Chapter 354 - The World’s Biggest Problems And Why They’re Not What First Comes To Mind[1]

We've spent much of the last eight years trying to answer a simple question: what are the world's biggest and most urgent problems?

We wanted to have a positive impact with our careers, and so we set out to discover where our efforts would be most effective.

Our analysis suggests that choosing the right problem could increase your impact over 100 times, and so be the most important decision you ever make.

In trying to answer this question, we've had to tear up everything we thought we knew, and then again more than once.

Here, we give a summary of what we've learned. Read on to hear why ending diarrhoea might save as many lives as world peace, why artificial intelligence might be even more important, and what to do in your own career to make the most urgent changes happen.

In short, the most urgent problems are those where people can have the greatest impact by working on them. As we explained in the previous article, this means problems that are not only big, but also neglected and solvable. The more neglected and solvable, the further extra effort will go. And this means they're not the problems that first come to mind.

Reading time: 30 minutes. If you just want to see our current views on the world's most urgent problems, skip ahead.

Why issues facing rich countries aren't always the most important—and why charity shouldn't always begin at home.

Most people who want to do good focus on issues in their home country. In rich countries, this often means issues like homelessness, inner city education and unemployment. But are these the most urgent issues?

In the US, only 4% of charitable donations are spent on international causes. The most popular careers for talented graduates who want to do good are teaching and health, which receive about 18% of graduates, and mainly involve helping people in the US.

There are good reasons to focus on helping your own country – you know more about the issues, and you might feel you have special obligations to it. However, back in 2009, we encountered the following series of facts. They led us to think that the most urgent problems are not local, but rather poverty in the world's poorest countries, especially efforts within health, such as fighting malaria and parasitic worms.

Why do we say that? Well, here's a pretty staggering chart we came across in our research.

It's the distribution of world income that we saw in an earlier article.

Even someone living on the US poverty line of $11,000 per year is richer than about 85% of the world's population, and about 20 times wealthier than the world's poorest 1.2 billion, who mostly live in Africa and Asia on under $500 per year. These figures are already adjusted for the fact that money goes further in poor countries (purchasing power parity).

As we also saw earlier, the poorer you are, the bigger difference extra money makes to your welfare. Based on this research, because the poor in Africa are 20 times poorer, we'd expect resources to go about 20 times further in helping them.

There are also only about 47 million people living in relative poverty in the US, about 6% as many as the 800 million in extreme global poverty.

And there are far more resources dedicated to helping this smaller number of people. Total overseas development aid is only about $131bn per year, compared to $900bn spent on welfare in the US.

Finally, as we saw earlier, the majority of US social interventions probably don't work. This is because problems facing the poor in rich countries are complex and hard to solve. Moreover, even the most evidence-backed interventions are expensive and have modest effects.

The same comparison holds for other rich countries, such as the UK, Australia, Canada and the EU. (Though if you live in a developing country, then it may well be best to focus on issues there.)

All this isn't to deny the poor in rich countries have very tough lives, perhaps even worse in some respects than those in the developing world. Rather, the issue is that there are far fewer of them, and they're harder to help.

So if you're not focusing on issues in your home country, what should you focus on?

Global health: a problem where you could really make progress.

What if we were to tell you that, over the second half of the 20th century, progress on treatments for diarrhoea did as much to save lives as achieving world peace over the same period would have done?

The number of deaths each year due to diarrhoea have fallen by 3 million over the last four decades due to advances like oral rehydration therapy.

Meanwhile, all wars and political famines killed about 2 million people per year over the second half of the 20th century.

The global fight against disease is one of humanity's greatest achievements, but it's also an ongoing battle to which you can contribute with your career.

A large fraction of these gains were driven by humanitarian aid, such as the campaign to eradicate smallpox. In fact, although many experts in economics think much international aid hasn't been effective, even the most sceptical agree there's an exception: global health.

For instance, William Easterly, author of White Man's Burden, wrote:

Put the focus back where it belongs: get the poorest people in the world such obvious goods as the vaccines, the antibiotics, the food supplements, the improved seeds, the fertilizer, the roads…. This is not making the poor dependent on handouts; it is giving the poorest people the health, nutrition, education, and other inputs that raise the payoff to their own efforts to better their lives.Within health, where to focus? An economist at the World Bank sent us this data, which also amazed us.

This is a list of health treatments, such as providing tuberculosis medicine or surgeries, ranked by how much health they produce per dollar, as measured in rigorous randomised controlled trials. Health is measured in a standard unit used by health economists, called the "quality-adjusted life year".

The first point is that all these treatments are effective. Essentially all of them would be funded in countries like the US and UK. People in poor countries, however, routinely die from diseases that would certainly have been treated if they'd happened to have been born somewhere else.

Even more surprising, however, is that the top interventions are far better than the average, as shown by the spike on the right. The top interventions, like vaccines, have been shown to have significant benefits, but are also extremely cheap. The top intervention is over ten times more cost-effective than the average, and 15,000 times more than the worst. This means if you were working at a health charity focused on one of the top interventions, you'd expect to have ten times as much impact compared to a randomly selected one.

This study isn't perfect – there were mistakes in the analysis affecting the top results (and that's what you'd expect due to regression to the mean) – but the main point is solid: the best health interventions are many times more effective than the average.

So how much more impact might you make with your career by switching your focus to global health?

Because, as we saw in the first chart, the world's poorest people are over 20 times poorer than the poor in rich countries, resources go about 20 times as far in helping them (read about why here).

Then, if we focus on health, there are cheap, effective interventions that everyone agrees are worth doing. We can use the research in the second chart to pick the very best interventions, letting us have perhaps five times as much impact again. In total, this makes for a 100-fold difference in impact.

Does this check out? After years of research, analysts at GiveWell have estimated that spending $7,500 on 1,500 malaria nets through the Against Malaria Foundation is enough, on average, to prevent one death.