While their year-in-review may seem less controversial than an expansive critique of a partnering organization, I am going to set myself up for my own smack down (assuming they even read this blog) and say that focusing on how to save the most lives is a misguided view of charity. Instead of trying to save lives, charities should tackle and confront the major underlying cause of the world's problems: Injustice.
I am not an expert on the philosophy of injustice, so I will let Dr. David Hilfiker make my argument for me in his essay "Justice and the Limits of Charity." In summary:
[T]he fundamental problem for the poor in our country is not homelessness or AIDS or hunger or the like—or even any combination of these. They are just symptoms; the problem is injustice. In promoting our institutions, it is natural to emphasize the importance of our own project. But this can lead to subtle impressions that if we just distribute enough food, or create enough bed space, or find enough homes—that is, if we just treat the symptoms—we will have solved “the problem.”The essay is a little outdated and focused on the importance of advocacy, but the takeaway is powerful: Donating to charities based on their capacity to save lives uses a fundamental approach of treating the symptoms of problems and not the problem of injustice itself. This approach is ultimately unsustainable and therefore detrimental in the long run. The plight of the African slum dweller, or the Southeast Asian farmer, or the inner-city American youth isn't that they don't have health care or that they don't have enough to eat, but that they are not entitled to receive those services. Offering those services in the short-run is necessary and essential, but it does not confront the reality of injustice and work toward a more just world.
Six out of the ten top-rated charities on GiveWell are health-related. I do not think health organizations are doing detrimental work, I think they are offering necessary services to those who need it. But providing necessary services to individuals (also know as saving or changing lives) should not be the end goal for charities, or for the individual who invests in those charities.
Instead, charities should see themselves as a band-aid solution to fill in when governments and traditional institutions cannot (or refuse to) meet the needs of their communities. My friend who works at the DC Rape Crisis Center told me her organization wants "to put themselves out of business." This should be the end goal for all charities: Creating enough transformative change in society to rid the world of the need for them.
It should be noted that many health organizations are working to change the overarching structures in society. Village Reach, GiveWell's top charity, works to improve the health structures in rural Africa. The second highest-rated, Stop TB Partnership, aims to, well, stop tuberculosis. But choosing (and evaluating) based on the capacity to save lives ignores the fact that even with every individual life saved, the need for those charities still remains.
So what to do? You can do what I did and invest in charities that work on economic empowerment, which I think can create systemic transformative change from the bottom up. But if everyone did that, charities would fold and lives would be lost. (I made my decision with the safe assumption that most people don't act based on what I do.) It's tricky. But what's important is to remember, whether you evaluate charities, you work in a non-profit, or if you are a social investor, you should always be in the business of putting yourself out of business.
(Additional thanks to my other friend, Nora, who sent me the Hilfiker essay.)