Top Health and Development Policy Charity Ideas We're Researching in 2020 (Idea Prioritization Report)
From a starting point of 256 ideas, we selected the top 31 for further research through an idea sort. This Idea Prioritization Report is the second stage of our research process, and ranks the 31 ideas from most to least promising. Now the top 7 ideas will move to the next stage: 80-hour reports, which we will release in the coming weeks.
To rank the 31 ideas, we spent two hours evaluating each idea using our informed consideration methodology. This method was chosen because it is very flexible and therefore well suited to health and development policy, which is a broad and complex area.
The table below ranks each idea based on its performance on this methodology. The informed consideration scores link to the full reports, and brief summaries of each intervention follow the table. The ideas in bold (green background in the table) are the top priority for research and will be assessed in more depth this year.
* These research interventions will be looked at as part of the ‘Effective altruist-minded research and development spending in developed countries’ intervention
Lead paint regulation
This intervention involves campaigning for the introduction of lead paint regulation in a country where it doesn’t currently exist or is weak/unenforced. The report concludes that this is a strong intervention because lead paint has a large health and income burden; GiveWell ranks the intervention highly; it’s pretty uncontroversial; and it looks quite neglected - only 36% of countries have regulations, and the regulations that do exist are often not enforced that well.
Effective altruist-minded research and development spending in developed countries
This intervention is to start an organization that advocates for developed countries to increase their R&D expenditure on effective altruist-aligned activities. The report concludes that this could be a highly effective way of improving global health and development. This is particularly due to the public good nature of research, and because many developed countries have specific targets to significantly increase their research spending. It is also relatively neglected by EAs in the health and development space. Two key issues need to be looked into further: how difficult it is to influence budgets; and the expected returns of research, as these will strongly determine the effectiveness of this intervention.
Alcohol control - taxes, regulation, information campaign, other
This intervention involves looking at different ways to control alcohol consumption - for example, taxes, regulation, and information campaigns - to reduce its negative individual and social costs. The report concludes that this could be a strong intervention, as alcohol consumption has a lot of negative externalities for society and is addictive. The cost-effectiveness estimates are extremely high and there’s a lot of good evidence that we can work with from the World Health Organization. It’s also one of GiveWell’s top-rated policy interventions. There are some reasons to be cautious, such as the intrusiveness of ‘sin taxes’ and that they are often considered to be regressive, but non-pricing policies may be a good alternative, and pricing policies may still outweigh those considerations.
Effective altruist organization researching economic growth interventions
This intervention is to set up an organization that does research to find the most effective economic growth interventions or organizations. This idea comes from a recent post on the Effective Altruism Forum about economic growth. The report concludes that this area is highly neglected by EAs and has the potential to shift a large amount of resources to more effective areas. The research would also provide new information to the EA community, as well as help develop a methodology for estimating the impact of difficult-to-measure interventions.
Research and development into antimicrobials
This intervention is to encourage governments and research bodies in developed countries to increase research and development into new antimicrobial drugs. The report finds that the World Bank’s estimates of the cost-effectiveness of tackling AMR suggest that this is a potentially highly cost-effective area. Current funding seems low compared to what needs to be invested. Given developed-country goals of increasing R&D and the fact that this affects developed countries, this seems like quite a promising area. Ideally this funding would not come from aid budgets, as at least some of it currently does, but even if it did the World Bank’s estimates suggest it would very likely be a good use of money. This intervention could be incorporated into the general R&D intervention.
Organization that monitors and advocates for better aid quality
This intervention is to set up an organization that monitors and advocates for better aid quality in a developed country. While developed country governments have commitments on the quantity of aid they provide, they do not have as clearly defined commitments for the quality of aid. Furthermore, it seems possible that governments can be successfully convinced to improve aid quality. For example, the recent Effective Altruism Foundation ballot initiative in Switzerland resulted in Zurich’s development budget emphasizing effective allocation of resources. The report concludes that this intervention may work best by using the Center for Global Development’s extensive research on aid quality to advocate for better quality aid expenditure.
Information campaign on biofortification
This intervention is to run an information campaign on biofortification, which is the process of breeding food crops with enhanced levels of micronutrients such as vitamin A, zinc, and iron. Biofortification can involve conventional breeding methods and genetically modified methods; this intervention considers conventional breeding only. Analysis by Copenhagen Consensus Center suggests this intervention is highly cost-effective, and there is a lot of evidence that can be used to design an effective campaign. A lot of this work is, however, being done by the charity HarvestPlus. The report concludes that there may still be room for an EA organization to enter this space, for example, by finding an optimal country and focusing there
Research into causes of cluster headaches
This intervention involves campaigning to increase research into the causes of cluster headaches using developed country R&D funds. The report concludes that while it doesn’t affect as many people as some other interventions, the pain from cluster headaches seems so extreme that this should be a strong candidate for further research. It is also neglected, and it affects developed countries, so it can be funded through these research budgets. It is a good candidate to be considered as part of the general R&D intervention.
Accelerate direct measurement of causes of death
This intervention is to encourage direct measurement of causes of death in a country where more indirect methods are currently used. In many countries measurement of causes of death is highly assumption-driven, affecting their ability to set priorities and allocate resources efficiently. There is evidence that rolling out direct measurement in India caused changes in government priorities, and it was implemented quite cheaply. A key problem with this intervention is that it’s quite hard to measure the benefits to do a robust cost-effectiveness analysis.
Community monitoring of health problems - scorecards, planning meetings, etc.; regional comparison/competition for outcomes-focused government
These interventions look at making efficiency improvements to health systems by strengthening incentives for performance. The intervention found to be more effective is the first - community monitoring of health problems. This involves strengthening incentives for performance by, for example, providing community members with performance scorecards and involving them in holding delivery service providers to account. The evidence for this intervention is quite mixed - some find very large effects, while others find no effect. The report concludes that we would need to do more research to understand the contexts in which this intervention works, as well as how neglected it is.
Reducing regulation to access pain relief; palliative care campaign
This intervention looks at ways that pain, especially pain associated with terminal illnesses, can be managed in developing countries. The two main options considered are reducing regulation to allow greater access to pain relief medication, and running a campaign that encourages the government to prioritize palliative care. While this seems like a very important and cost-effective area to work on that is also neglected on a global level, an EA-aligned organization, Organization for the Prevention of Intense Suffering (OPIS), is already working on it. The report concludes that it might make more sense for OPIS to expand than start a new organization in the area.
Research and development to improve agriculture - biofortification; increasing yields; drought-resistant crops
This intervention is to encourage the government to increase agricultural R&D - for example, into biofortification, increasing yields, and drought-resistant crops. There are reasons to think research in development is underfunded and that the proportion of aid going to research should be increased. However, this is also the main downside of this intervention - it will likely replace other projects in developed countries’ aid budgets. The report concludes this intervention may be worth considering as part of the general R&D intervention.
Development aid targeted toward more research-based interventions
This intervention involves encouraging the UK or other developed country governments to increase the proportion of development aid that is spent on research. The report concludes that there are strong arguments in favor of increasing research, though measuring the benefits is difficult due to the uncertain nature of research. However, it may be better to focus on influencing research budgets that sit outside development budgets, to avoid replacing potentially effective existing development projects.
Global poverty behavioral and preference research
This intervention would start an organization to carry out behavioral and preference research to better understand the global poor, to help donors and policy makers make better decisions. The report concludes that research on beneficiaries’ preferences, particularly related to the value judgments donors make, is important and understudied, but that the research may be too technical to be done well by a new organization. A new organization could perhaps instead synthesize existing evidence and encourage researchers to fill gaps.
Research and development into green energy
This intervention involves encouraging governments, funders and research bodies to increase investment into green technologies to tackle the effects of climate change. One approach could be to lobby on Mission Innovation, an agreement between 24 countries to double their expenditure on green energy technology. The report finds that, while climate change is not a particularly neglected issue, R&D into clean energy is only a small proportion of climate budgets. With most emissions expected to come from emerging markets rather than developed countries in the future, increasing R&D seems like an important intervention because the technologies can be taken up globally. There is already an EA-aligned organization working on this issue on this basis (Let’s Fund), so it may be better to encourage them to expand rather than starting a new organization.
Research and development into non-addictive pain medication
This intervention would encourage governments and research funders to increase R&D into non-addictive pain medication. This report concludes that while this could be an important area to look into as part of the overall research intervention, it will mainly affect issues related to opioid addiction rather than the more severe problem of lack of access to pain medication, which may be better addressed through regulatory reform.
Universal health coverage of catastrophic health expenses
This intervention would encourage a developing country government to introduce universal health coverage for catastrophic health expenditures. Financial catastrophe related to health expenditures affects 100 million people per year, adding around 15% to the number in extreme poverty, and it seems like it could be neglected in the health space. The report therefore concludes that this could be a good area to look into further. The main concern is why it is so neglected. It could be difficult to implement politically, as only the poorest experience catastrophic health risk, but it requires the richer people in society to subsidize insurance.
Mosquito gene drives advocacy and research
This intervention involves encouraging governments to carry out gene drives to reduce disease-carrying mosquito populations. The report concludes that this is a promising but sensitive intervention. Some interventions, such as those targeting only specific species, are likely to get more public support. It is unclear who would be best placed to promote this though - perhaps the scientists working on the technology.
Outdoor air pollution - campaign to promote greater public transport/less car use
This intervention is to campaign for greater public transport or less car use in areas where outdoor air pollution is high. The report concludes that while outdoor air pollution is an important issue, convincing people to use public transport as it currently exists in many developing countries does not seem like the best or most effective solution. Greater investment in sustainable transport is more likely what is needed, but it’s unclear whether this would be cost-effective compared to other interventions, because it’s so much more expensive than information campaigns.
Reduce migration restrictions within a country
This intervention is to promote policy change to reduce migration restrictions within a country. The report concludes that internal migration is relatively neglected and tractable compared to international migration, though less impactful overall. There aren’t many legal restrictions, but there are non-legal barriers, for example, lack of support for migrants in accessing services, or information about jobs. While there are potentially some interventions in this space that would be effective, the research on which interventions to look further into is inconclusive.
Universal salt iodization
This intervention would encourage the government of a neglected country to introduce and roll out universal salt iodization. The report concludes that while this seems like a very cheap and sustainable way to increase development, it is relatively crowded and so it will be harder to make an impact in this area.
Use of Xpert MTB/RIF technology to diagnose tuberculosis and drug resistance
This intervention would encourage governments to switch to the use of Xpert MTB/RIF, a technology to more quickly and accurately diagnose tuberculosis (TB) and drug resistance. TB is neglected within EA compared with other infectious diseases, and it has a large impact - many deaths, and deaths occurring at peak productive years. But it seems that this has been happening since the WHO’s recommendation to roll it out, and it seems generally less neglected than I initially thought.
Trade policy reform
This intervention considers several ideas, including UK/EU trade policy reform; trade reform in developing countries; lobbying for regional trade agreements; lobbying for completion of the Doha Development Round; and advocating on revenues lost by developing countries from bilateral tax treaties. These interventions have the potential to be very high impact, and could also have significant positive externalities, in particular reducing global conflict. There are some negative effects that would need to be managed, and the specific policies to promote will depend on the context, so more research is needed. The report concludes this could be a very good intervention to look at further as part of the ‘growth research’ intervention.
Campaign to influence developed country views on agricultural subsidies
This intervention would campaign to influence people in developed countries’ views on agricultural subsidies, with the end goal of reducing or ending these subsidies. While there is public misperception concerning agricultural subsidies, and this is a timely moment to try and affect it, the report concludes that the likelihood of success with this intervention is too low.
Incentivize development of pharmaceuticals to address developing country issues
This intervention would encourage the government to incentivize pharmaceutical industry investment in R&D for health issues in developing countries. The report finds that there are a couple of organizations in this area that are quite strongly focused on effectiveness, so it might be a bit crowded. If the incentives are financial this intervention could be very expensive, though it could also work through non-financial incentives. Overall, though, because there are already a couple of organizations in this space, this intervention has been given a relatively low score.
Increase cost-effective government spending; program prioritization research; help identify and stop ineffective programs
This set of interventions involves starting an organization that helps governments prioritize programs in terms of cost-effectiveness, focus on those programs, and identify and stop ineffective programs (i.e. those that don’t have the intended effect or turn out to be unimpactful). The report concludes that a new organization is probably not needed because the Copenhagen Consensus Center (CCC) already does this kind of work and is quite EA-aligned. A better approach is probably to support CCC, or to encourage EAs to work there and make it more EA-aligned if we think this is necessary.
Regulatory reform for genetically modified crops/biofortification in developed countries
This intervention would encourage developed country governments to relax regulations around genetically modified/biofortified crops so that developing countries can grow and sell them on global markets. The report concludes that trying to create demand for biofortified crops in developed countries is an interesting intervention, but the causal chain is quite long, making it quite hard to succeed. For example, even if we convince people that they should care more about their nutrition, private health companies will probably be able to more effectively step in and market their health products (and lobby against biofortified crops) than we would. So I think it might be better to focus on information campaigns in developing countries and leave this intervention to an organization like HarvestPlus, who is already working on it.
Mass media promotion/campaign for behavior change - breastfeeding, food supplementation, handwashing
This intervention would work with a government to carry out mass media promotion or information campaigns to affect behavior change relating to newborn and maternal health. Key areas considered are breastfeeding, food supplementation, and handwashing. The report concludes that while these interventions are likely to be effective, Development Media International is already either already working on them or would be well placed to do so, so it doesn’t make sense to replicate this work.
Legal change to prevent modern slavery
This intervention is to lobby for legislative change to reduce modern slavery. An example is lobbying for a Modern Slavery Act in a country where slavery is a problem, similar to the one introduced in the UK and some other countries. The report finds that there is generally a lack of robust evidence on the impact of legal and policy change to reduce modern slavery. It concludes that this lack of a strong evidence base means that a lot of experience is likely necessary in this field, for example to judge the effectiveness of different types of interventions. It’s quite a risky area as well, because of the possibility of legislation creating the wrong incentives. The best thing for EAs who believe this is really important may be to contribute to the evidence base and donate to existing organizations.
Gender quotas for political positions
This intervention is to campaign for a policy that requires gender quotas for political positions. The report concludes that the evidence for this intervention is much more mixed than initially thought. Combined with the political nature of this intervention, this intervention has been given a relatively low score.
Voter information campaigns
This intervention would run a campaign to give voters information about political candidates. The report finds that while initial evidence looked encouraging, a pre-registered meta-analysis of seven randomized trials found no effect of information campaigns on voter behavior. Because of the weak evidence and the political nature of this intervention, this intervention has been given a relatively low score.