Bread and roses

Both advocates and critics of effective altruism like to contrast arts charities with public health charities. Peter Singer writes on art auctions:

In a more ethical world, to spend tens of millions of dollars on works of art would be status-lowering, not status-enhancing. Such behavior would lead people to ask: “In a world in which more than six million children die each year because they lack safe drinking water or mosquito nets, or because they have not been immunized against measles, couldn’t you find something better to do with your money?”

This sometimes strikes art-lovers as harsh. After all, they point out, life is about more than just surviving (although this always seems backwards to me, because surviving is obviously a prerequisite for any sort of higher enjoyment, and the unspoken implication is that some people should be left to struggle so others can enjoy the ballet).

But I think one of our problems is that when we think of "the arts," we think of expensive ones—symphony orchestras playing in concert halls, museums with paintings that cost millions of dollars.

Around the world and throughout history, art has been something more homegrown—people making music in their own families and communities, decorating their belongings and dwellings, composing stories and poetry. There have been many human societies without arts foundations, but none without dance, music, and storytelling.

I was totally charmed to hear some evidence of how promoting human survival also promotes human flourishing: the GiveDirectly theme song. GiveDirectly is a highly rated charity providing cash transfers to poor households in Kenya.

They write: "One of our recipients used part of his transfer to buy instruments and start a band, and wrote this song. We think they sound pretty happy with our service."



A partial translation of the song:

We thank GiveDirectly, the work you are doing in Kenya, Africa is great
GiveDirectly has helped those who were in thatched houses
And now almost everyone is having iron roof house
They have helped everyone who used to sleep in thatched houses,
Now all you see are shining iron roofs.

Another piece from a GiveDirectly worker on the role of celebration in the lives of the very poor:

I recently visited Peter, nicknamed Ous Papa, a 50-year-old man and beneficiary of GiveDirectly. Ous Papa had an accident a long time ago and lost one of his legs; as a result, his wife left him. He therefore takes care of his 80-year-old widowed mother alone. They are in absolute poverty -- he has a small grass-thatched house, with mud walls and floor. 

He has old crutches that he uses to help him walk and do chores. They are quite old, and therefore difficult to work with. In spite of that, he still wakes up early to work on the farm. When we met, I asked him what he was planning to do with the transfer he was going to receive from GiveDirectly. These were his words: “I would buy a leg.” 

I did not understand why he would buy a leg, when he could get a wheelchair that would help him move quickly and easily. He explained that he loves dancing and that he can’t dance in a wheelchair. Furthermore, once he got an artificial leg, he would be able to work, just like anybody else. He said that he would put the rest of the money into his farm, and later get a wife to keep him company and help him take care of his old mother. 

I found it really inspiring that a 50-year-old can be in absolute poverty and still dream of dancing.

To me, the message is that the basics are not just about the basics. Even the very poor want enjoyment and creativity in their lives—bread and roses, as James Oppenheim put it in his 1911 poem about striking millworkers.

And once people have the basics—a decent roof, a leg to dance on—just like anyone, they want to cut loose and celebrate.

Thanks to Catriona for pointing out the song and the connection to the arts debate!

The other mother

Years ago, I got in the habit of making financial decisions by thinking of someone I thought of as the Other Woman. Not a romantic rival, just a woman whose life is very different from mine. She's a mother somewhere in Africa, working hard to take care of her children. I think of how difficult it is for her family to get the basics: clean water, enough to eat, a decent dwelling, safety from disease, fees and uniforms for the children's school.

I think of what that woman would want if she knew I was considering whether to spend the money on another pair of shoes or to give it to her. Maybe she would laugh at the absurdity of it, the excess of what I have compared to what she has. Maybe she would cry at the tragedy of it.  But I am almost certain she would want me to share some of my abundance so that her children could have the basics.

My first child will be born in a few weeks.  My life is about to change in a lot of ways.

People warned that parenthood would change me. Some of them said there was no way I'll keep up my level of giving when it's my child screaming for sweets in the grocery store. Some of them indicated that it would be monstrous for me to even have children if I would potentially give money to help other people's children instead of spending it entirely on my own.

And of course parenthood will change me. The joys and fears will grip my heart like nothing else. My daughter will get more of my time, energy, and money than anyone else. She will want for nothing that she actually needs. But I reject the idea that I am responsible only to my child.  Not as long as the Other Woman has trouble buying food for hers.

Because I am a little closer to her now. That woman loves her child like I love mine.

New family, southern Somalia.  Photo credit: Trocaire / Foter / CC BY

Malaria, one-trick ponies, and lasting change

It's a summer afternoon, and I'm reading the latest debate about narrow vs. systemic charitable interventions.  Scratching a mosquito bite, I'm reminded of a public health intervention that took place in my own country.

When my grandparents were growing up, the American South was still plagued by malaria (or ague, as it was often called.)  And what was the effect of the disease?

“While there is good land in the Southern United States as in the North, the land in the North sells at about 12 to 20 times the price, the difference being mainly due to malaria.”  - Carter, 1922, quoted here

“The diseases due to all four species of malaria parasite share the characteristic febrile episodes with their tendency to regular periodic paroxyms with chills, rigors, and sweating. They also have many symptoms in common with other infectious illnesses, including body aches, headache and nausea, general weakness, and prostration. . . . Lethargic and with sunken and sallow features, spindly limbs, and hard swollen belly is the general description of the condition. In this state the affected individual succumbs to diseases or other hardships that would scarcely threaten a person in reasonable health.” - Carter and Mendis, Evolutionary and Historical Aspects of the Burden of Malaria

PAHO/WHO, December 1969

The disease had been lessening over the late 19th and early 20th centuries due to better housing (glass and screens for windows) and the use of quinine.  But in the 1940s, the government took matters into its own hands.

During World War II, troops were succumbing to malaria on bases in the Southern US.  The Office of Malaria Control in War Areas was founded in 1942 to protect the areas around military bases. After the war it became the Centers for Disease Control (the CDC) and took on the task of eliminating the disease from the entire nation.  By 1951, the disease was eradicated from the United States.

Woman in rural Georgia, 1941.  Note the wooden shutter - no glass or screen.

This is the type of intervention that I've often heard criticized for its narrow focus.  I've heard single-issue medical interventions called "one-trick ponies", "short-sighted", "kicking the can down the road."  And to be sure, the eradication of malaria in the US was a top-down intervention carried out by a government agency without much community involvement.  There was not an attempt to change the social and economic conditions that prevented people from buying their own windowscreens and DDT. It just dealt with actual disease transmission.

Instead of narrowly-focused efforts, proponents of broad social change advocate "lasting solutions," "systemic change," "a new operating system." Which is great when it happens. But if public health interventions are difficult to carry off well, systemic change is even harder.

And yet it does happen. Interestingly enough, the Civil Rights movement sprang up in the South just as malaria was ending. The newly-formed CDC, located in Atlanta to be near the most malarial areas, declared the disease eliminated from the United States in 1951. That same year Martin Luther King, Jr. graduated from seminary. American blacks still bore the burdens of political disenfranchisement, inadequate education, poor access to health services, violence, and daily acts of hate and humiliation. But they no longer ran the risk of illness or death with every mosquito bite.

Obviously there was a lot more to the Civil Rights movement than a lack of malaria. But it was one of the factors that helped. How likely is someone with “body aches, headache and nausea, general weakness, and prostration” to make it to the polls, to school, or to work? How likely are they to march on Washington?

It's easier to dream big from behind a windowscreen. Easier when you're not hungry. When you're not sick.  When you're not weakened from parasites and malnutrition.  And for those of us who would love to see systemic change, the "one-trick ponies" may be a good way forward.

The ones we choose to mourn

Last week, my city erupted (literally and figuratively). Two bombs exploded, five people died in the bombings and subsequent shootings, and many more were wounded.

Boston has talked of nothing else. The victims' names are everywhere. Their pictures and mundane details of their lives are in the papers. Billboards memorialize them. There are memorials on street corners. We know their names, where they lived, their favorite sports teams.

The next day in Baghdad, 50 people were killed in a wave of bombings.  I had to look that up, because that's a pretty normal day in Iraq. 

Part of me wants to say, “Why are we treating some people's lives as so precious because of the particular way they died? Where are the memorials for the 89 Americans who die in car accidents every day? For that matter, where are the memorials for the 50 Iraqis who were blown up last week? Or the 4,000 people a day who die from unsafe water?”

But I also understand.  When someone you love is hurt or gone, when the loss is not a statistic but a real person, it really does feel like the world should stop and take note. What's remarkable is that we're actually doing it this week (albeit for a small and strangely selected number of people).

I don't think we can actually go around in a perpetual state of mourning. While we're alive, the best we can do is enjoy life and work hard to be sure other people get to enjoy their lives.

But I'm taking this week as a reminder that human lives really are precious. It's harder to think about the larger, ongoing disasters. But every one of those is made of actual, precious people with faces, families, and favorite sports teams. The girl next door. Someone's son. Someone's best friend. They are priceless.

Ways to learn

Last time, I argued that those of us in rich countries can help more by earning money to give than by traveling to poor countries. But what about the understanding you can get from first-hand experience?

Travel is always a learning experience. It's a good way to see things about your own society that you never noticed until you saw a system that worked differently. It's a way to meet people whose lives have been very different from your own.

But most of my learning from living in other countries (Denmark and Ecuador) came from talking to people who had lived there all their lives. Conversations with my host families and teachers there were more illuminating than what I was able to observe walking around the streets. If you're in a place for a few weeks or months, you spend a lot of time getting your bearings. Unless you're going to spend years in a place, most of your learning will be mediated through people who have lived there a long time. And you don't need to leave your home country to meet people from around the world.

Several times when I've been between jobs, I've volunteered for a few weeks at a refugee services organization. I didn't accomplish anything earth-shattering, but I got to know people from places I had only read about: Nepal, Cuba, Ethiopia, Haiti, Somalia.

Instead of statistics, they became real people to me. I admired their bravery, their humor, their work ethic, and their loyalty to their families. When you listen to other people's life stories you get things through their filter, but when you hear enough stories you can piece together a complex picture.

Sometimes I hear “armchair philanthropists” criticized for not getting out there and seeing the situations they are trying to change. But you don't need to go to a refugee camp to hear someone's experience of what it's like there. If you want to meet people from hard-hit places, there are certainly immigrants living in your town.

For that matter, there are hard-hit people who are from your town. As a social worker I meet people who have been through appalling deprivation just miles from my house. But the elements I see missing in my client's lives are usually related to parenting rather than material resources.

Learning about people's experiences doesn't always mean I can help. Learning about what life is like in a Quito orphanage, Kenyan refugee camp, or South Boston doesn't enable me to fix any of it. Civil war and broken families are not problems that I can make much of a dent in. So I focus my donations on lower-hanging fruit.

But I still think there's value in learning from other people's experiences. Sitting down to talk with people from the other side of the tracks or the other side of the world can help us be more aware, more compassionate people.

In your town, there are refugees and immigrants who want to learn more English. There are kids at homeless shelters who want someone to read to them. There are people who want help writing a resume so they can apply for jobs. If you want to see a different side of life, try working with them for a while. No plane tickets needed.

What I learned

I think one reason people want to help locally, and to do something hands-on rather than just writing a check, is that they want to see the situation first-hand. I can see the appeal of this.

I'm finishing up my visit to Ecuador. I wanted to experience a developing country, and to some extent I have. I've seen kids begging in the streets. I've seen people with deformities that probably would have been corrected in the US. I see how nothing is wasted here. Yesterday my host family curiously asked me if it's true that in America we throw out things that are still good. I confessed that it was.

And yet I'm not sure that this experience has changed my goals or how I think about philanthropy. Yes, it hit me in the gut the first time I saw a child begging on the street at night, when I saw her playing with broken glass for lack of any other toy.

But I pretty already much knew that poverty sucks, and that I want to do something about that. My donations won't go to help that girl, because the best organizations I know of don't work in Ecuador. But they will help other people who had the bad luck to be born with few resources.

Some people are more driven by emotion and first-hand experience than others. If you're one of those people, maybe it would make sense to go see the work you think is important. Charities are very happy to tell you about what they're doing, and if you want to pay your own way, you could probably visit their field sites.

I'm affected by the poverty I see here, and for that matter, by the problems I see at home in Boston. But for every person I see who tugs at my heart, there are millions more I don't see. I feel I owe it to them to give the best help I can. Which means giving based on the best research I can find, not who I happened to see.

The way it was

In thinking about problems that currently affect developing nations, I try to remember that the US was a developing nation not so long ago.

Malaria once plagued the American south and Midwest. It's the reason English colonists abandoned the Jamestown, Virginia settlement for somewhere with fewer mosquitoes. In 1946, the Centers for Disease Control (CDC) were formed to fight malaria. Five years later, malaria was eliminated from the United States.

In her memoir Little House on the Prairie, Laura Ingalls Wilder describes her family's experience with the disease in Kansas in 1870:

Laura tried to get up, but she was too tired. Then she saw Ma's red face looking over the edge of the bed. Mary was all the time crying for water. Ma looked at Mary and then she looked at Laura, and she whispered, "Laura, can you?"

"Yes, Ma," Laura said. This time she got out of bed. But when she tried to stand up, the floor rocked and she fell down. . . . She knew she must get water to stop Mary's crying, and she did. She crawled all the way across the floor to the water-bucket. There was only a little water in it. She shook so with cold that she could hardly get hold of the dipper. But she did get hold of it. She dipped up some water, and she set out to cross that enormous floor again. 

It drives me crazy when people in rich countries hesitate to address developing world health for fear of "overpopulation" or "environmental impacts." Do they wish that for their own families? Do they feel they have too many siblings, too many cousins, and we really ought to get some contaminated water or intestinal parasites in here to deal with the problem? Do they wish we hadn't eliminated malaria from the US?

No one wants that for their family. We want low child mortality and reasonable family size. Developed nations made that transition, but it took a while.

Hans Rosling does an excellent job at making public health statistics understandable to non-statisticians. I recommend his talk on "The good news of the decade”, especially for its comparison of child mortality rates across nations (at 8:40). Rosling notes that his home country of Sweden had a high child mortality rate in 1800, twice as high as anywhere now. Over time, with better education and better public health, the rate declined to its current low level. Most countries are currently on this journey of decreasing family size and child mortality, many of them progressing faster than Western countries ever did. (The site Gapminder lets you play with the charts yourself.)

While it's clear that large family size is correlated with child mortality, I'm not as convinced as Rosling is that lower child mortality is the main cause of smaller families. I gather it's a combination of fewer child deaths, female education, access to birth control, and urbanization.

The Ingalls family were typical 19th-century Americans – they had five children, one of whom died in infancy and one of whom went blind from a fever. I come from a typical 20th-century American family with two children, both still alive and healthy. I'm thrilled we made this demographic transition. My hometown no longer has malaria. I'm educated, I drink clean water, and I control my own fertility. When I choose, I will raise one or two children who will probably also be quite healthy.

We've come a long way.  Now I want this life for everyone.

The sweet spot

Jeff and I are traveling in Ecuador, and this weekend we visited the small town of Mindo. Saturday evening I watched these kids playing with some pieces of wood:

At first I was surprised to see them so apparently happy, because these kids are poor by my standards. I think this is part of what makes people throw up their hands at the idea of redistributing anything worldwide. How can every child in the world live like first-world children, with a Tickle Me Elmo, a bedroom in a big house, and a seat in an SUV?

They can't. There is not enough space, not enough fuel, not enough raw material in the world for every child to live like rich children. Nor for all adults to live like American adults.

But an American standard of living is not necessary for happiness. Despite having higher incomes and higher consumption of goods, Americans aren't as satisfied with their lives as Danes or Costa Ricans (source). That's probably because we're behind in some other things that help us be happy, like social connection. And if everybody consumed at the level of Americans, the planet would be trashed.

One model of global well-being I've seen is a "doughnut" - the sweet spot where people's needs are met but they're not burning through too many natural resources. And it occurs to me that these Ecuadoran kids are probably somewhere in that doughnut. Their house, like most in Mindo, was simply made from cement, wood, and corrugated metal. It has running water and a gas stove. Their town has a health center, a school, and a paved road going to the city. The kids looked healthy and cared-for, and they were clearly having a great time until it started raining and the grownups made them come inside.

I don't know much about these kids' lives, and I don't want to idealize them. I don't know how much education they'll get, or how safe their water is, or what opportunities there are for them in this small town. But I don't think people need to live like Americans to be happy.  Personally, I try not to live like a typical American.

I think it's possible to hit that sweet spot where our needs – health, safety, useful work, good relationships, a functioning society – are met.  Where we can enjoy our lives because we're not distracted by hunger or fear or sickness.  That's the kind of world I'm aiming for.

Just like me

For a school project, I'm helping a local mental health center apply for a grant. In looking through grants, I was struck by how many of them are for very specific demographics.

This foundation only funds projects in the northeastern US. That one only funds projects that serve people with paralysis. Why so specific? Because the founders were from those demographics. They wanted to help people like them. A lot of charitable giving works this way. Disease foundations do major fundraising from people with that illness and from their relatives.

Now, I can see how this problem selection makes sense if you're doing some kind of direct service. If I were going to a support group, I would want help from someone who had been in my situation. But the nice thing about money is that it works the same no matter who gives it. You don't have to have personally experienced another person's affliction to help ease it.

I had epilepsy as a child. When I hear about a kid with epilepsy, I do feel that squeeze of recognition, the memory of what it was like for me. I'm sure the Epilepsy Foundation would love to get my donation to help "people like me".

But I'd like to see a redefinition of who is "like me."

I've never starved, never experienced chronic pain, never watched people die around me. I can't know exactly what it feels like to have those experiences, but I have a guess. It sucks that other people are sick or hungry or oppressed, like it sucked for me to have epilepsy.

When I give, I want to help people like me. People with human loves, dreams, and hurts. We don't have to have the same problems. We're still kin.