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Owain Johnstone

Problems are in the eye of the beholder

Every time you choose to donate to a particular charity you're choosing a particular problem which you want to address. But the menu of problems that you choose from isn't fixed. What gets onto that menu and, to stretch the analogy, how each item is described, can change over time. In other words, you can change what we define as problems and how we define them. In this post I explore that idea and why it's so important.

Intuitively it may seem that there are many problems in the world ready to be found. We don't have to go looking for them – they're just there. We might think in very general terms of poverty, disease, inequality, or discrimination.

There's another way of thinking about these problems, though. And that is to say that no problems just 'exist', awaiting discovery and resolution. Instead, they are constructed by us. We look at the things happening in the world, decide to label some of those things as problematic, and set out to do something about them. There's nothing inherent to those things that makes them problems apart from our thoughts about them.

One of the key things, of course, is who that 'we' is. Different groups of people recognise different things as problematic, leading to different political or charitable priorities. And those priorities change over time as well. Not many people thought slavery was a problem before the 18th century; nowadays very few would defend it.

This is important, because influencing what circumstances are seen as problematic and in what ways can be a very effective way of bringing about social change.

A good example of a problem where we can see the process of construction in action is human trafficking, the subject of my own research. In the middle of the 20th century, it was rarely spoken about, but it became more prominent through the 1980s and 1990s. This history of the approach to human trafficking is a good example of how, if enough people are persuaded that an issue is problematic, it can become a policy priority and start to attract attention and resources.

When trafficking initially become prominent, it was largely thought of in gendered terms – as the trafficking of women and girls for sexual exploitation. More recently, since around 2000, that model has started to change and there has been a move towards seeing it as including, for example, the movement of men and boys into other kinds of exploitative practices such as agricultural labour, drug cultivation and street begging.

So it's not just a matter of recognising a problem that hasn't previously been talked about; the way we see that problem can change as well. The actual practices thought of as constituting human trafficking have changed substantially over time.

The same is true for the way the problem is framed more broadly. In the UK and elsewhere it was initially seen as essentially a problem of illegal immigration. The UN Protocol established to deal with trafficking in 2000 reflected that idea.

Yet other framings have subsequently become more prominent. The Council of Europe and the European Union (in its more recent Directives) have emphasised the human rights aspects of trafficking. More recently still, in the UK, the language of 'modern slavery' has become influential and some have started to talk about trafficking as an issue exploitation, with the movement element much less important.

These different framings share a common conception of the kind of practices thought to constitute trafficking but (while certainly not mutually exclusive) they place emphasis on very different aspects of the problem.

So human trafficking is an example of a problem where a set of circumstances not initially the subject of much policy or charity activity became widely perceived as a problem needing to be tackled. Once that had occurred, what was meant by 'human trafficking' rapidly changed its shape, and so did the broader framing of the problem.

This is potentially very important. Gaining recognition for a problem not previously talked about is obviously influential. However, changing the way a problem is constructed or framed can also have important effects. When we change how we think of a problem we change what we do to address it – what resources are allocated, by whom, for what purposes, etc.

In terms of framings, if human trafficking is fundamentally an issue of illegal immigration then the logical steps to take in order to address it involve tougher border controls and perhaps changes to the asylum system or visa allowances. If, on the other hand, it is basically about protecting the rights of victims then we need to establish mechanisms to identify those victims and offer them support. The lens through which we view the problem has important implications for what we do about it.

All this is open to the objection that human trafficking is basically a social problem, i.e. a messy, people-centred kind of an issue where data are lacking and it's entirely possible to have lots of competing perspectives on what it involves, why it is problematic, etc. What about problems which belong more in the realm of hard science, like disease? Surely it doesn't matter how you 'construct' an illness – it remains something very tangible with known effects and cures.

Even in relation to disease, however, the way we construct problems matters enormously. It affects both the priority we give to different diseases and also how we deal with each one. When it comes to priority, the recent trajectory of ALS (following the 'ice bucket' campaign) is a good demonstration of how a change in profile can affect the attention and resources made available to address a problem.

We can also change the way we construct or frame a particular disease. HIV/AIDS is a good example. Stigma against the disease has often derived from inappropriate fear of casual transmission or prejudice against groups that are disproportionately affected, such as intravenous drug users and homosexual men. That stigma has at times led to individuals not getting themselves tested or not revealing their illness for fear of discrimination. It also led to support for restrictive policies considered by some to threaten sufferers’ human rights. Changing the way in which HIV/AIDS sufferers are perceived can therefore make a big difference in how resources are allocated without any change in the basic science.[1]

What are some implications of this perspective?

Getting problems recognised as problems is the first step to tackling them. Changing what the public, politicians and charities think of as priorities alters the way resources are distributed – away from some areas and towards others. In some ways this is one of the most profound elements of a democratic society – the collective definition of social problems through public debate. Once problems have been identified, there is significant scope for shaping how they are conceptualised and consequently what is done about them. Problem recognition and construction can be very difficult processes to quantify, but they can also represent two particularly powerful ways through which to bring about social change.

HIV-Related Stigma and Knowledge in the United States: Prevalence and Trends, 1991–1999

Joseph O'Neill

The Cost of Violence I: What should our priorities be?

What is more costly for society – domestic violence or war? A report released recently by researchers at Oxford and Stanford University argues that, despite much greater coverage in the media, war and civil violence account for less than 5% of the total cost of violence worldwide. The greatest burden instead comes from physical violence against women and children in the home. This has implications for the funding of future interventions against violence in the developing world.

The “Conflict and Violence Assessment Paper”[1] was commissioned by the Copenhagen Consensus Centre (CCC), a think tank working to produce economic cost-benefit analyses of solutions to the world’s biggest problems. The Centre is currently focussed on evaluating proposals for the UN post-2015 Millennium Development Goals (MDGs), which will replace the current MDGs at the end of next year.

The current set of MDGs appear to have been largely successful in influencing development aid spending since they were unanimously endorsed by all UN member states in 2000. With up to $700bn of aid predicted to be spent between 2015 and 2030, the upcoming MDGs will have a role in directing very large amounts of money.

Hundreds of suggestions for post-2015 goals and specific targets have already been put forward[2] but most, although worthy, have not been subject to serious cost-benefit analysis. The CCC aims to provide Benefits-to-Cost Ratios (BCRs) for the various options on the table to help decision-makers prioritize the most effective goals.

We have been impressed by the Centre’s research in the past[3] and so far this year they’ve evaluated proposed MDGs around issues including improving education[4] and dealing with population growth.[5] If there turns out to be a high variance in the cost-effectiveness of potential MDGs (as is the case with the cost-effectiveness of ) a small investment in this kind of cause prioritization could end up doing a huge amount of good.[6]

The issue of violence has already been a focus in the post-2015 MDG discussion, with a UN panel recently highlighting major conflicts, violent crime, and violence against women and girls as high priority problems.[7] In their assessment paper, James Fearon from Stanford and Anke Hoeffler from Oxford University try to determine what kinds of violence we should try to tackle first.

The first step in their analysis is to assign a different “unit cost” to each kind of violent act. This cost represents the average amount of value destroyed by that act in dollar terms. Scaling the unit cost by GDP, and multiplying by the total number of incidents for each act gives the total cost worldwide, expressed as a monetary value or a percentage of global GDP (Table 1).

For example, the unit cost of a single homicide in the US was calculated at $9.1 million, using a model that relates increased wages to increased risk of death across different occupations.[8] Scaling this unit cost by country GDP:US GDP and multiplying by the annual number of homicides for each country[9] gives an estimated global cost of homicide of $700.5 billion USD - 0.82% of world GDP.

A similar approach was used to calculate the total cost of war and terrorism - the total number of war and terrorism-related deaths each year was multiplied by the unit cost for a homicide, and an additional cost was added based on the much larger negative externalities of war compared to homicide (namely, damage to infrastructure and relocation of displaced refugees).

Assigning a unit cost for these forms of violence is slightly more difficult, as their costs are mostly not accounted for in the wage vs. risk-of-death models used previously. Instead, unit cost was calculated by a “jury-compensation” approach that looked at the amount awarded by juries in personal injury cases.[8] Further complicating the calculations was the fact that many forms of non-fatal violence, such as sexual violence against women and children, are widely underreported in both the developed and the developing world. For example, despite the depressingly high worldwide prevalence of domestic (an estimated 30% of all women experience physical or sexual violence from intimate partners in their lifetime[10]), some studies claim that less than 5 percent of this violence is actually reported to the police.[11] Because the authors rely only on reported cases when costing sexual violence against women and children, their costings of these crimes (Table 1) are likely to be underestimates.

To avoid relying on victim reports for child physical abuse, researchers instead estimated prevalence from anonymous surveys on parenting practices.[12] From these data they estimate that 16 percent of all children regularly receive severe physical punishment (labelled Child Abuse in Table 1) , which is defined as “slapping them on the face, head or ears and beating them repeatedly with an implement such as a stick, cane or belt”.[1] Using a unit cost of $95,023 (the cost of a similarly severe assault on an adult), the global cost of child abuse was estimated at $3.59 trillion USD (Table 1).

It is important to note that the total costs reported here do not represent the actual yearly effect of these kinds of violence on global GDP. Rather, they are a way of valuing the welfare costs to the individual and society in objective terms. Another way of think about it is that if all forms of violence (total cost of ~11% GDP) were eliminated tomorrow, it would have a similar effect on human welfare to that of increasing global GDP by 11%.

Table 1. Summary of Cost Estimates Adapted from Hoeffler, Fearson 2014

Taken together, the authors estimate that the total cost of violence to the world is approximately $9.5 trillion each year, with domestic violence against women and children making up $8 trillion of that cost. The largest cost is imposed by violence perpetrated against women by their intimate partners, closely followed by physical violence against children (which is predominantly carried out by parents).

Given the relatively small cost of collective violence (including interstate and civil wars, and terrorism), this report makes a good case for increasing the attention we pay to domestic violence and child abuse, which are currently neglected in the global aid budget, and underreported in the media. As Fearson and Hoeffler put it, “[d]omestic abuse of women and children should no longer be regarded as a private matter but a public health concern.”[1] In the next post, we will look at what are the most promising interventions to reduce the cost of violence - stay tuned!

The North-South Institute’s Post-2015 Proposal Tracker

GWWC blog post on the Copenhagen Consensus Centre

Copenhagen Consensus Centre on Population

Toby Ord: The Moral Imperative Towards Cost-effectiveness

[EP: The Economic Cost of Violence Containment](I 

http://www.visionofhumanity.org/sites/default/files/The%20Economic%20Cost%20of%20Violence%20Containment.pdf

The cost of crime to society: New crime-specific estimates for policy and program evaluation

UN Office on Drugs and Crime: Statistics on homicide, assault, sexual assault and rape

Science: The Global Prevalence of Intimate Partner Violence Against Women

Tip of the Iceberg: Reporting and Gender-Based Violence in Developing Countries

UNICEF: The State of the World’s Children 2014 In Numbers

Michelle Hutchinson

The Centre for Effective Altruism is seeking a Chief Operating Officer

We are recruiting a Chief Operating Officer to lead our central division, managing a team that supports the operations, finance, logistics, human resources and fundraising functions of all our projects. This role is a unique opportunity to shape a rapidly-growing charity into an incubator that can quickly scale up the best ideas emerging from the nascent effective altruism movement. We see this as one of the most challenging roles in the organisation, requiring a high level of competency across most skill areas. The role is located in Oxford, and you would work in our offices which are housed within the University.

The Centre for Effective Altruism is an incubator of projects we believe have potential to create significant positive change in the world at low cost. Our organisation includes two established projects, Giving What We Can and 80,000 Hours, as well as two newer projects we are incubating, the Global Priorities Project and Effective Altruism Outreach. We have also spun two projects out of the Centre for Effective Altruism - Animal Charity Evaluators and The Life You Can Save - which are both now run independently in the US.

In this role you would be involved in the operational aspects of all of CEA’s projects. You will meet and provide invaluable help to a large share of the people and projects in the effective altruist movement today. You will learn about all aspects of CEA's work, including our expansion into other countries. As a result, it will provide you with the skills and contacts you would need to lead on future projects.

The position would place you on the senior management team of CEA along with the individual project Directors.

You would be managing up to several staff members and a budget in order to accomplish the objectives of the role. As a result, the role is principally about management, strategic planning and being responsible for the smooth running of the organisation, including reporting progress to our Trustees and the rest of the management team.

Specifically, you would be responsible for:

 - ensuring we have solid accounting and budgeting processes and comply with all regulations, as well as ensuring our reporting both internally and externally is clear and informative

 - ensuring a smooth process is in place for donor relationship management, collaborating with the Executive Directors on their fundraising efforts; reporting on fundraising and incorporating this with our accounting processes

 - including recruitment, head-hunting talented new staff, accommodation, management of visas, payroll, mentorship and training

 - ensuring we comply with employment, company and non-profit legal requirements; contracting and collaborating with legal experts as necessary

Office management, some aspects of events, and other logistics

This role combines great potential for impact with significant potential for growth and learning. Making sure our projects are well run, and collaborating on the vision and strategy for the Centre offers tremendous opportunity for having a large scale impact. As one of the key team members of a rapidly growing small organisation, you’ll have a huge amount of responsibility, autonomy and room to grow.

If you work for CEA, you’ll be part of a focused team of intelligent, enthusiastic and driven colleagues who want to change the world, located in offices within the University of Oxford, in the centre of the beautiful city of Oxford, just one hour from London.

We are looking for someone who cares deeply about making the world a better place and using evidence and reason to find the best way to do so. A familiarity with the purpose of our projects and the ethos of Effective Altruism is valuable.

You’ll need a mix of strategic thinking, good judgement of risks and priorities, the ability to manage people, a high level of attention to detail and excellent written and spoken communication skills. You will also need to be comfortable representing the organisation to a variety of external stakeholders.

Some examples of experience that would be particularly useful includes management in for-profit, non-profit and government organisations, entrepreneurship, running student groups/societies and of course having worked on operations for other organisations.

Candidates will be selected on the following traits, and should aim to demonstrate them in their application:

We would be willing to negotiate a starting salary between £19,000 and £40,000, depending on experience. Salaries are raised by £1,000 each six months conditional on good performance.

Applications close midnight GMT on Friday the 12th December. We are offering a $1,000 reward for introductions to anyone we don’t already know who we end up hiring for the roles we are currently advertising.

See other job openings at the Centre for Effective Altruism.

Elina Naydenova

Maternal Nutrition - Who Pulls the Strings of Maternal Mortality

This is the second part of 'Why sometimes less is more in maternal mortality'. You can read the first part, about the safe childbirth checklist, 

The story of food is really the story of human kind. Many facets of the human experience have forged the development of food through the ages. For example, socio-political history: after the Second World War, Western governments vowed to end hunger, increase production and reduce the cost of food. Inevitably, science plays a deep role - fertilizers changed the landscape completely, doubling agricultural production between 1947 and 1979 [1]. Then there is fashion - take Julia Child, who singlehandedly introduced a generation of Americans to French cuisine. And let's not forget the influences of climate change, cultural differences, or the food corporate battles dictating the market. But this is not a blog post about how we shaped food. Rather, it is about how food subliminally shapes us, our health and our well-being.

The big performers on the maternal mortality stage

800 women die every day due to often avoidable complications related to pregnancy or childbirth

99% of these cases occur in developing countries

 [2]. Why does this still happen in today's day and age? In 2006, the World Health Organisation (WHO) published a strategic analysis of leading maternal death causes, accounting for regional differences (Figure 1) [3]. Which are the big players? Haemorrhage is the leading cause of deaths in Africa and Asia. Hypertensive disorders claim most maternal lives in Latin America.

Accessible and affordable interventions to counteract causes of maternal death exist. They vary in nature, cost-effectiveness and universality:

: from women's empowerment and education programmes to community groups for family planning

: from the construction and improvement of appropriate maternal health facilities to training schemes for midwives and healthcare workers

: from screening programs for preeclampsia and hypertensive disorders to management tools and programmes for sepsis and obstructed labour.

What do these two stories - the story of food and the story of childbirth - have in common?

As cost-effective as most of the interventions mentioned above are, some of them are only scratching the surface. There appears to be a more deeply rooted cause, a 

 as an example: on its own, it is a relatively minor cause of maternal deaths (1% - 13%). However, it can be 

indirectly associated with as many as 50% of maternal deaths

 worldwide, by aggravating haemorrhage cases [4, 5]. This effect is particularly horrifying when one considers the overwhelming prevalence of iron deficiency (anaemia) which affects 30-60% of pregnant women in developing countries [6,7]. How do we fight this hidden enemy? Daily 

 during pregnancy has been shown to reduce anaemia by as much as 70% [8,9]. Similarly, 

 during pregnancy has been shown to reduce incidence of hypertensive disorders: preeclampsia (a hypertensive disorder originating in pregnancy) by 55% and gestational hypertension by 35% [10, 11]. Additionally, low-dose weekly supplementation of 

, was seen to reduce mortality due to infection during labour by 44% [12, 13-14].

Does it really work in practice? Randomized trials have delivered compelling evidence that 

nutrition interventions are essential for the prevention of maternal as well as neonatal deaths

 [12]. Existing analysis of the cost-effectiveness of such programmes has indicated their comparable and often superior performance to other standard approaches [12, 15].

But exactly how far does the impact of malnutrition stretch? Much further than we thought...

In the last two decades, multiple studies have demonstrated the indisputable link between maternal health & nutrition and the well being of the child [16-19]. This link originates in pregnancy, where nutritional deficiencies adversely affect foetal development, resulting in low-birth weight or overweight infants and increased risk of complications during labour. But this link extends further than just these first years of life - both low-birth weight and overweight infants have been shown to be more prone to diabetes and cardiovascular disease later in life [20-21]. Nutritional interventions can improve the health of children and adults born to well-nourished mothers; they have also proven to be remarkably cost-effective in ensuring dramatic and sustained impact for little up-front investment [15,22].

Nutrition pulls the health strings of more than one generation - its effects run from maternal health, to the health of her child, and on to the adult they will become. This trans-generational passage of risk constitutes a curse as well as an opportunity - with one cost-effective intervention we can deliver multi-dimensional benefit. Nutrition is the hidden force against maternal and neonatal mortality.

, one of our recommended charities, provides nutritional solutions to communities worldwide in a cost-effective and population-contextualised way. If you would like to empower the hidden force of nutrition, fight maternal mortality and improve the health of future generations, supporting Project Healthy Children is one way to do this effectively. You can learn more about Project Healthy Children 

Somers, M. The Story of our food, Next Nature, 

http://www.nextnature.net/2011/08/the-story-behind-our-food/

http://www.who.int/mediacentre/factsheets/fs348/en/index.html

Khan, K. S. et al. WHO analysis of causes of maternal death: a systematic review 2006.

Gillespie, S. et al. Controlling iron deficiency. United Nations Administrative Committee on Coordination/Sub-Committee on Nutrition, State-of-the-Art Series Nutrition Policy Discussion, 1991 WHO.

Galloway, R. et al., Women's perceptions of iron deficiency and anaemia prevention and control in eight developing countries, Social Science & Medicine 55 (2002) 529 - 544.

Fifth report on the world nutrition situation: nutrition for improved development outcomes, United Nations, ACC/SCN, 2004.

Hunt, J.M. Reversing Productivity Losses from Iron Deficiency: The Economic Case, Journal of Nutrition, 2002.

Pena-Rosas JP et al. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev 2012; 12: CD004736.

WHO. Guideline: daily iron and folic acid supplementation in pregnant women. Geneva: World Health Organization, 2012.

Hofmeyr GJ et al. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev 2010.

Imdad A et al. Effects of calcium supplementation during pregnancy on maternal, fetal and birth outcomes. Paediatr Perinat Epidemiol 2012; 26: 138–52.

Rouse, D.J., Potential Cost-effectiveness of nutrition interventions to prevent adverse pregnancy outcomes in the developing world, The Journal of Nutrition, 2003.

Sommer A,West KP Jr. Vitamin A deficiency: health, survival, and vision. New York: Oxford University Press, 1996.

Green HN et al. Diet as a prophylactic agent against puerperal sepsis. BMJ 1931;ii:595­8.

Baltussen, R. et al. Iron Fortification and Iron Supplementation Are Cost-Effective Interventions to Reduce Iron Deficiency in Four Subregions of the World, 2004, The Journal of Nutrition 134 (10): 2678–84.

Wijesuriya, M. et al. The Kathmandu Declaration: ‘Life Circle’ Approach to Prevention and Care of Diabetes Mellitus, 2010, Diabetes Research and Clinical Practice 87 (1): 20–26.

Kimani-Murage, E. W. et al. The Prevalence of Stunting, Overweight and Obesity, and Metabolic Disease Risk in Rural South African Children, 2010, BMC Public Health 10 (1): 158.

Whitaker, R. C. Predicting Preschooler Obesity at Birth: The Role of Maternal Obesity in Early Pregnancy. 2010, Pediatrics 114 (1): e29–e36.

Bhargava, S. K. et al. Relation of Serial Changes in Childhood Body-Mass Index to Impaired Glucose Tolerance in Young Adulthood, 2004 New England Journal of Medicine 350 (9): 865–75.

Blog

Problems are in the eye of the beholder

The Cost of Violence I: What should our priorities be?

The Centre for Effective Altruism is seeking a Chief Operating Officer

Maternal Nutrition - Who Pulls the Strings of Maternal Mortality

Giving What We Can is seeking a Director of Communications

The Promise of the Safe Childbirth Checklist

Giving What We Can is seeking a Director of Research

Promising news for deworming

Endgame for Polio?

An AIDS-free generation? A summary of the discussion held on the Guardian Development Blog