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Owain Johnstone

Go Big or Go Home? Marginal and Systemic Change

At the root of effective altruism is a concern with how best to bring about social change. However, effective altruism discussions rarely distinguish overtly between two different kinds of change: marginal and systemic. It's really important we make this distinction – because it has the potential to profoundly influence some of the choices that we face, and to lead to very different effects.

By 'marginal', I don't mean 'minimal'. I'm using the word in the economic sense to describe 

a change that is incremental relative to some other possible change

. What does that mean exactly? Say you're about to graduate from university and you have two possible career options. One is in publishing and the other is working for a development charity. Your one criterion for job choice is the amount of positive social impact you can have.

You decide that you will likely have more impact as a charity worker than as a publisher and you take that option accordingly. Your social impact is higher than it was when you were a student – that's a marginal increase. And it's higher than it would have been if you'd made a different choice – to go into publishing. The difference in social impact between these positions is a marginal difference.

A lot of effective altruism discussion revolves around examples like this. Most are to do with three different kinds of marginal change, measured against potential social impact. First, change relative to something else you could be doing. Should you change career from A to B or stay where you are? What would the marginal change be in your likely social impact potential?

The second kind is change relative to what someone else might do. I'll borrow an example from 

: should you go to work in your own country or volunteer as a doctor in a developing country? Assuming a high demand for such positions (so someone else will take the position if you don't), the marginal difference you make is equal to how much better you are than whoever else would have taken the job. Maybe you save two more lives a week, for example.

Questions about where you should donate fall into a third category, where you're asking about the difference in the potential social impact of two third parties. Should you give your money to organisation A or B? What you're asking is: what is the marginal difference between the impact A would have (by using your money) and the difference B would have?

The main feature of marginal change is that it is commensurable.

 That is, you can assess the difference between the change represented by two possible choices using some common unit – a unit that in this case represents social impact. You might decide to use a unit like quality adjusted life years (QALYs), for example. So, comparing two possible jobs, or two possible donation recipients, you try to enumerate the possible QALYs you will be able to add to the world with each course of action, and you choose accordingly.

Systemic change doesn't feature in these sorts of examples – and in general is less prominent in effective altruism discussions (it's not absent entirely, but when it is discussed it can often be implicit). So, what is it and why does it matter?

Systemic change is hard to define precisely, but we can start by suggesting that it's 

not just large amounts of marginal change

. To borrow another example from 80,000 hours, let's say you convince several hundred high net-worth individuals to contribute large amounts to specific, highly effective charitable organisations. The amount of change you could bring about is potentially enormous – but I would argue that it's still marginal change.

Why? Because this is basically a quantitative approach. You're not questioning your overall goal of getting as much money to these organisations as you possibly can. Nor are you questioning who those organisations are. In other words, you're not challenging the system parameters. More on that in a moment, but first we need to define what the 'system' is that systemic change transforms.

It's important to remember that although 'system' sounds big, it doesn't have to be. A system can be small or large, just as marginal change can be small or large. Here's one definition of system: a group of actors with related interests who interact with one another in pursuit of certain goals and end up producing a measurable outcome.

That's pretty abstract, so here's an example to illustrate.

Let's take the 'donating to charity' system. We can think of this as just one part of the overall effective altruism system (another property of systems: they can be part of other, larger systems). In the 'donating to charity' system we have a few groups of actors – amongst others there are donors, recipients and analysts.

The donors want to donate to the most effective charity, the analysts want to work out which organisations are the most effective, and the recipients want funding to pursue their particular objectives. From an effective altruism perspective, this system's outcome is money directed towards particular causes.

A system like this offers opportunities for both marginal and systemic change. Imagine that you want to focus on getting money to effective organisations. You've got some choices as to how best to do that. Some of those involve marginal change, and others are systemic.

Let's say you go down the marginal route and concentrate on donating. Your choices are things like: do you become an investment banker and donate a set percentage of your income, or do you become a persuader, trying to convince other people to donate their income to charity? Or do you try to combine both? If so, how? Those choices accept the basic metric (amount donated) and the system parameters (which organisations are, broadly, best to donate to; the actors involved, etc.). In other words, they involve working within the system.

But what if you're more inclined towards a systemic approach? Now your choices involve 

. You could become an analyst and work on methodologies for measuring charitable effectiveness. By altering which organisations are assessed as particularly effective you change a key element of the system – those organisations that interested donors will target most. (Note how analysts can change the system while also forming a part of it).

Alternatively, another systemic choice could be to work towards introducing a mandatory charitable donation tax on everyone who earns above a certain amount. You're not challenging the metric used (amount donated) but you're creating a new method of affecting it, and so affecting other actors' choices. If that kind of tax were introduced, it might well mean that you're less likely to go round trying to persuade wealthy people to donate more. It also has the potential to create new choices – for example, you now have the option of forming pressure groups to try to lower the income threshold at which that tax kicks in.

That kind of radical transformation, challenging metrics and choices within a specific sphere (however small or large that may be), is what systemic change is all about.

Systemic change isn't a panacea. The discussion I've given here has been tilted towards the idea of systemic change out-performing marginal change. But that's not necessarily true, for three reasons.

systemic change might be smaller in scale than marginal change

. Maybe changing the organisations assessed as effective is less important than persuading some of the world's wealthiest individuals to donate billions to a slightly less effective set of causes.

systemic change is context-dependent and its effects may be difficult to foresee

. What if a mandatory charitable donation tax actually reduced absolute levels of donation to a given set of causes by increasing complacency or even hostility amongst the wealthiest donors?

systemic change can require a greater investment of resources to bring about

. A tax reform such as the one I’ve described here would be politically extremely difficult to achieve. Devoting that amount of time, expertise and resources to an alternative marginal option might result in far more significant results.

systemic change does have the potential to introduce powerful transformations. It's a question of leverage – and changing system parameters can undoubtedly be a very powerful tool.

We need to be aware that these two types of change are quite distinct. Depending on the context, they may be more or less appropriate and have different degrees of potential influence. If you find yourself in a situation where there is limited potential for further marginal change it might be that systemic change offers a more promising set of choices.

Marginal and systemic change also require different skillsets and attitudes.

Analysing systems for leverage points (points at which systemic change can be introduced) and possessing the technical know-how to operate them emphasises certain skills over others. Introducing tax reform is obviously quite different to persuading individuals to donate. And appreciating that your efforts to find such leverage points might be in vain requires a certain risk/reward mindset. Pursuing your tax reform would likely require a substantial investment of resources, and even then may never happen – or, worse, could be counter-productive.

What's important overall is to recognise that marginal and systemic change represent distinct approaches to tackling social problems and producing positive social impact. 

When tackling any particular problem we should bear both in mind as possible options, consciously choosing whether to work with an existing system or challenge its parameters, taking into account our personal strengths and the relevant context. Ultimately, that choice could make all the difference.

Coralie Oddy

Effective Altruism on a Tight Budget

Let’s face it: while money isn’t everything, not having enough of it certainly isn't much fun. I want to show how you can still have a lot of altruistic impact without a big budget, something that has become a personal project for me.

The idea came from suddenly being in a position where I didn’t have as much money coming in as I did before, but still wanted to 

. While cheerfully using terms like ‘bankrupt’ and ‘skint’ in my blog, I realised I needed to make a vital proviso to this.

Even by the standards of my developed nation, I am spectacularly lucky to have a job and a wonderful family who helped me out when I stopped studying earlier this year (and thus suddenly lost a large amount of my income from a student bursary).

Indeed, what we judge as ‘a lot of money’ or ‘not enough money’ is completely relative. You might feel well off if you’re the first one to have the latest gadget, but hard done by if all your friends have it and you don’t.

Similarly, there are presumably millionaires struggling to get a yacht as nice as their neighbour’s and feeling overstretched financially, and subsistence farmers feeling newly wealthy when they are able to furnish their home with a concrete floor. This is critical to our understanding of wealth, poverty and need.

In the UK, a household in poverty is usually defined as one receiving less than 60% of the median income of the other households in the UK. This means that right now, 

the poverty threshold in the UK is just under £14,000 per year per household

It’s even harder to make a judgement on what poverty is across nations and societies. This isn’t just down to money; poverty also depends on factors like how supportive the community you live in is, or how able you are to take part in a full and active life.

However, we can draw this contrast – in the UK, there are measures in place to prevent people from starving, dying of preventable diseases or failing to receive a basic education. Millions of people across the world do not have these measures in place for them. 

1.2 billion people live on under $1.25 a day

Clearly, this is not the same thing as living on less than £14,000 a year.

This brings up several conclusions. One happy conclusion is realising how lucky we are and being grateful in this. Generally speaking, we know there are people who are in need in a way unimaginable to ourselves; hopefully you already realise the vital importance of giving, and crucially, giving what you can.

Whatever you can commit to giving can and will change and save lives if given consistently, which is why 

Another conclusion is that while poverty relative to the rest of your nation 

 deeply matter, poverty relative to the whole world 

 deeply matters. Increasingly it is being suggested that we should be focusing on the concept of ‘inequality’.

 takes into account the number of people in your household and the cost of living in your nation. Instead of telling me how high or below a global poverty threshold I am, it tells me how rich I am in comparison to everyone in the world, with issues like cost of living taken into account.

Even while I’m adjusting to having a little less, the calculator let me know that I am still within the richest 10% of people in the world, and my income is more than 11 times the global average. Donating 10% of my relatively small income to effective charities would still be equivalent to saving one life per year.

Of course, there are still actions you can take without spending any money at all. On a national scale, we can use our local knowledge and geographical position to 

volunteer our time to local organisations

, help ensure our communities are inclusive and 

raise concerns with our political representatives

keeping up a discussion with others around inequality

, both face to face and through social media, is vital for raising awareness of the issue. Actions speak louder than words, but these actions will make the biggest impact when we are all involved, and that means talking about solving global inequality together.

One of the best ways to do this is by participating in or 

, where people come together to discuss how to give most effectively and spread these ideas to others. Giving What We Can will 

 for anyone wanting to set up their own chapter, and it’s 

, needing just a few hours of commitment a week. If you persuade another person to donate or volunteer in an impactful way, you double your own impact. Persuade 50 people who go on to persuade another 50, and 

Worldwide and locally, we can tackle inequality by understanding its nature and importance in both contexts. Now there’s something you can give no matter how poor you feel.

Hauke Hillebrandt

Charity Update II: Schistosomiasis Control Initiative (SCI)

This is the second of our series of charity updates. You can read the first one, on Development Media International, 

 for several years now. Our colleagues at Givewell have published an 

 on SCI recently that was generally very positive and SCI continues to rank among Givewell’s top charities.

In this blog post, we give you an update on their efforts that complements Givewell’s report. You can find more general information about SCI on our 

SCI continues to be one of the most effective charities in the world

Recent scientific findings related to SCI’s effectiveness

 on new research indicating that treating 

schistosomiasis might reduce - with great effectiveness [1] - both malaria [2] and HIV [3] infections

 (due to reduced immunodeficiency and reduced female genital schistosomiasis). Even though such disease interaction had long been speculated about [4, 5], evidence for a causal connection and a cost effectiveness analysis had been lacking. In the light of this new evidence, we have increased confidence in recommending SCI, even though more research is needed on the topic.

It has also been suggested that schistosomiasis might interact with Tuberculosis [6], Hepatitis [7], and Appendicitis [8], all of which make up a substantial amount of the global burden of disease, and we are currently doing more research to look into these links. We are also re-investigating in how far schistosomiasis parasites contribute to undernutrition and lack of micronutrients.

However, some recent studies hint at a potential decrease in SCI’s effectiveness. A recent report [9] shows that climate change will make temperatures more suitable for schistosomiasis transmission over the next 20 years, not only in terms of spread to other currently non-endemic countries, but also in terms of increasing the intensities of the disease in countries currently affected. The authors suggest that this increase in infection and reinfection intensity may reduce the impact of control and elimination programmes such as those undertaken by SCI. On the other hand, the resulting increase in need and thus scalability of SCI’s programs might increase their effectiveness.

Furthermore, researchers continue to be worried about the development of drug resistance to praziquantel, as it is the only drug currently recommended by the World Health Organization for the treatment and control of human schistosomiasis, which is also used by SCI [10]. Some signs of resistance of schistosomes against praziquantel have been observed in the laboratory, but in the field only isolated cases of decreased effectiveness of praziquantel have been observed so far [10, 11]. However, these are not issues that decrease SCI’s effectiveness in the near future, as resistance is localized and limited.

SCI has room for $3.8-8.3 million of additional funding over the next few years

. However, as the number of people targeted to receive deworming rises (see Figure 1), SCI could probably scale up and strengthen its efforts in the countries where they currently operate and expand to new countries.

A recent report by the World Health Organisation estimates that the overall costs for all kinds of preventive chemotherapy (i.e. mass deworming, not chemotherapy used as cancer treatment) in the coming year are in the hundreds of millions (see Figure 2). The investment target for preventive chemotherapy against schistosomiasis (for delivery only- medicines are donated by the pharmaceutical companies) during 2015–2020 is estimated to be about US$ 59 million (US$ 51–67 million) per year (see Figure 3). This already takes into account that countries such as Brazil and India completely covered the cost of distributing the donated medicines using their own resources.

In poorer countries such as the DRC, Senegal and Niger [12], costs of distributions are shared among the local Ministries of Health and SCI, as well as other organisations such as the USAID, END Fund, CNTD, and APOC. But poor countries are not in a position to execute these programs by themselves and bigger aid givers such USAID are also do not completely fund such programs. Thus, SCI, with their unique expertise, might play a substantial part implementing such future deworming programs and thus require substantially more funds. This could change in case bigger agencies such as USAID recognize the cost effectiveness of interventions targeting NTDs and star investing more in this area.

Fig. 1: Number of people targeted for coverage with integrated preventive chemotherapy, selected NTDs (from recent WHO report on NTDs [13])

Figure notes: school-age children; STH, soil-transmitted helminthiases.

Notes: The dots indicate the number of people treated in 2012; the solid lines are targets not forecasts. Targets assume integrated delivery of preventive chemotherapy for LF and onchocerciasis in Africa, schistosomiasis and STH among school-age children, and LF and STH outside Africa. Pending further evidence, they do not yet assume further integration of LF and onchocerciasis in Africa with schistosomiasis and STH.

![](https://lh3.googleusercontent.com/Q2Y3FDavEwPBDbhwIIrR9xJWsH-fY6_y_6dT_ygAithzHydbfDsD9Hl7t-z626mMb5ZGC0tSUhqcJkiWq49i24F1WqN2iN4h1lwOcrITDqjL8ZDVS1EY43ezcQ15Q5TR42-o_VM)

Fig. 2: Figure showing the overall projected costs of all preventive chemotherapy (i.e. mass drug administration against NTDs including schistosomiasis and soil transmitted helminths) in the coming years. This excludes medicine prices, which are donated by the pharmaceutical companies. Figure adapted from (Fig. 2.4 Investment targets for universal coverage against NTDs from recent WHO report on NTDs [13]).

![](https://lh4.googleusercontent.com/U2t2t3_M3RsHJk8MINgLn2OPwxlxPvuGWkcxN31sIAzd4IuqiS-G6iixq1AVwMeF6gMKeGODlGuyVza0QxiUB829vA67jPCzCwrRSiEW_5QPyUDpmKjJPWQVWoLopV8L07kJ2c0)![](https://lh4.googleusercontent.com/HIKeaxz0bZOSuCrXc1O78GzI6jfKLP2HqIn5tVo-oTAJyCnXeCTsvr12JLF0iWP4Lyz_Wt6qJNyU4_HspB5USD_KBho_FBB4vgXlKg1CbmrmBo5NbiqEfsLPv_nNVAUuYoS5J8A)

Fig. 3: Figure showing the projected costs of preventive chemotherapy against schistosomiasis (upper panel) and soil transmitted helminths (lower panel) in the coming years. This excludes medicine prices, which are donated by the pharmaceutical companies. Figure adapted from a recent WHO report on NTDs [13].

Notes: Shaded areas reflect the range determined by low and high values of the unit cost benchmarks; they do not reflect uncertainty about future rates of scale-up and scale-down of interventions. The dots in 2012 are actual numbers reported (when available) multiplied by the unit cost benchmarks, which is the approximate cost of delivering one treatment; these are not actual expenditures, but can be thought of as a benchmark for actual expenditures. All numbers expressed in US$ are constant (real) US$, adjusted to reflect purchasing power in the United States of America in 2015.

very successful at starting partnerships and receiving funding from governmental and 

. However, based on their effectiveness, reputation, and room for additional funding, one might have expected then to have received more funding from private foundations and private donors in recent years. Based on conversations with SCI, they are currently working closely with the Imperial College Development Office team on increasing their efforts to attract grants from private foundations and philanthropists. They are also in the process of hiring additional staff for their Fundraising and Advocacy team. At Giving what we can we 

 and not exclusively based on overhead costs, so we think using resources to attract more funding can potentially be a very good idea.

Recently, SCI has hired more staff for their operations. The five new hires have graduate degrees and among them are a 

, who has published in peer reviewed journals, and an expert on the link between schistosomiasis and HIV infections (an important topic on which we have 

). We believe that it reflects well on SCI that they continue to 

expand their team with the needed expertise

Updates on SCI’s Plans and Activities from November 2014 to March 2015

In most of the 16 countries that SCI operates in, 

the deworming programs are going according to plan

, according to SCI [14]. However, there were problems with deworming programs in three countries. In Liberia, due to the Ebola epidemic, all deworming operations have been suspended. In Yemen, due to political tension, a staff member had to be temporarily evacuated last year, but has now resumed work. In Zambia, drug delivery seems to be a continuing problem: SCI reported in April 2014 [15] that, due to delays during 2013, treatment scheduled across 6 provinces only took place between January - March 2014. The remaining 4 provinces were scheduled to receive MDA during July 2014. However, then in December 2014, SCI reported that only “piecemeal treatments” – about 60,000 – were successfully delivered.

Overall, we feel that, since there were only 3 out of 16 countries in which operations had problems, and some were due to reasons that were hard to predict, SCI’s operations seem to run very well.

In sum, SCI continues to be one of the most effective charities in the world. Its operations are very well executed and this is likely to continue as SCI has recently hired new, highly qualified staff. Recent scientific findings suggest that treating schistosomiasis might reduce - with great effectiveness - both malaria and HIV infections, which might make SCI even more effective than we previously thought. Finally, both in the short, but especially in the long-term, we believe that there is room for millions of dollars of additional funding and therefore 

we strongly recommend SCI as a charity to donate to

Mbah, Martial L Ndeffo et al. "Potential cost-effectiveness of schistosomiasis treatment for reducing HIV transmission in Africa–the case of Zimbabwean women." PLoS neglected tropical diseases 7.8 (2013): e2346.

Mbah, Martial L Ndeffo et al. "Impact of Schistosoma mansoni on Malaria Transmission in Sub-Saharan Africa." PLoS neglected tropical diseases 8.10 (2014): e3234.

Mbah, Martial L Ndeffo et al. "Cost-effectiveness of a community-based intervention for reducing the transmission of Schistosoma haematobium and HIV in Africa." Proceedings of the National Academy of Sciences 110.19 (2013): 7952-7957.

Morrow, Richard H, Robert L Colebunders, and James Chin. "Interactions of HIV infection with endemic tropical diseases." AIDS 3.1 (1989): S79-88.

Feldmeier, H, I Krantz, and G Poggensee. "Female genital schistosomiasis as a risk-factor for the transmission of HIV." International journal of STD & AIDS 5.5 (1994): 368-372.

Li, Xin-Xu, and Xiao-Nong Zhou. "Co-infection of tuberculosis and parasitic diseases in humans: a systematic review." Parasit Vectors 6.1 (2013): 79.

Gasim, Gasim I, Abdelhaleem Bella, and Ishag Adam. "Schistosomiasis, hepatitis B and hepatitis C co-infection." Virology Journal 12.1 (2015): 19.

Botes, SN et al. "Schistosoma Prevalence in Appendicitis." World Journal of Surgery (2015): 1-4.

Blog

Go Big or Go Home? Marginal and Systemic Change

Effective Altruism on a Tight Budget

Charity Update II: Schistosomiasis Control Initiative (SCI)

Apply for the September Internship!

Charity Update I: Development Media International

Our Charities Update Is Coming!

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