Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Speculation on Current Opportunities for Unusually High Impact in Global Health, published by johnswentworth on November 11, 2022 on LessWrong.
Epistemic Status: armchair speculation from a non-expert.
Short version: I expect things to get pretty bad in the Sahel region over the next year in particular. The area is an obvious target for global health interventions even in good times, and impact is presumably higher in bad times. A simple baseline intervention: fill a backpack with antibiotics, fly to the region, and travel around distributing the antibiotics.
What’s The “Sahel” Region?
The Sahel is a semi-arid region along the southern edge of the Sahara desert. Think roughly Mali, Niger, Chad and Sudan.
Bad How?
Based on statistics on the Sahel, it’s one of the few remaining regions on Earth where the population is near Malthusian equilibrium. Fertility is high, contraception is rare; about half the population is under age 16. Infant mortality is around 6-8%, and ~a quarter of children are underweight. (Source: CIA World Factbook entries on Mali, Niger, Chad and Sudan.)
Being near Malthusian equilibrium means that, when there’s an economic downturn, a substantial chunk of the population dies.
Die How?
Traditional wisdom says: war, famine, disease. In this case, I’d expect famine to be the main instigator. Empty bellies then induce both violence and weak immune systems. On priors, I’d expect infectious disease to be the main proximate killer.
The Next Year In Particular?
The global economy has been looking rough, between the war in Ukraine shocking oil and food markets, and continuing post-Covid stagflation. Based on pulling a number out of my ass without looking at any statistics, I’d guess deaths from violence, starvation, and disease in the Sahel region will each be up an order of magnitude this year/next year compared to a good year (e.g. the first-quartile best year in the past decade).
That said, the intervention we’ll talk about is probably decently impactful even in a good year.
So What’s To Be Done?
Just off the top of my head, one obvious baseline plan is:
Fill a hiking backpack with antibiotics (buy them somewhere cheap!)
Fly to N'Djamena or take a ferry to Timbuktu
Obtain a motorbike or boat
Travel around giving away antibiotics until you run out
Repeat
Note that you could, of course, substitute something else for "antibiotics" - maybe vitamins or antifungals or water purification tablets or iron supplements or some mix of those is higher marginal value.
There are some possibly-nonobvious considerations here. First, we can safely assume that governments in the area are thoroughly corrupt at every level, and presumably the same goes for non-government bureaucracies; trying to route through a local bureaucratic machine is a recipe for failure. Thus, the importance of being physically present and physically distributing things oneself. On the other hand, physical safety is an issue, even more so if local food insecurity induces local violence or civil war. (That said, lots of Westerners these days act like they’ll be immediately assaulted the moment they step into a “bad neighborhood” at night. Remember, folks, the vast majority of the locals are friendly the vast majority of the time, especially if you’re going around obviously helping people. You don’t need to be completely terrified of foreign territory. But, like, don’t be completely naive about it either.)
Also, it is important to explain what antibiotics are for and how to use them, and there will probably be language barriers. Literacy in these regions tends to be below 50%, and presumably the rural regions which most need the antibiotics also have the lowest literacy rates.
How Much Impact?
I’m not going to go all the way to estimating QALYs/$ here, but. according to this source, the antibiotic impor...