How to do the Most Good: Where & How to Aid

Part 2 of the effective altruism post coming at you, we'll talk about where to aid by identifying biases and then how to aid by looking at where your individual balance lies. Email/message any questions or comments!

Where to Aid

I grew up as spot of brown in predominantly, confederate flag waving South Carolina. My parents struggled with their immigration status. At age 11 my father bought me an immigration law book and told me to help them. At age 20 I joined Harvard Law’s Immigration and Refugee Clinic as a student intern. My family continues to face immigration struggles today. If I told you I’ve decided to go to law school to pursue the injustices embedded in our immigration system because of my background you’d probably think that was okay, maybe even admirable. However, as a 23-year-old Harvard graduate with a wide realm of possibilities and a passion for equality I believe it would be a biased and disrespectful decision if I had made it without first logically thinking through all of the different areas my skillsets could be of use as well as what my larger life goals are.

Biased: I completely let my background and personal connection to the cause overshadow any capabilities for logically analyzing my career possibilities as well as any recognition of the wide array of other problems that plague our world.

Disrespectful: In refusing to explore and acknowledge other options I am disrespecting a huge array of professions that I could embark on. Further, I’m disrespecting my own ideals and goals. If my goal is to save the most amount of lives possible – then perhaps a life as an immigration advocate isn’t the best choice. Or perhaps it is. Only logic and careful consideration will tell. Finally, I’m disrespecting all of the people who don’t have the opportunity to analyze their own situation like I do. People who don’t have this freedom to choose their career, because sure choosing a career can be stressful but it’s a rare privilege to have so in order to honor that privilege I think you should do it with a careful balance of passion, goals and logic.

Instead of letting that motivate me in a specific direction, if I let it motivate me to seek equality for the world at large then maybe I can get one mili-step closer to that goal: equality for the world. Of course, your emotions and passion cannot be discounted and we’ll go into that in the “How to Aid” section, but first let’s take a look at how we can decide where to aid.

• Neglected Areas: issues that effect a lot of people and aren’t well funded/ publicized.

• I’d recommend global health as an easy one here, but then you have to figure out where exactly there is neglect. For example, there’s a good amount of campaigns in the world to operate cataracts (I’ve had personal contact with 3 of them) but I’ve never heard of anyone taking on trachoma: a river blindness disease that was long eliminated in the USA and is rampant in the developing world.

• Think carefully about this one – chances are it won’t be things like HIV or Cancer given their presence in the media and large donor base. 1/3 of our world is effected by TB and funding for it is abysmal. Causes that have millions of people and dollars are not neglected, it doesn’t mean that they’re not worthy of your attention it just means they don’t get points in this category.

• Here’s another fun fact to get you thinking: more people die from mismanaged/in-access to surgery than from malaria, TB and HIV.

• Tractability: How feasible is this problem to solve? Is it possible?

• Can you actually make a dent in this world issue? Let’s say we’re both trying to eliminate a disease from this Earth. Your disease is a result of genetics and environment, you cannot see it’s manifestation and indicators of it can be seen through blood tests or when you have a massive attack that could kill you, the cure revolves mostly around lifestyle change. Mine is a disease that’s caused by a virus, you can easily identify those who have it as they develop scarring on the outside of their body, the cure involves a treatment of drugs. Whose more likely to succeed? Me. My disease was smallpox – in 1977 it was eliminated, saving up to 3 million lives a year. Your disease was heart disease – which due to its incredibly complex nature is a harder beat to tackle.

• How Many People Benefit: Scale

• As a general rule the global will always trump the local in terms of numbers. Your money will make a great impact on someone whose living on $2.5 than someone in the developed world. This isn’t to say that there isn’t poverty and need in the USA because there is. Take a walk through the Appalachian back alley through coal country if you disagree. It’s just a number’s game.

• A good indicator of this is a QALY that we’ve previously defined as a quality adjusted life year. 1 QALY indicates 1 year of high quality life and you can theoretically “buy it” for someone in the developing nation for a pretty low cost depending on the NGO.

• Think about how important this is to you to weigh it on your balance. An easy example is comparing a geneticist whose focus is on rare genetic diseases that less than 100 people in the world have verses a pulmonologist who’s a specialist on TB. Both are noble but one has the higher possibility to impact a greater number of people.

The point here is to show you where you can have the greatest impact if your goal is having the greatest impact and saving the most amount of lives. It might not be so let’s talk about that first – life goals and career.

How to Aid: Career & Donating

Top medical school advisors are starting to steer their students away from saying they want to be a doctor because “they want to help,” it’s a good sign for sure. Not because it indicates that the next generation of doctors will be heartless but because if it takes into consideration that in todays interdisciplinary, globalized world there are dozens of careers you can pursue to help if that’s your intention. So let’s look at some intentions you can have with your career:

• Financial Stability

• It would really be obnoxious to not bring up the obvious fact that most of the world struggles to get a job to support themselves and their family. My father worked 17 hour days for years to make sure we were well taken care of and much of the world experiences the same reality – so if that’s yours then you are not alone. But you too can make a difference. If you think you can raise $100 in your lifetime you could give someone a year of quality life. Even if it takes you 40 years to do this, then I feel like that’s still something that’s worth doing.

• There’s a difference between stability and wealth – but it’s up to you how much you think you need before you start giving back. I’m not going to tell you, you don’t deserve that $50,000 Porsche. If you think you need it then go for it. But keep in mind the plethora of options you have for that money. A global perspective goes a long way.

• Career Independence

• Being able to have a career that’s variable enough and gives you enough skills to be able to work in a wide range of settings. You are not constrained to a specific industry you can move around the world and change companies. Given that the average American moves every 10 years, this might be something you value.

• Personal Fit

• Here’s where your passions come in – sort of. If you like it and if you believe in the mission is super important – if you are unmotivated and unhappy in your job your productivity will plummet and you might as well not go to work. In terms of how important and necessary passion is in what you do that’s totally up to you. If I can’t get it out of my head the pain my family endured in the immigration system enough to seriously consider other options, if every time I look at a career in aerospace engineering it feels like I’m turning my back on them, well then it looks like a career in immigration is coming my way. If I am extremely gifted in math and physics with a degree from MIT then this might not be the “best” or most “high impact” decision, but we’re all humans at the end of the day. And immigration is an issue that needs help. We can’t be perfect robots and calculate our skillset coldly. Further, the level of passion you have can’t be quantified and put into a formula – no one knows how far it’ll take you so good luck.

• However, if you do have the ability and desire to analyze yourself then we can move on to looking at if your skills are right for the job, if you are well-qualified.

• Human beings don’t have the best long-term decision making, we’re emotional beings. And at times emotions overtake our ability for logic. As ever adapting beings our interests too are ever changing. Just because I loved playing the piano when I was a child doesn’t mean I think I want to be a world famous pianist. Maybe I can keep it as a hobby, maybe I can teach under-resourced kids how to play in order to show them discipline/ goal-setting or maybe I’ll drop it all together.

• In order to maximize your personal fit you need to set your priorities—going through this list is a start.

• Kinds of impact:This is about the motivation you need to get up in the morning and do your job at its highest level.

• Making the most, sure fire, impact in the world

• If you need to see the faces of the people you’re helping to keep doing a stellar job then you probably need to be at an effective non-profit or in education or healthcare – somewhere with lots of human interaction.

• Having the potential to make the most positive impact

• However, if you are just so motivated by the bigger picture in what you’re doing (research breakthrough, policy) that you don’t need to see your impact then you can consider other options.

• These have the greatest potential for impact – if you find the cure for HIV then you’ve saved millions of lives vs a doctor that on average saves 4 – but also the greatest risk. Maybe you’ll spend your whole life slaving away in the lab working 15 hour days all to discover a grand total of nothing. Sure maybe your research contributions will be utilized long after your death – like Mendel who many people thought was a crazy monk playing with peas and whose taught in every genetics class across the world. However, maybe they won’t be. And even if they are you’ll be dead so you might not see it depending on your beliefs.

• I had an interesting conversation with the former director of the NIMH in which she came to visit us in Lima, Peru at PIH to see where her grant money was going. She seemed so happy to be there, “in the field.”

• On a three hour ride back to the city I commented: “Isn’t it funny that the places we do the most good are in a nice office, behind a desk? But in order to stay motivated and see the bigger picture we need to come back to the field. It’s like we need to see it, it almost seems selfish but I guess that’s just a part of being human. We all need reminders and a bit of validation.” Tilting her head as if to re-evaluate who this 22 year old sitting next to her was, she kind of laughed at me, took a pause and agreed.

• Being an active member of your community: Relationships

• Here’s a segment from Coco coming your way. Think about how much you value having relationships and taking care of them – after all we already know that relationships are the key to happiness and the top things humans wish for are: happiness, health and family. Community can have a range of meanings:

• Family – being a good sibling, aunt, uncle, parent, child, grand parent, etc.

• Friends

• Co –workers/ teammates

• Neighborhood

• Time is the game here – how much time do you want to spend on your work verses how much time do you want to spend on your relationships. Balance.

• It’s all well and good to say that your biggest goal is causing the most amount of impact possible but what about when your 7-year-old has a soccer championship and you have to choose between that and going on a brigade to do heart surgeries in sub-Saharan Africa. This isn’t an exaggeration it’s a real life scenario from a professor’s life. Are you a bad dad for not going to see your child? Maybe. But if you’re the only one who can preform the life saving surgeries and you don’t go and 50 people die then what’s worse? There are solutions to these problems but you need to be conscious of their existence to plan them out accordingly. A beautiful family life doesn’t just happen, especially if the parents are working professionals, like everything it takes time and dedication. Both of which could have been spent doing other things.

• A family is a classic example, this takes time and money and is a worthwhile investment if you ask me. A global health leader once told me that he doesn’t give his children presents because they don’t need it - this led to two divorces and more than a few tearful Christmas mornings. He’s a superstar so maybe it’s worth it but it's not my ideal balance. Especially since I’m don't think a two-year-old can really wrap his head around the global scale of inequality. I really tried to refrain from bringing these kinds of things up to my sisters until recently, because I think the worst thing you can do is make someone feel guilty over the life they’ve literally been born into.

• Beyond making you happy and providing a higher quality of life for all of those around you if we look at it on the global high impact scale and use a bit of Elon Musk’s cold logic – if I, as a well educated, globally minded woman choose not have children I’m depriving the world of the opportunity of people who will continue to have my same ideology and capability to help others. As my mother pointed out, just because I choose to have children doesn’t mean that they’ll share my ideals or views on life it’s definitely a risk. A risk that can be mitigated significantly by actually taking time to be a good parent but still a risk.

• Coco’s all about family legacy, and how you still have a place in the world as long as someone remembers you. Other than making me feel valued and like I’m cheating the number of years humans can live on this planet – I really do think it’s a good indicator of the amount of impact you’ve caused. If my great-great grand child shares my same views and drive to create positive impact then that’s a win and well worth the 18 years it’ll take to raise a child. You probably have 50 years of working life, but there’s a possibility that your bloodline can go on for hundreds of years and could continue working towards the same goals of equality you had. So that’s the argument for children.

• Community and relationships don't have to center around family. Definitely if you cannot give sufficient time to having a family because you feel so called to your work or are not willing to take the risk then don’t do it. Don’t underestimate the long lasting impact you can have as a mentor.

• It just depends on what level of commitment and community you want to have to define your daily life.

Now that we’ve done a little bit of priority setting we can come to the conclusion that you can either pursue a career that delves into tackling the world’s greatest problems or you can donate to institutions that are working to do this. It really just depends on where your balance lies. Here are some examples of careers we commonly think of through the lens of this perspective.

• Doctor

• Positives: visible impact, daily contact with populations in need, working in a needed area (most countries don’t have enough doctors), working on a team, being immersed in an environment that’s always pushing you to learn and grow, good paycheck and quality of life, work hours if you specialize in certain fields, in the USA alone an average of 4 lives (pretty dope)

• Negatives: most common complaint is “feeling like a wheel in the system,” you can see all the hardships of the people and treat them but you cannot treat their root, systematic cause, since your expertise is in health it’s hard to move to other areas of work. A career in law will be challenging. Work hours can be crazy in certain fields.

• Options: be a doctor for a few years then change careers, or be a doctor and be a teacher/ hospital administrator/ activist at the same time. Many doctors practice 1-3 days a week and then have another career. Or take part of your $150k+ paycheck and donate it to an effective charity.

• Policy Maker

• Positives: possibility for making a high amount of change with impactful policies, wide variety of options for work, great recognition, good work hours

• Negatives: intractability of problems, corruption of the system, difficulty to even get to an impactful position, not great money unless high up

• Options: Generally, for policy makers you can have another career prior to policy or post-policy

• Educator

• Positives: face to face impact, fulfilling a need (lots of teachers are just teachers because they found no other jobs not because they are passionate), great hours and vacation time

• Negatives: intractability of problems, corruption of the system, difficulty to make change outside your classroom, see the problems but cannot attack their root cause, low pay

• Options: Combine with policy, activism or higher level of administration

• Worker/ Volunteer at an effective Non-Profit

• Positives: face to face impact, fulfilling a need (many great non-profits are short on people I know mine is), furthering a larger organizations goals, can have good work hours especially if you’re a volunteer

• Negatives: not being able to get at the social injustices that cause the problem

• Options: Combine with policy, activism or higher level of administration

• **NOTE: the volunteer portion of this one is tricky because it depends how needed the skills are to the organization. Be real with who’s really gaining in the moment – is it you because you are getting experiences that will motivate/help you to pursue a career that’ll do good in the world or is it really the company because you are providing them with invaluable knowledge. Either way is good if both end in high impact, positive work. And it doesn’t have to be black and white. Just be straight with yourself that this might not cause the greatest immediate impact. Further, do a close analysis to make sure that this non-profit is actually worth your time, see some guidelines in the choosing where to work and donate.

• Researcher

• Positives: potential for a huge impact, flexibility in your ideas, flexible working hours (long but you don’t have to do 9-5pm), the joy of getting to unravel the world’s mysteries, you are the backbone for change

• Negatives: academia is challenging environment to succeed in, long working hours, little pay, might be years or even decades before anyone uses your work

• Options: combine with something like teaching, mentoring to get more face to face impact or look at other avenues or change careers

• Hedge fund Manager & Management Consultant

• Positives: money, flexibility in career, wide array of skills that can be applied to diverse situations

• Negatives: you’re helping rich people get richer, not face to face impact, work hours can be long, competitive/ elite environment

• Options: Donate some of your million-dollar paycheck to a non-profit, transition careers into the public sector or non-profit world once you’ve developed skills, connections and have enough money. The new CEO of the Global Fund worked at Mckinsey for most of his life and now he’s working to get rid of the some of the world’s most threatening diseases. This merge of for-profit business and non-profit/public sector is excellent for fostering the diversity of perspectives needed to combat the worlds complex social qualms. Or do both – transition your career and donate. If you’ve worked in these kinds of jobs your whole life you can probably afford it.

Now let’s look at a career that isn’t often associated with doing good but is something that over 70% of American's aspire to be.

• Small/Family Business Owner

• Positives: money, flexibility in hours, control of your vision, implement your "dream"

• Negatives: you might not be engaging in the most altruistic of endeavors if your business is to sell $5 cupcakes, it can be super hard to get off the ground leaving you with little time for family and anything else

• Options: Donate is probably the biggest one especially if you have money, donate to small projects help fund them and serve on their board of trustees as they grow. This is a board that basically just has to have financial knowledge and controls the money to some extent. Volunteering is great too but if you don’t have specialized expertise it can be less valuable. Other options include starting your own non-profit if you have flexibility in your time.

The point here isn't to make you feel bad about the cupcake business you spent decades building up just because it doesn't directly correlate to helping others. Take pride in your accomplishments, only you know how much you deserved them but congrats from me either way. Rather the point here is to showcase once more that anyone with the possibility of making an extra $100 in their lifetime can make a difference. Further, if you decide that you want a career helping the world but still don’t know where to turn then I encourage you to do a careful analysis of your skills. If self reflection is difficult take some tests to figure out where you lie, asks your friends and then try reflecting once more.

Decision time: Take time to think about where you want your balance to lie, a lot of time: you work on average 80,000 hours in your lifetime so even if you spend 800 of these hours aka 20 work weeks non-stop thinking about where your balance falls that will still only be 1% of your working life deciding what you want to do. So think about it, take a gap year, stay in school, get an internship, explore options. If you can, you should. It’s hard to decide this in one go and I don’t think you need to. You can get a vague sense and then decide that with more knowledge will come more decision making ability. This is what I did and what I’ll showcase in the last portion.

If you can’t take 800 hours to think about what you want to do in your life because you are seeking financial stability, then that’s okay too. If you’re 50 and you’re just now able to think about giving back great! Welcome. Figure out where you want to aid and then read below to see where you can donate. Don’t under-estimate your own potential, we can all help our world – just in different ways. Which is great due to the deep complexity of the problems.

But let’s say you decided to go down the path of donating (pictured below).

Donating: Choosing an Effective Charity

After you’ve chosen your areas to aid in the two big things that you need to look at are use & effectiveness.

• Need More Money: ensure your contribution will be valued and utilized

• If someone offered to give me a million dollars for Refresh Bolivia and said I had to spend it in the next year, I would probably have to pass. Refresh Bolivia needs roughly $40,000 a year to operate effectively and run its programming. We can effectively use up to $200,000 a year but no more than that. This is because we are a small organization with a limited number of efficient members who are able to develop, implement and monitor programs. Further, if I run a $30 billion non-profit and you give me $30 – well I’m not sure I needed it. I probably need more people to give all that money away to the under resourced – in this case your time might be more valued than your money.

• So before you give money make sure it’s actually needed and will be used for what you consider to be a valuable cause. Make sure your contribution will be valued and that the organization you are giving it too has the administrative capacity to use it.

• Effective in Implementation

• If you give me $500 to build a bathroom in Bolivia I’ll build it in 4 weeks or less because I’ve been to Bolivia a dozen times, have an intricate knowledge of the free market, can access local masons and have a personal knowledge of the community’s needs. If you give me $500 to build a bathroom in Burkina Faso – it’s going to take me at least 3 months because first I have to learn about the market, market costs, resources available then I have to identify community need and gain community trust or partner with other local NGOs.

• Ensure that the charity you are giving to implements your donated funds at a reasonable timeline and impacts a high number of people.

• This does not mean look at their administrative overhead cost. That’s such a false indicator of effectiveness and perpetuates a number of non-profit myths that Akshay writes a bit about in his posts. If my NGO spends 18% on overhead but I’m impacting double the amount of people that you do in half of the time, but you only spend 10% on overhead and claim to be “more effective” because of it.

• Let’s say you give $100, I need $18 of them to pay my staff and get transport the rest goes towards our programming which gives you 10 QALYs. Meaning your donation literally bought 10 high quality years of life for people in the developing world. Seems pretty solid. Let’s say I only spend $10 of your dollars on administration but my programming only gives you 5 QALY’s – less solid.

• Thus, administrative overhead cost just isn’t a good indicator however, for financial transparency Refresh Bolivia is working on getting our financials online for the world to see.

So there it is – with this guide you’ll be one step closer to figuring out how you can help. Everyone can help- even those who are chasing financial stability. It just depends on what your priorities are and what you want to do in life. We can’t have it all and everyone’s balance tips differently and that’s okay. It doesn’t make you a bad person, the very fact that you’re reading this indicates that you are concerned for our world and want to help. So thanks from me. Glad to have someone else fighting the same battle. Let's work on making this map