EA has growing communities in low and middle-income countries. Off the top of my head: Philippines, Nigeria, South Africa, Kenya.
This is very good. It also means that EA orgs and communicators should move away from "western-by-default" messaging and thinking[1].
Here's an instance of how assuming readers are all western can lead to wrong, or at least incompletely thought-through, conclusions.
EA thinking tends to lead people in the US/UK away from being doctors. I've heard "don't be a doctor if you care about people" used as a shorthand for the at-first-counterintuitive recommendations EA can sometimes give.
But, in poorer countries, it might be reasonable on EA grounds to be a doctor:
- There is a shortage of doctors in countries like Kenya -> higher direct impact
- Earning opportunities are much lower -> lower impact through counterfactual options [2]
It may be that it still nets out that being a doctor is not the best career choice for people in poorer countries. Seems pretty uncertain, because I don’t think anyone has thought about it in detail. In the 80k hours post, the top-level recommendation "people likely to succeed at medical school admission could have a greater impact outside medicine" is only backed up with evidence from US/UK.
Takeaway: As EA attracts people from all over the world, we need to move away from “western-by-default” communications to ensure people get the correct, and correctly-reasoned, advice.
- ^
In many circumstances it will still make sense to focus on a western audience for different types of communication. But this should be a decision based on the specifics of what you're communicating, not an unthinking default based on "all EAs are western"
- ^
Quick back of the envelope on this based on stats from an 80k interview with Gregory Lewis:
- Assume that over a UK career, a doctor saves saves 6 lives. You could do the same by donating ~$30k (assuming $5k per life saved)
- He says it could be 10x in a developing country (here he says it could be more like 40-50x). This would require donating $300k to offset
- A very very good job in Kenya would be earning $50k / year. Someone making that much and donating 10% would not donate $300k over their lifetime (unless they worked for 60 years)
- -> being a doctor looks pretty reasonable for someone in Kenya, relative to earning to give
Hi Gregory,
Very interesting analysis here, but I would add one potential drawback of moving to a high-income country: brain drain. In some countries, there is a lot of lost economic value that happens when highly skilled workers leave developing countries, and it appears that it sometimes (though not always) can harm economic growth. Harming economic growth in a developing country is a bad thing, and can potentially outweigh the benefits of earning to give. The second study I have linked focuses specifically on the negative effects of healthcare worker emigration in Kenya, and though it is a bit old, I think it's an interesting read.
I was also wondering if you can explain what you mean by "The effect size interval of 'physician density' crosses zero (P value ~ 0.4(!)). So with more sceptical priors/practices you might take this as a negative result." I haven't encountered some of these terms before so if you could explain them to me I would really appreciate it!
Just off hand-having spent a couple of months in a rural part of Kenya with a severe doctor shortage, the estimate of 1 'life saved' per year of Kenyan medical practice seems off to me, especially in rural areas, but I'm basing this purely off of discussions with people and anecdotal stories so I could be completely wrong. I've just heard a lot of stories of patients dying bc there wasn't enough available healthcare staff in the area. I do think you're right that investing in less intensive medical training like nursing is probably more cost-effective than investing in doctors.
Sources:
https://wol.iza.org/articles/brain-drain-from-developing-countries/long
https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-6-89