Chapter 354 - The World’s Biggest Problems And Why They’re Not What First Comes To Mind[1] (2/2)

All this isn't to deny the poor in rich countries have very tough lives, perhaps even worse in some respects than those in the developing world. Rather, the issue is that there are far fewer of them, and they're harder to help.

So if you're not focusing on issues in your home country, what should you focus on?

Global health: a problem where you could really make progress.

What if we were to tell you that, over the second half of the 20th century, progress on treatments for diarrhoea did as much to save lives as achieving world peace over the same period would have done?

The number of deaths each year due to diarrhoea have fallen by 3 million over the last four decades due to advances like oral rehydration therapy.

Meanwhile, all wars and political famines killed about 2 million people per year over the second half of the 20th century.

The global fight against disease is one of humanity's greatest achievements, but it's also an ongoing battle to which you can contribute with your career.

A large fraction of these gains were driven by humanitarian aid, such as the campaign to eradicate smallpox. In fact, although many experts in economics think much international aid hasn't been effective, even the most sceptical agree there's an exception: global health.

For instance, William Easterly, author of White Man's Burden, wrote:

Put the focus back where it belongs: get the poorest people in the world such obvious goods as the vaccines, the antibiotics, the food supplements, the improved seeds, the fertilizer, the roads…. This is not making the poor dependent on handouts; it is giving the poorest people the health, nutrition, education, and other inputs that raise the payoff to their own efforts to better their lives.Within health, where to focus? An economist at the World Bank sent us this data, which also amazed us.

This is a list of health treatments, such as providing tuberculosis medicine or surgeries, ranked by how much health they produce per dollar, as measured in rigorous randomised controlled trials. Health is measured in a standard unit used by health economists, called the ”quality-adjusted life year”.

The first point is that all these treatments are effective. Essentially all of them would be funded in countries like the US and UK. People in poor countries, however, routinely die from diseases that would certainly have been treated if they'd happened to have been born somewhere else.

Even more surprising, however, is that the top interventions are far better than the average, as shown by the spike on the right. The top interventions, like vaccines, have been shown to have significant benefits, but are also extremely cheap. The top intervention is over ten times more cost-effective than the average, and 15,000 times more than the worst. This means if you were working at a health charity focused on one of the top interventions, you'd expect to have ten times as much impact compared to a randomly selected one.

This study isn't perfect – there were mistakes in the analysis affecting the top results (and that's what you'd expect due to regression to the mean) – but the main point is solid: the best health interventions are many times more effective than the average.

So how much more impact might you make with your career by switching your focus to global health?

Because, as we saw in the first chart, the world's poorest people are over 20 times poorer than the poor in rich countries, resources go about 20 times as far in helping them (read about why here).

Then, if we focus on health, there are cheap, effective interventions that everyone agrees are worth doing. We can use the research in the second chart to pick the very best interventions, letting us have perhaps five times as much impact again. In total, this makes for a 100-fold difference in impact.

Does this check out? After years of research, analysts at GiveWell have estimated that spending $7,500 on 1,500 malaria nets through the Against Malaria Foundation is enough, on average, to prevent one death.