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
Hello Luke,
I suspect you are right to say that no one has carefully thought through the details of medical career choice in low and middle income countries - I regret I certainly haven't. One challenge is that the particular details of medical careers will not only vary between higher and lower income countries but also within these groups: I would guess (e.g.) Kenya and the Phillipines differ more than US and UK. My excuse would be that I thought I'd write about what I knew, and that this would line up with the backgrounds of the expected audience. Maybe that was right in 2015, but much less so now, and - hopefully - clearly false in the near future.
Although I fear I'm little help in general, I can offer something more re. E2G vs. medical practice in Kenya.
First, some miscellaneous remarks/health warnings on the 'life saved' figure(s):
Anyway, bracketing all the caveats and plugging in Kenya's current physician per capita figure into the old regression model gives a marginal response of ~40 DALYs, so a 15x multiplier versus the same for the UK. If one (very roughly) takes ~20-40 DALYs = 1 'life saved', each year of Kenyan medical practice roughly roughly nets out to 5-10k USD of Givewell donations.
As you note, this is >>10% (at the upper end, >100%) of the average income of someone in Kenya. However, I'd take the upshot as less "maybe medical careers is a good idea for folks in lower-income countries", but more "maybe E2G in lower-income countries is usually a bad idea" as (almost by definition) the opportunities to generate high incomes to support large donaions to worthy causes will be scarcer.
Notably, the Kenyan diaspora in the US reports a median houshold income of ~$61 000, whilst the average income for a Kenyan physician is something like $35 000, so 'E2G + emirgration' likely ends up ahead. Of course 'Just move to a high income country' is not some trivial undertaking, and much easier said than done - but then again, the same applies to 'Just become a doctor'.
Brian drain is an interesting topic. The brief research and thinking I've done on brain drain leaves me without clear answers as to what an individual facing a decision to emigrate should actually do.
Even if it is in aggregate bad that so many people move from poorer to richer countries (which is not obvious to me), it could still be the rational thing to do on an individual basis.
I would love to see a sort of guide based on EA-principles written for people in low-middle income countries considering moving to higher-income countries.
- what are the benefits y
... (read more)