What is the cost-effectiveness of GiveWell's top life-saving charities under total utilitarianism?

By Vasco Grilo🔸 @ 2022-04-22T17:22 (+14)

According to this report from David Roodman, deaths of young childs could lead to additional births:

"Looking within families in Uttar Pradesh in the decades up to 1999, a context in which fertility was high but had begun to fall, Bhalotra and van Soest 2008 finds partial replacement, with 0.37–0.52 extra births for each neonatal death".

Consequently, the cost-effectiveness of GiveWell top life-saving charities (e.g. in multiples of cash transfers) could be smaller under total utilitarianism (as has been discussed here). For example, the cost-effectiveness would be about 50 % lower for the above estimate of the replacement effect (neglecting longterm effects).

What is the cost-effectiveness of GiveWell top life-saving charities in terms of total additional years of healthy life per dollar? How different from 0.01 year/$^[1]?

^{^}
Estimated as follows:
- GiveWell top life-saving charities avert one death for about 4.5 k$.
- According to this post from Open Philanthropy, "GiveWell uses moral weights for child deaths that would be consistent with assuming 51 years of foregone life in the DALY framework (though that is not how they reach the conclusion)".
- Consequently, the cost-effectiveness of GiveWell top life-saving charities is 51 DALY / 4.5 k$ = 0.01 DALY/$.

Alexander_Berger @ 2022-04-23T05:32 (+3)

This isn't an answer to the question, but two additional considerations I think you're missing that point the opposite direction and I think would make AMF look even better than GiveWell counts it as, on the total view:

There's some evidence that bednets lead to higher fertility and that channels sound somewhat intuitively plausible.
Roodman's report is only counting the first generation. If preventing two under-5 deaths leads to ~one fewer birth, that's still one more kid net making it to adulthood and being able to have kids of their own. Given fertility rates in the places where AMF works, I think that would more than offset the Roodman adjustment in just a few decades.

I haven't seen any concerted public attempts to grapple with these factors or to think about how to bound the considerations in #2 in a way that would lead to a numerical answer to your question. I would be curious if people have other references to point to on this.

Vasco Grilo @ 2022-04-23T07:56 (+3)

Thanks for the feedback! Some thoughts:

That evidence supports an increase in fertility, but only in the very short term. From the abstract:
- Abstract: "The effect on fertility is positive only temporarily – lasting only 1-3 years after the beginning of the ITN distribution programs – and then becomes negative. Taken together, these results suggest the ITN distribution campaigns may have caused fertility to increase unexpectedly and temporarily, or that these increases may just be a tempo effect – changes in fertility timing which do not lead to increased completed fertility".
- Conclusion: "In contrast, our findings do not support the contention that erosion of international funding for malaria control, specifically of ITNs, would lead to higher fertility rates in the short-run. While our results are suggestive that this may be the case for long-run fertility, we show the exact opposite for the short-run".
  - If the results are suggestive that decreasing ITNs leads to higher long-run fertility, AMF would tend to decrease longterm fertility.
Yes, I wrote "neglecting longterm effects" above to signal that Roodman's report did not refer to the longterm effects on population size, but thanks for clarifying!
Besides modelling the longterm effects on population size, it would also be important to determine how harmful/beneficial is a given change in population size (e.g. as a function of the country).

Alexander_Berger @ 2022-04-23T21:01 (+2)

Agree that the paper leaves open the ultimate impact on completed fertility and on your #3. On #2 - I think it would be a mistake to try to adjust for this and neglect long run effects, as in your estimate in fn1.

Vasco Grilo @ 2022-04-24T00:29 (+2)

I agree, and have adjusted the text and footnote accordingly.

Vasco Grilo @ 2022-07-31T16:46 (+1)

Carl Shulman has discussed the Flow-through effects of saving a life through the ages on life-years lived.