Akhil
Posts 8
Comments45
Topic Contributions1
Hey Sanjay, thanks for your comment
- Internal validity-I think it is important to bear in mind there are a number of high quality RCT's conducted with low quality of bias- given that, although this might not feel like it has as strong an evidence as bednets or vaccines, it does have a strong evidence base. You can see the cRCTs here- Abramsky et al (2014), Dunkle et al (2020), Leight et al (2020), Wagman et al (2015), Ogum Alangea et al (2020), Le Roux et al (2020), Chatterji et al (2020).
- On surveys- To summarise, the concern you raise is that the programs aim to reduce social acceptability of VAWG, and mostly use local interviewers to assess incidence of violence, which may introduce social acceptability bias. Although this seems plausible, interviews were trained, conducted privately and used validated questionnaires. To quote one paper
The study was conducted in accordance with WHO guidelines for the safe and ethical collection of data on violence against women [[24]]. These guidelines seek to minimize reporting biases and risk of harm to both respondents and interviewers. At both baseline and follow-up, interviewers received at least three weeks of training on the ethical and methodological issues surrounding the conduct of a survey relating to IPV and HIV, as well as ongoing support during the course of the survey. Interviewers were all from the local area, and interviewed respondents of the same sex as themselves. Interviews were conducted in private settings, in Luganda or English, and were concluded by providing information on additional support services in the area. At baseline, interviewers conducting the baseline survey were blinded as to the allocation of the intervention. It was not, however, possible to keep follow-up interviewers blinded.
As a result, I think this risk of bias is quite low. Also, I think that inherently, any impact evaluation of interventions in this space would require surveys.
3. External validity- A valid concern. I have two comments: (1)There are a number of studies in different settings which show positive results, suggesting external validity. (2) Although cultural and social drivers of violence vary, the intervention is co-designed with community and quite locally tailored, which mitigates some of the concern around external validity.
4. Meta-comment- I think that some of my estimates of the persistence of effects were quite conservative, which may counterbalance slightly smaller discounts for external and internal validity
Great questions Joel
1- SO my impression is from looking at : (1) trends in VAWG over time (unfortunately mostly old data here) (2) differences in rates of VAWG depending on level of country economic development, that it seems unlikely that VAWG will decrease (at all, or at least to a moderate extent) by itself.
2- There is a bit of work on policy related interventions in this space, which had mixed results and were harder to map the cost-effectiveness of. My impression is that opportunistic identification of potentially promising policies that are tractable may be cost-effective, but that solely focusing on this may not be (that is purely my thoughts based on a few hours of reading broadly around policy changes in the space, and without a thorough deep dive).
3- Great to hear you are interested in researching this. Always happy to share all my knowledge and information!
Great question Michael, and I have a similar intuition. I have reached out to HLI to see if they would be interesting in working together on this. From a very brief literature search, there is a small but existent body of work that looks at the effect of VAWG on SWB. Here are a few papers I found that you might find interesting:
Hey Joel, great report- overall, I am also pretty excited about interventions for hypertension. A couple of questions about your report:
- You decided to narrow down on sodium policy taxation advocacy- whilst I think this is probably one of the more appealing interventions in this space, I wonder whether you considered other interventions e.g. community salt substitution, which was looked into by Givewell and recently had a very large RCT conducted.
- The impact of sodium reduction extends beyond BP effects- Although the majority of the health effect of sodium reduction does seem to be through reducing BP, there are some other causal mechanisms that are suggested e.g. reducing oxidative stress, reducing sympathetic tone. I wonder whether you looked into/considered these
- The cost of advocacy- it seems like you have by and large taken the cost of quite a lean charity doing this. I wonder whether it would be worthwhile looking at organisations that have previously successfully helped advocate for taxation policy, and estimated their size/cost. I would imagine this might be a higher cost by several factors
- Are there good advocacy groups out there- I would be really interested to know whether there are highly effective organisations advocacy for sodium taxation policy already out there, that funders might be able to look int further + potentially fund!
A great report- thanks Joel!
High Impact Medicine and Probably good recently produced a report on medical careers that gives more in-depth consideration to clinical careers in low and middle income countries- you can check it out here: https://www.highimpactmedicine.org/our-research/medicalcareers
Yeah great question! There were some similarities and differences from our normal research process
Similarities
- We predominantly looked for ideas where there were good feedback loops to measure the impact of the charity and the good that it was doing
- Our research process largely worked and could be adapted to biosecurity as a cause area
- We considered the potential of the negative impact of our ideas, and ideas where this was more likely were far less likely to pass through our research stages
Differences
- We had to very seriously consider information hazards in our idea, which is not a consideration we had given much weight on or considered at all for other cause areas
- Had to rely a bit more on expert opinion and ‘lower’ quality forms of evidence like theoretic evidence, case studies
- We had a lot more uncertainty about our cost-effectiveness analyses, since estimates vary a lot depending on priors about likelihood of future pandemics and how bad they could be; to an extent, these uncertainties were multiplicative, which made quantification particularly challenging
- We had to coordinate and talk a lot more to EA biosecurity folk- the space is small and growing, and it was important to coordinate to make sure we were not duplicating something that was already happening in a way that might be harmful
We are happy to chat to anyone interested in biosecurity who might want to start a charity and wants to talk more about our research process and the ideas we are most excited about in this space
Hi cflexman,
I think these are valuable comments, and you are absolutely correct. Limited time meant that I (1) was very short-hand in how I aggregated effect sizes/results from academic studies, (2) used simplistic point estimates. Ideally, I would have done a meta-analysis style method with risk of bias assessment etc. My main limitation is a frustrating one- time.
I did try and caveat that with trying to make all my shorthands and uncertainties explicit, but I dont think I quite succeeded at that.
One area I would push back on is the comments regarding social interventions and survey data- the methods in most/all these studies are survey effects asking women wehther they have experienced violence in the last year. To me, this seems pretty robust, and as long as the surveys are conducted to a high standard with low risk of bias (which most of the studies have dedicated sections to explain how they tried to do this, to varying degrees of success), think this is credible and internally valid data.