TL;DR version: Mental illness is probably much worse than poverty or physical illness. Interventions which change how people think - i.e. reduce mental illness and increase happiness - may be more cost-effective ways of increasing happiness than AMF or Give Directly. I outline some new opportunities EA should look into.
Update (18/06/2017): this paper is now slightly out of date. It doesn't reflect my latest thinking and contains some errors. For one, it was unhelpful to compare saving lives (preventing premature deaths) to improving lives (increasing the average happiness within a life) as there are multiple views you can have about the value of saving lives. For more on that, see this post questioning anyone should want to give to AMF.
Longer version:
Hello EAs,
I don't really use the forum but I've been encouraged by others (Rob Wiblin of 80k, Joey Savoie of Charity Entrepreneurship) to share some of my research I've discussed with them here. I've written a 5,000 word draft paper "What should a billionaire do to maximise world happiness" as a potential draft chapter in my PhD where I argue EA currently overlooks human happiness and mental health.*
Here's the summary of main points which I discuss in greater depth in the draft:
1. Effective altruism has so far focused on "external happiness interventions" (EHIs) which aim make people happier by changing their external circumstances (e.g. poverty, malaria). It's neglected "internal happiness interventions" (IHIs) which try to increase happiness by changing how people think (e.g. mental health treatments).
2. It's very plausible, but as yet untested, that some Internal Happiness Interventions might turn out to be more effective than our current EHIs such as Give Directly or AMF.
3. Mental health and ordinary human unhappiness (e.g. 'normal' stress, worry, sadness) are big. The former affects 700m+ (depends how you count it) and everyone suffers from the latter.
4. Our intuitions about how happiness works are very misleading. We adapt to lots of changes (hedonic adaptation) are a very bad at correctly predicting how we'll feel in the future (affective forecasting). For instance, people in poverty are not as unhappy as you imagine they are.
5. It's questionable whether cash transfers to those in poverty will increase happiness. The only RCT into Give Directly showed their cash transfers had no long-term effect on life satisfaction scores. The trial showed GD's recipients did have increased life satisfaction in the short-term (6 months) but that the non-recipients had their life satisfaction go down by more than recipients' went up. This suggest Give Directly's work does not increase happiness (taking 'happiness' as 'life satisfaction'). More research is needed.
6. QALYs/DALYs very likely underrate the badness of mental health conditions on happiness. First, they are measures of health, not happiness. Second, their weighting are creating by asking people how bad they expect various conditions to be, rather than assessing asking people with those conditions to report their subjective well-being. As mental health conditions are hard to imagine and hard to adapt to, their are underrated. As a estimate that can definitely be argued about, they might be 10-18 times worse than we imagine them to be.
7. Putting all this together, I guess that mental health and ordinary human unhappiness cause 4-72 times more misery each year to living people than do poverty and malaria combined (see Annex B of my paper). This shouldn't be taken too seriously, it's just to get a sense of scale.
8. Mental health and ordinary unhappiness unhappiness might be surprisingly tractable. There are quite a few methods which seem to work for both of them: cognitive behavioural therapy, mindfulness-based stress reduction and positive psychology to name the most promising. They can be delivered in person and, also exciting, electronically. Anti-depressants also seem to be somewhat effective (although I don't discuss this in the paper).
9. No one has really tried to disseminate these widely. Therefore promising strategies for EA are: digital public health campaigns for happiness/mental health; setting up new charities in the developing world to deliver in-person therapy and drugs ("AMF for Prozac" H/T Rob Wiblin); lobbying developed world governments to do stuff.
10. Once you revise the $/DALY cost-effectiveness figures to take into account how DALYs underrates happiness, it's possible treatments for depression at around $1000/DALY (such as by Stronger Minds) are in roughly the same ball park as AMF, which is $100/DALY (this gets confusing when you account for the badness of death). Given that mental health treatment is new compared to physical health treatments, there is good reason to be optimistic that our mental health treatments will get much more effective in the future.
11. I discuss some of the objections. Most relevant: if you already think X-risk is the biggest problem, my argument probably won't bite. If you support AMF or Give Directly, I think you should reconsider those and join me. If you support animal welfare you may want to reconsider depending on how cost-effective you think animal interventions are at present.
Feedback and thoughts would be very welcome. Because of I think human happiness is neglected I've working on a happiness app, Hippo, that I'd also be delighted to talk to people about (note: you might think this makes my above argument biased, or you might think is me trying to be consistent. Up to you)
Michael
*I'd like to credit Konstantin Sietzy, with whom I co-wrote an earlier version of the paper. I'd like to thank Hilary Greaves (my PhD supervisor), Michelle Hutchinson, John Halstead, Hauke Hillebrandt, James Snowden and probably other people I've now forgotten for their helpful comments.
Hello Ben and thanks for your comments!
I think I'm substantially more pessimistic than you are about the role economic growth has in making people happier ('happiness' conceived either as life satisfaction or emotional experiences). So I buy the story that Give Well charities make people healthier, this allows them to get an education, this helps them become richer and so help their children, but I'm sceptical that any of this increases happiness.
For instance I came across this analysis of the Easterlin Paradox yesterday (http://bit.ly/28XXisi) which looked at GDP and life satisfaction scores of European countries over the last 40 years. I emailed the author for some clarification and he explained "if long run growth increased by 1%[per year], then life satisfaction would rise from 3 to 3.0027" (life satisfaction was measured on a 1-4 scale). So he thought economic growth was statistically significant but not interesting as far as life satisfaction is concerned.
All this seems quite surprising. As far as I know there is lots of evidence suggesting economic growth doesn't do much/anything for happiness - including the Haushofer (2015) paper into Give Directly, but almost none indicating growth would increase happiness. If you know of any, please send it to me, because this seems strange.
As a debunking explanation for why we think money matters when it doesn't, I think it helps to remember we're not very good at affective forecasting. When we think about wealth it seems important ("I'd be so much happier if I were on a yacht right now") but we forget we'll adapt to whatever it is, focus on other things, and that our being wealthier will make other people feel comparatively less wealthy.
I agree there's more work to be done in terms of comparing the flow-through effects (I'm still not really sure what these are - is this just about economic growth? Could you provide a link to where I can read about them?) of mental health to physical health. A quick scan suggest the former is also bad, but I'm not sure how bad. This is probably the most relevant point for those concerned about the very long run. On this one, I think I'm probably more optimistic than you about how low the low-hanging mental health fruit are. AFAIK, no one has really tried to pick them and find out.
Regarding your last paragraph I'm not sure physical health interventions do a whole lot better than mental health ones. I think physical health is a lot easier to imagine and show progress on because you can see it. One of my general concerns is I don't think we currently do a very good job of measuring human suffering (i.e. via QALYs) and we're relying too heavily on our intuitions about the imagined badness of various things. I'm also hopeful that, with digital technology, we may find it's much easier to treat mental health because those often receive cognitive rather than physical interventions. Maybe at some point in the future we're consider physical health problems, which require a real human to help you, as the complicated ones.