Hi Wayne, that’s fair. I hadn’t been including farmed animal welfare in the comparison because I don’t think people donating to therapy organizations are doing it for animal welfare reasons.

I don’t think it would be practical for givewell to include animal welfare in its evaluations. I think donors who care about both animal and human welfare would have more impact giving to separate projects optimising for each of those goals

Nice post Joey, thanks for laying it out so clearly.

I agree with almost all of this. I find it interesting to think more about which domains / dimensions I'd prefer to push towards prioritization vs. pluralism:

• Speaking loosely, I think EA could push more towards pluralism for career decisions (where personal fit, talent absorbency and specialization are important), and FAW/GHD/GCR cause prioritization (where I at least feel swamped by uncertainty). But I'm pretty unsure on where to shift on the margin in other domains like GiveWell style GHD direct delivery (where money is ~fungible, and comparisons can be meaningful).
• e.g. I suspect I'm more willing to prioritize than you on bednets vs. therapy. I think you / AIM are more positive than me about therapy (as currently delivered) on the merits. Sure, there's a lot of uncertainty, but having spent a bit of time with the CEAs, I just find it real hard to get to therapy being more cost-effective than bednets in high burden areas.

• you could pretty easily imagine a GW-like charity evaluator that ranks income as x4 as important as GW does coming to pretty different but still highly compelling top charities

  • I agree moral weights are one of the more uncertain parameters, though I think the range of reasonable disagreement given current evidence is a bit less wide than implied here. I'd love to see someone dive deep on the question and actually make the case that we should be using moral weights for income 4x higher vs. health, rather than they're plausible.

I guess a general theme is that I worry about a tendency to string together lots of "plausible" assumptions without defending them as their best guess, and that eroding a prioritization mindset. I think you'd probably agree with that in general, but suspect we have different practical views on some specifics.

Hi Midtermist, I think this is a pretty important worry and appreciate you sharing your perspective.

Just speaking for myself and the EA (global health and wellbeing) program I work on (though it’s mostly led by Mel Basnak now).

Here are a few things we’re doing:

• We fund Probably Good, who try to empower people to think along impact-focused lines while remaining open-minded about how different people can best help others.
• We support orgs like Founders Pledge and Charity Entrepreneurship, who share our core values but who do their own research and might have different views.
• Our grants to effective giving orgs have not been conditional on them changing their recommendations (though we're more likely to support orgs whose recommendations we believe in).

Tbc, I think it’s a tough problem and tradeoffs between respecting autonomy and standing behind your judgment calls as a grantmaker.

Yes, I think that’s mostly fair.

Air pollution in South Asia has a lot of different sources requiring distinct policy interventions, and often at local levels. Eliminating emissions entirely from any one source category would address a relatively small fraction (5%-10%, say) of the problem in a given city or state.

Some interventions that are relatively scalable across India, and likely to be effective are politically intractable: power plant emission controls (expensive and with costs borne by a small group of influential firms), or subsidies to make cleaner fuels affordable for household cooking (expensive-- needs an outlay of at least $1B/year).

That said, about $5M/ $18M spent so far in the program in India fund organizations that work with government agencies in identifying and executing interventions, leveraging existing government resources.

Some of the promising ideas so far that our grantees are working on include better handling of construction dust by large private developers, and support for city governments to handle dispersed sources (municipal waste burning, resuspension of road dust). We also think that crop residue burning in northern India has seen steady (if slow) improvement, and expect to continue supporting governments in this process.

Thanks ajyl! I think the biggest takeaway for me is that you can do a bit of storytelling without compromising on rigor / honesty.

• The ITN framework is compelling and appeals to people outside EA.
• Jenna Forsyth's work in Bangladesh really resonated with people. Combining that story with an estimate of 20,000 lives saved seemed to hit home for a lot of folks.
• Comparison is helpful. Lead exposure is estimated to kill 1.5 million people but receives only $15m in funding is compelling to people who can put those numbers in perspective. But lead exposure is estimated to kill more people than HIV/AIDS and malaria combined, but receives ~1,000x less funding is much more universally powerful.
• I think focusing on our plan in the funding proposal (measurement, mitigation, mainstreaming), and setting measurable goals against that was helpful.

You’re right that was referring to LEAF. We’ve been excited at how well this collaboration’s gone, so we’re thinking about what else we might be able to do in a similar vein, but haven’t decided what that’ll look like yet.

Thanks Rafael! A few theories:

• There just aren’t many people whose job it is to look for important, tractable and neglected causes. It’s striking how much of the recent upsurge in interest has been related to EA.
• While there are some individual cases of very severe exposure, most of the burden is caused by relatively small risks of harm spread across entire populations, so victims aren’t identifiable.
• A lot of global health funding is allocated by disease category. Lead exposure cuts across disease categories, so it just doesn’t naturally fit into a lot of funding mechanisms.
• The elimination of leaded gasoline had a huge positive impact globally. The US, and a few other countries, also do regular testing and surveillance to identify other sources of exposure. But not many other countries do that. So I think there’s a story that with the decline in US blood lead levels, people assumed the problem was fixed by eliminating leaded gasoline when other countries, particularly LMICs, still have a lot of exposure from other sources.

The most direct focus of LEAF’s source-specific mitigation work is paint and spices, but that’s largely because of tractability: these are both products where there are only weak economic incentives to use lead, and where production is fairly consolidated. That makes them easier to regulate. For other sources (batteries, cookware, cosmetics etc.), we want to fund more exploratory work: piloting and testing regulatory interventions rather than scaling them.

I think figuring out what to do on informal ULAB recycling is really important. ~80% of global lead is used in lead acid batteries, and informal recycling is responsible for particularly severe cases of exposure for people living nearby.

A benefit of all the recent attention on lead exposure is I expect we’ll increasingly see requests for assistance from governments, so it would be very helpful to have “best practice” playbooks we could apply to ULAB regulation. To my knowledge, those don’t currently exist (though there are some resources here and here). Intuitively, I’m excited by market-based solutions like tax breaks or even subsidies for well-regulated formal sector battery recycling to make it cost-competitive with unsafe informal recycling. But that’s pretty weakly held. Pure Earth have been thinking about this a lot, as have the US EPA and others.

Thanks Parth, I appreciate it and thank you for your support along the way!

How did you first learn about lead as an issue? I know you were looking into public health regulation broadly at that time (e.g. pesticides) and in your conversation notes from 2017 you cite various statistics (e.g. WHO statistic that 10% of children globally have >20 micrograms of lead NYU study on $1 trillion of economic costs).  What first rang the alarm bells for you that this was an area worth investigating?

IIRC, I first learned about it as a development issue from some very early work my colleague Andrew did at GiveWell. At the time, GiveWell wasn’t funding policy work, so it’d been deprioritized. But I’d got interested in public health policy from investigating this grant on pesticide suicide when I was at Giving What We Can, so I was pretty keen to dig into it.

But it was a pretty slow burn and I only got really excited about it between 2019 and 2021. Things I found particularly persuasive were this systematic review suggesting the median kid in an LMIC had elevated blood lead by US standards, Pure Earth telling me about Jenna Forsyth’s work in Bangladesh to remove lead from spices, and this comparative analysis highlighting its relative neglectedness, even compared to other hugely neglected issues like tobacco.

How was Pure Earth so far ahead of everyone on this? They published their first "World's Most Polluted Places Report" in 2008 and wrote in it: "Relative to other public health interventions, pollution remediation can be very cost effective..... projects cost between $1 - $50 per year of life gained. This compares favorably to the $35 to $200 per year of life gained for World Bank estimates on interventions related to water supply, improved cooking stoves and malaria controls." 

I’m not sure! When I first started talking to Pure Earth, they’d recently started to focus more narrowly on lead exposure, having previously worked across a bunch of different pollutants. They were also starting to explore focusing on more regulatory interventions when before they were mostly cleaning up individual toxic waste sites. It was pretty cool to see an organization really shifting and following the burden like that. Fwiw I haven’t reviewed the $1-$50 estimate, but I’m skeptical of the claim if it’s referring to remediating individual toxic waste sites (though so much is down to how many years of “speedup” to count that it’s hard to know without digging in).

Besides your $250K grant to IPEN in July 2019, why did it take you nearly four years from when you started investigating the topic in late 2017 to start funding work in the space? Relatedly, why did it take you so long to fund LEEP, and with relatively small grants to-date? 

Yeah, I think about this a lot. If we believe the GBD estimates, 6 million people died from lead exposure in the four years it took me to recommend substantial grants in the space. So even though that certainly wasn't the only bottleneck, it’s a source of personal angst.

The short (and probably unsatisfying) answer is I was working on a lot of other things. I think over the ~5 years I spent at GiveWell, ~25% of my time was on public health policy, and lead was only a fraction of that. With hindsight, I wish I’d advocated more effectively for GiveWell to put more capacity towards that work (though it’s also worth noting that a lot of the most compelling data points weren’t available until ~2020).

On LEEP specifically, we were pretty close to making a grant at GiveWell, but I’d got hung up on whether I believed the evidence for lead paint being a significant source of exposure (I still find that evidence tricky to interpret, but lead paint regulation has also been far more tractable than I expected such that I think it should be a priority anyway). When I moved to Open Phil in 2022, it was to launch the EA program on global health and wellbeing. We also agreed to transition the lead portfolio and other public health policy grants from GiveWell to Open Phil, but it took a bit of time for us to get to launching a program. I agree with Alexander’s assessment of our mistakes here. Fwiw this has all made me quite appreciative of other funders in the EA space who funded LEEP. I admire their work, and it's been fun working with Lucia and Clare (LEEP's co-EDs) in the build up to the launch.

Open Phil’s main role was organizing a group of donors to commit most of the funding which was announced alongside the Partnership for a Lead-Free Future. The Lead Exposure Action Fund comprises $104m of the $150m that was announced, and Open Phil staff will manage the allocation of those funds. The work to launch a collaborative fund was quite far along when we formalized a partnership with USAID, so it’s an interesting coming together of two strands.

We’ve also been working very closely with USAID and UNICEF to help design the PLF (and we’re still working together to flesh it out), and have pledged to co-fund a portion of the PLF’s operating costs.

Overall, it’s been a really positive (and fun!) experience working with USAID. Smoother than I would’ve guessed. I think there’s a few things that have helped with that. 

First, lead exposure is just really compelling on impact grounds; Samantha Power and Atul Gawande are convinced about it for the same reasons we are. Two generalizable takeaways for me were that the ITN framework is convincing outside narrow EA circles, and people at the very highest levels of government resonate with cause prioritization. That makes sense: they’re the people who have to make decisions at that level. Both those make me optimistic about the potential for more collaboration.

Second, we’ve been working with some really cool people who share our values. Samantha Power’s senior adviser, Garrett Lam, is the person who first brought lead exposure to Samantha Power’s attention, and I believe that was partly due to various touchpoints with this community (but wouldn’t want to speak too much for him).