The lack of controversy over well-targeted aid

by GiveWell6 min read6th Nov 2015No comments

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GiveWellForeign aid skepticismGlobal health and development
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There are a number of high-profile public debates about the value of overseas aid (example). These debates generally have intelligent people and arguments on both sides, and they rightly give many people the sense that “Does aid work?” is a complex question with no simple answer.

However, we believe these debates are sometimes misinterpreted, causing unnecessary confusion and concern. Specifically, people sometimes ask questions along the lines of: “Since many well-informed people believe that aid does more harm than good, should I believe that GiveWell’s top charities are even helping?”

We believe that the most prominent people known as “aid critics” do not give significant arguments against the sorts of activities our top charities focus on, particularly with respect to health interventions. Instead, their critiques tend to focus on the harms of government-to-government aid, particularly when it is not effectively targeting those most in need and not effectively focusing on interventions with strong track records.

While we seek out and acknowledge the possible downsides of our top charities’ work (example), we don’t see a serious case to be made that the harms outweigh the benefits. Going through each potential harm and discussing how it relates to our top charities could make for a lengthy writeup (note that we address many potential harms in our research FAQ); this post has the simpler goal of discussing the people best known as “aid critics” and establishing that they provide few (if any) arguments against the sort of work our top charities carry out.

We focus on the three people we believe are best known as aid critics: Bill Easterly, Angus Deaton and Dambisa Moyo.

William Easterly

William Easterly has debated Jeffrey Sachs on the merits of ambitious aid programs and written several books questioning the effectiveness of what he calls “the West’s efforts to aid the rest.”

The best-known such book is probably The White Man’s Burden, which contains the following passage:

Once the West is willing to aid individuals rather than governments, some conundrums that tie foreign aid up in knots are resolved … Shorn of the impossible task of general economic development, aid can achieve much more than it is achieving now to relieve the sufferings of the poor … Put the focus back where it belongs: get the poorest people in the world such obvious goods as the vaccines, the antibiotics, the food supplements, the improved seeds, the fertilizer, the roads, the boreholes, the water pipes, the textbooks, and the nurses. This is not making the poor dependent on handouts; it is giving the poorest people the health, nutrition, education, and other inputs that raise the payoff to their own efforts to better their lives.

His other writings seem broadly consistent with this message. For example, "Can the West Save Africa?" looks at the track record of several broad classifications of aid, emphasizes the strong results from health-oriented aid (pages 53-62). The abstract states: “This survey contrasts the predominant ‘transformational’ approach (West saves Africa) to occasional swings to a ‘marginal’ approach (West takes one small step at a time to help individual Africans) … the ‘marginal’ approach has had some successes in improving the well-being of individual Africans, such as the dramatic fall in mortality.”

We have some disagreements with Prof. Easterly. But the brunt of his critiques of aid seem directed at a different kind of aid from that represented by our top charities, and as discussed above, he explicitly expresses a more positive attitude toward aid that focuses on relatively simple interventions aiming to help individuals directly.

Angus Deaton

Angus Deaton has received a fair amount of attention recently for his criticism of aid. He is the author of The Great Escape, which discusses the major and unequal improvements in wealth and health over the last 250 years and is quite skeptical of the role of aid. Recently, he won the Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel.

Prof. Deaton seems to be positive on a particular kind of aid that has some overlap with the kind promoted by Prof. Easterly.

His book states:

Health campaigns, known as “vertical health programs,” have been effective in saving millions of lives. Other vertical initiatives include the successful campaign to eliminate smallpox throughout the world; the campaign against river blindness jointly mounted by the World Bank, the Carter Center, WHO, and Merck; and the ongoing— but as yet incomplete— attempt to eliminate polio.

Later in the book, he states: “There may … be cases in which aid is doing good, at least on balance. I have already made that case for aid directed toward health.”

He particularly mentions “the classic public goods of public health provision, such as safe water, basic sanitation, and pest control” as a promising fit for aid, stressing their suitability for “low-capacity settings.”

Much of his book argues that aid has not played a major (if any) role in the biggest improvements in wealth and health. It also points out the extent to which much aid is mistargeted:

One reason why today’s aid does not eliminate global poverty is that it rarely tries to do so. The World Bank flies under the flag of eliminating poverty, but most aid flows come not through multilateral organizations like the Bank but as “bilateral” aid, from one country to another, and different countries use aid for different purposes. In recent years, some donor countries have emphasized aid for poverty relief, with Britain’s Department for International Development (DFID) one of the leaders. But in most cases, aid is guided less by the needs of the recipients than by the donor country’s domestic and international interests. This is hardly surprising given that donor governments are democratic and are spending taxpayers’ money.

Like Prof. Easterly, Prof. Deaton does not specifically address GiveWell’s top charities. He expresses great skepticism of Peter Singer’s thought experiments and of being too literal/linear in estimating things like the “cost per life saved” (a view we share to some degree). But his work does not seem to provide much basis for accusing relatively simple, targeted aid programs (particularly those focused on public health) of doing harm.

Dambisa Moyo

Dambisa Moyo is the author of Dead Aid: Why Aid Is Not Working and How There Is a Better Way for Africa. She is harshly critical of aid in general, and accuses it of doing active harm. However, she is also quite explicit that her book concerns only government aid, not private charity:

But this book is not concerned with emergency and charity-based aid … Besides, charity and emergency aid are small beer when compared with the billions transferred each year directly to poor countries’ governments.

In 2013, she reiterated this point in response to Bill Gates’s criticism of her: “I find it disappointing that Mr. Gates would not only conflate my arguments about structural aid with those about emergency or NGO aid, but also that he would then use this gross misrepresentation of my work to publicly attack my knowledge, background, and value system.”

Bottom line

The people discussed above raise many potentially important criticisms of aid. They question whether it has lived up to its ambitions, whether it has contributed meaningfully to economic growth, whether certain forms of it empower abusive governments, and more. But they are all also fairly explicit about the limits of their critiques.

Our current top charities focus on (a) focused public-health programs, bringing proven interventions to fight diseases (malaria and parasitic infections) that are essentially unknown in the U.S.; (b) direct cash transfers, generally structured as one-time transfers to avoid dependency. I think one has to stretch quite a bit to argue that these sorts of interventions are doing net harm, and I don’t think the arguments of prominent aid critics – important though they may be in many contexts – provide grounds for such an argument.

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