Health in poor countries problem profile

By Robert_Wiblin @ 2016-04-01T17:59 (+14)

This is a linkpost to https://80000hours.org/problem-profiles/health-in-poor-countries/

Summary

Every year around ten million people in poorer countries die of illnesses that can be very cheaply prevented or managed, including malaria, HIV, tuberculosis and diarrhoea.

Around $100 is spent on the healthcare of the poorest 2 billion people per capita each year (adjusted for purchasing power). As a result there remain many opportunities to scale up treatments that are known to prevent or cure these conditions.

Options for working on the problem include serving as a donor to effective projects, working as an economist in intergovernmental organizations such as the World Bank or World Health Organization, or starting or working in a nonprofit that scales up proven treatments.

Our overall view

Sometimes recommended

This is a pressing problem to work on, but you may be able to have an even bigger impact by working on something else.

Scale^[1]  

We think work to alleviate global health problems has the potential for a large positive impact. The damage done by easily preventable diseases in the least developed countries plus India amounts to between 200 million DALYs and 500 million DALYs per year.^[2]

Neglectedness^[3]  

This issue is much less neglected than most others we prioritise. Current spending in the least developed countries plus India is about $300 billion per year.

Solvability^[4]  

Making progress on alleviating global health problems seems highly tractable. It is mostly a matter of scaling up approaches that are known with near certainty to work if done correctly.

Profile depth

Exploratory ^[5]

This is one of many profiles we've written to help people find the most pressing problems they can solve with their careers. Learn more about how we compare different problems, see how we try to score them numerically, and see how this problem compares to the others we've considered so far.

What is the problem?

Every year around ten million people in poorer countries die of illnesses that can be very cheaply prevented or managed, including malaria, HIV, tuberculosis and diarrhoea. Tens of millions more suffer from persistent undernutrition or parasitic diseases that cause them to be less mentally and physically capable than they otherwise would be.

Why is this problem pressing?

What is our recommendation based on?

Focussing on basic health treatments in the developing world is supported by GiveWell, the Global Priorities Project, the Copenhagen Consensus. In addition to that the Bill and Melinda Gates Foundation with which we share many values, spends most of its money on this cause. Our recommendation is a compilation of their findings, as well as basic data from the Global Burden of Disease and World Bank, among others.

Why is it pressing?

These diseases cause unnecessary suffering and death both to victims and their families. They also lead to a range of other negative effects:

• Lower educational attainment.
• Lethargy and reduced ability to think and work.
• Worse health later in life.
• Higher birth rates to compensate for infant mortality.

In many cases these diseases or their impacts can be largely eliminated with cheap technologies that are known to work and have existed for decades. For example:

• Malaria is prevented by insecticide-treated bednets.
• TB is almost always cured by sustained treatment with antibiotics (so called DOTS).
• People with HIV live nearly normal lifespans, and rarely pass on the virus to others, if promptly and consistently treated with anti-retroviral drugs.
• Diarrhoea can be prevented through better sanitation, and death prevented by oral rehydration therapy.
• Parasitic diseases can be cured with a pill that costs under $1 a year.
• A range of other diseases can be prevented through the the basic vaccination program (e.g. diphtheria, whooping cough, etc).

While the cost-effectiveness of the above approaches ranges quite widely, they can in most cases generate an extra year of healthy life for under $1,000, in a few cases for less than $100.

Over the last 60 years, death rates from several of these diseases have been more than halved using these techniques, suggesting a very clear way to make progress.

What are the major arguments against it being pressing?

• You might think that it is not a particularly neglected problem, given it is very widely recognised and is funded by organizations, including aid agencies, with billions of dollars to spend each year. Governments in developing countries are also making significant progress in improving health, although some gaps certainly remain in practice. In this view it will be hard to find exceptional opportunities because there are so many other people trying to do so.
• You might worry that reducing poverty and improving health in poor countries will not have major long-run effects on the future, which will instead be determined in other ways, for example through war or the invention of new technologies.
• You might think that other means for reducing poverty will be more effective, such as reforming government and legal institutions in developing countries.

Key judgement calls made to prioritise this problem

• That the lives of people in other countries are not much less important than the lives of people in the country you (probably) live in.
• That improving health will cause developing countries to become sustainably richer and nicer to live in, for example by reducing fertility or improving education and governance.

What can you do about this problem?

What’s most needed to contribute to this problem?

Deliver basic health services to all people who have or are at risk of contracting easily prevented contagious diseases. For example:

• Get all children to receive the basic schedule of vaccinations (currently around 85% do). ² (Listen to our 2021 podcast with Varsha Venugopal about recent work in this space.)
• Get everyone exposed to malaria sleeping under bednets. Currently a bit over half of people in the relevant parts of Africa have access to bednets. ³
• Get all TB cases treated – currently at least a third are not diagnosed. ⁴
• Ensure everyone has access to clean drinking water – currently at least a billion people do not.⁵

This is primarily a funding and logistical issue. The treatments are usually simple and do not require advanced medical training to deliver (though treatment of TB and HIV requires medical oversight).

What skill sets and resources are most needed?

• The ability to fundraise large sums, or move money within bureaucracies to better projects.
• People with on-the-ground logistical skills in international development (i.e. the kind of person who could get 100,000 malaria nets distributed in Africa).
• Entrepreneurs (mostly in nonprofits but also sometimes for-profits) who could found one of these charities.
• Development economists and cost-effectiveness researchers, including economists, statisticians and disease control experts.
• Money to fund GiveWell recommended charities.

We think that people capable of starting outstanding projects in this area are likely to be able to attract the necessary funding, making the area mostly talent constrained.

Who is working on this problem?

• See our extended list of places to potentially apply to work at within this cause.
• Domestic health departments in developing countries.
• A range of foundations such as the Bill and Melinda Gates Foundation and Children’s Investment Fund Foundation.
• Also intergovernmental organizations such as the World Health Organization, Global Alliance for Improved Nutrition, GAVI, World Bank, and the Global Fund.
• A range of NGOs such as Doctors Without Borders, CARE, UNICEF and Evidence Action.

What can you concretely do to help?

• Donate to a GiveWell recommended charity today.
• Take the Giving What We Can pledge to donate at least 10% of your income to people in extreme poverty.
• Plan a career around founding a new global health nonprofit – see our profile for next steps.
• Apply to work at GiveWell (example research role) or at one of these dozens of organisations in the field.
• Study an economics PhD, then apply your skills to development, for example by working in an intergovernmental organization such as the World Bank or World Health Organization.
• Become a grantmaker in a foundation that funds (or could fund) global health projects, for example the Gates Foundation.
• Get a job in any organization scaling up proven health treatments, for example Against Malaria Foundation, SCI, Stop TB, Evidence Action and Project Healthy Children.
• Become a biomedical researcher and work on better ways to prevent neglected diseases of the poor.

Some especially recommended organisations

• GiveWell conducts thorough research to find the best charities available to help people in the developing world. See current vacancies.
• The Center for Global Development is a U.S. nonprofit think tank that focuses on international development. See current vacancies.
• Evidence Action scales proven interventions to improve life for the global poor. Their Deworm the World Initiative is one of GiveWell’s top-rated charities. See current vacancies.
• Charity Entrepreneurship helps people start new charities that have the potential to become recommended by GiveWell.
• Against Malaria Foundation is one of charity evaluator GiveWell’s top charities and provides funding for antimalarial bed net distributions.
• Schistosomiasis Control Initiative is one of charity evaluator GiveWell’s top charities and works with governments across Sub-Saharan Africa and Yemen to develop national schistosomiasis control programmes.
• Innovations for Poverty Action is a nonprofit research and policy organisation which, since its inception in 2002, has conducted over 600 randomised controlled trials and other evaluations. See current vacancies.
• GiveDirectly, one of GiveWell’s top-rated charities, distributes unconditional cash transfers to people living in East Africa. See current vacancies.

Related issues

Our impression is that treating and preventing infectious diseases, especially malaria, is the most cost-effective health intervention right now.

There are two other sub-issues within global health, however, that seem worth highlighting:

• Smoking in developing countries — while smoking rates in the US and UK have been falling, smoking in China and the developing world is on the rise, bringing a large health toll. Read more.
• Pain relief — most people around the world lack access to adequate pain relief, which leads to widespread suffering due to injuries, chronic health conditions, and disease. One natural approach is increasing access to cheap pain relief medications that are common in developed countries. One group working in this area is the Organisation for the Prevention of Intense Suffering. Read more.

Further reading

• Podcast: Karen Levy on fads and misaligned incentives in global development, and scaling deworming to reach hundreds of millions.
• Podcast: Finding the best charity requires estimating the unknowable. Here’s how GiveWell tries to do that, according to researcher James Snowden.
• Podcast: We can use science to end poverty faster. But how much do governments listen to it anyway?
• Podcast: Ofir Reich on using data science to end poverty and the spurious action/inaction distinction
• Podcast: The nonprofit that figured out how to massively cut suicide rates in Sri Lanka, and their plan to do the same around the world
• Podcast: Dr Eva Vivalt’s research suggests social science findings don’t generalize. So evidence-based development – what is it good for?
• Podcast: James Tibenderana on the state of the art in malaria control and elimination
• Career profile interview with Catherine Hollander and Olivia Larsen, research analysts (outreach focus) at GiveWell
• See our related profile on smoking in the developing world.
• Is it fair to say that most social programmes don’t work?
• One of the most famous essays on this topic is Famine, Affluence and Morality by Peter Singer.
• Toby Ord wrote about why it’s particularly important to make sure health resources are spent in a cost-effective manner: The Moral Imperative Towards Cost Effectiveness.
• Millions Saved, a book about global health successes.
• GiveWell reports on different health interventions.
• Copenhagen Consensus Centre research.
• Disease Control Priorities Project.
• Wikipedia entry on global health.
• Giving What We Can’s research
• The Global Burden of Disease study.

This work is licensed under a Creative Commons Attribution 4.0 International License.

1. ^{^}

   If we solved this problem, by how much would the world become a better place? Read more.

2. ^{^}

   The population of these countries is around 2 billion. To prevent 100 million DALYs each year each person in these countries would have to be given an average of 1/20th of a DALY each year. Given an existing life expectancy of around 65, this would require extending life expectancy by 3.25 years, or the equivalent in improved quality of health. This seems possible and if anything small relative to health gains achieved by other countries that have eliminated easily prevented diseases in the past.

3. ^{^}

   How many resources are already being dedicated to tackling this problem? Read more.

4. ^{^}

   If we doubled direct effort on this problem, what fraction of the remaining problem would we expect to solve? Read more.

5. ^{^}

   We've made an initial evaluation of this problem by speaking to advisors and looking at preliminary research.