We’re proud to announce our 2020 Top Charity Ideas!
Each year Charity Entrepreneurship identifies highly effective interventions in chosen cause areas. Our Incubation Program gives participants the skills they need to start high-impact nonprofits based on our top intervention recommendations.
Our 2020 research period focused on four cause areas: mental health, animal advocacy, family planning, and health & development policy. We began with several hundred ideas in each cause area. Progressive stages of our extensive research process whittled down to eight recommended ideas.
Eighty-hour reports linked below illustrate how we came to recommend this year’s top interventions. We also provide Incubation Program participants with implementation reports, which provide specific recommendations to map a path forward for a new charity.
Our 2020 top recommendations are as follows (in no particular order):
1. Guided self-help – Distributing workbooks to enable individuals to work independently on their mental health, supported by short weekly calls from lay health workers.
Health & development policy:
2. Lead paint regulation – Advocating for tighter regulation of lead paint to reduce the burden of lead exposure on human health and economic prosperity.
3. Alcohol regulation – Advocating for increased alcohol taxation to mitigate the harmful effects of consumption.
4. Shrimp welfare – Improving the welfare of farmed shrimp, e.g. through collaborating with Vietnamese farmers to better oxygenate the water, thus reducing chronic suffering for shrimp.
5. Feed fortification – Fortifying feed with micronutrients to combat deficiencies and improve the health of laying hens.
6. Ask research – Helping organizations and policy-makers decide what best to ask of the animal agriculture industry. (We explored this intervention during our 2019 research period and passed it on to 2020, as despite its promise it was not started.)
7. Mass media campaigns – Broadcasting information about family planning to reduce misconceptions and empower women to make decisions about their fertility.
8. Postpartum family planning – Providing family planning guidance to women at pivotal moments for their health and fertility, such as after giving birth.
The above reports are time-capped at eighty hours and follow the chronology of our research process. The reports begin with preliminary research and identifying crucial considerations. Next, we consult with experts. We then create a weighted factor model and a cost-effectiveness analysis. These two methodologies allow us to numerically quantify an intervention; by including both, we balance out their different strengths and weaknesses. Our final section brings together information gained throughout the research process.
We have chosen to organize our reports in this way to increase transparency. Readers are able to follow the research as it unfolds and develops, and can see how an idea performs from multiple perspectives.
For specific questions on the research process, reach out to Karolina Sarek at [email protected].
Lead researcher: George Bridgwater [email protected]
Our four cause areas achieve impact in different ways, so we tailor our metrics accordingly. In this cause area, our cost-effectiveness analyses quantify impact using two metrics: the satisfaction with life scale (SWLS), and quality-adjusted life years (QALYs). We measure the expected number of incremental increases on the SWLS, and of QALYs per dollar spent. We use two metrics because of how difficult it is to capture subjective well-being: although we believe that the SWLS may more accurately reflect well-being, QALYs offer the benefit of being widely used and thus more comparable. Our metrics report (forthcoming) provides further information on the various metrics used in this space.
Distributing self-help workbooks enables individuals to make progress on their mental health either independently (known as pure self-help) or with minimal support (guided self-help). Our research found strong evidence that guided self-help in particular can significantly improve symptoms of anxiety, depression, and chronic pain – conditions that collectively affect over 2 billion people worldwide.
Demanding much less staff time than face-to-face therapy, self-help can deliver highly cost-effective treatment for mental health issues. Initially, we were concerned about dropout rates because of the low intensity of self-help. However, we found evidence that dropout rates for self-help are similar to those of traditional therapy. For severe cases, the strong interpersonal relationship between therapist and patient may be preferable. But for those with mild and moderate mental health issues, self-help seems a strong alternative to traditional therapy.
We modeled the cost-effectiveness of self-help under six scenarios. These vary according to the income level of the country of operations, support available to beneficiaries, and whether the workbooks distributed are new or reused. The most likely scenarios involve distributing new workbooks and offering telephone support.
In a high-income country, modeling our most likely scenario suggests a cost-effectiveness of $78 per incremental increase in SWLS score, or $20,016 per QALY. In a low-income country, cost-effectiveness rises to $20 per SWLS increase, and $1,203 per QALY. All of these figures account for the counterfactual impact of funding and co-founders.
Our research suggests that supporting individuals with short phone calls strikes a good balance between factors like cost and effect size. Online options such as Skype-based support or the use of avatars seem promising and may be worth exploring in future, but currently the evidence for these is weaker. We also would like to see more evidence in low-income countries, as most of the randomized controlled trials on self-help took place in high-income countries.
Involving largely independent work means that self-help may be a promising way to deliver therapy in contexts where stigma surrounds mental health, and where people are therefore reluctant to visit a therapist. Depending on the context, workbooks may need to be culturally adapted, ideally with input from the local community. An expert we spoke to suggested this could be done in three months, although the time frame will depend on various factors and could easily extend longer.
A key advantage of self-help is its flexibility. A new charity will be able to explore various therapeutic techniques and target a range of beneficiaries. Based on unmet needs and available evidence, we think that Overcoming Anxiety, Overcoming Depression, and Living With Your Pain are promising workbooks for a self-help charity to distribute, but we expect co-founders of this charity to experiment and pivot according to their findings.
Our research on self-help has left us confident in our recommendation, but we still have some remaining questions and space for development. We’d like to see further studies in different contexts, and into other types of support (e.g. avatars). We also have remaining concerns over how best to recruit beneficiaries and over the logistics of management at large scale (i.e., upwards of 10,000 beneficiaries).