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The Simplest Way to Save Lives With Your Money | The Ezra Klein Show

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The Simplest Way to Save Lives With Your Money | The Ezra Klein Show

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1850 segments

0:00

It's holiday season [music] and in the

0:02

holiday season here at New York Times

0:04

Opinion, Nick Kristoff many years ago

0:06

kicked off [music] a tradition which I

0:07

love. It's one of my favorite parts

0:08

about being here where different

0:10

columnists and parts of the organization

0:11

[music]

0:12

offer up their recommendations for

0:14

giving trying to make people aware of

0:17

charities, philanthropies they might

0:19

want to support where money that they

0:22

can spare [music] might do a tremendous

0:24

amount of good. In my personal giving,

0:27

every year I give [music]

0:29

some of the money I'm giving to a local

0:31

charity, but then I give a lot of it to

0:33

give [music] well of every organization

0:36

I know of. I have the most [music] trust

0:39

in them to vet, to run the experiments,

0:42

to read the research, to really figure

0:44

out where my money [music] will go the

0:47

furthest in helping other people. Give

0:50

all has not been around that long, but

0:52

in the time they've been around, they've

0:54

become a [music] pretty big channeler of

0:56

givers funds for this exact reason

0:58

because a lot of people trust the work

1:00

they do because it is so transparent

1:01

because it is so rigorous. Billions of

1:04

dollars have ended up [music] being

1:05

given through them. And so I am

1:07

recommending that if you have money to

1:09

spare, you consider giving some of it

1:10

[music] through Give Well, which you can

1:11

do at givewell.org.

1:13

But I thought as a way to talk about

1:14

this, rather than writing a column, I

1:16

would [music] have Ellie Hassenfeld,

1:18

Gwell's CEO and one of its founders on

1:20

the show to talk about how Give Well

1:22

started, how it does its work, how it

1:25

makes some [music] of its very arguable

1:27

and very difficult decisions in terms of

1:28

what to recommend and what not to

1:30

recommend, and how givers [music]

1:33

themselves should think about donating

1:36

money, to whom, to where, and under what

1:39

conditions. [music]

1:40

as we all sort of wrestle with how we

1:43

can do a little bit more good in a world

1:45

that needs a [music] lot more good done.

1:47

As always, my email, Ezra Kleinshowny

1:49

Times.com.

1:53

[music]

1:56

Ellie Housefeld, welcome to the show.

1:58

Great to be here. So, I want to start a

2:00

little bit before your work at Gwell.

2:02

When I was looking into this show, you

2:05

studied religion at college, which is

2:08

not what I would expect necessarily from

2:09

somebody who goes on to work at a hedge

2:11

fund and then become an apostle of

2:14

costbenefit analysis and randomized

2:15

controlled trials. So, religion, why?

2:19

>> I think in an alternative life, I'm not

2:21

doing what I'm doing here at Gwell and

2:23

instead I'm a academic studying the

2:26

Talmud. It was something that at the

2:27

time I was incredibly interested in. And

2:30

in college, I spent a lot of time in

2:32

Talmud courses, studying other religious

2:35

texts and Judaism and otherwise. And I

2:38

just found it incredibly fulfilling and

2:42

interesting to think about how people

2:43

had tried to answer questions about

2:45

their lives.

2:46

>> What is the Talmud for people who don't

2:48

know? And what did you learn from

2:50

studying it? It's a huge compendium of

2:53

Jewish ideas and thought from roughly

2:55

the 500s of the common era. And I think

2:59

the thing it taught me most is how

3:01

challenging it is to know anything. uh I

3:03

spent about a year just studying Talmud

3:06

and in that year after high school it

3:09

was the it was the first time that I

3:11

think I had a really challenging

3:13

intellectual experience where I wasn't

3:16

able to understand the the text and the

3:20

content that I was trying to and uh but

3:23

nevertheless found myself drawn to

3:26

understand it and to deal with the

3:29

layers of challenge that the the text

3:30

presented and spent a year doing that.

3:33

And then when I was in college, I would

3:35

say that this was my main

3:36

extracurricular activity outside of

3:38

school was spending several hours a day

3:41

uh studying studying Tolmood and

3:43

thinking about whether that is something

3:44

I would do as a career and ultimately

3:46

realized it wasn't the right fit for me.

3:48

>> And what you move on to is Bridgewater,

3:50

a very unusual hedge fund. How what is

3:53

that movement for you?

3:56

You know, sometime I as I moved through

3:58

college, I was thinking about what my

4:00

career would be and had the opportunity

4:02

to have internships in many different

4:04

places. So, my parents are both lawyers.

4:06

I got to work at a law firm. That

4:08

convinced me not to go to law school

4:09

because I didn't think that would be

4:11

that would be right for me. I was able

4:12

to get a job in finance at a small

4:14

company and they were they were

4:16

essentially selling research to the big

4:18

banks and just trying to figure out how

4:20

to ac succeed as an organization. And

4:24

because of that, they were willing to

4:25

give me, a 21-year-old college kid, a

4:27

lot of leeway to try to do things and

4:29

help the company grow. That experience

4:32

of being in a place where I was needed

4:34

and able to do something interesting and

4:37

challenging motivated me to look for

4:39

jobs in in finance coming out of school.

4:41

And so I went to, you know, I was able

4:42

to get a job at Bridgewwater Associates,

4:44

which in 2004 when I graduated college

4:47

was not wellknown at all. Uh, everyone I

4:49

talked to said, "Don't don't go work

4:51

there. You know, go work at a well-known

4:52

investment bank. that'll be better for

4:54

your career. But when I interviewed

4:55

there, they they asked me about my

4:58

senior thesis, which I was a religion

5:00

major, so it was about martyrdom in

5:02

medieval Islam, Judaism, and

5:04

Christianity. And we talked about that

5:05

for an hour, and I got a call back. And

5:08

it was one of the few places that that

5:09

called me back as a you might not be

5:11

surprised to hear that religion majors

5:13

don't often do so well interviewing for

5:15

finance jobs. And because of that, I

5:17

thought that this place, Bridgewwater,

5:18

was just uh one of the more interesting

5:21

places to go work. and I was grateful to

5:23

be able to work there.

5:24

>> So it later becomes fairly wellnown

5:26

because it's Ray Dallio's hedge fund and

5:28

Dalia of course is a a sort of I know

5:31

public finance intellectual now but had

5:34

a very strange and famous management

5:37

style. What was working at Bridgewater

5:40

like for somebody who doesn't know much

5:41

about it? What is unusual about working

5:43

at Bridgewwater in that time?

5:45

>> So so what Bridgewater is known for is

5:47

its culture of [snorts]

5:49

radical transparency. just saying what

5:52

you think, sharing that with other with

5:54

your colleagues, not worrying too much

5:56

about how you say it, but just saying

5:58

what you believe. And then over time,

6:00

>> more about how they'll feel about it

6:01

>> or how they'll feel about it. And over

6:02

time, Rey developed these principles

6:06

that were passed out inside the

6:08

organization. The way I described it to

6:10

my friends at the time is it felt to me

6:12

like working in almost an academic

6:14

environment. People didn't wear fancy

6:16

clothes. They argued a lot about ideas.

6:20

uh you know sure there were ways in

6:22

which um I think the culture wasn't

6:25

ideal for many you know it was a place

6:26

where it was more about getting things

6:29

right and then worry about people's

6:31

feelings later and if that wasn't the

6:32

right fit for you then people moved on

6:34

but for me it was an extremely valuable

6:37

experience and and the thing that I

6:38

appreciated certainly as a young person

6:40

in my early 20s is I would go to my boss

6:41

sometimes and he was one of the heads of

6:43

the company and say hey I think you're

6:45

wrong about this and he would listen to

6:47

me and not you know sometimes I was

6:49

wrong Sometimes I was right, but just to

6:51

be taken seriously early in your career

6:54

was uh so valuable. It's something I'm

6:55

really grateful for them for providing

6:57

me.

6:57

>> What did you actually do there?

6:59

>> I worked in the research department for

7:00

a year. So that meant thinking about uh

7:02

investment decisions and then move to

7:04

the trading or the execution department

7:06

where the job was to try to put trades

7:08

into the market in a way that didn't

7:10

push the market too far in the direction

7:12

that we were going. I I think this is

7:14

relevant to what you end up doing

7:15

because when hedge funds, investment

7:18

banks, you are trying to understand a

7:21

company, a sector,

7:24

uh quirk in the market

7:27

at a level where you can make a trade

7:30

other people will not make and you'll

7:32

lose a lot of money if you're wrong. So,

7:35

how does a religion major coming out of

7:37

college, what is the pathway to having

7:40

something of any value to say when

7:43

you're, you know, whatever it is?

7:45

>> I think the core the core idea that was

7:48

true then and I think has carried

7:50

through in give well and in my life

7:52

today was, you know, first in order to

7:55

make decisions about what to do in the

7:56

world, we have to understand the world

7:58

accurately. And for a hedge fund,

8:01

understanding reality is really key. If

8:04

you're right, you make money. Or you

8:06

can. If you're wrong, you tend to lose

8:07

money. And so the stakes of getting to

8:10

the quote unquote truth are very high.

8:13

Part of that is you have to be careful

8:14

not to fool yourself. So one of the

8:16

things that investors do is they have an

8:18

idea about what might perform well in

8:20

the market. And then you can say, well,

8:22

how well did this idea perform

8:23

historically? And you can back test the

8:25

idea. And when you do that, you have to

8:26

be really careful not to fool yourself

8:29

and fit your idea to the past. Instead,

8:33

you have to ask this question.

8:34

>> Wait, can you describe what that would

8:35

mean?

8:36

>> So, you might say uh like a simple rule

8:38

like let's say when I'm going to make

8:39

something up uh that's entirely

8:41

fictitious, but you know, let's say if

8:43

oil stock if oil prices go up, then

8:46

train stocks go down because an input

8:49

into railroad costs is the price of gas.

8:52

And so when you know the input cost goes

8:54

up, the performance will be poor. And

8:56

you could try to look at this

8:57

historically and say, let's say we

8:59

tested this going back. Would this have

9:02

been a successful strategy in the

9:03

market? The challenge is it's very easy

9:06

to convince yourself that you should

9:07

tweak your rule in one way or another to

9:10

enable the idea that you have to perform

9:13

uh on the back test, but you don't want

9:15

to do that cuz you only want to bet

9:17

money on this idea if it really will

9:19

work. So you're working at Bridgewwater,

9:22

a hedge fund, I would say one of the

9:24

more inquisitive industries that exist.

9:28

Where does the interest for you, where

9:30

does the the glimmers

9:32

of giving as a pursuit and giving

9:36

differently come from?

9:39

I've been there for a couple of years.

9:40

Uh my friend had a friend there, Holden

9:42

Carnowski, and and he and I just started

9:45

realizing, you know, we have we're

9:47

young. We don't have high expenses.

9:49

we're saving some money. Let's try to

9:52

use some of this money to to help

9:54

people. And so back in the summer of

9:56

2006, he and I and a few others got

9:58

together and said, "Let's just work on

10:00

figuring out where where we'll give by

10:02

the end of the year." You know, few a

10:04

few thousand dollars. [snorts]

10:06

And it was in that process with that

10:09

group of people that we learned a few

10:10

things. You know, first we learned it's

10:12

really hard to get answers about what

10:14

charitable organizations do and how well

10:16

it works. Uh number two, I just found

10:19

myself,

10:20

you know, somewhat obsessed by this

10:23

question of where should we give? You

10:25

know, at the time I knew very little

10:28

about what the lives of people around

10:30

the world were like. It's not something

10:32

I'd studied. It's not something I knew

10:33

much about, but learning about the

10:35

challenges accessing water or disease,

10:37

it was just a very motivating motivating

10:40

topic to work on. I I remember this

10:42

night in probably December of 2006. I

10:45

was up at 2 or 3 in the morning reading

10:47

academic papers about diarrhea in

10:49

Africa. If you find yourself reading

10:50

about diarrhea at 3:00 in the morning,

10:52

you know you found something that is

10:54

you're really drawn to. And so after

10:56

working on this essentially part-time,

10:59

Holden, my co-founder and I left

11:01

Bridgewater and started Give as a

11:02

full-time project back in the summer of

11:04

2007. Two things in there. One is the

11:08

impulse to start looking for

11:11

the effectiveness data on the charities

11:13

you might support. Not to just say we're

11:16

going to, you know, give the money to

11:17

Doctors Without Borders. We're going to

11:18

give it to UNICEF, right? There there

11:20

are big charities out there. We've all

11:21

heard of them. There was Charity

11:22

Navigator, which is something that I

11:23

used when I was younger.

11:26

And and also what happened, what you saw

11:29

when you began looking.

11:31

We just started asking some really basic

11:33

questions and the answers we got back uh

11:35

were shocking. So we we each researched

11:39

a different cause. I decided to research

11:41

the cause of water in Africa. I'd call

11:43

up first we looked at Charity Navigator

11:45

and at the time Charity Navigator

11:47

essentially just reported financial

11:48

metrics. So it said this is the amount

11:50

of money that's spent on overhead versus

11:54

programs and fundraising. And while this

11:56

measure can tell you that a charity is a

11:58

scam or not, it's it's not going to tell

12:01

you whether the program is actually

12:03

working. Let's say the charity spends

12:05

all its money digging wells, but those

12:06

wells disappear a year later. They fall

12:08

into disrepair. Well, that's not a very

12:10

effective use of funds, even if all of

12:12

it was spent on programs. And so we we

12:14

knew that Charity Navigator wasn't

12:16

giving us the answers. I called the

12:18

organizations up and asked them, "Well,

12:20

so so what do you do? What do I get if I

12:22

give you money?" And they said, I

12:23

remember this $20 provides a child water

12:25

for life.

12:27

Great. That's amazing. I would love to

12:28

give to that. Uh what do you mean? Like

12:31

how how does that work exactly? What

12:32

does it pay for? And how do you know?

12:35

And at that point, it's like the

12:37

conversation fell flat. They they just

12:39

didn't have answers. What what they

12:40

actually said was, "We don't get

12:42

questions like these from our

12:44

million-dollar donors." And it it was

12:47

this light bulb like this light bulb

12:49

went off that you know almost no one was

12:52

asking these questions.

12:53

>> Were they annoyed by you?

12:55

>> Uh some of them were annoyed by us. One

12:57

organization

12:58

accused Holden of being a spy for a

13:01

rival organization. He had asked how

13:04

much money do you spend in each country?

13:06

And that question would they could only

13:08

imagine it would be asked if he had some

13:10

nefarious purpose. And so I I think they

13:13

were annoyed. I mean, we were what, 25

13:15

at the time, so I'm sure we were

13:17

annoying, but we really saw how

13:21

neglected this area was. And it really

13:25

motivated us to start Give Well.

13:27

>> What's striking to me about the way you

13:28

approached it is that

13:32

you even had the intuition

13:34

that maybe you would give to a charity.

13:36

And what you were doing was making a bet

13:38

in the same way that when you're

13:39

trading, when you're trading, the bet is

13:41

supposed to make you money. When you're

13:43

giving to a charity, it's supposed to

13:44

improve lives.

13:45

>> In some ways, this basic question of

13:49

what is true, how can we know that it's

13:51

true? How can we assess the empirical

13:54

[clears throat]

13:55

data and evidence that we have to make

13:56

the best decisions? I mean, that's

13:57

exactly what Give Well does in a very

13:59

different way, in a very different

14:00

context, but it's bringing that same uh

14:03

commitment to rigor and truth seeeking

14:07

to bear on trying to answer questions

14:08

about what we should do in the world.

14:10

What are the things that in your view

14:12

most commonly stand in the way of

14:14

organizations? Organizations that care

14:16

deeply about their mission or have

14:18

financial or otherwise skin in the game

14:22

from finding truthful answers.

14:25

Organizations or for that matter

14:26

individuals.

14:28

I mean I think there's two big things

14:31

that happen and there's many more that

14:33

are downstream. First is as an

14:36

individual running an organization, you

14:38

have an incentive for your organization

14:40

to succeed and [snorts] it's very

14:42

difficult to look for information that

14:45

would mean your organization is not

14:47

succeeding or shouldn't receive money.

14:51

uh it it's just it's it's it's not I

14:55

think it's not realistic to expect

14:57

someone who say is running an

14:58

organization that you know delivers food

15:02

in a way that is very cost inefficient

15:05

to determine that they should shut that

15:07

program down and move on to something

15:08

else. That's just not how human beings

15:10

operate. And I think that's completely

15:13

completely understandable. And then I

15:15

think the second challenge

15:17

um is that in order to make good

15:19

decisions about where to put money, it's

15:22

very helpful to have a a broad

15:24

perspective. If you're focused on, let's

15:27

just say, an inefficient delivery of

15:30

food aid, you're not going to be

15:32

thinking about the role that a malaria

15:34

vaccine could now have and whether you

15:36

should be in fact delivering malaria

15:38

vaccines instead of delivering food aid.

15:40

And so I just think the place that most

15:41

people sit in the let's call it the

15:44

nonprofit economy makes it implausible

15:47

that they would take this kind of

15:48

perspective. I think that when I was

15:52

younger and giving to charity, I didn't

15:54

really think at all about the idea that

15:56

the money could fail.

15:58

And I mean these are good people.

16:00

They're trying to do something hard. You

16:03

know, they're out there working on the

16:05

ground. The idea that you might just

16:07

give money to some of them and that

16:09

money would be useless, I actually think

16:12

until later on didn't really occur to me

16:14

deeply.

16:16

What was the intuition that led you to

16:18

treat money given to charity as money

16:20

that could fail? I don't I don't know

16:23

what, you know, led us to have that

16:25

realization. And what I remember is it

16:27

was at a time when, you know, you would

16:30

go to CNET on the internet for ratings

16:35

of printers if you wanted to know which

16:37

printer to buy. And it it almost seemed

16:39

intuitive that you should be able to get

16:41

the same kind of information about any

16:44

way that you would spend money,

16:45

including about charitable

16:47

organizations. And in many ways that was

16:49

the initial vision for give well which

16:52

you know we've evolved far from today

16:53

but the initial vision was a place that

16:55

donors could go and just get information

16:59

that is as good about where they'll give

17:01

as they could get at the time about

17:03

which computer to purchase or which

17:05

printer to buy. And it just seemed

17:08

it was it was offensive in some ways

17:10

that that didn't exist for charitable

17:12

organizations. You know, I think a lot

17:13

of the focus that people bring to

17:15

charity is is on the donor. It's saying

17:18

to, you know, donor, you should be

17:20

generous. And then when you're generous,

17:22

that's that's success. And of course,

17:24

what that misses is that the person who

17:28

you should ultimately be focused on is

17:29

is helping someone in need. That that's

17:31

the goal. Uh, you know, I think that

17:34

what, you know, what what really is

17:36

important to remember is is both the

17:39

fact that you can fail to help the

17:41

person in need and and that happens all

17:43

the time, but also that charitable

17:45

giving isn't just a nice thing that a

17:48

donor can do. It's a very practical way

17:51

to make the world a better place that

17:53

you can give and save lives. And and

17:55

this has been, you know, it's clear and

17:57

demonstrable that supporting public

17:59

health programs has this kind of impact.

18:01

That point about the focus being on the

18:02

donor is interesting. So in the

18:04

tradition you and I share, the Jewish

18:05

tradition, there's this idea of Saddaka.

18:08

And I remember being in Hebrew school

18:10

when I was young, going around with a

18:12

little Saddaka box and collecting, you

18:14

know, coins. And I think it went to at

18:16

that time UNICEF.

18:18

And and being taught that there were,

18:19

you know, different levels of saddaka.

18:22

And the highest level was when nobody

18:25

knew you gave and you did not know who

18:28

you gave to because that level was

18:30

selfless in both directions. you you

18:32

were not expecting gratitude. You were

18:34

not expecting prestige. Uh I do wonder

18:36

if some of it comes from the history of

18:39

of of charity and generosity as among

18:42

other things a spiritual practice.

18:43

You're trying to [sighs]

18:46

uh develop a certain facility

18:49

inside yourself as a virtuous and

18:50

spiritually alive person. The idea that

18:54

you'd be coming behind that money and

18:55

checking up on it, I think would be seen

18:56

in some ways as intention

18:58

with the attributes you were trying to

19:01

cultivate. When the focus of charitable

19:03

giving is on the generosity of the

19:05

donor, then those sorts of that

19:09

framework makes sense. And then there's

19:11

this alternative way of seeing the

19:13

world, which I think is more intuitive

19:15

to us in modern times than perhaps it

19:17

was 3,000 years ago, which says we we

19:20

know that we can make the world a better

19:21

place. The world is a much better place

19:23

in my opinion today than it was 3,000

19:25

years ago. We we do that via improved

19:29

technology. We argue about the best

19:31

political systems and what policies we

19:32

should have. And now I want the argument

19:35

that I'd like to bring forward is that

19:36

charitable giving is one more way that

19:38

each of us can take action and make the

19:40

world better. and and when you see it

19:42

from that perspective, it's critical to

19:44

think about the effects that the

19:46

programs have where you can get as much

19:48

uh impact as possible and also how to

19:51

avoid failure. So you and Holden split

19:54

off from Bridgewater, you create give

19:57

well. You begin trying to gather this

20:00

data,

20:02

begin trying to figure out even how you

20:04

would make recommendations. How do you

20:06

start? The idea we had is that when we

20:08

were individuals giving a few thousand

20:10

dollars, it was hard to get information,

20:12

but with some of the funds that we were

20:13

we put together to start Give Well

20:15

full-time heavily [snorts] from our

20:16

former co-workers at Bridgewwater. We

20:19

could incentivize organizations to share

20:21

data. We started by offering small

20:23

grants that organizations applied for.

20:25

Uh I think at the time we offered

20:27

several $25,000 grants. Organizations

20:29

would send us data. And what we learned

20:31

in that first year after we we

20:34

recommended our first round of

20:35

organizations is that while we needed

20:38

some data from organizations, what was

20:40

really critical in pushing us to make

20:41

recommendations was this huge trove of

20:44

academic information about what works to

20:47

help people overseas. So these are often

20:50

rigorous randomized control trials of

20:53

health programs uh like distributing

20:55

mosquito nets or provision of needed

20:58

vaccines.

20:59

Who are these academics doing this work?

21:01

Because on some level, it's weird work

21:03

to do to say to yourself, well, I'm

21:04

going to see if giving a family a cow

21:06

really does help them in 5 years.

21:09

Where where is this early

21:12

evidence coming from and what kinds of

21:14

weirdos are collecting it? Well, I mean,

21:17

there's there's different fields that

21:19

you know whose information we rely on.

21:21

One is the the public health field. So

21:23

people asking questions like how

21:24

effective are mosquito nets or how uh

21:27

what impact will we get from vitamin A

21:29

supplements delivered to young children.

21:31

This is coming out of of public health.

21:33

And I remember actually speaking to one

21:34

of these malaria researchers who told me

21:37

at one point early in his career he had

21:39

sat on the beach in Tanzania and just

21:43

let mosquitoes bite him because they had

21:45

to count how many bites he would get in

21:47

in some amount of time sitting on the

21:49

beach. So certainly people who were

21:51

themselves willing to go to great

21:53

lengths and risk personal harm to create

21:56

the information we rely on. And then

21:58

separately, there's a movement in

22:00

development economics around randomized

22:02

control trials where people are trying

22:04

to not just assess the health effects of

22:06

programs which are often more

22:07

measurable, more easily measurable, but

22:10

the economic effects of programs like

22:13

micro finance or provision of livestock

22:16

or even just giving people cash to let

22:18

them spend how they want. And this this

22:20

movement in the 90s and early 2000s in

22:23

in many ways I think of as uh being an

22:27

intellectual forebearer to give well and

22:29

you know I think we're in in our debt to

22:31

all the work they did because they

22:32

really helped generate many of the ideas

22:34

that we've taken forward.

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speed test intelligence data 125. How do

23:08

you think about freeing yourself from

23:12

the very natural human tendency to think

23:15

along with your group? I do find people

23:18

in finance or venture capital tend to be

23:22

trained to look for places where the

23:24

consensus might be wrong. I I mean at

23:27

the hedge fund level what everyone else

23:29

thinks on some of you if you only think

23:31

what they think you're not going to make

23:32

money. But I think there's also this

23:35

dimension, and I feel like this is

23:37

important to the work you all end up

23:38

doing at Give Well, where there are

23:40

things that that are comfortable to

23:42

think um stories we like to tell

23:45

ourselves or are moved by and the way in

23:48

which we can get wrapped up in

23:52

those sort of more emotionally driven

23:55

approaches or socially driven

23:56

approaches, right? You know, everybody

23:57

like you supports this kind of charity.

24:00

everybody like you knows that you know

24:02

the economy is going to be bad next

24:03

year. I

24:03

>> I mean [clears throat] the the ask that

24:05

I would make of most people is is not to

24:08

try to break away from the norm in an

24:13

extreme way but instead

24:15

you know there's this idea that that you

24:18

know that I have that many have this

24:19

traditional idea of giving 10% of your

24:21

income to charity. It doesn't ask you to

24:23

give

24:24

>> very old religious idea.

24:25

>> Old religious idea tithing.

24:26

>> And so it's it's not giving 90% or even

24:30

50%. It's it's 10%. And I think in the

24:32

same way, you know, if you're if someone

24:35

is supporting local causes, if they're

24:37

supporting programs that are meaningful

24:40

to them, one one step to take is just

24:43

move away by 10%. and move towards, you

24:48

know, if if you want the causes that we

24:49

focus on helping some of the poorest

24:51

people in the world, uh, with with 10%

24:53

of your focus and energy. And I think

24:55

that that 10% move is one that is

24:58

available to many people.

24:59

>> So, you're you're pointing towards a

25:01

very particular intuition people have,

25:04

which is that we all get wrapped up in

25:08

local causes. And I want to say for my

25:09

giving, I sort of give in a couple of

25:11

different buckets. And one is very

25:12

local, right? that I believe I have a

25:14

particular responsibility to the

25:15

community I am part of. Uh but there's a

25:19

tendency for the stories that you know

25:21

and are near you and people who know you

25:24

tell you to overwhelm the sort of

25:27

diffuse questions of global malaria or

25:30

vitamin deficiency. How did you travel

25:34

that path? Because my understanding of

25:35

when you began in this you began locally

25:37

as well. Uh when when we started, we

25:41

were based in New York. Now we're based

25:42

in the Bay Area, but we were looking

25:44

both at causes focused on New York and

25:46

causes focused overseas. Um I think the

25:49

first donation I ever gave was to a New

25:51

York-based organization called the

25:52

Harlem Children's Zone, you know,

25:53

well-known local organization helping

25:55

disadvantaged children in the New York

25:57

City area. And what we learned after

26:00

that first year of work at Give Well,

26:02

was just how far a dollar can go

26:04

overseas. And then I I think there's a

26:07

little bit of a in some we know this,

26:09

but it's a little bit of a a figment of

26:10

our imagination that the people who we

26:13

see every day are are really closer to

26:16

us in some way. Uh last summer, uh I

26:19

traveled to Malawi and this was just to

26:21

[snorts] see the the types of programs

26:24

we support, to speak with people who are

26:26

there, and they're they're far away.

26:28

It's true. But with 36 hours of flying,

26:32

I I can sit as close to them as I'm

26:34

sitting to you and ask them about their

26:37

lives, what they're struggling with,

26:39

what they're dealing with. And then in

26:40

the same way that in at home, I can see

26:43

someone who's in need in in sitting

26:45

across from someone in Malawi, I hear

26:46

about their struggle to have food the

26:49

days they went without eating, the the

26:50

mother who tried to bring her child to

26:52

the local clinic, but uh she had to

26:55

carry her child for an hour on her back

26:56

and then the clinic didn't even have the

26:58

drugs in stock. And I can also talk to

27:00

the parents who in a maybe a way that's

27:02

very familiar to to me, maybe to you,

27:04

are struggling with a new second grade

27:06

math book because they're teaching

27:07

arithmetic in a different way now in

27:08

Malawian schools than they did when she

27:10

grew up. And so she doesn't know how to

27:12

help her child with the math because

27:13

it's different than what she did. And so

27:15

being there, you know, on one hand,

27:17

there's the analytical argument that a

27:20

dollar goes further, and then I think

27:22

there's just the reality that uh people

27:25

in Africa aren't as far away as we

27:27

sometimes think. They're really there.

27:28

you can go and talk to them.

27:29

>> I think it is profoundly difficult as a

27:32

human being to live as if other people's

27:34

lives are as real and as valuable as

27:36

your own. [gasps]

27:38

There is a vividness to us and the

27:41

people right around us. I don't mean

27:43

necessarily in our community. I mean our

27:45

family, our friends, people whose

27:47

stories interweave with our own. and to

27:50

really treat people further from that.

27:52

You know, somebody fleeing from gang

27:55

violence in Honduras or just somebody

27:58

struggling at subsistence level labor in

28:03

another country to to treat their life

28:05

as if it is as real as yours to really

28:07

believe that not just say it. In some

28:10

ways, I don't think human beings are

28:11

wired for that. But but it does strike

28:14

me as a a a a genuine like emotional and

28:18

spiritual challenge.

28:20

>> And I'm not sure that that's what we

28:21

should be really aiming for because I

28:23

don't think it's possible. If if if we

28:25

felt like other people's lives were as

28:27

important as our own, we wouldn't be

28:28

talking about giving 10%. We'd be giving

28:31

far more. In the same way, I don't think

28:34

it's reasonable to ask expect to even

28:36

want parents to treat their children

28:38

equally to all other children in the

28:40

Would we want a society where all

28:42

parents thought of their their own child

28:44

exactly the same way as as every other?

28:46

I don't think that's a realistic

28:47

expectation.

28:48

>> No, that'd be inhuman.

28:49

>> And so, well, quite literally. And so, I

28:52

think this and so I think sometimes, you

28:54

know, the ideas of that that come from

28:57

people who say, you know, you can give

28:58

more and there are needs overseas. It

29:00

sounds like someone is saying you you

29:02

must or you're bad if you don't or you

29:05

should give everything away because look

29:06

at the great need. And in some way we

29:09

must accept that's true to some extent.

29:11

But more more practically I I don't

29:14

think that's the right target to shoot

29:16

for. And in in my experience people who

29:19

try to aim at the target which is

29:21

treating others exactly like yourself or

29:24

giving everything away to bring yourself

29:26

down to the global median income. I mean

29:28

that maybe succeeds in the short term

29:30

but certainly is not a long-term path to

29:33

helping others as much as possible. I'm

29:35

always struck by how few charities

29:37

actually make it into your top charities

29:38

and and it's pretty it has been fairly

29:41

stable year to year now for some years.

29:44

So, walk me through what they are and

29:46

what makes you confident in them.

29:48

>> Yeah, let me um let me first, if it's

29:50

okay, like frame up how the top

29:51

charities fit into our overall work. And

29:53

so, in 2025, we've directed funds to 70

29:57

organizations. uh four of them are our

29:59

top charities and then you know there's

30:01

more than 60 others that have received a

30:03

lot of money. You know perhaps they're

30:04

newer or our knowledge of the program is

30:07

newer or the evidence is slightly more

30:10

complicated and you know there's higher

30:12

risk that the program doesn't fail but

30:14

the program fails but if it works it'll

30:17

be incredibly successful. And so we

30:19

direct a lot of funds to those those

30:21

types of programs too. And so what what

30:24

these top charities represent uh to

30:26

maybe use the finance analogy is is

30:28

something like the blue chip programs,

30:31

the the ones that um have the strongest

30:34

combination of evidence and track record

30:37

and data uh behind them so that we can

30:40

say to anyone, you know, if you're if

30:41

you're trying to help people overseas,

30:43

these are really great places to give

30:45

to. So our our top charities, one is the

30:47

against malaria foundation which funds

30:50

malariaet distributions globally. The

30:53

second one also works on malaria

30:55

prevention and that's malaria consortium

30:57

in its seasonal malaria

30:59

chemoroprevention program. This program

31:01

provides seasonal antimmalarial

31:04

medication to children during the

31:05

malaria high season to prevent cases of

31:07

malaria and resulting deaths. uh one uh

31:10

Helen Keller International focuses on

31:13

provision of vitamin A supplements twice

31:15

a year to children between the ages of 6

31:17

month and 5 years. Uh and then the

31:19

fourth is called new incentives and they

31:22

deliver cash incentives to caregivers to

31:24

encourage them to come to clinics to

31:26

receive necessary childhood

31:27

immunizations. And you know those four

31:29

are not the I wouldn't call them the the

31:31

best. There's, you know, other programs

31:33

we've recommended uh outside of that for

31:35

water and uh malnutrition prevention and

31:39

uh the malaria vaccine, which, you know,

31:40

it's it's relatively new. It's not going

31:42

to get on our top charities list yet. Uh

31:44

but there's just this wide array of

31:46

programs that help people around the

31:47

world.

31:47

>> And this gets to there are multiple ways

31:49

to donate through Give Well. Walk me

31:51

through those and how they relate to the

31:53

this sort of division you're making

31:54

here.

31:55

>> Yeah. And so the Well, I mean, first

31:57

just, you know, anyone can use our our

31:58

research for free. Someone can come to

32:00

our website, read it, and you can donate

32:02

to any of the organizations that you see

32:03

on our top charities list directly

32:05

without ever telling give well that

32:06

you've done it. I mean, we hope you do

32:07

because that helps us understand our

32:09

impact. Um, but for you know, the the

32:11

primary options we offer people are

32:12

first to give to our top charities fund.

32:14

And so that is uh you know that those

32:17

are donations that we'll only give to

32:18

those four organizations based on the

32:21

needs they have at the time we received

32:23

the funds. We we push those money, you

32:26

know, out the door. We commit those

32:27

funds to organizations relatively

32:28

quickly. The next option for donors is

32:31

to support the all grants fund. And you

32:34

know that just gives us the flexibility

32:35

to give to either top charities or any

32:38

of the organizations or programs that we

32:41

might support including giving money to

32:44

help organizations or programs get off

32:45

the ground or funding the type of

32:47

research that we need to make our

32:49

decisions. And then finally, there are

32:50

donors who give unrestricted. And you

32:52

know that is the in some sense the

32:54

highest level of trust in give well

32:55

because you're allowing us to decide how

32:57

much we need to allocate to our own

32:59

operating expenses versus allocating

33:01

funds to the programs we support. Uh

33:04

we've we've been fortunate enough in the

33:05

last few years that we've raised more

33:07

unrestricted funds than we need for our

33:09

own operations and we've then designated

33:12

that money for granting and you know

33:13

sent it out the door to get it to people

33:15

who need it around the world. The most

33:17

common critique I hear of give well, one

33:20

I even somewhat believe is that it's

33:22

there's a limit to what can be measured

33:25

and it's possible to measure the effects

33:27

of vitamin A supplementation in a way

33:29

that measuring the effects of funding

33:32

for political change or fortifying

33:34

public health infrastructure is very

33:36

very hard. You know, it's very hard to

33:38

measure the effect of giving on climate

33:40

change. How do you think about that that

33:42

question of

33:44

what you can and cannot measure knowing

33:47

that much that cannot be measured is

33:48

going to be important in you know human

33:50

flourishing? [sighs and gasps]

33:52

>> Yeah, it's a great question. And I mean

33:53

I think uh to start I think it's really

33:57

important to have humility in this work

34:00

that we can be wrong and we know we can

34:03

be wrong and there are times when we've

34:05

supported programs that seemed like they

34:09

would clearly be effective. And then at

34:11

the same time we also funded a rigorous

34:14

randomized control trial to go along

34:15

with that program. There's an

34:16

organization called No Lean Season or a

34:18

program that we helped start and you can

34:20

read all about it on our website if

34:21

you're interested. That program provided

34:22

small cash incentives to encourage

34:25

people to migrate from the rural areas

34:27

of Bangladesh during the lean season to

34:30

the cities so that they could earn more

34:31

money and send money back home. There

34:33

was a series of randomized control

34:34

trials that preceded our support of it

34:36

that showed that it was having this

34:38

effect. People were earning more money.

34:39

They were even more likely to migrate in

34:41

future years. And then we provided

34:43

funding to start up this program with an

34:46

RCT randomized control trial alongside

34:48

it. and at scale it didn't have the

34:50

effects that we expected. Uh there's an

34:53

interesting I mean I have some theories

34:54

about

34:54

>> why do you think that is? So I think in

34:56

this case there there's just this big

34:57

challenge of going from a 2,000 person

35:00

research study to a 100,000 person

35:03

program that's existing in the world.

35:05

And I think what may have happened in

35:07

this case and this is what I heard from

35:08

the uh the lead the researcher of that

35:10

program Mushik Mubarak a great academic

35:13

that when they decided to deliver these

35:15

cash incentives they did it via micro

35:17

finance institutions uh essentially

35:19

banks that were there in in Bangladesh

35:21

and the loan officers who were

35:24

delivering these incentives which were

35:26

small loans at the time their personal

35:28

incentive was to find the people who

35:31

were already likely to migrate because

35:33

that made their job of finding

35:35

people to take these incentives much

35:37

easier. You know, I think an interesting

35:39

question about that program is we

35:41

decided to no longer continue supporting

35:44

it. Evidence Action, the organization

35:45

that implemented it shut it down. Uh

35:47

that was a joint decision at the time.

35:50

And I'm not even sure that decision was

35:52

right because it's possible that with

35:53

more time we would have been able to

35:55

solve this implementation challenge. But

35:58

I I think this this story just

36:00

illustrates the how critical measurement

36:03

is. measurement is is certainly

36:05

limiting, but I I think when you're

36:08

trying to help people living 10,000

36:10

miles away, it's just necessary to find

36:13

some mechanism for getting feedback. So,

36:16

be be part of a a feedback loop that

36:18

tells you if what you you know, if your

36:20

bets are right, you know, to use the

36:22

>> I think there's some way in which I feel

36:24

just hearing that story the danger of

36:25

being a donor because if I had donated

36:29

to that, which probably I did because

36:30

I've been donating through Give Well for

36:31

a long time. if I had donated to that

36:35

and what I had heard is there's great

36:37

evidence that giving people grants to to

36:39

migrate in the you know during during

36:41

key seasons will will help them out and

36:43

look now we're giving all these people

36:44

grants. would never occur to me to think

36:48

maybe it's not working

36:50

and

36:52

it makes you wonder how much money is

36:54

out there being wasted

36:57

or and I think this would be the other

36:59

question

37:01

if there's something wrong with the

37:02

studies right the

37:07

subjecting every project to the rigor of

37:12

you know expensive randomized control

37:13

trials which you can't do that many of

37:15

them. Like, do you have concerns that

37:19

you might be discarding things that

37:21

actually work or that work in ways that

37:23

you're not measuring or that you're not

37:25

measuring for long enough,

37:28

etc.

37:29

What we try to do is just find ways to

37:34

build in a feedback loop so we learn

37:37

something and we can update from our you

37:39

know update our our predictions about

37:41

the future based on the reality of what

37:44

occurs. Sometimes that's a randomized

37:46

control trial. It's a great way to do

37:47

it. Other times we supported a program

37:49

that and we still do that uh helped

37:52

countries around the world transition

37:54

from

37:56

a a single HIV test and syphilis test

38:00

two individual products that were given

38:02

to women who came into antiatal

38:03

appointments to [snorts] a dual test and

38:05

the idea was if we can transition from

38:08

having to apply two tests and two

38:10

products to one we can reach more

38:12

people. I think this program has been

38:14

very effective, very coste effective. We

38:17

don't know that from randomized control

38:19

trial data. Instead, we know that from

38:23

more uh more programmatic follow-up

38:26

about monitoring the data that comes

38:30

from people who are going to antiatal

38:32

visits from seeing the stock levels in

38:34

countries of these tests. I think that

38:37

ultimately

38:38

I sort of wish it were the case that you

38:41

could have a randomized control trial

38:43

for everything and we could push in the

38:45

direction of of greater certainty. And I

38:47

think it's it's clear that there are

38:51

that there are so many uh so many

38:54

programs that could be so valuable that

38:57

just can't be subjected to that level of

38:58

scrutiny. We can see today, you know,

39:00

programs like uh, you know, people who

39:02

scaled up HIV treatment in Africa in the

39:07

early 2000s, whether that was advocacy

39:08

to the US government or the

39:10

philanthropic work that supported uh,

39:13

t-fold reduction in drug prices, maybe

39:15

even 100fold reduction in drug prices

39:16

from some original levels. I mean, those

39:19

are incredibly

39:21

impactful programs. You know, with with

39:23

hindsight, we can look back and say

39:24

those programs saved a lot of lives per

39:27

dollar. And I think that is uh you know

39:31

a challenge that

39:33

I feel like I'm always trying to make to

39:35

researchers internally at give well that

39:37

we see as a challenge to ourselves which

39:39

is you know when are we inappropriately

39:42

prioritizing certainty and measurability

39:45

over expected impact.

39:47

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40:19

What are the areas or the charities that

40:23

you think have either the highest

40:25

expected impact or maybe more relevant

40:28

for this, the highest possible impact,

40:31

but you just can't measure it? And I'm

40:34

thinking here in the present, not, you

40:36

know, doing long- termism and trying to

40:37

save society, you know, 10 billion years

40:39

from now.

40:43

What are the things that feel to you

40:44

like they are the riskiest in terms of

40:46

may not pay off but man maybe they do

40:49

pay off and and it's worth it for that

40:51

reason.

40:52

>> Yeah. Uh let me give a couple different

40:54

kinds of examples because I think the

40:56

the spectrum of potential impact but

40:59

also risk is very wide. So one one

41:01

example is a program we've recommended

41:04

for a long time which is treating

41:06

children for parasitic infections. Often

41:08

this goes by the name deworming. And the

41:11

reason there's so much uncertainty is

41:13

that we have a single randomized control

41:16

trial from about 30 years ago in one

41:19

area of Kenya where they treated kids

41:21

who had very high worm infections

41:23

followed them for many years. They're

41:24

still following them today. It's really

41:26

an incredible study and see that the

41:28

kids who were treated in as part of that

41:31

experiment have much higher earnings

41:33

today than they did than than the

41:35

control group. This is one very strong

41:37

piece of evidence. There's also evidence

41:39

of uh improved weight gain from pooling

41:41

multiple randomized trials and some

41:43

evidence from the American South when

41:45

hookworm was eradicated here in the

41:47

early 20th century. But at the same

41:49

time, I don't think any of us would see

41:52

that as clear knockdown evidence of

41:56

significant effect. The the public

41:58

health community says, you know, these

42:00

trials don't meet our standards uh for

42:04

rigor. the uh you know we're we're not

42:07

convinced by these results and

42:10

the worm levels today in 2025 are very

42:13

different than they were at times in the

42:15

past when these studies were

42:16

implemented. At the same time, it's so

42:19

cheap to treat a child for parasitic

42:21

infections. We know that these parasitic

42:23

infections are bad. And so this is one

42:26

example of a program that you know may

42:29

have an absolutely massive impact. But

42:31

I'm asking you to answer in terms of

42:34

something bigger than that because you

42:35

went to something again where there's

42:36

inc there's an incredibly clear specific

42:39

causal mechanism. And the the reason I'm

42:43

fairly comfortable with deworming is the

42:45

medicine works, right? You know what

42:47

you're finding there. There are a lot of

42:49

other kinds of interventions, democracy

42:52

promotion, right? Um that we don't

42:55

really know if they work, but if they

42:56

work, they're transformative. What do

42:59

you think about where you think we can't

43:02

measure it, but you know, maybe there's

43:04

a case for it? Uh

43:08

not in the way that you know you're just

43:10

trying to figure out the the magnitude

43:12

of the impact of deworming. So where you

43:14

can't figure out the magnitude of the

43:15

impact and you know you can't. So uh a

43:18

couple years ago we made a grant to

43:20

support our world in data. They're a

43:22

website that provides amazing

43:24

information on problems facing the

43:27

world. Uh as as someone who about 20

43:30

years ago tried to find good data on

43:33

problems in global health and

43:34

development, uh I wish that a site like

43:37

our world in data had existed then

43:38

because I know how hard it is to

43:40

download multiple spreadsheets and match

43:41

them up. And so we made this we I talked

43:43

to their their head Max Max Roser and he

43:45

was telling me that they were facing uh

43:48

you know a challenge in raising

43:49

operational funding. I have so so we

43:52

made we made a grant to them out of our

43:53

all grants fund. We can't measure what

43:56

effect that had but you know that's a

43:58

site that I think in aggreate has so

44:01

much impact. Um another another example

44:04

is a grant that we made this past year

44:05

in response to the US aid cuts. So we

44:07

supported

44:09

uh essentially consulting units in at at

44:13

two organizations, one called CHI and

44:14

one called PATH that would work closely

44:17

with governments to plan their response

44:19

to the aid cuts to uh understand where

44:24

they had gaps that needed to be filled.

44:26

Um even to articulate the funding needs

44:29

that that they had so they could

44:31

potentially raise money from other

44:32

donors. But that sort of uh support to

44:36

government decision-m is something that

44:40

clearly could be incredibly impactful on

44:43

uh helping people in in those countries.

44:46

But we won't be able we don't have a a

44:48

quantitative estimate of what's

44:50

accomplished because of that.

44:52

>> You all don't just subject charities to

44:54

the binary question of does it work or

44:57

does it not work. You have a certain

45:01

measure of cost effectiveness. it has to

45:03

clear. So working is not enough. It has

45:06

to to be cost effective compared to

45:09

other interventions. Tell me about your

45:11

measure of cost effectiveness.

45:13

>> Yeah, I'm I I think I'll just use the

45:15

cost per death averted as a simplified

45:17

way of putting this. I mean we we do try

45:19

to look at the effects that come from

45:20

improved health uh increased income uh

45:23

to some extent increased well-being and

45:25

and put it all into one measure that

45:27

that we can use to compare across

45:29

programs. Uh we can talk about that. Of

45:30

course, that is incredibly subjective.

45:33

Uh but nevertheless, as we're trying to

45:35

look across programs, we have it. But

45:38

what we aim to do to to go back to the

45:39

simplified version is say if you could

45:42

use

45:44

$60,000 and avert the deaths of 10

45:47

children, that's a much better decision

45:49

than using that same amount of money to

45:51

avert the death of only one child. It's

45:52

it's better to use the resources you

45:55

have to help people to a greater extent.

45:57

How do you weigh things against each

45:59

other that are not the same thing? And

46:01

and I mean this on two levels. So one,

46:03

there's a question of lives saved versus

46:06

income versus what's the value of, you

46:09

know, not suffering from an illness that

46:11

doesn't kill you. What's the value of an

46:12

education?

46:14

And then there's also

46:16

the way in which different people just

46:19

weight different moral questions

46:22

differently.

46:23

I I know you all have put a ton of work

46:25

into this. So, so how do you try to do

46:27

that? How do you both try to standardize

46:30

the the first set of questions and then

46:31

how do you try to create space for the

46:34

different ways you know different donors

46:36

might think about what is important?

46:40

>> Yeah. So the starting point for us is

46:42

that you know in many cases donors come

46:44

to us and they essentially say we want

46:48

you give well to decide where and how to

46:51

allocate our funds. And so because of

46:53

that we're responsible for making these

46:55

decisions about how to weigh up

46:56

different kinds of good against each

46:58

other. You know to do that we're we're

47:01

trying as as we often do to collect the

47:03

information we can and then just make

47:05

the best judgments that we're able to

47:07

with that information. And so for us, we

47:10

do a variety of uh [snorts] looking at

47:12

academic research. So for example, in

47:14

trying to weigh things like income

47:16

against health, there's academic studies

47:19

that look at the value of a statistical

47:21

life and and we're trying to use that

47:23

data to the extent we can. Uh we also

47:25

try to survey our donor community and

47:27

understand the preferences that they

47:29

have collectively. And we've also tried

47:31

and and have funded some studies in

47:33

Africa where we just ask people how they

47:35

would make these same choices and

47:37

trade-offs. Uh all of this is very

47:39

challenging. I would not claim that it

47:40

is in any way getting us closer to

47:42

truth, but it's it's the mechanism that

47:44

we use to try to make these decisions.

47:47

And then I think importantly

47:49

we're certainly not I'm certainly not

47:51

trying to say that our answer is

47:53

correct. Instead, you know, we give

47:56

Well, Phil is an important part of in

47:58

the donation ecosystem where, you know,

48:00

we're trying to be almost like the

48:02

economist's approach to giving overseas

48:05

and we're just trying to do that as well

48:08

as we can. And of course, there are many

48:09

other ways and many other approaches

48:11

that people could take.

48:12

>> You know, very controversially, a few

48:13

years ago, give directly, which is a

48:15

program where, you know, you give them

48:17

money and they give the money to other

48:18

people and the idea is that people know

48:20

best how to spend the money in their own

48:22

lives. you stopped recommending them.

48:24

Um, that's a group I still support. I

48:26

I'm a believer in their work. And that

48:29

was very controversial because your

48:30

argument was not that it's not doing

48:32

what it says it's doing or even that

48:34

it's not good for people to get money.

48:36

So, so what is the the line for you? And

48:38

how do you think about some of the

48:39

things that that that fall beneath it

48:41

because they are not primarily it seems

48:43

to me often about saving lives but

48:44

about, you know, changing incomes or

48:46

changing health or or improving lives.

48:48

>> Yeah. And I should say I'm also a huge

48:50

fan of Give Directly. I'm still

48:51

personally a donor to give directly. Um

48:54

I think the work that they do is is

48:56

amazing and wonderful. The reason that

48:59

Give Well doesn't recommend funds to

49:00

give directly now is that roughly

49:03

speaking, we think the organizations

49:05

we're supporting are able to do three

49:07

times as much good per dollar as give

49:09

directly does as a dollar to give

49:11

directly right now. And so because of

49:12

that, we feel like we're faced with the

49:15

question um you know with limited

49:16

resources, where should we give?

49:18

especially now when resources are lower

49:20

than they've been in many years uh

49:22

because of cuts in US foreign

49:23

assistance. We just think it's all the

49:25

more important to just to try and

49:27

allocate resources where they'll do the

49:29

most. Uh and and that doesn't mean that

49:33

the organizations we're not supporting

49:34

aren't doing good work uh or in some

49:37

ways they're failing. It just means with

49:38

the limited resources we have, we'd like

49:40

to see them go as far as they can.

49:42

Something we've circled a bit here is

49:45

that Give Well has an unusual

49:47

relationship to transparency

49:51

to being pretty open about mistakes. If

49:52

you go to the Give Well website, you can

49:54

click on a tab that says mistakes and

49:56

read a ton about things you've gotten

49:58

wrong and what has happened and places

50:00

where you've aired.

50:02

In almost everything you do, there's a

50:03

section on doubts and uncertainties.

50:05

Tell me a bit about that approach. And

50:10

maybe the best way to do it is for me to

50:11

ask you just what have been your biggest

50:13

mistakes.

50:14

[sighs and gasps]

50:16

We've made a lot of mistakes over the

50:17

years uh both in terms of specific

50:20

organizations we've recommended with

50:22

method methodological approaches. You

50:24

know for a long time just one example we

50:26

were relying primarily on one data

50:29

source to estimate mortality from

50:31

diseases and countries. And when we more

50:35

recently went and collected more data

50:37

sources, we saw how different they could

50:39

be and the effect that those different

50:41

sources of data about the causes of

50:43

mortality could have on our ultimate

50:44

recommendations. And so that's just a I

50:47

don't know pretty significant mistake

50:48

that we corrected in the last few years.

50:50

To me, I I think transparency is so

50:53

important because charitable giving

50:56

isn't like solving a math problem where

50:58

you can just say, you know, I I know the

51:00

right answer. Uh I've proven it.

51:01

therefore you should listen to me.

51:03

Instead, there are huge amounts of

51:05

judgment and values that go into the

51:07

decisions that we're making. And so,

51:09

first, we think it's important for the

51:11

people using our work to be in a

51:12

position to understand it and judge it

51:14

for themselves to know that uh others

51:17

have evaluated our work and looked at it

51:20

critically.

51:21

>> [snorts]

51:21

>> I also think it plays an important role

51:22

in in holding us accountable internally

51:25

because every single decision that we

51:26

make about how to spend money is is

51:29

ultimately subjected to or can be

51:31

subjected to public scrutiny.

51:32

>> So, you know, Trump took office not even

51:35

a year ago. It's been a been a long

51:36

year. [snorts] Very soon after uh his

51:39

administration decapitated US ID, cut

51:41

foreign aid in a number of other domains

51:45

and directions.

51:47

almost a year later, how much less

51:49

foreign aid is United States as a

51:53

government giving and how has the

51:55

composition of what we're giving

51:56

changed?

51:58

So, there's still a lot that we don't

51:59

know. Uh, you know, the US government

52:01

previously was giving about 12 billion a

52:04

year to global health programs and we

52:07

think there might end up being about a

52:09

50% cut in total US government giving.

52:13

So that would be a whole of $6 billion

52:16

going to global health programs. This is

52:18

a large portion of aid going to health

52:22

around the world because it's a US

52:24

government was accounting for about 20%

52:26

of total global health aid. And so you

52:28

know $6 billion or 10% of what was going

52:31

to support these programs uh maybe

52:34

disappearing. We've seen plenty of great

52:37

programs that that needed money that

52:39

weren't getting them. So these are

52:40

programs that provide basic health

52:42

services, malnutrition treatment, and

52:44

malaria control where, you know, we were

52:46

in a position to step in and we directed

52:48

about $40 million in response to the

52:50

cuts this year. Um, just as another

52:52

example, when I was in Malawi this past

52:54

summer, we talked to clinicians and

52:57

hospital administrators about their

52:59

experience responding to aid cuts. And

53:01

for them, some of the biggest cuts that

53:03

they felt immediately were in HIV

53:05

because the US government has such a

53:07

large HIV program. And so there one

53:10

hospital administrator told me the story

53:13

that you know the day of the cuts it was

53:15

9:00 a.m. they had all come to work

53:16

there were patients lining up outside to

53:18

get their AIDS treatment that they had

53:20

come for they were called into a staff

53:22

meeting the facility staff and just told

53:24

to go home immediately. And so you had

53:26

these patients lining up and no staff to

53:28

give them their medicine. Many people

53:29

travel from miles and miles away because

53:32

they'd rather pick up their HIV

53:34

treatment further from home because of

53:35

the stigma of having HIV. They don't

53:37

want to be seen close to home getting

53:38

their drugs. And so then the hospital

53:41

had to bring in some of their limited

53:43

staff from other departments and get

53:46

them in place to try and deliver the the

53:49

age treatment. I mean people the way he

53:50

told me the story is they they were they

53:53

were like looking at the pill boxes that

53:55

a patient brought in and trying to match

53:56

them to what was on the shelf just to

53:58

keep delivering the what they had. Um

54:00

similarly I visited a small clinic in a

54:03

in a more rural area and uh an important

54:06

part of HIV treatment is viral load

54:08

testing. So this is testing people to

54:10

ensure that the the treatment that

54:12

they're undertaking is preventing them

54:14

from progressing to full-blown disease.

54:16

And viral load testing, you know, really

54:18

stopped in early 2025. I was able to see

54:21

this because we just pulled up the data

54:23

on their computer screen and we could

54:24

see how they went from uh testing

54:27

hundreds of people in a month to almost

54:30

none in you know following the cuts.

54:32

>> Are there significant areas where

54:33

money's been restored?

54:34

>> We've seen a lot of money come through

54:36

in malaria. So one of the um you know

54:38

one of the one of the programs we

54:41

supported earlier this year was planning

54:43

for these seasonal anti-mal malarial

54:46

medication campaigns. Basically in

54:47

certain parts of the world [snorts]

54:49

malaria has a high season and if we can

54:51

provide children with antimmalarial

54:53

medication during the high season we

54:56

reduce about 80% of the cases during

54:58

that time of year and those campaigns I

55:01

I believe were happening starting in

55:03

June and the planning had to happen in

55:05

March, April and May. And so this was

55:07

right after the cuts and organizations

55:08

didn't know if they were going to have

55:10

money to conduct planning and so you

55:12

know we went to them and said uh if the

55:15

money doesn't come through you know

55:16

we'll cover it and if it does then you

55:18

know we won't have to but you can go

55:20

ahead knowing that you'll have funding

55:21

to cover what you need and ultimately

55:23

many of those programs the funding came

55:25

back and we didn't have to spend a

55:26

dollar to enable them to move ahead.

55:28

when you've looked at what has happened

55:29

and I'm not trying to get to be

55:31

political. Has have you seen a theory of

55:34

foreign aid or simply a hostility to

55:36

foreign aid?

55:40

We haven't seen a lot of interest in

55:43

trying to answer the question, what

55:45

would great foreign aid look like? You

55:47

know, I think that uh you know, if you

55:49

go back to January 15th, there are

55:51

plenty of people on both sides of the

55:53

aisle saying USAD should be a lot

55:56

better. there are a lot of ways that we

55:58

can improve foreign aid. And I think

55:59

there were some people that I remember

56:01

talking to before uh the the the cuts

56:05

occurred

56:07

where they were excited about the

56:09

possibility of a focus on efficiency in

56:12

delivering outstanding cost-effective

56:14

foreign aid. And I just don't think

56:16

that's what we've seen.

56:18

>> If somebody did come to you and and

56:20

said, "Listen, we want we're going to

56:22

restore USAD funding, but we want it to

56:24

be better. We want our money to go as

56:27

far as it possibly can. What does that

56:29

theory of reform look like to you?

56:32

>> I think two big pillars would be first

56:35

focusing on the public health programs

56:37

that we know how to deliver at scale

56:40

that we can deliver cost effectively at

56:42

scale that have significant impact. And

56:43

so these are similar to the programs

56:45

we've been discussing HIV treatment and

56:47

prevention, malaria treatment and

56:50

prevention and more. And then I also

56:52

think there's a big place for just

56:55

delivering cash directly to people who

56:57

need it. You know, I think at at at Give

57:00

Wells Margin, I think that we're

57:01

spending funds more cost- effectively,

57:03

but at large scale, I think cash is one

57:06

of the most uh cost-effective ways to

57:09

just let people

57:11

make their own decisions about how to

57:12

improve their lives.

57:13

>> And how about data? One thing that I've

57:15

heard a lot of people worry about and

57:16

seems to me like a particular problem

57:17

for Gival given how data oriented you

57:19

try to be is that these cuts ravaged a

57:23

lot of the surveys and data collection

57:26

and studies that create the

57:28

possibilities of this evidence and these

57:31

feedback loops and being able to know

57:33

next year what would be better than what

57:35

we did this year. What what has happened

57:38

in that space? What seems to be being

57:40

done about it? One of the most important

57:43

tools that we and others rely on is

57:45

something called the demographic and

57:46

health surveys or or DHS that USAD has

57:49

funded for years. And these are large

57:51

nationally representative surveys that

57:53

inform

57:55

people in positions like us allocating

57:58

money to low-income countries, but also

57:59

country governments themselves. You

58:00

know, when they're trying to answer the

58:01

question, how many students are going to

58:05

be in each district? So therefore, how

58:07

many schools and teachers do we need?

58:08

They're often relying on this kind of

58:10

data. And you know this is one of the

58:13

data sets that is you know has gone away

58:15

under this uh under the cuts that we

58:18

observed. Uh you know these surveys are

58:21

are so critical that in one way or

58:23

another I believe that some some form of

58:26

them will be preserved. It's something

58:27

that I know other funders have looked

58:29

at. We ourselves are considering um but

58:31

it's just so critical that this this

58:33

data continues to exist. But it's

58:35

undoubtedly been a big part of the

58:36

challenge in understanding what has

58:38

happened. You know, a question that you

58:40

asked that I get a lot is well, you

58:42

know, what what have the effects of the

58:44

cuts been and where has money gone and

58:47

not gone and where is it flowing and not

58:48

and what has been the humanitarian

58:49

impact and I think the true answer is we

58:52

don't know and you know some of that not

58:55

knowing is a function of the data that

58:57

we rely on is less available than it was

59:00

before and that makes the situation even

59:02

more challenging. You talked a bit about

59:03

how you've sort of directed 40ome

59:06

million dollars around trying to fill

59:08

some of these holes. What has happened

59:10

in the rest of the philanthropic space?

59:12

I mean, you have huge foundations much

59:14

bigger than than give well like the

59:15

Gates Foundation. You have other

59:17

countries, European countries. What has

59:20

the landscape of players who could have

59:23

possibly filled holes, you know, how has

59:25

the the I calling it an industry but the

59:28

sector responded?

59:30

>> Yeah. So I we've seen you know similar

59:32

action from philanthropies you know

59:34

trying to give

59:36

[snorts] uh what are large amounts of

59:38

money in in level terms but certainly

59:41

small relative to what governments were

59:43

giving allocate more in response. I I

59:47

think the big challenge that everyone

59:48

recognizes is philanthropy is just very

59:50

small compared to the level of giving

59:52

that the US government was providing.

59:55

And then at the same time many countries

59:56

around the world are also giving less.

59:58

And so in aggregate uh it seems like we

60:01

are entering a period where uh global

60:04

foreign assistance especially for health

60:06

will be lower than it has been in the

60:08

recent past. And so what um you know

60:11

what what I what I hope that means is

60:14

that individual donors will step up and

60:16

give more. Uh I [snorts] also hope and

60:18

we've seen some evidence of this that it

60:20

means there'll be a higher priority

60:22

focused on using the limited resources

60:26

we have as well as we possibly can. I

60:28

think that um for a long time we felt

60:31

like ideas of cost effectiveness were

60:33

were not taken perhaps as seriously as

60:36

you might expect in the world of global

60:38

health and development. But I think with

60:40

more limited resources, there's much

60:42

more of a focus on on taking what we

60:43

have and trying to cause it to go as far

60:46

as we can. Uh and so that might mean,

60:49

you know, allocating more funds towards

60:52

Nigeria and the Democratic Republic of

60:54

Congo for malaria because they account

60:56

for 40% of the global malaria burden and

60:59

I think we've seen a lot more interest

61:01

and uh you know behind those kinds of

61:04

ideas.

61:04

>> So then has this pullback in public

61:06

health funding has it changed looking

61:09

forward what you think will be the most

61:11

effective opportunities for giving?

61:13

>> It it certainly might and and here's

61:15

why. You know what we're trying to do is

61:18

deliver funds where they'll be most cost

61:20

effective at the present margin. And

61:22

really what these cuts mean is that the

61:23

the margin has shifted. So one area that

61:27

we never really looked at before was

61:29

HIV. HIV was extremely well funded. Uh

61:32

another area that uh we we made a grant

61:34

to support an organization called AL

61:36

Lima and this grant was uh primarily

61:39

focused on just enabling them to deliver

61:42

primary health care services and

61:43

malnutrition treatment in a very

61:45

challenging area of Cameroon. And that's

61:48

another kind of work that had been

61:50

previously more supported by government

61:52

donors. And so as as we look forward, we

61:55

know that, you know, the the changing

61:57

level of funding just means that there

61:59

going to be all sorts of programs that

62:01

we didn't consider before that we're

62:02

going to have to look at because this

62:04

underlying situation has changed.

62:05

>> Is lobbying on foreign aid, particularly

62:08

paying Trump associated lobbyists, maybe

62:10

an effective use of charitable funding?

62:14

No,

62:14

>> no, we've we've worked with uh you know,

62:16

an organization that's just trying to

62:18

inform people on the hill about the the

62:20

facts of what can be achieved. And I you

62:23

know I guess you know much more than I

62:25

do about what would be effective

62:26

lobbying. But you know I hope that uh

62:28

what I think we can bring to the table

62:30

is just providing

62:33

accurate information about what can be

62:36

accomplished and hoping that decision

62:38

makers will will take that on board when

62:40

they decide what to do. So I see one of

62:42

the challenges for for give well for

62:44

this kind of giving as being that giving

62:48

often relies

62:50

on an emotional hook for people. There's

62:54

you know charismatic megapana in the

62:56

philanth in the philanthropic space and

62:58

and then there's this more you know

63:01

conversation about cost effectiveness

63:02

and deworming and what are the spillover

63:04

benefits of deworming.

63:06

I can watch you trying to be objective

63:09

about what you're funding and and and

63:11

watch the requirement that that imposes

63:14

on you to be serious about trade-offs in

63:17

ways that are probably emotionally kind

63:18

of hard. And on the other hand, giving

63:19

is an emotional project that people

63:22

give. They give emotionally.

63:24

You know, we could talk about uh

63:26

randomized control trials all day and

63:28

all night, but most people don't get out

63:30

of bed because they read an RCT. So, so

63:33

how do you reconnect those

63:35

impulses

63:37

running an organization that is so much

63:38

about

63:40

trying to correct for the biases our

63:43

emotional drives might create for us?

63:47

Yeah. I mean, first off, I I think

63:49

sometimes this argument can go too far.

63:51

You know, we all know that that most

63:53

people are giving uh based on a personal

63:57

attachment. And when we were thinking

63:59

about starting Give Well, I just

64:01

remember everyone told us donors don't

64:03

give this way. This is never going to

64:04

work. What are you even trying? And now

64:07

more than, you know, 18 years later, we

64:09

have 100,000 plus donors who've used our

64:11

research. We've directed more than $2

64:13

billion. So there's certainly a lot of

64:15

donors and a lot of people who are

64:17

excited to give this way. And then when

64:20

I think about, you know, how this all

64:21

works, you know, I'd say that

64:24

the the motivation to do this work, it

64:27

it comes from the emotional place. And

64:29

and you know, for me, sometimes that's

64:31

people that I meet when I've traveled to

64:33

to Africa. Um, you know, an experience I

64:35

always have is I go to the pharmacy and

64:37

I pick up a moxicillin for my cat and it

64:40

has an ear infection and it cost me 50

64:43

cents. It it literally takes me 5

64:45

minutes. And I always think it's so wild

64:49

that I can just go to the store and pick

64:51

up this amoxicylin like it's nothing.

64:53

And I remember that there was time when

64:55

Give well supported an organization to

64:57

deliver amoxicylin to Tanzania because

64:59

they were running low on amoxicylin

65:01

stock and they weren't going to have a

65:03

moxicylin in all the clinics around the

65:05

world. And so it's sure you know we

65:08

spent all our time talking about the

65:10

data because it's the data that helps us

65:11

make the right decisions. But for me and

65:14

and I think for for everyone that I work

65:16

with, it's it's just this knowledge that

65:19

uh you know we're we're in such a

65:22

fortunate position and there are so many

65:24

people who aren't in that position and

65:28

yeah sometimes we have to key on

65:29

individuals to focus our work but

65:32

ultimately what we want to do is just

65:34

bring those benefits to as many people

65:36

as we can.

65:36

>> And then always our final question, what

65:38

are three books you'd recommend to the

65:39

audience? uh one is factfulness by the

65:42

late Hans Rosling. Uh this is a book

65:44

that just brings global health data to

65:47

to to the world. It's say the core

65:49

argument of the book is something like

65:51

in order to prioritize correctly we need

65:53

to understand the world accurately. And

65:55

then for me uh Hans Rosling's site gap

65:58

minder was one of the things that got me

66:00

very excited about this work back in

66:02

2006. Uh second book poor economics by

66:05

Esther Duffel and Abig Banerjee. They're

66:08

two of the founding members of this

66:10

randomized control trial movement in

66:12

development economics. And this book

66:14

gives an overview of of their work and

66:16

the ideas behind this work. And this

66:18

work that's no not just them but people

66:19

like Michael Kramer, Rachel Glennister,

66:22

Dean Carlin, Ted Miguel. It really was

66:24

just part of the animating values of of

66:27

what has led to give well in our work.

66:30

And then finally a book called Behind

66:32

the Beautiful Forevers by Katherine Buu.

66:35

uh she spent years in uh in Anawadi.

66:38

It's an informal urban settlement

66:39

sometimes known as a slum near the

66:41

Mumbai airport and it just paints a very

66:44

vivid picture of what life is like in

66:46

poverty. I

66:47

>> think Behind the Beautiful Forevers

66:48

might be it's definitely in my top five

66:50

pieces of non-fiction ever. If people

66:52

have not read that, they really should.

66:53

Ellie Henfeld, thank you very much.

66:56

>> Thank you.

66:59

[music]

67:01

Hey,

67:06

[music] hey, hey.

Interactive Summary

The video features an interview with Ellie Hassenfeld, CEO of GiveWell, an organization that rigorously vets charities to ensure donations have the maximum positive impact. Hassenfeld shares her background in studying religion and her experience at Bridgewater Associates, a hedge fund known for its culture of radical transparency. This experience shaped her approach to understanding the world accurately and avoiding self-deception, principles she later applied to philanthropy. GiveWell was founded on the realization that most charities lacked transparent data on their effectiveness. The organization focuses on evidence-based interventions, particularly in global health and poverty reduction, aiming to direct funds where they can achieve the most good per dollar. Hassenfeld discusses the challenges of measuring impact, the importance of cost-effectiveness, and the organization's commitment to transparency about its mistakes and uncertainties. She highlights effective interventions like malaria prevention and deworming, while also acknowledging areas where impact is harder to quantify, such as policy change or infrastructure development. The conversation also touches on the impact of US foreign aid cuts and how GiveWell has responded by directing funds to fill critical gaps.

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