by GiveWell, from Giving 101

We understand the sentiment that "charity starts at home," and we used to agree with it, until we learned just how different U.S. charity is from charity aimed at the poorest people in the world.

Helping people in the U.S. usually involves tackling extremely complex, poorly understood problems. Many popular approaches simply don't work. Many more approaches have simply never been investigated, beyond the stories and anecdotes.

In the poorest parts of the world, people suffer from very different problems. A child may die of malaria for lack of a $10 bednet, or of diarrhea for lack of a 5-cent packet of nutrients.

The table below illustrates the difference, comparing U.S.-focused charities to international charities.





Developing-world health

Against Malaria Foundation

Approximately $3,400 per life saved

Improve health, save lives

Early childhood care and education (U.S.)

Nurse-Family Partnership

$10,000 per child served

Increase academic performance and reduce criminal behavior

US Education


$7,500-$17,000 per student per year (including state funds)

Improve academic performance

Employment Assistance (NYC)

The HOPE Program

$10,000 per client served

Unclear, if any


We estimate that it costs the Against Malaria Foundation approximately $3,400 to save a human life. This includes transportation, administration, etc. Compare that with even the best U.S. programs: the Nurse-Family Partnership and KIPP both cost over $10,000 per child served, and their impact is encouraging but not overwhelming.

This is not to say that developing-world aid is easy or simple. Some activities are highly proven and cost-effective; others have very poor track records. As in the U.S., generating evidence of impact (not just stories) is essential.

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The problem is that international charities are also tackling complex, poorly understood problems. Charities like AMF oversimplify these problems since the donors will generally never visit the actual people that they are donating to, and therefore will never realize all of the harm that AMF has ignored and failed to measure. Local charities have greater accountability, since the people that are being served can actually be connected to the donors. When the only data we have is from the charity itself, it is easy for the charity to ignore the long term harm, and only measure the short term impact. Here's the full argument

What is the most effective charity at saving lives in the U.S.? The reason I'd like to know is to tell people who are considering EA just how much more good they can do by donating to charities working in developing countries. I'm thinking the most effective U.S. intervention would either be a campaign against smoking, a campaign against drunk driving, or a child mortality reduction program.

It seems plausible that might be one of the most effective charities for saving lives in the US. Michael Greger and his team distill nutrition research to provide practical tips on what to eat to prevent heart disease, cancer and other top killers. The website has more than one million hits a month, so it seems likely that his research saves hundreds if not thousands of lives a year.

Their 2014 revenue was $571,178. So it seems plausible that nutritionfacts is saving lives at around approximately $1,000 per life saved.

As a bonus, he advocates for a plant based diet, so it seems like his research could lead to a reduction of factory farming. I have wondered if they have more room for funding for advertising their website.

Note that the this article was written over a year ago and $3,400 is on the more optimistic side of Givewell's more recent estimates