In part 3 of The Life You Can Save, Singer tries to answer the question whether we each really can save a life (or several) by donating more to overseas aid. Specifically, how much does it take to save a life, and is aid actually effective in improving the lives of the world’s poorest people?

Chapter 6 looks at the cost of saving a life and how you can tell which charities do it best. Singer spends much of this chapter telling the story of GiveWell, a nonprofit group dedicated to determining the effectiveness of charities. As Singer points out, groups like Charity Navigator look at charities’ program costs vs. their administrative costs, but this is not necessarily a good proxy for the impact charities have on the lives of those they’re trying to help.

GiveWell, by contrast, actually tries to measure this impact, which–not surprisingly–turns out to be pretty difficult. The organization gives grants to charities based in part on its assessment of their effectiveness. The founders, two former hedge fund employees named Holden Karnofsky and Elie Hassenfeld, found that the information provided by most charities on the effectiveness of their programs was nowhere near the level of the information they would’ve expected to be provided with for a prospective investment.

Karnofsky and Hassenfeld undertook a study of organizations working to save lives and improve health in Africa, and, of the fifty-nine organizations who applied for GiveWell grants, only fifteen provided what they considered adequate information. Of these, they gave their top rating to Population Services International, a DC-based group that “sells condoms, bed nets, water purification treatment, and treatment for malaria and diarrhea, and educates people on their uses” (p. 88), all at nominal prices. Other highly-rated organizations were Partners in Health, a group that started in Haiti to provide health care to poor people, and Interplast, which provides surgeries to correct cleft palates, among other things. GiveWell also looked at poverty-relief programs and high marks (and a $25,000 grant) to Opportunity International, a microfinance organization that gives very small loans at low interest to poor people.

The point here is that proving effectiveness is a pretty tricky thing to do. Virtually all aid organizations can offer descriptions of the kinds of activities they undertake, but not their effectiveness or efficiency. Singer discusses some attempts to quantify the effectiveness of aid programs, but he also recognizes that not all benefits can be so easily quantified. For instance, Oxfam ran a program that helped organize a group of Indian “ragpickers” (“women who make their living by sifting through the town garbage dump to collect not just rags but anything else that can be recycled” (p. 94)), enabling them to demand higher prices, avoid harassment, and receive entry to apartment buildings to collect residents’ recyclables. This resulted in not just more money for these women, but a greater sense of dignity, something that’s pretty hard to reflect in numbers. Singer also discusses another Oxfam effort, one to improve the legal rights of women in Mozambique, as providing hard-to-quantify but still undeniable benefits.

The chapter ends with a list of forms of aid that, in Singer’s words, “we can reasonably judge to be highly cost-effective, even without formal studies” (p. 97). These include

–providing well-drilling equipment to villages in Ethiopia, relieving women from having to walk miles each day just to get clean drinking water

–providing arsenic filters to families in Nepal

–providing cooking stoves that shorten cooking time, allowing girls time for school

–helping residents in a slum of Kathmandu build indoor toilets

–helping villagers in remote mountain areas of Nepal to build a school

–providing inexpensive surgeries to correct cataracts

–providing surgeries to help women with fistulas (a hole between a woman’s vagina and either the bladder or rectum that is sometimes produced by the pressure of a baby’s head during labor)

Singer writes:

It’s difficult to calculate how much it costs to save or transform the life of someone who is extremely poor. We need to put more resources into evaluating the effectiveness of varoius programs. Nevertheless, we have seen that much of the work done by charities is highly cost-effective, and we can reasonably believe that the cost of saving a life through one of these charities is somewhere between $200 and $2,000. (p. 103)

He notes that, by contrast, the median cost of saving a life in the U.S. is around $2.2 million, and the EPA estimated the value of a generic American life at $7.22 million. Given the money we spend on saving lives here, and the money we spend on what can, by any reasonable accounting, be considered luxuries, nearly all of us could make a huge difference to the life of someone very poor by giving away more of what we have.

This doesn’t mean that aid as it exists doesn’t need to be improved, which is the subject of chapter 7.