Absolutely new to effective altruism since July 2021. Pediatrician working in low resource settings, now Masters student in global health policy, because I wanted to help more people. Here to learn.
Thank you for your reply. I am sorry to hear about your poor personal healthcare experience.
Regarding your other points:
"Cost-effectiveness doesn't mean only efficiency. I think when you're trying to do the most good, ditching the use of cost-effectiveness is quite hard because what will you use instead?"
Equity. I am suggesting a paradigm shift to considering equity as the most important goal. It means spending more on those less fortunate, but sometimes cost-effectiveness and equity align. For example, Give Well donates to low income countries because it is more cost-effective, but it happens to also be a more equitable choice. The provision of primary health care for all is equitable, and is not always at odds with cost-effectiveness, see the US spending on healthcare and morbidity and mortality outcomes vs other rich countries which have social health care. The only process by which equity is advanced is through human rights lobby, as far as I can tell.
""Billionaire philanthropy isn't okay, it'd be better if the masses decided what to do" and "Universal healthcare is a moral imperative" are claims which a lot of moral theories would disagree with"
I am interested to see these moral theories.
"A third critique is tractability. Isn't it quite hard to change global political discourse, especially in Africa where most EAs do not have no connection to, and institute health as a global right and actually enforce this? This seems quite unlikely, because this would require increasing state capacity all over the global south, advancement of technologies in underdeveloped countries(if we take veil of ignorance seriously), setting effective and capable health bureucracies in countries where bureucracies tend to be home clientelistic and kleptocratic tendencies rather than effectiveness. Again, I don't think the goal this post propose are actually tractable. This is different distributing bednets."
I agree with this; it highlights the purpose of my post, which is to suggest EAs aim higher in their altruistic goals.
Also this report that big pharma R&D costs are vastly overblown; it is what I had suspected, now upheld by research.
Strong upvote! I came here to say something similar. One of your most compelling points is addressing the needs and wants of the intended beneficiaries, in contrast with pursuing the most economically efficient cause area. I think there is significant moral weight in ensuring people have what they want and need, which cannot be commodified.
Peter Singer has done the math, and it is possible to reduce by half global hunger and extreme poverty, with modest numbers (old article, but I just found it):
While I am here, humbly, I need to ask a burning question: Your advocacy and behaviour are incongruent with respect to consumption; you consume in a degrowth pattern, but advocate for growth, why?
Thank you!!! For efficiency, I almost only read books by audio now, so as self-declared expert, I agree books read by the author are superior because the author understands the meaning, inflection, and nuance in their words. I think it added value to WWOTF.
I most recently read Winners Take All by Anand Giridharadas, read by the author, and cannot help but feel moral unease about EA position in the philanthropic world right now. He makes a defensible argument for politics as the means of doing the most good.
I would be suspicious of anyone (the libertarians you describe) who claims to be protecting children by endorsing child labour.
Fair point. Although, I think I did also mean “dumbed down longtermism”. Every far longtermist threat, like engineered pandemics, AI alignment, existential risk, great power war, environmental degradation, etc, also threatens current children. Possibly regular people (non-EAs) would understand the threat better/empathize more easily if it were a threat to children vs concepts of future people.
Thank you for the informative comment. I learned two things today - "adultism", and the difference between disenfranchised agent and patient.
I really appreciated your linked question/comment about relating abolition, suffrage, to non-human animals and future people. I agree! Do you think of my association between children and future people is a closer match?
Although I would 100% endorse increasing the agency of children and youth, I can't help but understand adultism as less of a prejudice, and more of a matter-of-fact with respect to small children. The study you cited are youth who already have some agency, as they are capable of reading and completing a survey, rather than babies who cannot control their own limbs.
Lastly, as an ally who has interest in children, what might move you closer to lobbying for consensus on the rights of the child?
I appreciate your questions on both of these points.
Tractability - Yes, I see the senate as the roadblock, depending on the party makeup within it. Of course, lobbying state-specific-laws might be more successful, but not as comprehensive. This is the reason I am suggesting going for the big goal. It is more about universal acknowledgement of child rights as agent-less future people. Even if the senate is destined to block it, do you see the possible value in bringing child rights to the agenda, raising the issue in the news, raising public awareness, spinning the possibility US ratification as "American champions of child rights", or any similar secondary goals?
Value of ratification - True, ratification does not directly guarantee improved child survival or welfare. It is why I am suggesting it as "hits based". As I am sure you know, UN treaties are only as strong as the sanctions other countries choose to place on violators. If the US ratified, as a relative global power, it would carry weight in sanctions, which it cannot do now. The benefit to US children I see as a positive externality only.
The goal would be in what universal consensus represents, step one in a global value change toward the importance of future people.
As someone with interest in political interventions as EA cause areas, I am curious whether you think there is a better approach?