Happy helping people is not enough when the factors that determine resource allocation are improper.
The the previous posts we have seen that resource allocation is based on a number of things – proximity, emotions, timing – but that efforts to define and measure actual outcomes are lacking. The result is that resources are likely misdirected such that sizable opportunity costs can be measured in actual children killed (not saved) because of the action of badly determined criteria.
Let me explain. An NGO is spending $100m on children in a crisis in Africa. We don’t know exactly what effect this will have (because it is not measured) but the NGO hopes to save $4m children. That’s $25 per child, which sounds pretty good. But is it? First of all, $25 might not be all that cheap, despite huge healthcare costs in the West it might be possible to help a child for much less in a different context and for a different ailment. Second, we haven’t really defined ‘life saved’ (see previous post), although we could just do that. Let’s say it is that the child lives beyond childhood and reaches 16. That doesn’t solve the problem since, third, we haven’t measured what actually happens and the ‘confidence interval’ on our 4m saved estimate is very wide, wide enough that resource allocation goes from cheap and effective to extremely expensive, even wasteful. So a number of things have to come together for the $100m for 4m claim to hold up and without it there is a good chance that our $100m is not helping as many children reach 16 as it would do if it were spent elsewhere. What seems like a rational basis for action – maximum number of children reaching 16 per dollar spent – is not the basis at all.
As a result, children needlessly fail to reach 16 – are saved – when we have the funds to help them.
What does it mean to save a life? Or at least, what do we mean by it?
The first thing we need to do is stop and think a bit about causation. Causation, notorious in philosopher’s circles, is not normally the best way to make a clear definition. But here we are talking about a psychological interpretation of cause, as in how do we cause this or cause that, and so it is sufficient to suggest a loose picture of causation that we can accept. A very popular interpretation is, ‘if I had not done this, then that would not have happened.’ Now, beset with problems, I believe this is roughly how we each think about when we have caused and outcome, more especially when we have not caused it.
Next we need to be explicit about what we mean by ‘a life’. This is tricky because we probably don’t mean a couple of hours but we also don’t mean living until 74. There is some middle ground and I think that it is defined by our action: ‘life’ is what you get when the immediate risk to your life is removed by someone who has saved it. For example, if a nurse delivers nutrients to a child who would have died of starvation then that is a ‘life saved’ and we don’t wonder how much longer that child does actually live. You have ‘saved a life’ when in the counter factual case the person would have died but instead the person does not die from the cause of death you intervened on.
What is clear, is that it isn’t actually that clear what it really means to ‘save a life’. But I think that there is a type of apparent clarity that is associated with humanitarian work that is not found in say vaccine delivery. The psychological effect of delivering aid is to feel like you are saving lives. There is immediacy and contrast between the results of action and non-action. If you were not there, if we didn’t send food, then people would die. Saving lives, therefore, is just a matter of delivering aid. With vaccines you need to appreciate a population level effect. You might not be saving this child, or the next child, from measles but there is a vague counter factual world where more children die for lack of vaccination. There is no immediacy and no certainty of the results of your actions.
This psychology is found in all areas of reactionary care. This sense of cause and effect is motivation for working in the humanitarian industry; getting ‘out there’ and saving lives.