Less Wrong is a community blog devoted to refining the art of human rationality. Please visit our About page for more information.

Saving lives via bed nets is hard to beat for immediate impact

8 Post author: JonahSinick 21 June 2013 06:46PM

In my last post I wrote about how Peter Singer’s implicit past claim that [one can save a child’s life for the cost of a pair of shoes] is misleading.

Having said that, it’s important to highlight that if one ignores indirect effects, funding bed net distribution to save lives is an extremely good opportunity for people in the developed world to increase the number of valuable years of life that people experience.

The situation is probably completely different when one considers indirect effects. I’ll postpone discussion of indirect effects to a later date.

Consider the question of what the quality of life is in the developing world. The GiveWell blog post Quality of life in the developing world reads:

When we argue that donors should give internationally, one of the most common questions we get is, “Sure, you may be able to save a life in Africa, but what type of life are you saving? If you save a child from malaria will s/he likely die from something else soon after? Will s/he suffer from other problems that significantly reduce his/her quality of life?” 

[…] 

People in poor countries are less satisfied with their lives (they ranked their satisfaction as 4.3 out of 10, while rich country residents ranked theirs as 6.7). 

[…]

Those who live past age 5 have nearly a 70% chance of living until age 60. 

[…]

Fewer than 1 out of 100 people have HIV/AIDS, 1 out of 40 have lymphatic filariasis, and about 1 out of 2,700 have river blindness. 

[…]

About a third of children are stunted (significantly shorter than normal due to undernutrition).

[...]

Incomes are low, but discretionary spending does exist even among the poorest. People in extreme poverty (defined in the past as under US $1 a day of income) do not spend every “additional dollar” on additional food; they frequently own TVs and radios and participate in festivals.

The reader can draw his or her own conclusion from this. It seems likely to me that the average life in the developing world is worth living, and that the value of an average year of life in the developing world is no more than 3x lower than the value of an average year of life in the developed world.

In my last post, I wrote about how the explicit estimate for Against Malaria Foundation’s marginal cost per life saved is $2k, and the fact that the actual cost could be significantly higher owing to Bayesian regression

  • Place yourself in the shoes of the average person in the developed world who makes $60k/year. 
  • Suppose that you donate enough to Against Malaria Foundation to save a life each year (whether it be $2k or $10k or whatever your best guess is).
  • Suppose that saving a life corresponds to allowing someone to live 51 additional years in the developing world.
  • Suppose that the value of a year of your own life is no more than 3x the value of a year of life saved.
  • To a first approximation, the immediate value of a year of your work is equal to the value of a year of your life.
  • Therefore, by donating, you can give create at least 51/3 = 17x as much value as you can through your immediate work.
Some types of work are much more valuable than average, and indirect value can swamp immediate value. Nevertheless, the above discussion helps place things in perspective.

Note: I formerly worked as a research analyst at GiveWell. All views are my own.

Comments (41)

Comment author: Wei_Dai 22 June 2013 05:58:26AM *  11 points [-]

It seems likely to me that the average life in the developing world is worth living, and that the value of an average year of life in the developing world is no more than 3x lower than the value of an average year of life in the developed world.

I think it should be the marginal life saved by AMF that is relevant here, and it is probably of much lower quality than the average life in the developing world. AMF was chosen by GiveWell because it represents the lowest cost per life saved, which must be because it targets people with the lowest incomes, people who can't afford to purchase even very low cost disease preventions on their own behalf.

Comment author: JonahSinick 22 June 2013 04:27:43PM *  2 points [-]

Your point is a valid one, but in practice, I don't think it alters the bottom line. Some points:

  • It's not clear to me that AMF's net recipients are poorer than usual. If they're not, you might wonder why the people don't purchase nets themselves. I think that they may not be fully aware of the health benefits. You have to cover on the order of 400 people with nets to save a single life, and people may not be attuned to such small probabilities.
  • I think that the difference in income between "average" and "poorest of the poor" in these countries is probably no more than a factor of 2.
  • Note that the poorest of the poor may be able to improve their economic standing over the next 50 years.
Comment author: army1987 23 June 2013 12:01:34PM 6 points [-]

I think that the difference in income between "average" and "poorest of the poor" in these countries is probably no more than a factor of 2.

Surely by “average” you actually mean “median”?

Comment author: JonahSinick 23 June 2013 05:04:20PM 1 point [-]

Yes.

Comment author: Wei_Dai 26 June 2013 09:08:22AM 1 point [-]

I think that the difference in income between "average" and "poorest of the poor" in these countries is probably no more than a factor of 2.

If you define "developing world" as "low-income countries" (GNI per capita up to $1,025), which is what GiveWell seems to do in its blog posts, then I think you're probably right about this difference in income being no more than a factor of 2, but then I'd doubt that an average year of life in a low-income country is worth at least 1/3 that in the developed world. Also I think even a factor of 2 is a big deal when you're talking about going from barely having enough to eat, to having half of your income available for making quality of life improvements.

On the other hand, if you define "developing world" as "low and middle income countries" (GNI per capita up to $12,475), which is what I had been assuming since that's how the World Bank defines it, I can buy "at least 1/3" but I think the median income in those countries is probably between $5 and $10 per day, which is much more than twice that of the "poorest of the poor".

Comment author: ChristianKl 23 June 2013 10:48:48AM 1 point [-]

It probably cheaper to transport bednets to a city which engages into economical trade than a small town in some remote place.

Distribution to wealthier people might be cheaper.

Comment author: curiousepic 22 June 2013 12:45:57PM *  1 point [-]

...or don't beware trivial inconveniences.

Comment author: DanielLC 21 June 2013 10:05:51PM 3 points [-]

Those who live past age 5 have nearly a 70% chance of living until age 60.

The life expectancy of a five-year-old would be more helpful. This just shows that it's at least 38.5.

Comment author: JonahSinick 21 June 2013 11:10:32PM 1 point [-]

Yes, this is fair. I was implicitly assuming something about the distribution of life expectancies. The relevant figure seems to be 55 years. I'll modify my post accordingly.

Comment author: DanielLC 21 June 2013 11:43:53PM 0 points [-]

Is that life expectancy of a baby, or life expectancy of a five-year-old?

What you really need to know is the remaining life expectancy of the people you save.

Comment author: JonahSinick 21 June 2013 11:49:02PM 1 point [-]

I agree. The figure of 55 years is the life expectancy of a baby. Child mortality rates are around 10%. So the life expectancy of the people saved is something like 60 years.

Comment author: ThisSpaceAvailable 22 June 2013 01:30:48AM 0 points [-]

"average year of life in the developing world is no more than 3x lower"

I assume you mean "average year of life in the developing world is no less than one third as much". I really don't like the "X times lower" rather than "one Xth as much" construction, and I think this is an example of it being needlessly confusing; presumably, you were thinking "(no more than three) times lower", but I first read it as "no more than (three times lower)".

Comment author: gjm 23 June 2013 07:55:35PM 0 points [-]

Why the downvotes for this? (Note: ThisSpaceAvailable is not the only person who initially misinterpreted JonahSinick's "no more than 3x lower" construction in the same way; elharo did too, and was -- I think -- more offended than he need have been as a consequence.)

Comment author: wedrifid 22 June 2013 02:27:02AM *  -1 points [-]
  • Place yourself in the shoes of the average person in the developed world who makes $60k/year.
  • Suppose that the value of a year of your own life is no more than 3x the value of a year of life saved.
  • To a first approximation, the immediate value of a year of your work is equal to the value of a year of your life.

Please supply evidence that the average yearly income over the life of the person saved at the margin of malaria-net donation is (at least) US$20,000. If this is not the case please stop inconsistently applying arbitrary metrics in order to support your social-political agenda. It is possible to explain how awesome AMF is without confounding the audience with misleading numbers.

Note: I think malaria nets, efficient charity and AMF are awesome. However, I also oppose bullshit. I even oppose bad arguments for my side. I call for restraint.

Comment author: JonahSinick 22 June 2013 02:31:15AM 2 points [-]

Please supply evidence that the average yearly income over the life of the person saved at the margin of malaria-net donation is (at least) US$20,000.

I don't see the relevance of this – can you elaborate?

Comment author: wedrifid 22 June 2013 02:50:34AM *  4 points [-]

I don't see the relevance of this – can you elaborate?

You told us that the value of a year of our life is the value of a year of our work, which is in turn assumed to be $60k. We are also assuming we created 51 years of life in someone and that each of their years is worth at least 1/3 of the value of ours. You then directly divide one of these by the other in order to pull out "17x as much". Either you are equivocating between two entirely different measures of value (in which case you can't just divide one by the other and produce a meaningful scale factor) or "to a first approximation" the average amount yearly income over those 51 years for the hypothetical saved person must be $20k.

Essentially, this number (17x) that you produce is utterly meaningless. The post would be strictly better if you had just said "You can save 51 years of life for just $2k to $10k. That's probably more important than most things you will do. How amazing!"

Comment author: JonahSinick 22 June 2013 03:44:10AM 1 point [-]

Either you are equivocating between two entirely different measures of value (in which case you can't just divide one by the other and produce a meaningful scale factor) or "to a first approximation" the average amount yearly income over those 51 years for the hypothetical saved person must be $20k.

I was using two different measures of value.

Essentially, this number (17x) that you produce is utterly meaningless. The post would be strictly better if you had just said "You can save 51 years of life for just $2k to $10k. That's probably more important than most things you will do. How amazing!"

My post addresses the differential in quality of life. The choice of a factor of 3x is somewhat arbitrary. But it arguably makes things more vivid than "51 years of life."

I don't necessarily stand by an upper bound of $10k on cost per life saved.

Comment author: wedrifid 23 June 2013 06:31:08AM 1 point [-]

I was using two different measures of value.

Yes. Creating arbitrary assumptions that are in opposition to each other is not necessarily outright fallacious but it is certainly something that requires some significant justification. There is a rather large 'arbitrariness' overhead for assuming two contradictory measures of value in a way that happens to be convenient for a desired agenda that is above and beyond the arbitrariness of the assumptions considered separately.

The calculations and conclusions in this post are presented as shutting up and multiplying value when they can more realistically be considered a work of creative fiction. "17x" here would be better off replaced with "Over 9000" which at least has the correct connotations of "completely arbitrary large number that indicates that I think the value is significant but is meaningless as a quantisation of anything".

Unfortunately talking about the Virtuous Cause seems to turn off people's critical reasoning capabilities but that only works when preaching to the already converted. AMF is an actually high value cause. It doesn't need sloppy and misleading calculation in order to justify it. That way people who aren't already true believers may accept the argument rather than discarding it at the first unreasonable assumption they encounter.

Comment author: elharo 23 June 2013 05:44:22PM *  0 points [-]

"To a first approximation, the immediate value of a year of your work is equal to the value of a year of your life."

This statement demonstrates a type error. The value of a year of work is not the same type of thing as the value of a year of life. They are not comparable. We cannot meaningfully compare one to the other, or exchange one for the other. The value of each is found in a different set of intrinsic goods.

Comment author: arundelo 23 June 2013 09:27:21PM 0 points [-]
Comment author: elharo 23 June 2013 10:51:07PM 0 points [-]

Yep, thanks. Link corrected.

Comment author: army1987 22 June 2013 08:30:42AM 0 points [-]

Suppose that the value of a year of your own life is no more than 3x the value of a year of life saved.

The latter is how much that person values their own life, or how much I value it? Since I'm not perfectly selfless, the latter is smaller than the former.

Comment author: JonahSinick 22 June 2013 04:17:49PM 0 points [-]

I have in mind value according to a disinterested altruistic perspective.

Comment author: drethelin 23 June 2013 06:23:26AM 2 points [-]

Then you need to make an argument for why I or anyone else should take a disinterested altruistic perspective rather than our own interested one.

Comment author: hen 21 June 2013 09:00:24PM *  0 points [-]

The reader can draw his or her own conclusion from this. It seems likely to me that the average life in the developing world is worth living,

I don't ask this in the spirit of any disagreement (your post seems to me to be well reasoned), but just curiosity: what do you mean by 'worth living'? What sorts of things need to be present for a life to be worth living? Is it just that, say, my life is worth living if I would choose to live rather than painlessly die on a given day?

Comment author: DanielLC 21 June 2013 10:06:39PM 6 points [-]

What if someone has an instinct that makes them not want to die, but that in no way increases how much they enjoy life?

Comment author: army1987 22 June 2013 08:36:54AM *  1 point [-]

Someone might not find their own life worth living but still not commit suicide because e.g. they don't want their children to mourn them, they think that if they killed themselves they would go to hell whereas if they endured life they might eventually go to heaven, because there's no reliable way of committing suicide available to them, etc.

ISTR negative utilitarians claiming that that's the case for a sizeable fraction of people.

Comment author: hen 22 June 2013 04:12:33PM 0 points [-]

ISTR negative utilitarians claiming that that's the case for a sizeable fraction of people.

Yeesh, that's grim. Okay, so if that's a problematic standard, would you care to take a swing at the question? The idea of a 'life worth living' appears to be an important part of how we think about EA, but I'm not sure what it means.

Comment author: army1987 22 June 2013 04:33:41PM *  0 points [-]

Me neither. ISTR that EY puts the bar at “lives worth celebrating”, but that depends on you already having intuitions about which lives to celebrate.

(Personally, I think that a supermajority of human lives today are worth living/celebrating, but I'm not terribly confident about this.)

Comment author: JonahSinick 21 June 2013 09:39:42PM 0 points [-]

Yes.

Comment author: hen 21 June 2013 09:42:08PM 2 points [-]

Can I be wrong about whether my life is worth living?

Comment author: JonahSinick 21 June 2013 11:11:45PM *  0 points [-]

Maybe, if you misremember what's happened in the past or incorrectly predict what will happen in the future.

Comment author: hen 21 June 2013 11:35:58PM 0 points [-]

But I can't be wrong about the value of my life if I'm clear-eyed about the past and future?

Comment author: JonahSinick 22 June 2013 12:50:38AM 0 points [-]

I wasn't making a claim about that. Do you have a certain hypothetical in mind?

Comment author: hen 22 June 2013 02:02:22AM 0 points [-]

Well, suppose I'm a successful assassin: my life seems to me to have very high utility, but in fact I am the source of overwhelming net disutility. I take my life to be worth living, but you might think if I were clear-eyed about my situation, I would consider a painless death to be preferable than going on as before.

But that's just off the top of my head, I haven't really thought that through.

Comment author: JonahSinick 22 June 2013 02:30:11AM 0 points [-]

I was discussing immediate impacts rather than indirect consequences. Discussion of indirect consequences will follow.

Comment author: buybuydandavis 22 June 2013 06:55:21PM 0 points [-]

if one ignores indirect effects

Which means ignoring the things which I think make the most difference - communication and information.

Comment author: JonahSinick 22 June 2013 06:57:02PM 0 points [-]

I agree that the indirect effects probably make the most difference, and will be writing about this.

Comment author: elharo 23 June 2013 12:51:57PM *  -1 points [-]

It is reasonable to ask the question, “you may be able to save a life in Africa, but will the child child you save from malaria likely die from something else soon after?" The question here is simply how many life-years will a given amount of money actually save?

Indeed, this is a very real, non-hypothetical question in health care within the developed world today, particularly for the old and infirm. We have gone so far in the direction of heroic and expensive interventions to preserve life, that many patients and people who fear they may become patients are actively advocating for the right to refuse treatment and die with dignity. This has led to the development of living wills, for example. Much of this may be due to other factors such as an insanely inefficient and irrational (1) health care system and the reluctance of doctors to provide sufficient pain relief out of misplaced concerns about addiction and demonization of effective narcotics.

Even taking these into account, it is certainly reasonable to account for other likely causes of death when calculating the lives saved for dollar. If X dollars are sufficient to save the life of a five year old with a 65-year life expectancy or a 70-year old with a 10 year life expectancy, and X dollars are all you have to spend, then by all means save the five year old. This is an emotionally difficult choice, one I hope never to face, but it's not especially controversial or challenging.

However, I find it morally repugnant to go from there to the incredibly patronizing position that a year of life for a poor person in the developing world is worth less than a year of life of a rich person in the developed world. I take as one of my fundamental moral principals that "All men are created equal." (2)

I am frankly astonished that people would suggest that "an average year of life in the developing world is no more than 3x lower than the value of an average year of life in the developed world." (I am, of course, not surprised that people would act as if this were true, but most folks are far too polite to say it. I doubt most folks are even consciously aware of this preference.) Have people really suggested this to you? Is this really an expressed concern of donors? The ethnocentrism of such a position is staggering.

In my own moral system, the only approach I accept is that every currently existing (3) person's year of life is worth as much as every other currently existing person's year of life, no more, no less. One criterion I have for where to direct my charity dollars is that the organizations I donate to act as if that were true, which as has been pointed out many times before by GiveWell and others means that most of my donations are directed toward work in the developing world because the same money goes further there. I do not accept that a life in the Congo is worth less than a life in Paris, even if one is on average more pleasant than the other.

(1) In the economic, not LessWrong sense of the word "rational"

(2) I include the usual modern explication of this phrase to include people of both genders in "men", and the understanding that this means "that they are endowed ...with certain unalienable Rights, that among these are Life, Liberty, and the Pursuit of Happiness", not that everyone is identical. Boring, well-known, straw man caricatures of the meaning of "equals" in this context will be ignored.

Comment author: gjm 23 June 2013 07:40:48PM 2 points [-]

I have the impression that you're reading "no more than 3x lower than X" as meaning "<= X/3" when in fact I'm almost certain ">= X/3" is intended. In other words, the argument JonahSinick is making is: "You may consider that saving lives in the developing world is less valuable than saving lives in the developed world, because the extra years you provide that way are more pleasant ones; but even if so, it doesn't seem credible that there's more than a 3x difference, and even if we assume that developed-world years are 3x better to have than developing-world years it still comes out much more efficient to save developing-world lives".

There's an important distinction to make here, which I think makes it less reasonable to get outraged about such ideas. The things that may be less valuable in worse-off (poorer, less-developed, more disease-ridden, worse-governed) parts of the world aren't people or lives but years of life. A poor person in Somalia is every bit as important and valuable as a rich person in Norway, and perhaps more deserving in some sense on account of having had so much worse a life previously; but if your intervention gives one of them 20 extra years of life, the poor person in Somalia gets an extra 20 poor-person-in-Somalia-years and the rich person in Norway gets an extra 20 rich-person-in-Norway-years, and the latter are better years. The best thing would probably be to give the poor person in Somalia 20 extra rich-person-in-Norway-years, but that would be even more expensive than giving them to the rich person in Norway and therefore much less effective in benefit/$ than giving the poor Somalian an extra 20 poor-Somali-years.

(Suppose you cost of an extra 20 poor-Somali years for the poor Somali, and of an extra 20 rich-Norwegian years for the rich Norwegian, were the same. Should we then favour the Norwegian because s/he is getting much better extra years? Not necessarily; giving a smaller benefit to someone who's had a worse deal before might be better overall, helping poor Somalis may do more indirect good to others by helping the country grow, bad conditions in Somalia may be less unpleasant to those used to them and good conditions in Norway less pleasant to those used to them, etc. Again: the best thing, were it possible, would probably be to give the 20 extra rich-Norwegian-years to the poor Somali.)

Comment author: falenas108 23 June 2013 04:25:22PM *  0 points [-]

I haven't thought about this enough to come to a conclusion personally, but the argument phrased non-horribly would be:

"I would be ambivalent between living 1 year in a first world country, then dying, and living 3 years in a 3rd world country, then dying. If I treat everyone the same as myself, then I should be ambivalent between 3 years of life for someone in the first world and 1 year for someone in the third world."

However, one huge problem with this is you're taking your own morality and imposing it on others.

ETA: Re-reading the original post, it doesn't look like it's saying that first world is worth 3 times third world. It's saying that assume that you don't value your personal life more than 3x a random other person's, which is an entirely different argument.