NickLaing
Bio
Participation1
I'm a doctor working towards the dream that every human will have access to high quality healthcare. I'm a medic and director of OneDay Health, which has launched 35 simple but comprehensive nurse-led health centers in remote rural Ugandan Villages. A huge thanks to the EA Cambridge student community in 2018 for helping me realise that I could do more good by focusing on providing healthcare in remote places.
How I can help others
Understanding the NGO industrial complex, and how aid really works (or doesn't) in Northern Uganda
Global health knowledge
Posts 18
Comments1144
I know we had a couple of disagreements about the content of your last post, but I really love the transparency and honesty here about your fundraising efforts and the unexpected increased cost of the facility@Anthony Kalulu, a rural farmer in eastern Uganda. It saddens me to say that level of transparancy quite unusula from my experience in Uganda so good on you for that.
Good on you and all the best with your development endeavors.
And like @MathiasKB🔸 said, advise against the crypto investment!
Also I suspect due to the style, and request in this post you might be downvoted quite a bit but dont be discouraged. This forum isn't an easy place!
Wow amazing 2022 article by the way. I never saw it at the time, it was before I was on the forum!
After reading the thread I might fall marginally more on your side of the argument there, especially as inflation probably did contribute to the trump victory. But it is also yet another demonstration of how hard philanthropy gets, the higher level you get in politics or economics, with so much disagreement and uncertainty. There's just so much disagreement from experts on almost every major issue, so it's very hard to know on which side to push the money.
Taking a low percentage "hit based" approach on human welfare issues is one thing, but when it's super unclear even if you make that hit whether its positive or negative EV is where I start to think why not just take a punt on something deeply uncertain but never negative EV like shrimp instead.
I like your point about careers and systemic change, and that it is harder to convert money directly into results. I also agree with @jackva though that measurement problems aren't a likely reason for the lack of investment, Open Phil are investing in lots of speculative and almost impossible to measure things, I don't think that's the issue.
I was encouraged to read this Economist article, "The demise of foreign aid offers an opportunity Donors should focus on what works. Much aid currently does not" which I would say has at least some EA adjacent ideas.
They mention health spending, which by the nature of all 4 of GiveWell's top charities can often be more cost effective than other options, plus pandemic prevention.
"What should they do? One answer is to stop spending on programmes that do not work, and to focus on the things that might, such as health spending. Even here, however, governments must be vigilant that they are putting their money to its best use. Three principles should guide them.
The first is to act in areas where governments (or the UN agencies they fund) have special co-ordinating power, say because they have the security apparatus to reach disaster or conflict zones. Another is to get involved if they have information the public will struggle to assess, about adapting to climate change, say, or a new pandemic. Last, are they funding causes that generate positive spillovers, such as preventing the global spread of infectious diseases?"
Not exactly ITN, but not a bad take either!
I agree with this, yet im yet to hear of concrete ideas which could have significant impact at the kind of high level you are taking about. It would be great to see some ideas fleshed out here on the forum.
I've always been a huge advocate for the cost effectiveness of tractable systematic change on the margins, like lead paint policy and my wife's work to ban certain types of alcohol in Uganda.
But at the really high level you talk about, the "fractured democracy" level I struggle to see where we could have clear impact. It might be one of the least "neglected" areas around, which of course doesn't mean there can't be niche highly cost effective areas we could move the needle
Like you suggest there's also the counterfactual of what if we had been putting hundreds of millions into systemic changes that were then just deleted by the current world order situation. There are good arguments both for and against working on specific programs vs. Systemic change right now. At least the nets still save lives cost effectively as global conflict becomes more likely and global aid is slashed? Given the reduction in aid money donations in global health, donations become a bit more impactful now too.
It's not as if people haven't been thinking and even investing along these lines at times. Open Phil have thrust a bunch at "global economic stability", but this isn't an area I understand well and feel I can judge well.
https://www.openphilanthropy.org/focus/macroeconomic-stabilization-policy/
There have been a few interesting posts on the forum such as this one recently, but I'm yet to hear convincing ideas - which is not to say those ideas aren't there.
I agree this is absurd, this is probably the most obvious action open Phil has not taken. What do they have to lose at this stage by filling a lawsuit or at the very least like you say making an official comment.
Perhaps EAs and EA orgs are just by nature largely allergic to open public conflict even if it has decent potential to do good?
I think this question would have been b more effectively asked without going through your animal welfare argument for the upteenth time.
If you're really asking a genuine and important question about the value of direct work vs donating, why not just keep the first paragraph which states your argument well enough, without your second paragraph (which contains most of the words in the question), which is a distraction from your main point which can easily alternate people like me and drag the discussion away from the question itself.