Deworming

Reading this article made me depressed.

The article itself is not depressing.  It is an upbeat review of a book that looks at the evidence on effective antipoverty programs in the developing world.  The thing that depressed me was this:

I do think more Americans will support international aid programs if the sales pitch is focused on effectiveness and efficiency. The last chapter of More Than Good Intentions presents a "takeaway" of seven ideas that have stood up to rigorous evaluation. They include:
...
• Deworming programs in Africa that drastically increased school attendance at extraordinarily low cost.

This is depressing because public health campaigners knew this a hundred years ago. 

Think about it.  By 1920, the success of hookworm eradication in the American South was obvious.  A generation of lethargic dullards had been turned into a generation of good students and productive workers by evicting the parasites from their intestines.  It dramatically improved the health, wealth, and quality of life of a large portion of the country.  It was one of the public health miracles of the century

And yet, for the past ninety years, this lesson has been ignored or forgotten by people in the international aid community.  They have squandered billions on aid programs that accomplished nothing, or given money to corrupt governments in ways that were actively harmful to the population.  They have wasted amazing amounts of time and effort on various schemes that tried to alleviate a few of the symptoms of poverty, while the people they were trying to help suffered under crippling parasite loads that could have been erased cheaply and easily.

It is enough to make my mind start spinning cynical conspiracy theories.  Charities and aid organizations do not have any incentive to actually solve problems.  They have an incentive to let the problems linger and fester while they try various visible but ineffective remedies, so they can constantly attract more money and pay their own salaries.

This is a perfect example of why you need to pay people based on results.  Charities should only get money if they can demonstrate that they have done something useful and permanent.  There seems to be some movement in this direction.  Hopefully it will catch on.  If we had applied the lessons of basic economics to charity and public health campaigns, then poverty in the developing world would have been eliminated decades ago.

The root cause of all of this is people and governments who give money to inefficient charities.  Think of how many times you have seen people brag "We raised $X for cause Y".  The language of giving makes input, not output, the goal, with the predictable consequence that efficiency, the amount of output you get per unit of input, falls to about zero.  People brag and feel good about how much money they gave away, as if there was some fixed correlation between input and output, but in reality they accomplish nothing at all.

Here's a bit of advice: Never give any money to anyone who seems to have a goal of raising money, and talks about success in terms of raising money.  Demand results and do your research.