Every year around 10 million people in poorer countries die of illnesses that can be very cheaply prevented or managed, including malaria, HIV, tuberculosis, and diarrhoea.
Only around $100 per capita is spent annually on the healthcare of people living in low-income countries (adjusted for purchasing power). To put this in context: annual health spending in the EU is over $4,500 per capita, in the UK it’s about $5,000 per capita, and in the US it’s nearly $11,000.
As a result, there remain many opportunities to scale up treatments that are known to prevent or cure common health conditions in low-income countries.
Options for working on the problem include serving as a donor to effective projects, working as an economist in intergovernmental organisations (such as the World Bank or World Health Organization), or starting or working in a nonprofit that scales up proven treatments.
Our overall view
We’d love to see more people working on this issue. But you might be able to do even more good working on one of our top priority problem areas.
We think work to alleviate global health problems has the potential for a large positive impact. The damage done by easily preventable diseases in the least developed countries plus India amounts to between 200 million DALYs (disability-adjusted life years) and 500 million DALYs per year.
This issue is much less neglected than most others we prioritise. Current spending in the least developed countries plus India is about $300 billion per year.
Making progress on alleviating global health problems seems highly tractable. It is mostly a matter of scaling up approaches that are known with near certainty to work if done correctly.
What is the problem?
Every year around 10 million people in poorer countries die of illnesses that can be very cheaply prevented or managed, including malaria, HIV, tuberculosis, and diarrhoea. Tens of millions more suffer from persistent undernutrition or parasitic diseases that cause them to be less mentally and physically capable than they otherwise would be.
Why is this problem pressing?
What is our recommendation based on?
Focussing on basic health treatments in the developing world is supported by GiveWell, the Global Priorities Project, and the Copenhagen Consensus. In addition to that, the Bill and Melinda Gates Foundation, with which we share many values, spends most of its money on this cause. Our recommendation is a compilation of these organisations’ findings, as well as basic data from the Global Burden of Disease and World Bank, among others.
Why is it pressing?
These diseases cause unnecessary suffering and death both to victims and their families. They also lead to a range of other negative effects:
- Lower educational attainment.
- Lethargy and reduced ability to think and work.
- Worse health later in life.
- Higher birth rates to compensate for infant mortality.
In many cases, these diseases or their impacts can be largely eliminated with cheap technologies that are known to work and have existed for decades. For example:
- Malaria is prevented by insecticide-treated bed nets.
- Tuberculosis is almost always cured by sustained treatment with antibiotics (so-called DOTS).
- People with HIV live nearly normal lifespans, and rarely pass on the virus to others, if promptly and consistently treated with antiretroviral drugs.
- Diarrhoea can be prevented through better sanitation, and death prevented by oral rehydration therapy.
- Parasitic diseases can be cured with a pill that costs under $1 a year.
- A range of other diseases can be prevented through the basic vaccination programme (e.g. diphtheria, whooping cough, etc.).
While the cost effectiveness of the above approaches ranges quite widely, they can in most cases generate an extra year of healthy life for under $1,000, and in a few cases for less than $100.
Over the last 60 years, death rates from several of these diseases have been more than halved using these techniques, suggesting a very clear way to make progress.
What are the major arguments against it being pressing?
- You might think that it is not a particularly neglected problem, given it is very widely recognised and is funded by organisations — including aid agencies — with billions of dollars to spend each year. Governments in developing countries are also making significant progress in improving health, although some gaps certainly remain in practice. In this view, it will be hard to find exceptional opportunities because there are so many other people trying to do so.
- You might worry that reducing poverty and improving health in poor countries will not have major long-run effects on the future, which will instead be determined in other ways, for example through war or the invention of new technologies.
- You might think that other means for reducing poverty will be more effective, such as reforming government and legal institutions in developing countries.
What are the key judgement calls needed to prioritise this problem?
- That the lives of people in other countries are not much less important than the lives of people in the country you live in (assuming you live in a country that doesn’t face these challenges).
- That improving health will cause developing countries to become sustainably richer and nicer to live in, for example by reducing fertility or improving education and governance.
- That there aren’t [other pressing global problems](/problem-profiles/) you can make a bigger positive difference working on instead.
What can you do about this problem?
What’s most needed to contribute to this problem?
We need to deliver basic health services to all people who have or are at risk of contracting easily prevented contagious diseases. For example:
- Get all children to receive the basic schedule of vaccinations (currently around 85% do). (Listen to our 2021 podcast with Varsha Venugopal about recent work in this space.)
- Get everyone exposed to malaria sleeping under bed nets. Currently a bit over half of people in the relevant parts of Africa have access to bed nets.
- Get all TB cases treated — currently at least a third are not diagnosed.
- Ensure everyone has access to clean drinking water — currently at least a billion people do not.
This is primarily a funding and logistical issue. The treatments are usually simple and do not require advanced medical training to deliver (though treatment of TB and HIV requires medical oversight).
What skills and resources are most needed?
- The ability to fundraise large sums, or move money within bureaucracies to better projects.
- People with on-the-ground logistical skills in international development (i.e. the kind of person who could get 100,000 bed nets distributed in Africa).
- Entrepreneurs (mostly in nonprofits but also sometimes for-profits) who could found one of these charities.
- Development economists and cost-effectiveness researchers, including economists, statisticians, and disease control experts.
- Money to fund GiveWell-recommended charities.
We think that people capable of starting outstanding projects in this area are likely to be able to attract the necessary funding, making the area mostly talent constrained.
Who is working on this problem?
What can you concretely do to help?
Some especially recommended organisations
Find opportunities on our job board
Our job board features opportunities to work on global health & development:
View all opportunities
Our impression is that treating and preventing infectious diseases, especially malaria, is the most cost-effective health intervention right now.
There are two other sub-issues within global health, however, that seem worth highlighting:
- Smoking in developing countries — while smoking rates in the US and UK have been falling, smoking in China and the developing world is on the rise, bringing a large health toll. Read more.
- Pain relief — most people around the world lack access to adequate pain relief, which leads to widespread suffering due to injuries, chronic health conditions, and disease. One natural approach is increasing access to cheap pain relief medications that are common in developed countries. One group working in this area is the Organisation for the Prevention of Intense Suffering. Read more.
Want to learn more about global issues we think are especially pressing? See our list of issues that are large in scale, solvable, and neglected, according to our research.