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

What this episode is about

The discussion emphasizes the significance of effective charitable giving during the holiday season, highlighting the work of Give Well, an organization known for its rigorous evaluation of charities. The conversation with Give Well's CEO, Ellie Hassenfeld, explores the importance of transparency in philanthropy, offering insights on how individuals can maximize the impact of their donations to foster meaningful change.

Key takeaways

• Giving wisely is the best holiday tradition; GiveWell turns donor dollars into gold star charity impact.
• Cost-benefit analysis beats seasonal shopping frenzy; each dollar given is a ripple of change.
• From Talmud to trade, religion major to finance ace; embracing the unpredictable career leap.
• Radical transparency at Bridgewater: say what you think, even if the echo sounds like a hedge fund.
• Hedge fund meets holiday spirit; perfect match of logic, empathy, and spreadsheets at GiveWell.

What is discussed, and when

1. 0:00 – 10:00: Talmud, Ellie Hassenfeld, GiveWell, givewell.org
2. 10:00 – 20:00: Charity Navigator, UNICEF, Doctors Without Borders, malaria vaccine
3. 20:00 – 30:00: Malawi, mosquito nets, development economics, Harlem Children's Zone
4. 30:00 – 40:00: cash incentives, Against Malaria Foundation, All Grants Fund, childhood immunizations
5. 40:00 – 50:00: Parasitic infections, All Grants Fund, American South, Cost per death averted
6. 50:00 – 1:00:00: AIDS treatment, Malawi, public health, Viral load testing
7. 1:00:00 – 1:07:14: Cost-effectiveness, Behind the Beautiful Forevers, Cameroon, development economics

Notable quotes from "The Simplest Way to Save Lives With Your Money | The Ezra Klein Show"

• Doing what I'm doing here at Gwell and instead I'm a academic studying the Talmud. It was something that at the time I was incredibly interested in. And in college, I spent a…

  about Talmud · at 2:21

• Give it to UNICEF, right? There are big charities out there. We've all heard of them. There was Charity Navigator, which is something that I used when I was younger.

  about Charity Navigator · at 11:18

• Just say, an inefficient delivery of food aid, you're not going to be thinking about the role that a malaria vaccine could now have and whether you should be in fact delivering malaria vaccines instead of delivering food aid.

  about malaria vaccine · at 15:27

• You can give and save lives. And this has been, it's clear and demonstrable that supporting public health programs has this kind of impact.

  about public health · at 17:53

• Are often rigorous randomized control trials of health programs like distributing mosquito nets or provision of needed vaccines.

  about mosquito nets · at 20:48

• See every day are really closer to us in some way. last summer, I traveled to Malawi and this was just to see the types of programs we support, to speak with people who are there, and they're they're far away.

  about Malawi · at 26:13

• Month and 5 years. and then the fourth is called new incentives and they deliver cash incentives to caregivers to encourage them to come to clinics to receive necessary…

  about cash incentives · at 31:17

• The binary question of does it work or does it not work. You have a certain measure of cost effectiveness. it has to clear. So working is not enough. It has to be cost…

  about Cost-effectiveness · at 44:54

Who and what is mentioned in this episode?

People

• Holden Karnofsky — Person · 2 mentions
• Ellie Hassenfeld — Person · 1 mention · first at 1:16
  But I thought as a way to talk about this, rather than writing a column, I would have Ellie Hassenfeld, Gwell's CEO and one of its founders on the show to talk about how Give…
• Max Roser — Person · 1 mention · first at 43:43
  Download multiple spreadsheets and match them up. And so we made this we I talked to, their, their, head, Max, Roser, and, he was telling me that they were facing you know a…
• Hans Rosling — Person · 1 mention · first at 1:05:42
  Are three books you'd recommend to the audience? one is factfulness by the late Hans Rosling. this is a book that just brings global health data to the world. It's say the core…
• Ted Miguel — Person · 1 mention · first at 1:06:22
  Work that's no not just them but people like Michael Kramer, Rachel Glennister Dean Carlin, Ted Miguel. It really was just part of the animating values of what has led to give well in our work.
• Ellie Henfeld — Person · 1 mention · first at 1:06:53
  Ellie Henfeld, thank you very much.
• Abhijit Banerjee — Person · 1 mention
• Dean Karlan — Person · 1 mention
• Esther Duflo — Person · 1 mention
• Katherine Boo — Person · 1 mention
• Michael Kremer — Person · 1 mention
• Mushfiq Mobarak — Person · 1 mention
• Nick Kristof — Person · 1 mention
• Rachel Glennerster — Person · 1 mention

Books & papers

• Talmud — Book · 2 mentions · first at 2:26
• Factfulness — Book · 1 mention · first at 1:05:39
  And, then, always, our, final, question,, what are three books you'd recommend to the audience? one is factfulness by the late Hans Rosling. this is a book that just brings…
• Poor Economics — Book · 1 mention · first at 1:06:02
  Minder was one of the things that got me very excited about this work back in 2006. second book poor economics by Esther Duffel and Abig Banerjee. They're two of the founding…
• Behind the Beautiful Forevers — Book · 1 mention · first at 1:06:30
  And then finally a book called Behind the Beautiful Forevers by Katherine Buu.

Companies & orgs

• GiveDirectly — Company · 8 mentions
• Charity Navigator — Company · 3 mentions · first at 11:21
• UNICEF — Company · 2 mentions · first at 11:18
  Going to, give the money to Doctors Without Borders. We're going to give it to UNICEF, right? There are big charities out there. We've all heard of them. There was Charity Navigator, which is something that I used when I was younger.
• UCLA Speed Test — Company · 2 mentions · first at 22:48
  Knows all about that. They're now the best network according to the experts at UCLA Speed Test. And they're using that network to launch SuperMobile, the first and only…
• supermobile.com — Company · 2 mentions · first at 23:00
  Coverage. That's your business supercharged. Learn more at supermobile.com. Seamless coverage with compatible device in most outdoor areas in the US where you can see the sky.
• Speed Test Intelligence — Company · 2 mentions · first at 23:06
  Best network based on analysis by UCLA speed test intelligence data 125. How do you think about freeing yourself from the very natural human tendency to think along with your group? I do find people in finance or venture capital tend to be.
• New York Times Opinion — Company · 1 mention · first at 0:02
  It's holiday season and in the holiday season here at New York Times Opinion Nick Kristoff many years ago kicked off a tradition which I love. It's one of my favorite parts about being here where different columnists and parts of the.
• GiveWell — Company · 1 mention · first at 1:12
  Spare, you consider giving some of it through Give Well, which you can do at givewell.org.
• givewell.org — Company · 1 mention · first at 1:12
  Spare, you consider giving some of it through Give Well, which you can do at givewell.org.
• Doctors Without Borders — Company · 1 mention · first at 11:17
  You might support. Not to just say we're going to, give the money to Doctors Without Borders. We're going to give it to UNICEF, right? There are big charities out there. We've…
• Harlem Children's Zone — Company · 1 mention · first at 25:52
  First donation I ever gave was to a New York-based organization called the Harlem Children's Zone, you know well-known local organization helping disadvantaged children in the…
• Against Malaria Foundation — Company · 1 mention · first at 30:47
  These are really great places to give to. So our top charities, one is the against malaria foundation which funds malariaet distributions globally. The second one also works on…
• Malaria Consortium — Company · 1 mention · first at 30:55
  Malariaet distributions globally. The second one also works on malaria prevention and that's malaria consortium in its seasonal malaria chemoroprevention program. This program…
• Helen Keller International — Company · 1 mention · first at 31:10
  Malaria high season to prevent cases of malaria and resulting deaths. one Helen Keller International focuses on provision of vitamin A supplements twice a year to children…
• New Incentives — Company · 1 mention · first at 31:19
  A year to children between the ages of 6 month and 5 years. and then the fourth is called new incentives and they deliver cash incentives to caregivers to encourage them to…
• Evidence Action — Company · 1 mention · first at 35:44
  Question about that program is we decided to no longer continue supporting it. Evidence Action, the organization that implemented it shut it down. that was a joint decision at the time.
• ALIMA — Company · 1 mention
• CHI — Company · 1 mention
• Gapminder — Company · 1 mention
• microfinance institutions — Company · 1 mention
• PATH — Company · 1 mention

Products & tech

• Amoxicillin — Product · 4 mentions
• malaria vaccine — Product · 2 mentions · first at 15:32
• vaccines — Product · 2 mentions · first at 15:38
  Vaccine could now have and whether you should be in fact delivering malaria vaccines instead of delivering food aid.
• mosquito nets — Product · 2 mentions · first at 20:54
• vitamin A supplements — Product · 2 mentions · first at 21:27
  People asking questions like how effective are mosquito nets or how what impact will we get from vitamin A supplements delivered to young children.
• livestock — Product · 1 mention · first at 22:13
  Measurable, more easily measurable, but the economic effects of programs like micro finance or provision of livestock or even just giving people cash to let them spend how they…
• HIV test — Product · 1 mention · first at 37:56
  Countries around the world transition from a single HIV test and syphilis test two individual products that were given to women who came into antiatal appointments to a dual test and the idea was if we can transition from having to.
• syphilis test — Product · 1 mention · first at 37:56
  Countries around the world transition from a single HIV test and syphilis test two individual products that were given to women who came into antiatal appointments to a dual test and the idea was if we can transition from having to.
• antimalarial medication — Product · 1 mention
• cow — Product · 1 mention
• dual HIV/syphilis test — Product · 1 mention

Concepts & topics

• Randomized controlled trial (RCT) — Concept · 14 mentions
• public health — Concept · 6 mentions · first at 17:57
• cash incentives — Concept · 3 mentions · first at 31:22
• Cost-effectiveness — Concept · 3 mentions · first at 45:01
• development economics — Concept · 2 mentions · first at 22:00
  The information we rely on. And then separately, there's a movement in development economics around randomized control trials where people are trying to not just assess the…
• All Grants Fund — Concept · 2 mentions · first at 32:31
  Funds to organizations relatively quickly. The next option for donors is to support the all grants fund. And you know that just gives us the flexibility to give to either top…
• Parasitic infections — Concept · 2 mentions · first at 41:06
  Example is a program we've recommended for a long time which is treating children for parasitic infections. Often this goes by the name deworming. And the reason there's so…
• backtesting — Concept · 2 mentions
• Demographic and Health Surveys (DHS) — Concept · 2 mentions
• microfinance — Concept · 2 mentions
• Saddaka (Tzedakah) — Concept · 2 mentions
• radical transparency — Concept · 1 mention · first at 5:47
  So, so, what, Bridgewater, is, known, for, is its culture of radical transparency.
• tithing — Concept · 1 mention · first at 24:25
• childhood immunizations — Concept · 1 mention · first at 31:26
  Deliver cash incentives to caregivers to encourage them to come to clinics to receive necessary childhood immunizations. And you know those four are not the I wouldn't call…
• Top Charities Fund — Concept · 1 mention · first at 32:12
  Impact. but for the primary options we offer people are first to give to our top charities fund.
• No Lean Season — Concept · 1 mention · first at 34:16
  Randomized control trial to go along with that program. There's an organization called No Lean Season or a program that we helped start and you can read all about it on our…
• syphilis — Concept · 1 mention · first at 37:56
  Countries around the world transition from a single HIV test and syphilis test two individual products that were given to women who came into antiatal appointments to a dual test and the idea was if we can transition from having to.
• Democracy promotion — Concept · 1 mention · first at 42:49
  Medicine works, right? You know what you're finding there. There are a lot of other kinds of interventions, democracy promotion, right? that we don't really know if they work…
• Cost per death averted — Concept · 1 mention · first at 45:15
  Yeah,, I'm, I, think, I'll, just, use, the cost per death averted as a simplified way of putting this. I mean we do try to look at the effects that come from improved health increased income to some extent increased well-being and.
• Value of a statistical life — Concept · 1 mention · first at 47:19
  Weigh things like income against health there's academic studies that look at the value of a statistical life and we're trying to use that data to the extent we can. we also…
• AIDS treatment — Concept · 1 mention · first at 53:18
  9:00 a.m. they had all come to work there were patients lining up outside to get their AIDS treatment that they had come for they were called into a staff meeting the facility…
• Viral load testing — Concept · 1 mention · first at 54:06
  Similarly I visited a small clinic in a more rural area and an important part of HIV treatment is viral load testing. So this is testing people to ensure that the treatment…
• cost-benefit analysis — Concept · 1 mention
• Development economics randomized control trial movement — Concept · 1 mention
• Hookworm eradication — Concept · 1 mention
• Seasonal antimalarial medication campaigns — Concept · 1 mention
• seasonal malaria chemoprevention (SMC) — Concept · 1 mention

Places & events

• Malawi — Place · 3 mentions · first at 26:19
• American South — Place · 1 mention · first at 41:43
  Of improved weight gain from pooling multiple randomized trials and some evidence from the American South when hookworm was eradicated here in the early 20th century. But at…
• Cameroon — Place · 1 mention · first at 1:01:45
  Primary health care services and malnutrition treatment in a very challenging area of Cameroon. And that's another kind of work that had been previously more supported by…
• Mumbai — Place · 1 mention · first at 1:06:41
  It's an informal urban settlement sometimes known as a slum near the Mumbai airport and it just paints a very vivid picture of what life is like in poverty. I think, Behind, the, Beautiful, Forevers might be it's definitely in my top five.
• Mumbai airport — Place · 1 mention · first at 1:06:41
  It's an informal urban settlement sometimes known as a slum near the Mumbai airport and it just paints a very vivid picture of what life is like in poverty. I think, Behind, the, Beautiful, Forevers might be it's definitely in my top five.
• Annawadi — Place · 1 mention
• United States (US) — Place · 1 mention

Sponsors

• T-Mobile — Sponsor · 2 mentions · first at 22:42
  Environment, the edge goes to those who push harder, move faster, and level up every tool in their arsenal. T-Mobile knows all about that. They're now the best network…

Full transcript with timestamps

0:00 It's holiday season and in the holiday season here at New York Times Opinion Nick Kristoff many years ago kicked off a tradition which I love. It's one of my favorite parts about being here where different columnists and parts of the organization offer up their recommendations for giving trying to make people aware of charities philanthropies they might want to support where money that they can spare might do a tremendous amount of good. In my personal giving, every year I give some of the money I'm giving to a local charity, but then I give a lot of it to give well of every organization I know of. I have the most trust in them to vet, to run the experiments, to read the research, to really figure out where my money will go the furthest in helping other people. Give all has not been around that long, but in the time they've been around, they've become a pretty big channeler of givers funds for

0:57 this exact reason because a lot of people trust the work they do because it is so transparent because it is so rigorous. Billions of dollars have ended up being given through them. And so I am recommending that if you have money to spare, you consider giving some of it through Give Well, which you can do at givewell.org. But I thought as a way to talk about this, rather than writing a column, I would have Ellie Hassenfeld, Gwell's CEO and one of its founders on the show to talk about how Give Well started, how it does its work, how it makes some of its very arguable and very difficult decisions in terms of what to recommend and what not to recommend, and how givers themselves should think about donating money, to whom, to where, and under what conditions. as we all sort of wrestle with how we can do a little bit more good in a world that needs a lot more good done. As always, my email Ezra Kleinshowny Times.com.

1:56 Ellie Housefeld, welcome to the show. Great to be here. So, I want to start a little bit before your work at Gwell. When I was looking into this show, you studied religion at college, which is not what I would expect necessarily from somebody who goes on to work at a hedge fund and then become an apostle of costbenefit analysis and randomized controlled trials. So, religion, why?

2:19 I, think, in, an, alternative, life,, I'm, not doing what I'm doing here at Gwell and instead I'm a academic studying the Talmud. It was something that at the time I was incredibly interested in. And in college, I spent a lot of time in Talmud courses, studying other religious texts and Judaism and otherwise. And I just found it incredibly fulfilling and interesting to think about how people had tried to answer questions about their lives.

2:46 What, is, the, Talmud, for, people, who, don't know? And what did you learn from studying it? It's a huge compendium of Jewish ideas and thought from roughly the 500s of the common era. And I think the thing it taught me most is how challenging it is to know anything. uh I spent about a year just studying Talmud and in that year after high school it was the it was the first time that I think I had a really challenging intellectual experience where I wasn't able to understand the the text and the content that I was trying to and uh but nevertheless found myself drawn to understand it and to deal with the layers of challenge that the the text presented and spent a year doing that.

3:33 And then when I was in college, I would say that this was my main extracurricular activity outside of school was spending several hours a day uh studying studying Tolmood and thinking about whether that is something I would do as a career and ultimately realized it wasn't the right fit for me.

3:48 And, what, you, move, on, to, is, Bridgewater, a very unusual hedge fund. How what is that movement for you? You know, sometime I as I moved through college, I was thinking about what my career would be and had the opportunity to have internships in many different places. So, my parents are both lawyers. I got to work at a law firm. That convinced me not to go to law school because I didn't think that would be that would be right for me. I was able to get a job in finance at a small company and they were they were essentially selling research to the big banks and just trying to figure out how to ac succeed as an organization. And because of that, they were willing to give me, a 21-year-old college kid, a lot of leeway to try to do things and help the company grow. That experience of being in a place where I was needed and able to do something interesting and challenging motivated me to look for

4:39 jobs in in finance coming out of school. And so I went to, you know, I was able to get a job at Bridgewwater Associates which in 2004 when I graduated college was not wellknown at all. Uh, everyone I talked to said, "Don't don't go work there. You know, go work at a well-known investment bank. that'll be better for your career. But when I interviewed there, they they asked me about my senior thesis, which I was a religion major, so it was about martyrdom in medieval Islam, Judaism, and Christianity. And we talked about that for an hour, and I got a call back. And it was one of the few places that that called me back as a you might not be surprised to hear that religion majors don't often do so well interviewing for finance jobs. And because of that, I thought that this place, Bridgewwater was just uh one of the more interesting places to go work. and I was grateful to be able to work there.

5:24 So, it, later, becomes, fairly, wellnown because it's Ray Dallio's hedge fund and Dalia of course is a a sort of I know public finance intellectual now but had a very strange and famous management style. What was working at Bridgewater like for somebody who doesn't know much about it? What is unusual about working at Bridgewwater in that time?

5:45 So, so, what, Bridgewater, is, known, for, is its culture of radical transparency. just saying what you think, sharing that with other with your colleagues, not worrying too much about how you say it but just saying what you believe. And then over time

6:00 more, about, how, they'll, feel, about, it or, how, they'll, feel, about, it., And, over time, Rey developed these principles that were passed out inside the organization. The way I described it to my friends at the time is it felt to me like working in almost an academic environment. People didn't wear fancy clothes. They argued a lot about ideas. uh you know sure there were ways in which um I think the culture wasn't ideal for many you know it was a place where it was more about getting things right and then worry about people's feelings later and if that wasn't the right fit for you then people moved on but for me it was an extremely valuable experience and and the thing that I appreciated certainly as a young person in my early 20s is I would go to my boss sometimes and he was one of the heads of the company and say hey I think you're wrong about this and he would listen to me and not you know sometimes I was

6:49 wrong Sometimes I was right, but just to be taken seriously early in your career was uh so valuable. It's something I'm really grateful for them for providing me.

6:57 What, did, you, actually, do, there? I, worked, in, the, research, department, for a year. So that meant thinking about uh investment decisions and then move to the trading or the execution department where the job was to try to put trades into the market in a way that didn't push the market too far in the direction that we were going. I I think this is relevant to what you end up doing because when hedge funds, investment banks, you are trying to understand a company, a sector uh quirk in the market at a level where you can make a trade other people will not make and you'll lose a lot of money if you're wrong. So how does a religion major coming out of college, what is the pathway to having something of any value to say when you're, you know, whatever it is?

7:45 I, think, the, core, the, core, idea, that, was true then and I think has carried through in give well and in my life today was, you know, first in order to make decisions about what to do in the world, we have to understand the world accurately. And for a hedge fund understanding reality is really key. If you're right, you make money. Or you can. If you're wrong, you tend to lose money. And so the stakes of getting to the quote unquote truth are very high. Part of that is you have to be careful not to fool yourself. So one of the things that investors do is they have an idea about what might perform well in the market. And then you can say, well how well did this idea perform historically? And you can back test the idea. And when you do that, you have to be really careful not to fool yourself and fit your idea to the past. Instead you have to ask this question.

8:34 Wait,, can, you, describe, what, that, would mean? So,, you, might, say, uh, like, a, simple, rule like let's say when I'm going to make something up uh that's entirely fictitious, but you know, let's say if oil stock if oil prices go up, then train stocks go down because an input into railroad costs is the price of gas. And so when you know the input cost goes up, the performance will be poor. And you could try to look at this historically and say, let's say we tested this going back. Would this have been a successful strategy in the market? The challenge is it's very easy to convince yourself that you should tweak your rule in one way or another to enable the idea that you have to perform uh on the back test, but you don't want to do that cuz you only want to bet money on this idea if it really will work. So you're working at Bridgewwater a hedge fund, I would say one of the more inquisitive industries that exist.

9:28 Where does the interest for you, where does the the glimmers of giving as a pursuit and giving differently come from? I've been there for a couple of years. Uh my friend had a friend there, Holden Carnowski, and and he and I just started realizing, you know, we have we're young. We don't have high expenses. we're saving some money. Let's try to use some of this money to to help people. And so back in the summer of 2006, he and I and a few others got together and said, "Let's just work on figuring out where where we'll give by the end of the year." You know, few a few thousand dollars.

10:06 And it was in that process with that group of people that we learned a few things. You know, first we learned it's really hard to get answers about what charitable organizations do and how well it works. Uh number two, I just found myself, you know, somewhat obsessed by this question of where should we give? You know, at the time I knew very little about what the lives of people around the world were like. It's not something I'd studied. It's not something I knew much about, but learning about the challenges accessing water or disease it was just a very motivating motivating topic to work on. I I remember this night in probably December of 2006. I was up at 2 or 3 in the morning reading academic papers about diarrhea in Africa. If you find yourself reading about diarrhea at 3:00 in the morning you know you found something that is you're really drawn to. And so after working on this essentially part-time

10:59 Holden, my co-founder and I left Bridgewater and started Give as a full-time project back in the summer of 2007. Two things in there. One is the impulse to start looking for the effectiveness data on the charities you might support. Not to just say we're going to, you know, give the money to Doctors Without Borders. We're going to give it to UNICEF, right? There there are big charities out there. We've all heard of them. There was Charity Navigator, which is something that I used when I was younger. And and also what happened, what you saw when you began looking.

11:31 We just started asking some really basic questions and the answers we got back uh were shocking. So we we each researched a different cause. I decided to research the cause of water in Africa. I'd call up first we looked at Charity Navigator and at the time Charity Navigator essentially just reported financial metrics. So it said this is the amount of money that's spent on overhead versus programs and fundraising. And while this measure can tell you that a charity is a scam or not, it's it's not going to tell you whether the program is actually working. Let's say the charity spends all its money digging wells, but those wells disappear a year later. They fall into disrepair. Well, that's not a very effective use of funds, even if all of it was spent on programs. And so we we knew that Charity Navigator wasn't giving us the answers. I called the organizations up and asked them, "Well so so what do you do? What do I get if I

12:22 give you money?" And they said, I remember this $20 provides a child water for life. Great. That's amazing. I would love to give to that. Uh what do you mean? Like how how does that work exactly? What does it pay for? And how do you know? And at that point, it's like the conversation fell flat. They they just didn't have answers. What what they actually said was, "We don't get questions like these from our million-dollar donors." And it it was this light bulb like this light bulb went off that you know almost no one was asking these questions.

12:53 Were, they, annoyed, by, you? Uh, some, of, them, were, annoyed, by, us., One organization accused Holden of being a spy for a rival organization. He had asked how much money do you spend in each country? And that question would they could only imagine it would be asked if he had some nefarious purpose. And so I I think they were annoyed. I mean, we were what, 25 at the time, so I'm sure we were annoying, but we really saw how neglected this area was. And it really motivated us to start Give Well.

13:27 What's, striking, to, me, about, the, way, you approached it is that you even had the intuition that maybe you would give to a charity. And what you were doing was making a bet in the same way that when you're trading, when you're trading, the bet is supposed to make you money. When you're giving to a charity, it's supposed to improve lives.

13:45 In, some, ways,, this, basic, question, of what is true, how can we know that it's true? How can we assess the empirical data and evidence that we have to make the best decisions? I mean, that's exactly what Give Well does in a very different way, in a very different context, but it's bringing that same uh commitment to rigor and truth seeeking to bear on trying to answer questions about what we should do in the world. What are the things that in your view most commonly stand in the way of organizations? Organizations that care deeply about their mission or have financial or otherwise skin in the game from finding truthful answers.

14:25 Organizations or for that matter individuals. I mean I think there's two big things that happen and there's many more that are downstream. First is as an individual running an organization, you have an incentive for your organization to succeed and it's very difficult to look for information that would mean your organization is not succeeding or shouldn't receive money. uh it it's just it's it's it's not I think it's not realistic to expect someone who say is running an organization that you know delivers food in a way that is very cost inefficient to determine that they should shut that program down and move on to something else. That's just not how human beings operate. And I think that's completely completely understandable. And then I think the second challenge um is that in order to make good decisions about where to put money, it's very helpful to have a a broad perspective. If you're focused on, let's

15:27 just say, an inefficient delivery of food aid, you're not going to be thinking about the role that a malaria vaccine could now have and whether you should be in fact delivering malaria vaccines instead of delivering food aid. And so I just think the place that most people sit in the let's call it the nonprofit economy makes it implausible that they would take this kind of perspective. I think that when I was younger and giving to charity, I didn't really think at all about the idea that the money could fail. And I mean these are good people.

16:00 They're trying to do something hard. You know, they're out there working on the ground. The idea that you might just give money to some of them and that money would be useless, I actually think until later on didn't really occur to me deeply. What was the intuition that led you to treat money given to charity as money that could fail? I don't I don't know what, you know, led us to have that realization. And what I remember is it was at a time when, you know, you would go to CNET on the internet for ratings of printers if you wanted to know which printer to buy. And it it almost seemed intuitive that you should be able to get the same kind of information about any way that you would spend money including about charitable organizations. And in many ways that was the initial vision for give well which you know we've evolved far from today but the initial vision was a place that donors could go and just get information

16:59 that is as good about where they'll give as they could get at the time about which computer to purchase or which printer to buy. And it just seemed it was it was offensive in some ways that that didn't exist for charitable organizations. You know, I think a lot of the focus that people bring to charity is is on the donor. It's saying to, you know, donor, you should be generous. And then when you're generous that's that's success. And of course what that misses is that the person who you should ultimately be focused on is is helping someone in need. That that's the goal. Uh, you know, I think that what, you know, what what really is important to remember is is both the fact that you can fail to help the person in need and and that happens all the time, but also that charitable giving isn't just a nice thing that a donor can do. It's a very practical way to make the world a better place that

17:53 you can give and save lives. And and this has been, you know, it's clear and demonstrable that supporting public health programs has this kind of impact. That point about the focus being on the donor is interesting. So in the tradition you and I share, the Jewish tradition, there's this idea of Saddaka. And I remember being in Hebrew school when I was young, going around with a little Saddaka box and collecting, you know, coins. And I think it went to at that time UNICEF. And and being taught that there were you know, different levels of saddaka.

18:22 And the highest level was when nobody knew you gave and you did not know who you gave to because that level was selfless in both directions. you you were not expecting gratitude. You were not expecting prestige. Uh I do wonder if some of it comes from the history of of of charity and generosity as among other things a spiritual practice. You're trying to uh develop a certain facility inside yourself as a virtuous and spiritually alive person. The idea that you'd be coming behind that money and checking up on it, I think would be seen in some ways as intention with the attributes you were trying to cultivate. When the focus of charitable giving is on the generosity of the donor, then those sorts of that framework makes sense. And then there's this alternative way of seeing the world, which I think is more intuitive to us in modern times than perhaps it was 3,000 years ago, which says we we

19:20 know that we can make the world a better place. The world is a much better place in my opinion today than it was 3,000 years ago. We we do that via improved technology. We argue about the best political systems and what policies we should have. And now I want the argument that I'd like to bring forward is that charitable giving is one more way that each of us can take action and make the world better. and and when you see it from that perspective, it's critical to think about the effects that the programs have where you can get as much uh impact as possible and also how to avoid failure. So you and Holden split off from Bridgewater, you create give well. You begin trying to gather this data, begin trying to figure out even how you would make recommendations. How do you start? The idea we had is that when we were individuals giving a few thousand dollars, it was hard to get information but with some of the funds that we were

20:13 we put together to start Give Well full-time heavily from our former co-workers at Bridgewwater. We could incentivize organizations to share data. We started by offering small grants that organizations applied for. Uh I think at the time we offered several $25,000 grants. Organizations would send us data. And what we learned in that first year after we we recommended our first round of organizations is that while we needed some data from organizations what was really critical in pushing us to make recommendations was this huge trove of academic information about what works to help people overseas. So these are often rigorous randomized control trials of health programs uh like distributing mosquito nets or provision of needed vaccines.

20:59 Who are these academics doing this work? Because on some level, it's weird work to do to say to yourself, well, I'm going to, see, if, giving, a, family, a, cow really does help them in 5 years. Where where is this early evidence coming from and what kinds of weirdos are collecting it? Well, I mean there's there's different fields that you know whose information we rely on. One is the the public health field. So people asking questions like how effective are mosquito nets or how uh what impact will we get from vitamin A supplements delivered to young children.

21:31 This is coming out of of public health. And I remember actually speaking to one of these malaria researchers who told me at one point early in his career he had sat on the beach in Tanzania and just let mosquitoes bite him because they had to count how many bites he would get in in some amount of time sitting on the beach. So certainly people who were themselves willing to go to great lengths and risk personal harm to create the information we rely on. And then separately, there's a movement in development economics around randomized control trials where people are trying to not just assess the health effects of programs which are often more measurable, more easily measurable, but the economic effects of programs like micro finance or provision of livestock or even just giving people cash to let them spend how they want. And this this movement in the 90s and early 2000s in in many ways I think of as uh being an

22:27 intellectual forebearer to give well and you know I think we're in in our debt to all the work they did because they really helped generate many of the ideas that we've taken forward.

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23:04 Best network based on analysis by UCLA speed test intelligence data 125. How do you think about freeing yourself from the very natural human tendency to think along with your group? I do find people in finance or venture capital tend to be trained to look for places where the consensus might be wrong. I I mean at the hedge fund level what everyone else thinks on some of you if you only think what they think you're not going to make money. But I think there's also this dimension, and I feel like this is important to the work you all end up doing at Give Well, where there are things that that are comfortable to think um stories we like to tell ourselves or are moved by and the way in which we can get wrapped up in those sort of more emotionally driven approaches or socially driven approaches, right? You know, everybody like you supports this kind of charity.

24:00 everybody like you knows that you know the, economy, is, going to, be, bad, next year. I

24:03 I, mean, the, the, ask, that, I, would, make, of most people is is not to try to break away from the norm in an extreme way but instead you know there's this idea that that you know that I have that many have this traditional idea of giving 10% of your income to charity. It doesn't ask you to give

24:24 very, old, religious, idea. Old, religious, idea, tithing. And, so, it's, it's, not, giving, 90%, or, even 50%. It's it's 10%. And I think in the same way, you know, if you're if someone is supporting local causes, if they're supporting programs that are meaningful to them, one one step to take is just move away by 10%. and move towards, you know, if if you want the causes that we focus on helping some of the poorest people in the world, uh, with with 10% of your focus and energy. And I think that that 10% move is one that is available to many people.

24:59 So,, you're, you're, pointing, towards, a very particular intuition people have which is that we all get wrapped up in local causes. And I want to say for my giving, I sort of give in a couple of different buckets. And one is very local, right? that I believe I have a particular responsibility to the community I am part of. Uh but there's a tendency for the stories that you know and are near you and people who know you tell you to overwhelm the sort of diffuse questions of global malaria or vitamin deficiency. How did you travel that path? Because my understanding of when you began in this you began locally as well. Uh when when we started, we were based in New York. Now we're based in the Bay Area, but we were looking both at causes focused on New York and causes focused overseas. Um I think the first donation I ever gave was to a New York-based organization called the Harlem Children's Zone, you know

25:53 well-known local organization helping disadvantaged children in the New York City area. And what we learned after that first year of work at Give Well was just how far a dollar can go overseas. And then I I think there's a little bit of a in some we know this but it's a little bit of a a figment of our imagination that the people who we see every day are are really closer to us in some way. Uh last summer, uh I traveled to Malawi and this was just to see the the types of programs we support, to speak with people who are there, and they're they're far away.

26:28 It's true. But with 36 hours of flying I I can sit as close to them as I'm sitting to you and ask them about their lives, what they're struggling with what they're dealing with. And then in the same way that in at home, I can see someone who's in need in in sitting across from someone in Malawi, I hear about their struggle to have food the days they went without eating, the the mother who tried to bring her child to the local clinic, but uh she had to carry her child for an hour on her back and then the clinic didn't even have the drugs in stock. And I can also talk to the parents who in a maybe a way that's very familiar to to me, maybe to you are struggling with a new second grade math book because they're teaching arithmetic in a different way now in Malawian schools than they did when she grew up. And so she doesn't know how to help her child with the math because it's different than what she did. And so

27:15 being there, you know, on one hand there's the analytical argument that a dollar goes further, and then I think there's just the reality that uh people in Africa aren't as far away as we sometimes think. They're really there. you can go and talk to them.

27:29 I, think, it, is, profoundly, difficult, as, a human being to live as if other people's lives are as real and as valuable as your own. There is a vividness to us and the people right around us. I don't mean necessarily in our community. I mean our family, our friends, people whose stories interweave with our own. and to really treat people further from that. You know, somebody fleeing from gang violence in Honduras or just somebody struggling at subsistence level labor in another country to to treat their life as if it is as real as yours to really believe that not just say it. In some ways, I don't think human beings are wired for that. But but it does strike me, as, a, a, a a, genuine, like, emotional, and spiritual challenge.

28:20 And, I'm, not, sure, that, that's, what, we should be really aiming for because I don't think it's possible. If if if we felt like other people's lives were as important as our own, we wouldn't be talking about giving 10%. We'd be giving far more. In the same way, I don't think it's reasonable to ask expect to even want parents to treat their children equally to all other children in the Would we want a society where all parents thought of their their own child exactly the same way as as every other? I don't think that's a realistic expectation.

28:48 No,, that'd, be, inhuman. And, so,, well,, quite, literally., And, so,, I think this and so I think sometimes, you know, the ideas of that that come from people who say, you know, you can give more and there are needs overseas. It sounds like someone is saying you you must or you're bad if you don't or you should give everything away because look at the great need. And in some way we must accept that's true to some extent. But more more practically I I don't think that's the right target to shoot for. And in in my experience people who try to aim at the target which is treating others exactly like yourself or giving everything away to bring yourself down to the global median income. I mean that maybe succeeds in the short term but certainly is not a long-term path to helping others as much as possible. I'm always struck by how few charities actually make it into your top charities and and it's pretty it has been fairly

29:41 stable year to year now for some years. So, walk me through what they are and what makes you confident in them.

29:48 Yeah,, let, me, um, let, me, first,, if, it's okay, like frame up how the top charities fit into our overall work. And so, in 2025, we've directed funds to 70 organizations. uh four of them are our top charities and then you know there's more than 60 others that have received a lot of money. You know perhaps they're newer or our knowledge of the program is newer or the evidence is slightly more complicated and you know there's higher risk that the program doesn't fail but the program fails but if it works it'll be incredibly successful. And so we direct a lot of funds to those those types of programs too. And so what what these top charities represent uh to maybe use the finance analogy is is something like the blue chip programs the the ones that um have the strongest combination of evidence and track record and data uh behind them so that we can say to anyone, you know, if you're if you're trying to help people overseas

30:43 these are really great places to give to. So our our top charities, one is the against malaria foundation which funds malariaet distributions globally. The second one also works on malaria prevention and that's malaria consortium in its seasonal malaria chemoroprevention program. This program provides seasonal antimmalarial medication to children during the malaria high season to prevent cases of malaria and resulting deaths. uh one uh Helen Keller International focuses on provision of vitamin A supplements twice a year to children between the ages of 6 month and 5 years. Uh and then the fourth is called new incentives and they deliver cash incentives to caregivers to encourage them to come to clinics to receive necessary childhood immunizations. And you know those four are not the I wouldn't call them the the best. There's, you know, other programs we've recommended uh outside of that for

31:35 water and uh malnutrition prevention and uh the malaria vaccine, which, you know it's it's relatively new. It's not going to get on our top charities list yet. Uh but there's just this wide array of programs that help people around the world.

31:47 And, this, gets, to, there, are, multiple, ways to donate through Give Well. Walk me through those and how they relate to the this sort of division you're making here.

31:55 Yeah., And, so, the, Well,, I, mean,, first just, you know, anyone can use our our research for free. Someone can come to our website, read it, and you can donate to any of the organizations that you see on our top charities list directly without ever telling give well that you've done it. I mean, we hope you do because that helps us understand our impact. Um, but for you know, the the primary options we offer people are first to give to our top charities fund. And so that is uh you know that those are donations that we'll only give to those four organizations based on the needs they have at the time we received the funds. We we push those money, you know, out the door. We commit those funds to organizations relatively quickly. The next option for donors is to support the all grants fund. And you know that just gives us the flexibility to give to either top charities or any of the organizations or programs that we

32:41 might support including giving money to help organizations or programs get off the ground or funding the type of research that we need to make our decisions. And then finally, there are donors who give unrestricted. And you know that is the in some sense the highest level of trust in give well because you're allowing us to decide how much we need to allocate to our own operating expenses versus allocating funds to the programs we support. Uh we've we've been fortunate enough in the last few years that we've raised more unrestricted funds than we need for our own operations and we've then designated that money for granting and you know sent it out the door to get it to people who need it around the world. The most common critique I hear of give well, one I even somewhat believe is that it's there's a limit to what can be measured and it's possible to measure the effects of vitamin A supplementation in a way

33:29 that measuring the effects of funding for political change or fortifying public health infrastructure is very very hard. You know, it's very hard to measure the effect of giving on climate change. How do you think about that that question of what you can and cannot measure knowing that much that cannot be measured is going to be important in you know human flourishing?

33:52 Yeah,, it's, a, great, question., And, I, mean I think uh to start I think it's really important to have humility in this work that we can be wrong and we know we can be wrong and there are times when we've supported programs that seemed like they would clearly be effective. And then at the same time we also funded a rigorous randomized control trial to go along with that program. There's an organization called No Lean Season or a program that we helped start and you can read all about it on our website if you're interested. That program provided small cash incentives to encourage people to migrate from the rural areas of Bangladesh during the lean season to the cities so that they could earn more money and send money back home. There was a series of randomized control trials that preceded our support of it that showed that it was having this effect. People were earning more money.

34:39 They were even more likely to migrate in future years. And then we provided funding to start up this program with an RCT randomized control trial alongside it. and at scale it didn't have the effects that we expected. Uh there's an interesting I mean I have some theories about

34:54 why, do, you, think, that, is?, So, I, think, in this case there there's just this big challenge of going from a 2,000 person research study to a 100,000 person program that's existing in the world. And I think what may have happened in this case and this is what I heard from the uh the lead the researcher of that program Mushik Mubarak a great academic that when they decided to deliver these cash incentives they did it via micro finance institutions uh essentially banks that were there in in Bangladesh and the loan officers who were delivering these incentives which were small loans at the time their personal incentive was to find the people who were already likely to migrate because that made their job of finding people to take these incentives much easier. You know, I think an interesting question about that program is we decided to no longer continue supporting it. Evidence Action, the organization

35:45 that implemented it shut it down. Uh that was a joint decision at the time. And I'm not even sure that decision was right because it's possible that with more time we would have been able to solve this implementation challenge. But I I think this this story just illustrates the how critical measurement is. measurement is is certainly limiting, but I I think when you're trying to help people living 10,000 miles away, it's just necessary to find some mechanism for getting feedback. So be be part of a a feedback loop that tells you if what you you know, if your bets are right, you know, to use the

36:22 I, think, there's, some, way, in, which, I, feel just hearing that story the danger of being a donor because if I had donated to that, which probably I did because I've been donating through Give Well for a long time. if I had donated to that and what I had heard is there's great evidence that giving people grants to to migrate in the you know during during key seasons will will help them out and look now we're giving all these people grants. would never occur to me to think maybe it's not working and it makes you wonder how much money is out there being wasted or and I think this would be the other question if there's something wrong with the studies right the subjecting every project to the rigor of you know expensive randomized control trials which you can't do that many of them. Like, do you have concerns that you might be discarding things that actually work or that work in ways that

37:23 you're not measuring or that you're not measuring for long enough etc. What we try to do is just find ways to build in a feedback loop so we learn something and we can update from our you know update our our predictions about the future based on the reality of what occurs. Sometimes that's a randomized control trial. It's a great way to do it. Other times we supported a program that and we still do that uh helped countries around the world transition from a a single HIV test and syphilis test two individual products that were given to women who came into antiatal appointments to a dual test and the idea was if we can transition from having to apply two tests and two products to one we can reach more people. I think this program has been very effective, very coste effective. We don't know that from randomized control trial data. Instead we know that from more uh more programmatic follow-up about monitoring

38:28 the data that comes from people who are going to antiatal visits from seeing the stock levels in countries of these tests. I think that ultimately I sort of wish it were the case that you could have a randomized control trial for everything and we could push in the direction of of greater certainty. And I think it's it's clear that there are that there are so many uh so many programs that could be so valuable that just can't be subjected to that level of scrutiny. We can see today, you know programs like uh, you know, people who scaled up HIV treatment in Africa in the early 2000s, whether that was advocacy to the US government or the philanthropic work that supported uh t-fold reduction in drug prices, maybe even 100fold reduction in drug prices from some original levels. I mean, those are incredibly impactful programs. You know, with with hindsight, we can look back and say those programs saved a lot of lives per

39:27 dollar. And I think that is uh you know a challenge that I feel like I'm always trying to make to researchers internally at give well that we see as a challenge to ourselves which is you know when are we inappropriately prioritizing certainty and measurability over expected impact.

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40:16 Best network based on analysis by UCLA speed test intelligence data 1 2025. What are the areas or the charities that you think have either the highest expected impact or maybe more relevant for this, the highest possible impact but you just can't measure it? And I'm thinking here in the present, not, you know, doing long- termism and trying to save society, you know, 10 billion years from now. What are the things that feel to you like they are the riskiest in terms of may not pay off but man maybe they do pay off and and it's worth it for that reason.

40:52 Yeah., Uh, let, me, give, a, couple, different kinds of examples because I think the the spectrum of potential impact but also risk is very wide. So one one example is a program we've recommended for a long time which is treating children for parasitic infections. Often this goes by the name deworming. And the reason there's so much uncertainty is that we have a single randomized control trial from about 30 years ago in one area of Kenya where they treated kids who had very high worm infections followed them for many years. They're still following them today. It's really an incredible study and see that the kids who were treated in as part of that experiment have much higher earnings today than they did than than the control group. This is one very strong piece of evidence. There's also evidence of uh improved weight gain from pooling multiple randomized trials and some evidence from the American South when

41:45 hookworm was eradicated here in the early 20th century. But at the same time, I don't think any of us would see that as clear knockdown evidence of significant effect. The the public health community says, you know, these trials don't meet our standards uh for rigor. the uh you know we're we're not convinced by these results and the worm levels today in 2025 are very different than they were at times in the past when these studies were implemented. At the same time, it's so cheap to treat a child for parasitic infections. We know that these parasitic infections are bad. And so this is one example of a program that you know may have an absolutely massive impact. But I'm asking you to answer in terms of something bigger than that because you went to something again where there's inc there's an incredibly clear specific causal mechanism. And the the reason I'm fairly comfortable with deworming is the

42:45 medicine works, right? You know what you're finding there. There are a lot of other kinds of interventions, democracy promotion, right? Um that we don't really know if they work, but if they work, they're transformative. What do you think about where you think we can't measure it, but you know, maybe there's a case for it? Uh not in the way that you know you're just trying to figure out the the magnitude of the impact of deworming. So where you can't figure out the magnitude of the impact and you know you can't. So uh a couple years ago we made a grant to support our world in data. They're a website that provides amazing information on problems facing the world. Uh as as someone who about 20 years ago tried to find good data on problems in global health and development, uh I wish that a site like our world in data had existed then because I know how hard it is to download multiple spreadsheets and match

43:41 them up. And so we made this we I talked to, their, their, head, Max Max, Roser, and, he was telling me that they were facing uh you know a challenge in raising operational funding. I have so so we made we made a grant to them out of our all grants fund. We can't measure what effect that had but you know that's a site that I think in aggreate has so much impact. Um another another example is a grant that we made this past year in response to the US aid cuts. So we supported uh essentially consulting units in at at two organizations, one called CHI and one called PATH that would work closely with governments to plan their response to the aid cuts to uh understand where they had gaps that needed to be filled.

44:26 Um even to articulate the funding needs that that they had so they could potentially raise money from other donors. But that sort of uh support to government decision-m is something that clearly could be incredibly impactful on uh helping people in in those countries. But we won't be able we don't have a a quantitative estimate of what's accomplished because of that.

44:52 You, all, don't, just, subject, charities, to the binary question of does it work or does it not work. You have a certain measure of cost effectiveness. it has to clear. So working is not enough. It has to to be cost effective compared to other interventions. Tell me about your measure of cost effectiveness.

45:13 Yeah,, I'm, I I, think, I'll, just, use, the cost per death averted as a simplified way of putting this. I mean we we do try to look at the effects that come from improved health uh increased income uh to some extent increased well-being and and put it all into one measure that that we can use to compare across programs. Uh we can talk about that. Of course, that is incredibly subjective. Uh but nevertheless, as we're trying to look across programs, we have it. But what we aim to do to to go back to the simplified version is say if you could use $60,000 and avert the deaths of 10 children, that's a much better decision than using that same amount of money to avert the death of only one child. It's it's better to use the resources you have to help people to a greater extent.

45:57 How do you weigh things against each other that are not the same thing? And and I mean this on two levels. So one there's a question of lives saved versus income versus what's the value of, you know, not suffering from an illness that doesn't kill you. What's the value of an education? And then there's also the way in which different people just weight different moral questions differently. I I know you all have put a ton of work into this. So, so how do you try to do that? How do you both try to standardize the the first set of questions and then how do you try to create space for the different ways you know different donors might think about what is important?

46:40 Yeah., So, the, starting, point, for, us, is that you know in many cases donors come to us and they essentially say we want you give well to decide where and how to allocate our funds. And so because of that we're responsible for making these decisions about how to weigh up different kinds of good against each other. You know to do that we're we're trying as as we often do to collect the information we can and then just make the best judgments that we're able to with that information. And so for us, we do a variety of uh looking at academic research. So for example, in trying to weigh things like income against health there's academic studies that look at the value of a statistical life and and we're trying to use that data to the extent we can. Uh we also try to survey our donor community and understand the preferences that they have collectively.

47:30 And we've also tried and and have funded some studies in Africa where we just ask people how they would make these same choices and trade-offs. Uh all of this is very challenging. I would not claim that it is in any way getting us closer to truth, but it's it's the mechanism that we use to try to make these decisions. And then I think importantly we're certainly not I'm certainly not trying to say that our answer is correct. Instead, you know, we give Well, Phil is an important part of in the donation ecosystem where, you know we're trying to be almost like the economist's approach to giving overseas and we're just trying to do that as well as we can. And of course, there are many other ways and many other approaches that people could take.

48:12 You, know,, very, controversially,, a, few years ago, give directly, which is a program where, you know, you give them money and they give the money to other people and the idea is that people know best how to spend the money in their own lives. you stopped recommending them. Um, that's a group I still support. I I'm a believer in their work. And that was very controversial because your argument was not that it's not doing what it says it's doing or even that it's not good for people to get money. So, so what is the the line for you? And how, do, you, think, about, some, of the things that that that fall beneath it because they are not primarily it seems to me often about saving lives but about, you know, changing incomes or changing health or or improving lives.

48:48 Yeah., And, I, should, say, I'm, also, a, huge fan of Give Directly. I'm still personally a donor to give directly. Um I think the work that they do is is amazing and wonderful. The reason that Give Well doesn't recommend funds to give directly now is that roughly speaking, we think the organizations we're supporting are able to do three times as much good per dollar as give directly does as a dollar to give directly right now. And so because of that, we feel like we're faced with the question um you know with limited resources, where should we give?

49:18 especially now when resources are lower than they've been in many years uh because of cuts in US foreign assistance. We just think it's all the more important to just to try and allocate resources where they'll do the most. Uh and and that doesn't mean that the organizations we're not supporting aren't doing good work uh or in some ways they're failing. It just means with the limited resources we have, we'd like to see them go as far as they can. Something we've circled a bit here is that Give Well has an unusual relationship to transparency to being pretty open about mistakes. If you go to the Give Well website, you can click on a tab that says mistakes and read a ton about things you've gotten wrong and what has happened and places where you've aired.

50:02 In almost everything you do, there's a section on doubts and uncertainties. Tell me a bit about that approach. And maybe the best way to do it is for me to ask you just what have been your biggest mistakes. We've made a lot of mistakes over the years uh both in terms of specific organizations we've recommended with method methodological approaches. You know for a long time just one example we were relying primarily on one data source to estimate mortality from diseases and countries. And when we more recently went and collected more data sources, we saw how different they could be and the effect that those different sources of data about the causes of mortality could have on our ultimate recommendations. And so that's just a I don't know, pretty, significant, mistake that we corrected in the last few years.

50:50 To me, I I think transparency is so important because charitable giving isn't like solving a math problem where you can just say, you know, I I know the right answer. Uh I've proven it. therefore you should listen to me. Instead, there are huge amounts of judgment and values that go into the decisions that we're making. And so first, we think it's important for the people using our work to be in a position to understand it and judge it for themselves to know that uh others have evaluated our work and looked at it critically. I also think it plays an important role in in holding us accountable internally because every single decision that we make about how to spend money is is ultimately subjected to or can be subjected to public scrutiny.

51:32 So,, you, know,, Trump, took, office, not, even a year ago. It's been a been a long year. Very soon after uh his administration decapitated US ID, cut foreign aid in a number of other domains and directions. almost a year later, how much less foreign aid is United States as a government giving and how has the composition of what we're giving changed? So, there's still a lot that we don't know. Uh, you know, the US government previously was giving about 12 billion a year to global health programs and we think there might end up being about a 50% cut in total US government giving.

52:13 So that would be a whole of $6 billion going to global health programs. This is a large portion of aid going to health around the world because it's a US government was accounting for about 20% of total global health aid. And so you know $6 billion or 10% of what was going to support these programs uh maybe disappearing. We've seen plenty of great programs that that needed money that weren't getting them. So these are programs that provide basic health services, malnutrition treatment, and malaria control where, you know, we were in a position to step in and we directed about $40 million in response to the cuts this year. Um, just as another example, when I was in Malawi this past summer, we talked to clinicians and hospital administrators about their experience responding to aid cuts. And for them, some of the biggest cuts that they felt immediately were in HIV because the US government has such a

53:07 large HIV program. And so there one hospital administrator told me the story that you know the day of the cuts it was 9:00 a.m. they had all come to work there were patients lining up outside to get their AIDS treatment that they had come for they were called into a staff meeting the facility staff and just told to go home immediately. And so you had these patients lining up and no staff to give them their medicine. Many people travel from miles and miles away because they'd rather pick up their HIV treatment further from home because of the stigma of having HIV. They don't want to be seen close to home getting their drugs. And so then the hospital had to bring in some of their limited staff from other departments and get them in place to try and deliver the the age treatment. I mean people the way he told me the story is they they were they were like looking at the pill boxes that a patient brought in and trying to match

53:56 them to what was on the shelf just to keep delivering the what they had. Um similarly I visited a small clinic in a in a more rural area and uh an important part of HIV treatment is viral load testing. So this is testing people to ensure that the the treatment that they're undertaking is preventing them from progressing to full-blown disease. And viral load testing, you know, really stopped in early 2025. I was able to see this because we just pulled up the data on their computer screen and we could see how they went from uh testing hundreds of people in a month to almost none in you know following the cuts.

54:32 Are, there, significant, areas, where money's been restored? We've, seen, a, lot, of, money, come, through in malaria. So one of the um you know one of the one of the programs we supported earlier this year was planning for these seasonal anti-mal malarial medication campaigns. Basically in certain parts of the world malaria has a high season and if we can provide children with antimmalarial medication during the high season we reduce about 80% of the cases during that time of year and those campaigns I I believe were happening starting in June and the planning had to happen in March, April and May. And so this was right after the cuts and organizations didn't know if they were going to have money to conduct planning and so you know we went to them and said uh if the money doesn't come through you know we'll cover it and if it does then you know we won't have to but you can go ahead knowing that you'll

55:21 have funding to cover what you need and ultimately many of those programs the funding came back and we didn't have to spend a dollar to enable them to move ahead. when you've looked at what has happened and I'm not trying to get to be political. Has have you seen a theory of foreign aid or simply a hostility to foreign aid? We haven't seen a lot of interest in trying to answer the question, what would great foreign aid look like? You know, I think that uh you know, if you go back to January 15th, there are plenty of people on both sides of the aisle saying USAD should be a lot better. there are a lot of ways that we can improve foreign aid. And I think there were some people that I remember talking to before uh the the the cuts occurred where they were excited about the possibility of a focus on efficiency in delivering outstanding cost-effective foreign aid. And I just don't think that's what we've seen.

56:18 If, somebody, did, come, to, you, and, and said, "Listen, we want we're going to restore USAD funding, but we want it to be better. We want our money to go as far as it possibly can. What does that theory of reform look like to you?

56:32 I, think, two, big, pillars, would, be, first focusing on the public health programs that we know how to deliver at scale that we can deliver cost effectively at scale that have significant impact. And so these are similar to the programs we've been discussing HIV treatment and prevention, malaria treatment and prevention and more. And then I also think there's a big place for just delivering cash directly to people who need it. You know, I think at at at Give Wells Margin, I think that we're spending funds more cost- effectively but at large scale, I think cash is one of the most uh cost-effective ways to just let people make their own decisions about how to improve their lives.

57:13 And, how, about, data?, One, thing, that, I've heard a lot of people worry about and seems to me like a particular problem for Gival given how data oriented you try to be is that these cuts ravaged a lot of the surveys and data collection and studies that create the possibilities of this evidence and these feedback loops and being able to know next year what would be better than what we did this year. What what has happened in that space? What seems to be being done about it? One of the most important tools that we and others rely on is something called the demographic and health surveys or or DHS that USAD has funded for years. And these are large nationally representative surveys that inform people in positions like us allocating money to low-income countries, but also country governments themselves. You know, when they're trying to answer the question, how many students are going to be in each district? So therefore, how

58:07 many schools and teachers do we need? They're often relying on this kind of data. And you know this is one of the data sets that is you know has gone away under this uh under the cuts that we observed. Uh you know these surveys are are so critical that in one way or another I believe that some some form of them will be preserved. It's something that I know other funders have looked at. We ourselves are considering um but it's just so critical that this this data continues to exist. But it's undoubtedly been a big part of the challenge in understanding what has happened. You know, a question that you asked that I get a lot is well, you know, what what have the effects of the cuts been and where has money gone and not gone and where is it flowing and not and what has been the humanitarian impact and I think the true answer is we don't know and you know some of that not knowing is a function of the data that

58:57 we rely on is less available than it was before and that makes the situation even more challenging. You talked a bit about how you've sort of directed 40ome million dollars around trying to fill some of these holes. What has happened in the rest of the philanthropic space? I mean, you have huge foundations much bigger than than give well like the Gates Foundation. You have other countries, European countries. What has the landscape of players who could have possibly filled holes, you know, how has the the I calling it an industry but the sector responded?

59:30 Yeah., So, I, we've, seen, you, know, similar action from philanthropies you know trying to give uh what are large amounts of money in in level terms but certainly small relative to what governments were giving allocate more in response. I I think the big challenge that everyone recognizes is philanthropy is just very small compared to the level of giving that the US government was providing. And then at the same time many countries around the world are also giving less. And so in aggregate uh it seems like we are entering a period where uh global foreign assistance especially for health will be lower than it has been in the recent past. And so what um you know what what I what I hope that means is that individual donors will step up and give more. Uh I also hope and we've seen some evidence of this that it means there'll be a higher priority focused on using the limited resources we have as

1:00:26 well as we possibly can. I think that um for a long time we felt like ideas of cost effectiveness were were not taken perhaps as seriously as you might expect in the world of global health and development. But I think with more limited resources, there's much more of a focus on on taking what we have and trying to cause it to go as far as we can. Uh and so that might mean, you know, allocating more funds towards Nigeria and the Democratic Republic of Congo for malaria because they account for 40% of the global malaria burden and I think we've seen a lot more interest and uh you know behind those kinds of ideas.

1:01:04 So, then, has, this, pullback, in, public health funding has it changed looking forward what you think will be the most effective opportunities for giving?

1:01:13 It, it, certainly, might, and, and, here's why. You know what we're trying to do is deliver funds where they'll be most cost effective at the present margin. And really what these cuts mean is that the the margin has shifted. So one area that we never really looked at before was HIV. HIV was extremely well funded. Uh another area that uh we we made a grant to support an organization called AL Lima and this grant was uh primarily focused on just enabling them to deliver primary health care services and malnutrition treatment in a very challenging area of Cameroon. And that's another kind of work that had been previously more supported by government donors. And so as as we look forward, we know that, you know, the the changing level of funding just means that there going to be all sorts of programs that we didn't consider before that we're going to have to look at because this underlying situation has changed.

1:02:05 Is, lobbying, on, foreign, aid,, particularly paying Trump associated lobbyists, maybe an effective use of charitable funding? No,

1:02:14 no,, we've, we've, worked, with, uh, you, know, an organization that's just trying to inform people on the hill about the the facts of what can be achieved. And I you know I guess you know much more than I do about what would be effective lobbying. But you know I hope that uh what I think we can bring to the table is just providing accurate information about what can be accomplished and hoping that decision makers will will take that on board when they decide what to do. So I see one of the challenges for for give well for this kind of giving as being that giving often relies on an emotional hook for people. There's you know charismatic megapana in the philanth in the philanthropic space and and then there's this more you know conversation about cost effectiveness and deworming and what are the spillover benefits of deworming.

1:03:06 I can watch you trying to be objective about what you're funding and and and watch the requirement that that imposes on you to be serious about trade-offs in ways that are probably emotionally kind of, hard., And, on, the other, hand,, giving is an emotional project that people give. They give emotionally. You know, we could talk about uh randomized control trials all day and all night, but most people don't get out of bed because they read an RCT. So, so how do you reconnect those impulses running an organization that is so much about trying to correct for the biases our emotional drives might create for us?

1:03:47 Yeah. I mean, first off, I I think sometimes this argument can go too far. You know, we all know that that most people are giving uh based on a personal attachment. And when we were thinking about starting Give Well, I just remember everyone told us donors don't give this way. This is never going to work. What are you even trying? And now more than, you know, 18 years later, we have 100,000 plus donors who've used our research. We've directed more than $2 billion. So there's certainly a lot of donors and a lot of people who are excited to give this way. And then when I think about, you know, how this all works, you know, I'd say that the the motivation to do this work, it it comes from the emotional place. And and you know, for me, sometimes that's people that I meet when I've traveled to to Africa. Um, you know, an experience I always have is I go to the pharmacy and I pick up a moxicillin for my cat and it

1:04:40 has an ear infection and it cost me 50 cents. It it literally takes me 5 minutes. And I always think it's so wild that I can just go to the store and pick up this amoxicylin like it's nothing. And I remember that there was time when Give well supported an organization to deliver amoxicylin to Tanzania because they were running low on amoxicylin stock, and, they, weren't, going to, have, a moxicylin in all the clinics around the world. And so it's sure you know we spent all our time talking about the data because it's the data that helps us make the right decisions. But for me and and I think for for everyone that I work with, it's it's just this knowledge that uh you know we're we're in such a fortunate position and there are so many people who aren't in that position and yeah sometimes we have to key on individuals to focus our work but ultimately what we want to do is just bring those benefits to as many people

1:05:36 as we can. And, then, always, our, final, question,, what are three books you'd recommend to the audience? uh one is factfulness by the late Hans Rosling. Uh this is a book that just brings global health data to to to the world. It's say the core argument of the book is something like in order to prioritize correctly we need to understand the world accurately. And then for me uh Hans Rosling's site gap minder was one of the things that got me very excited about this work back in 2006. Uh second book poor economics by Esther Duffel and Abig Banerjee. They're two of the founding members of this randomized control trial movement in development economics. And this book gives an overview of of their work and the ideas behind this work. And this work that's no not just them but people like Michael Kramer, Rachel Glennister Dean Carlin, Ted Miguel. It really was just part of the animating values of of

1:06:27 what has led to give well in our work. And then finally a book called Behind the Beautiful Forevers by Katherine Buu. uh she spent years in uh in Anawadi. It's an informal urban settlement sometimes known as a slum near the Mumbai airport and it just paints a very vivid picture of what life is like in poverty. I

1:06:47 think, Behind, the, Beautiful, Forevers might be it's definitely in my top five pieces of non-fiction ever. If people have not read that, they really should. Ellie Henfeld, thank you very much.

1:06:56 Thank, you. Hey, hey hey.

Questions about this episode

What is "The Simplest Way to Save Lives With Your Money | The Ezra Klein Show" about?

The discussion emphasizes the significance of effective charitable giving during the holiday season, highlighting the work of Give Well, an organization known for its rigorous evaluation of charities. The conversation with Give Well's CEO, Ellie Hassenfeld, explores the importance of transparency in philanthropy, offering insights on how individuals can maximize the impact of their donations to…

What is mentioned in this The Ezra Klein Show episode?

85 people, works and ideas are mentioned, including Randomized controlled trial (RCT), GiveDirectly, public health, Amoxicillin, Charity Navigator, Malawi. Each one on this page links to its own page with every episode that mentions it.

How long is "The Simplest Way to Save Lives With Your Money | The Ezra Klein Show"?

The episode runs 1 h 7 min; the transcript is about 12,600 words in 103 timestamped sections.

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