveWell to support dozens of new organisations, such as Kangaroo Mother Care, MiracleFeet, and Dispensers for Safe Water.

But some other researchers focused on figuring out the best ways to help the world's poorest people say GiveWell shouldn't just do more of the same thing, but rather ought to look at the problem differently.

Links to learn more, summary and full transcript.

Currently, GiveWell uses a range of metrics to track the impact of the organisations it considers recommending — such as 'lives saved,' 'household incomes doubled,' and for health improvements, the 'quality-adjusted life year.' 

The Happier Lives Institute (HLI) has argued that instead, GiveWell should try to cash out the impact of all interventions in terms of improvements in subjective wellbeing. This philosophy has led HLI to be more sceptical of interventions that have been demonstrated to improve health, but whose impact on wellbeing has not been measured, and to give a high priority to improving lives relative to extending them.

An alternative high-level critique is that really all that matters in the long run is getting the economies of poor countries to grow. On this view, GiveWell should focus on figuring out what causes some countries to experience explosive economic growth while others fail to, or even go backwards. Even modest improvements in the chances of such a 'growth miracle' will likely offer a bigger bang-for-buck than funding the incremental delivery of deworming tablets or vitamin A supplements, or anything else.

Elie sees where both of these critiques are coming from, and notes that they've influenced GiveWell's work in some ways. But as he explains, he thinks they underestimate the practical difficulty of successfully pulling off either approach and finding better opportunities than what GiveWell funds today. 

In today's in-depth conversation, Elie and host Rob Wiblin cover the above, as well as:

• Why GiveWell flipped from not recommending chlorine dispensers as an intervention for safe drinking water to spending tens of millions of dollars on them
• What transferable lessons GiveWell learned from investigating different kinds of interventions
• Why the best treatment for premature babies in low-resource settings may involve less rather than more medicine.
• Severe malnourishment among children and what can be done about it.
• How to deal with hidden and non-obvious costs of a programme
• Some cheap early treatments that can prevent kids from developing lifelong disabilities
• The various roles GiveWell is currently hiring for, and what's distinctive about their organisational culture
• And much more.

Chapters:

• Rob’s intro (00:00:00)
• The interview begins (00:03:14)
• GiveWell over the last couple of years (00:04:33)
• Dispensers for Safe Water (00:11:52)
• Syphilis diagnosis for pregnant women via technical assistance (00:30:39)
• Kangaroo Mother Care (00:48:47)
• Multiples of cash (01:01:20)
• Hidden costs (01:05:41)
• MiracleFeet (01:09:45)
• Serious malnourishment among young children (01:22:46)
• Vitamin A deficiency and supplementation (01:40:42)
• The subjective wellbeing approach in contrast with GiveWell's approach (01:46:31)
• The value of saving a life when that life is going to be very difficult (02:09:09)
• Whether economic policy is what really matters overwhelmingly (02:20:00)
• Careers at GiveWell (02:39:10)
• Donations (02:48:58)
• Parenthood (02:50:29)
• Rob’s outro (02:55:05)

Producer: Keiran Harris

Audio mastering: Simon Monsour and Ben Cordell

Transcriptions: Katy Moore