High Emotions, Low Returns: The Paradox of Healthcare Giving

The cold, hard truth of healthcare philanthropy is that some causes are just plain better than others. We’re not talking about some organizations being better than others—more efficient, lower overhead, etc.—we’re just talking about the causes themselves.

The infographic below, published in Vox magazine, has been getting a lot of traction, especially right now, in the midst of a chilly hurricane of dumped ice buckets. It shows there's a dismally low correlation between the health problems that kill the most people and those that attract the most money.

Despite its devastation, for example, ALS kills less than 7,000 Americans each year. By contrast, chronic obstructive pulmonary disease kills almost 150,000 people. So why aren’t we all lining up to give to the American Lung Association?

Good question. Of course, the decision about whether to donate for health and medicine, and how much to give, can be an intensely personal one. We write about this all the time here at Inside Philanthropy.

Recently, for example, we looked at an oil billionaire who has diabetes and is therefore focusing his giving on diabetes; a finance billionaire whose son has a rare genetic disorder, and is giving to fight that disorder; a blind heir who is spending his family fortune to prevent blindness; and how Google cofounder Sergey Brin, who's at risk for Parkinson's, is bankrolling research in this area. The examples go on and on. 

This tendency to give in very personal ways is equally pronounced among more ordinary folks. Many people give to charities in order to honor a loved one’s memory. Families ask for “in lieu of flowers” donations to specific medical causes at funerals, which you can see is a compelling ask: Hey, let's try to stop another person from dying in this same way

But the question of where to give gets squidgy when we start talking about bigger numbers, and philanthropists who should be thinking strategically about where to do the most good with the money they have available.

The most good. That's not so complicated a concept, actually, when it comes to donating healthcare dollars.

William MacAskill, founder of 80,000 Hours, points out that giving to developing-world health causes is often the shortest route to the biggest bang for your charity buck. The reason? Well, developing world health problems are often easier to solve. They’re problems of hygiene, for example, or infrastructure, so doing something simple like providing fresh drinking water, rubber gloves, and bed nets to prevent malaria can do a whole lot of good. One donation could save a life.

Even here, though, we often see money spent in less than efficient ways. For example, as we wrote recently, smoking is one of the top causes of premature death in developing countries and much can be done easily to reduce tobacco use. But this is anything but a sexy cause among global donors these days.

The smallest bang for the healthcare buck is money spent in rich countries to tackle problems like neurological disorders, as well as cancer. The U.S. has licked all its hygiene-and-infrastructure problems, for the most part, and so a lot of charities these days focus on brain stuff, and cancer. These could legitimately be called the First World problems of the charity world.

Of course, mulling over which cause is most worthy is a lot like considering which lives are most worth saving, and that’s a thought process a lot of charitable folks just aren’t going to participate in. Which may not be a bad thing. Ultimately, ALS and brain cancer need solutions, too, just like malaria and Ebola do.