Should charity prioritise the worst off?

Hot off the press on the Giving What We Can blog:

Giving What We Can focuses on finding the charities which result in the most benefit to the greatest number of individuals. This means that we aggregate the benefits to different people additively rather than giving extra weight to worse off individuals. While our top charities tend to help some of the worst off people in the world, we do not explicitly factor considerations of fairness and equity into our cost-effectiveness calculations. There are good reasons for this:

1. It’s simpler. It can be very complex to add together different benefits and also weight them differently for different people. This is why academic literature on cost-effectiveness tends to aggregate benefits additively.

2. It’s less controversial. Aggregating these benefits additively relies on the ethical intuitions everyone actually has. While egalitarians care about the distribution of benefits, they also care about total benefits. Different people may have very different ideas about how much weight to place on considerations of equity. It is easier to add your own weighting than to adjust ones that we have assumed.

3. It usually comes to the same answer. Those who are worst off are usually the easiest to help as there is more “low hanging fruit”.

We are certainly not suggesting that utilitarianism is the only plausible ethical theory (as has sometimes been suggested). But we do think that aggregating benefits additively provides a good starting point, which can then be supplemented by considerations of equity and fairness if required. We are aware that many of our members (and staff) think that prioritising helping the worst off may be of intrinsic importance, for either prioritarian or egalitarian reasons (for the purposes of this post we will refer to both as egalitarian). Recently, we’ve been thinking more about how our recommended charities fare on these ethical dimensions.

In this post, I will argue that:

1. Additive benefits are the most important consideration when choosing an effective charity. However, when the cost-effectiveness of charities is sufficiently close, it may be reasonable to factor in considerations of fairness and equity.

2. All our top charities fare well on considerations of fairness and equity. This is unsurprising given that they are all charities which help children with preventable diseases in poorer countries.

3. Against Malaria Foundation (AMF) fares particularly well on fairness and equity grounds as it prevents a disease with a high individual disease burden which affects the economically disadvantaged.

4. It is possible that there are other comparably cost-effective charities which do better than some of our charities on fairness and equity. However, AMF sets a high bar, as it is estimated to save a life for about $3,000, and children who die under the age of 5 are certainly among the very worst off globally.