If you want to help human beings alive right now, there are few better places to give than global health.

Diseases that have been largely eradicated in the US still claim hundreds of thousands of lives abroad. In 2022, the most recent year for which there’s data, ten Americans died of malaria; all acquired it abroad. But the World Health Organization estimates that worldwide, 600,000 people died of it that year, most of them children in Africa.

For a long time, the world was slowly pushing those numbers down. That progress is now at real risk.

In 2025, the Trump administration effectively dismantled USAID, canceling or gutting thousands of health programs and shifting a skeleton of its staff into the State Department. Other governments around the world have pulled back their funding, too. A conservative real-time tracker attributes roughly 600,000 deaths so far to the collapse of USAID, with modelling suggesting that if cuts on this scale continues, they could lead to more than 14 million additional deaths by 2030 from diseases like malaria, tuberculosis, diarrhea, and respiratory infections.

The weird, hopeful part is that global health interventions are fairly cheap. that’s how the US and other rich countries succeeded in stamping out these diseases. That is an opportunity for people seeking to give and make others’ lives better: It means that saving a life in a relatively poor country is possible at relatively low cost.

GiveWell, our favorite evaluator of global health charities, estimates that the groups it recommends can save a life for $3,500 to $5,500. Put another way, giving $300 a month for a year could be enough to save someone’s life. There are gym memberships that cost more than that. And there’s never been a better time to make a difference as an individual donor to the health and well-being of people around the world.

So if you want to donate to improve global health, where should you start? There are too many good causes to list here, but hopefully, the ones below give you some ideas.

Fighting malaria

GiveWell, the charity evaluator, currently lists four groups on its “top charities” list. Two of them focus on malaria: Against Malaria Foundation and the Malaria Consortium.

The two groups take two different approaches to preventing malaria transmission, both of which are extremely cost-effective. Against Malaria focuses on funding and distributing insecticide-treated nets, which people in malarial regions (largely sub-Saharan Africa but also parts of South Asia) can sleep under and protect themselves from bites by malaria-carrying mosquitos.

The nets themselves are incredibly cheap. GiveWell estimates that Against Malaria can provide a net for 6 each. You may have heard in the news that bednets are sometimes used for other purposes, like fishing. That’s true. GiveWell estimates, based on past studies and their own research, that about 75 percent of nets distributed will be used as intended. And the intervention is still incredibly cost-effective. A meta-analysis looking at five randomized studies of bednets found that mortality from any cause fell by 17 percent among children targeted for bednet distribution (whether they used the nets or not); they were 45 percent less likely to get malaria. The effect on children actually using the nets is, of course, much greater.

The other program GiveWell recommends donating to is the Malaria Consortium’s Seasonal Malaria Chemoprevention initiative, which uses another approach to prevent malaria infections. “Chemoprevention” means giving antimalarial medications to at-risk people before they’re bitten by a mosquito, in hopes of preventing a malaria infection. The campaigns are seasonal because in many malarial regions, malaria-carrying mosquitos only thrive and transmit the disease in certain seasons, often during a summer rainy season where there’s more water for mosquitos to breed in.

Seasonal chemoprevention is a newer approach than bednets, but there’s very strong evidence that it’s effective at stopping malaria transmission. GiveWell cites a Cochrane Collaboration review of six randomized studies that found that malaria cases among young children fall by 73 percent due to seasonal chemoprevention campaigns. GiveWell itself extended that review to add two newer studies, and drop an older one that they thought less relevant, and got a similar number: 79 percent less malaria among young children. 

A year of chemoprevention costs very little per person, about $7 on average. Combining that low cost with that degree of effectiveness makes it a very inexpensive way to save someone’s life.

Giving kids vitamin A

It’s pretty easy to get enough vitamin A if you’re in a rich country and can easily access leafy greens like spinach or lettuce, or other vegetables like carrots. But in many poor countries, vitamin A deficiency is a serious problem, which in children can lead to stunting, blindness, or even death. 

Thankfully, there’s a simple way to fight vitamin A deficiency: Give people vitamin A. Helen Keller International, a charity founded in 1915 by Keller, the noted deaf-blind writer and activist, is one of the world’s leading groups supporting vitamin A supplementation campaigns, and one of GiveWell’s top recommended charities. It subsidizes governments in affected countries and provides technical support for mass campaigns to distribute vitamin A capsules (about $1 each to deliver) to households with children.

GiveWell recommends Helen Keller because vitamin A supplementation, in their view, significantly reduces child mortality, by about 4 to 12 percent. They base this, as with their malaria judgments, on a Cochrane meta-analysis, which, depending on assumptions used, concluded that vitamin A supplementation reduces mortality by between 12 and 24 percent. That said, the largest study included there produced a much smaller estimate (4 percent). GiveWell leans conservative, assuming that, over time, with better global nutrition, the impact is likely on the lower end of that spectrum.

But even a 4 percent drop in mortality for $1 is a stunningly good deal. What’s more, vitamin A supplementation has other benefits. 

It can prevent blindness and stunting, helping children grow up with healthy vision and to healthy heights and weights, which could translate into higher incomes and other benefits as an adult. Though the evidence here is less voluminous than on mortality, it’s important to remember that there’s more to global health than just preventing deaths. Vitamin A can prevent deaths, but it also makes the lives it saves easier and more fulfilling.

Backing vaccinations

A landmark 2024 study from the WHO suggested that in the past fifty years, vaccines have saved 154 million lives, the vast majority of children under 5. Yet vaccine-preventable illnesses like hepatitis A and B or streptococcus pneumoniae still kill millions every year. Expanding access to the vaccines we already have can be as important as developing new ones.

But reaching the so-called last mile of hard-to-reach populations not currently being vaccinated can be difficult. New Incentives, the fourth and final charity recommended by GiveWell, tries a simple method to reach them: offering money. It gives cash incentives of around $5-8 to parents and other adults in northern Nigeria as an incentive to get vaccinated against against measles, pneumococcal disease, tuberculosis, and the five diseases the pentavalent vaccine protects against (diphtheria, tetanus, pertussis, hepatitis B, and Hib).

A randomized trial of New Incentives’s programs released in 2020 found that overall, children targeted by the program were 22 percentage points more likely to be vaccinated: 36 percent of children in the control group were immunized, compared to 58 percent in the group receiving incentives. And the program has rapidly scaled. By 2023, New Incentives had enrolled over 1.5 million infants.

Even if you suspect the actual impact isn’t quite that significant, the program is extremely cost-effective; roughly 9 to 18 percentage points according to GiveWell’s estimates. And that cost-effectiveness has actually improved. Due to the devaluation of the Nigerian currency Naira in 2024 and 2025, a US dollar now funds significantly more incentives than before.

Supporting local NGOs

Empowering and funding local, community-based organizations — as opposed to large, global agencies such as the World Health Organization or the Red Cross — helps create a more nimble, sustainable, and culturally relevant aid environment. Local organizations not only have a better understanding of local needs, but they can respond faster to emergencies. 

But in late 2025, this has become more complicated. For years, agencies like USAID pledged to shift 25 percent of their funding to local partners. With the dissolution of USAID and the retreat of major Western donors this year, those pledges have evaporated. The agencies are gone, leaving local groups as the primary — and often only — safety net for their communities.

Here are some local NGOs working to address challenges from health care and gender-based violence to unemployment and social development: 

• Taimaka is a Nigerian nonprofit in the Gombe State that treats children with severe malnutrition through community health workers, shifting care from crowded hospitals. They use a simple app to diagnose and track kids in their villages, treating a child for roughly $94 — less than half what standard programs cost — and early estimates suggest that it saves lives at around the same cost as the best-known malaria charities. My colleague Sigal Samuel wrote more about their work here.
• For 19 years, Rwanda Men’s Resource Centre has worked to teach healthy masculinity, promote gender equality, and reduce gender-based violence. For the past five years, gender-based violence has been steadily rising in the east African country. According to 2020 survey data, almost 40 percent of girls and women aged 15–49 years have experienced physical, sexual, or psychological violence. The NGO has a variety of training programs and community engagement events that teach couples and young people how to resolve conflict and cohabitate peacefully, improve communication and joint decision-making, and to leverage new tools to improve financial instability. 
• Afya Research Africa is a Kenyan NGO working toward universal health coverage by providing affordable primary care in rural communities. The organization funds door-to-door health services and supports brick-and-mortar health clinics and pharmacies. Afya also provides rare funding for its clinicians to conduct locally relevant research.

Aid to Sudan

Sudan continues to face the most devastating humanitarian crisis in the world. For more than a year, the country has been embroiled in a civil war that has displaced nearly 12 millions people, pushed entire communities into famine, and crippled the national banking, health care, and telecommunications systems. 

And yet, the conflict remains one of the most neglected in the world. As of November, the United Nations has received only about a third of the humanitarian funding it requested earlier this year — leaving a gap of nearly $2.8 billion.

Meanwhile, staff from international aid and human rights groups have repeatedly faced challenges accessing the most fragile parts of the country while other organizations have been forced to lay off local aid workers due to insecurity and budgetary constraints. These local and international NGOs are still working to fill critical gaps across Sudan and in neighboring countries hosting refugees from Sudan:

• Doctors Without Borders (MSF) provides health services to thousands of people across Sudan despite recurrent attacks against health care workers and health clinics. MSF doctors and nurses have treated tens of thousands of people facing malnutrition to avert famine-related deaths. The NGO is also working to quell a cholera outbreak and to ramp up care for malnutritioned children and expecting mothers who are dying from preventable infectious diseases. In many places, MSF clinics are the only functioning health care facilities still caring for people. 
• The Sudanese American Physicians Association (SAPA) is a lifeline for the country’s collapsing health system. This diaspora-led group uses its network to fund and supply hospitals that have been abandoned by the state. They provide salaries for local doctors who haven’t been paid in years and source critical supplies for surgeries and maternity care.
• Alight is a local group providing health care across five Sudanese states. Currently, the organization runs 42 primary health clinics, a field hospital, and four mobile health facilities. The NGO recently launched a program to feed mothers who give birth in severely resource-limited refugee camps. 

Surveillance to find the next pandemic

Most years, the deadliest infectious disease in the world is tuberculosis, a brutal bacterium that’s also frustratingly expensive to eradicate (which is why none of GiveWell’s top charities target it). But in 2020, 2021, and 2022, there was a new deadliest-disease, and you can probably guess its name: Covid-19.

All told, the Sars-Cov-2 virus has killed over 7 million people, with estimates of “excess deaths” (including deaths due to disruptions to the economy and health care access, and ones due to Covid but not reported as such) reaching into 20 to 30 million. The world spent untold trillions to fight the pandemic. It would have been much more humane, and cheaper, to have prevented it in the first place.

Ultimately, pandemic monitoring and prevention is the job of governments rather than charities, but there are nonetheless some valuable groups working to prevent a repeat of the Covid experience. One is the Nucleic Acid Observatory, a project developing ways to surveil wastewater and other sources and notice when novel pathogens start showing up. The technologies they’re helping to build could help us catch things like Covid weeks or months earlier, and give us time to squash them before they become full-fledged pandemics.

Ending lead poisoning

Lead poisoning has, historically, been a major blind spot in the global health world. The extent of the problem is enormous: A landmark study found that about half of children in poor countries are exposed to very high levels of lead. At least 1.5 million people die annually from cardiovascular diseases (like heart disease) caused by lead poisoning, imposing a global economic cost of about $6 trillion a year.

But the resources devoted to preventing lead poisoning were minimal. One estimate in 2021 found that charities and nongovernmental organizations were spending between  $6 and 10 million a year on the problem. That’s less than two cents per child poisoned by lead.

While there are several worthwhile charities working on this issue, I (Dylan) recommend in particular Pure Earth, which has been a leader on lead and metal contamination for decades; the Lead Exposure Elimination Project, which has been influential in fighting lead paint specifically in developing countries; and the Center for Global Development, which has become the center of lead policy in the global health world and helped make the issue a bigger priority in recent years.

Combatting superbugs

Researchers estimated that more than 1 million people died globally from antibiotic-resistant infections in 2019. Despite the emerging crisis, antibiotic research and development has long stalled. No large US or European pharmaceutical company is working to develop new antibiotics. 

Fortunately, a small but growing group of researchers and clinicians has been working to revive a decades-old treatment for drug-resistant infections: bacteriophages, viruses that target and kill bacteria. Phage therapy is starting to make inroads in the US and Europe, though clinicians still have to request emergency use authorization from the Food and Drug Administration, or equivalent agencies, before the treatment can be used. Today, there are some 80 clinical trials for phage therapy in the US alone. 

But while phage therapy is gaining ground in developed countries, many developing countries in Africa and Asia are falling behind, even though the burden of drug-resistant infections is highest in these countries. A lack of regulatory agencies to review and approve the treatment is one major barrier. Another is an absence of local manufacturing infrastructure, which has hindered local drug development in developing countries for years. 

Researchers consistently demonstrate that phage therapy is safe and effective for treating drug-resistant infections, even those caused by bacteria that no known antibiotics can treat. What is needed now is for the phage therapy technology and expertise to be transferred to developing countries. 

That is the mission of Phages for Global Health, an NGO run by Tobi Nagel and an international team of physician researchers. The organization trains laboratory technologists in Africa and Asia to study phages in their labs and partners with institutes to conduct research and develop new phage products that can be used, for instance, to prevent and quell cholera outbreaks and decontaminate poultry products to prevent foodborne illness.

The other day, economist Tyler Cowen made an offhand observation that took me aback a bit: that the French, today, enjoy “the longest financed retirements ever seen in the history of the world.”

Verifying the “history of the world” part is beyond my historical skill level. That said, the OECD’s Pensions at a Glance report from 2023 confirms that French retirees are enjoying a lot of years off the job.

French men, per the report, left the labor force at an average age of 60.7. At that point, they have a life expectancy of 84, meaning they can expect 23.3 years in retirement, longer than any of the other countries the OECD examined (mostly rich peer nations plus a few select others). French women can expect 26.1 years in retirement, which is beaten by Luxembourg, Spain, Slovenia, and the world leader, Saudi Arabia, but still very high. (The Saudi case is more about women working fewer and shorter stints than in more liberal polities, as opposed to retirement policy.)

French men and women alike can expect over five additional years in retirement compared to Americans.

Incidentally, the French government fell this week in part due to opposition parties demanding that the centrist coalition in power go back on its decision to raise the formal retirement age from 62 to 64. Funding 23 to 26 years of retirement per person is expensive, which is exactly why President Emmanuel Macron raised the age in the first place, but when the elderly voter bloc is only growing in size, failing to pay that money out can be politically suicidal.

Retirement, American-style

As a non-Frenchman, this fight inevitably makes me think about the coming retirement battle in the US. Our Social Security trust fund is due to be depleted in about eight years. Under current law, when that happens, retirees will see an across-the-board cut of about 23 percent in their benefit levels. Everything I know about how the US government works tells me it will not get to that point. The question, then, is what a deal to prevent those cuts would look like.

One obvious way to avoid the French predicament is to do what Macron did: raise the retirement age. There are two components to the aging problem hitting the US and other rich nations’ pension systems. One is that, because of the size of the baby boom population, more people are hitting retirement age than ever. The number of retired workers newly receiving Social Security hit 3.4 million in 2022, compared to under 2 million in 2000.

Raising the retirement age doesn’t solve this issue. But it does partially address the second issue, which is that the average time spent in retirement has risen as nutrition and medicine have improved. A man born in 1900 and turning 65 in 1965 could expect to live 12.9 more years. The Social Security Administration estimates that a man born in 1960 and turning 65 this year can expect 18.4 more years. Even accounting for the trend of people claiming Social Security later in life, that’s a good number of additional years that the program has to pay out per male retiree.

Between 2000 and 2022, the US gradually raised the retirement age for full Social Security benefits from 65 to 67. But most bipartisan proposals to reform Social Security (that is, proposals with any shot of passage) envision some kind of further age increase. Two years ago, Sens. Angus King (I-ME) and Bill Cassidy (R-LA) floated raising the normal retirement age to 70. The Bipartisan Policy Center brought together some ex-politicians and experts in both parties to put together a plan, which wound up advocating an age of 69.

One of the key political virtues of a retirement age increase is that it’s a benefit cut that doesn’t present itself quite as obviously as a benefit cut.

But it does amount to a cut, and potentially a large one. Right now, a 67-year-old woman can expect to live 18.5 more years. Suppose she has to wait until age 70 to claim the same amount of benefits she can now claim at 67. That eats up three of her 18.5 years of expected benefits, an over 16 percent cut. The cut for men, with our shorter lifespans, is even larger in percentage terms.

The most important question to ask about it, though, is whether it’s an across-the-board benefit cut, or in fact a regressive one. There are strong arguments that it is the latter.

Death inequality and Social Security

The eminent Social Security expert and economist Alice Munnell recently highlighted a chart from the program’s actuary’s office that underlined a pretty concerning gap and trend:

If you don’t speak Social Security jargon, this can be a little hard to parse. Essentially, it’s comparing two groups: men born in 1930 considering retirement in 1992 and men born in 1960 considering retirement in 2022. In both groups there is a large gap in life expectancy between the people who earned the least in their careers and those who earned the most. In 1992, the highest-earning men could expect to live 8.4 years longer than the lowest-earning men. In 2022, they could expect 10.3 more years. (“Highest-earning” here means the highest-earning fifth, This is not exactly Elon Musk money: in 2020, being in the top quintile as a man meant an average monthly income of at least $6,391, or $76,692 annually.)

Put differently: not only is there a big life expectancy gap between rich and poor people, but also the gap seems to be growing.

This puts retirement age discussions in a different light. Suppose we’re considering raising not the normal retirement age (now 67) but the early age (now 62), at which point retirees can claim reduced benefits. If we raise the age by three years, then men in the highest income bracket get a cut of 3 divided by 25.6, or about 11 percent. Men in the lowest income bracket get a cut of 3 divided by 15.3, or almost 20 percent. The specific numbers are different if you’re considering raising the normal retirement age, or looking at female workers, but the overall takeaway is the same: raising the age of retirement amounts to a bigger cut for poorer workers.

Recently, economists Henry Aaron at Brookings and Mark Warshawsky got into a heated dispute about how to make sense of these numbers. Warshawsky argues against using life expectancy numbers like those above on the grounds that they inevitably require one to make projections (we don’t know, of course, how long people who retired in 2022 will in fact live, chiefly because most of them haven’t died yet), and for restricting analysis to men aged 65-69. Aaron argues that this is too restrictive (everyone, including insurers, relies heavily on life expectancy projections as well) and neglects that women, for instance, have seen lifespan inequality increase.

To my non-expert eye, Aaron has the better of this specific dispute. But it’s worth emphasizing that the lifespan gap between rich and poor need not be increasing in order for hiking the retirement age to be regressive on net. If, in 30 years, rich men are still living 10 more years in retirement than poor men, an increase in the retirement age will still hit poor men harder than rich men, even if the gap itself hasn’t grown.

Splitting the difference 

The traditional Republican approach to Social Security has been to call for its shortfall to be closed entirely with benefit cuts; the traditional Democratic approach has been to rely entirely on tax hikes. Neither of these has any shot in hell of happening, especially if the Senate filibuster remains in place. 

I highly doubt that there are 50 Republicans in the Senate now willing to vote for major benefit cuts, and there certainly aren’t the 60 that would actually be needed. Similarly, I put the odds of Democrats ever electing 60 senators willing to pass a huge payroll tax hike, even just on top earners, at near zero.

If there’s going to be reform before the trust fund runs out in 2033, it’s going to have to be on a bipartisan basis and involve pretty huge concessions by each side. And I suspect some kind of a retirement age increase will be part of the deal.

If that happens, the best option out there is one that Wendell Primus, Tara Watson, and Jack Smalligan outline in their recent Brookings reform plan. They would raise the retirement age — but only for the top 40 percent of earners. Most retirees would not see the age rise at all, while the top fifth of earners would see it rise to 70. Those in the 60th to 80th percentiles would see smaller hikes. Along with other progressive benefit cuts and tax hikes, the plan would fix the program’s solvency issue.

This retirement age change would make the system somewhat more complicated, as people would have to look up what their specific retirement age is based on their income. But it’s the only plan I’ve seen that keeps the most popular kind of benefit cut from being painfully regressive.

It sometimes seems like the basic income wars will never go away. My first Vox piece on the idea of a government-provided guaranteed income came in the summer of 2014 — a simpler time, the Obama years. I wrote a big feature about it in 2017. Since then, we’ve had Andrew Yang’s presidential run, Covid-era stimulus checks, and massive progress in AI, all of which have made the idea feel more plausible.

We’ve also had some research findings that throw cold water on the concept, at least in the US. Three studies that gave out unrestricted cash to Americans during the pandemic found nulls on all the outcomes they tested: the cash didn’t improve health or self-reported well-being or even, in one study, how well people say they’re doing financially.

Two more recent, even bigger studies have backed that up. The Baby’s First Years Study, which began in 2018 and gave $4,000 a year to low-income American families with young kids for over four years, found no effects on child development outcomes at the four-year mark. No reduction in behavioral problems, no improvements in language ability — nada. Another study run by the group OpenResearch gave out $12,000 a year to families for three years. While it found some positive outcomes, like parents spending more on their kids, mostly it found null effects, too. Participants spent more because their incomes grew, but they also worked less, offsetting the income gain a bit.

But as I wrote back in 2017, “The biggest potential for basic income isn’t in the US but in developing countries.” A big new study from the charity GiveDirectly seems to back that up, finding that cash grants in Kenya not only reduced poverty but actually saved lives.

Even here, though, it’s important to be careful. Covering basic income experiments for more than a decade has taught me that readers love to hear about ways in which cash programs work and are less eager to hear about ways they fall short. That resulted in some big expectations that, in more recent US research, at least, have been dashed.

Some coverage of the GiveDirectly study has only focused on the good news (lives saved) and not limitations, like the fact that it didn’t save lives very cost-effectively. That’s a problem.

The new cash/infant mortality study, explained

The headline finding of the GiveDirectly study from economists Michael Walker, Nick Shankar, Edward Miguel, Dennis Egger, and Grady Killeen is that a randomized experiment providing one-time cash grants of worth about $1,871 each to over 10,500 households in rural Kenya found the cash reduced infant and child mortality. (The actual value was exactly $1,000, but given that prices are lower for most things in Kenya, it could buy what Americans think of as about $1,871 in goods and services.)

The intervention here is larger than most countries’ cash programs. Kenya’s main national cash program grants 2,000 shillings (about $45) a month to its most vulnerable citizens — a tiny fraction of the $1,871 drop this study examined. And the effect size from the $1,871 is truly massive as well: a 48 percent reduction in deaths, mostly shortly after the cash was dispersed in 2015-2017. 

A reduction that big from any intervention is eye-popping. From an intervention that isn’t even specifically meant to improve health or reduce deaths, it’s sufficiently impressive that you should be instinctively skeptical. Other, non-experimental studies have found reductions in mortality due to cash programs, but I’ve found only one other controlled experiment that found the same. It’s not a big evidence base.

What is the mechanism by which this might have happened? The study can’t say definitively, but it offers some clues. The cash drove a big increase in the share of mothers who delivered babies in hospitals as opposed to at home. If hospital-based delivery is safer than home delivery in these Kenyan villages, that could have caused some reduction in deaths. But it seems very unlikely to cause the entire reduction, especially given that other studies have not found that delivery in a hospital or other health facility reduces the odds of infant death.

But there are other ways the cash could have helped. Mothers bought more food, and a “food security” measure (reflecting how often children skipped meals or went to bed hungry) improved. That could plausibly drive greater survival. Among mothers who received cash,  hours worked fell by half in the three months before and three months after childbirth, implying that the transfer functioned as a kind of paid parental leave program (fathers’ work hours didn’t fall significantly). That could, perhaps, reduce maternal stress in ways that reduce infant mortality.

When I asked economists not involved in the study to comment, they generally said it was a well-designed, credible experiment. But no study is perfect. Berk Özler, formerly a top economist at the World Bank now at the University of Otago and Stanford, noted that overall childbirths were 13 percent more common in villages getting cash. That raises the possibility of a selection effect. Perhaps the cash didn’t cause babies who would’ve been born anyway to be healthier but instead induced women likelier to have healthy babies anyway to get pregnant and give birth. For their part, the study’s authors conducted a number of tests and argue that this is unlikely to explain much of the results.

Perhaps the most significant caveat about the study, however, is that, while the effect on infant mortality was large, the cost-effectiveness of the cash program as a lifesaving tool isn’t impressive. The cash program cost $25.75 million, and, per the study results, saved 86 children’s lives, for a cost per life saved of $299,418. That’s very good by rich country standards. For comparison, Medicaid takes $5.4 million to save a life. But it’s not competitive with the most cost-effective ways to save lives in countries like Kenya. GiveWell estimates that Vitamin A supplementation can save a life for about $3,500, while malaria prevention meds can do the same for about $4,500.

GiveWell helped fund the cash/infant mortality study, in part seeking to improve its estimates of the cost-effectiveness of cash grants. Its conclusion was that the finding doesn’t change its rankings of charities too much and that most of the benefit from cash transfers comes from reducing poverty (which the Kenya experiment certainly did) rather than saving lives.

Make your takeaways modest

One really bad takeaway you could have from this study is “cash grants are all you need to save lives in the Global South.” The study authors and GiveDirectly itself are clear that cash needs other health infrastructure to work. “People who were further away from health facilities, the improvement wasn’t as great,” Dr. Miriam Laker-Oketta, a physician based at Uganda’s Makerere University and an advisor at GiveDirectly, told me in an interview. “What we need as a complementary intervention is infrastructure” like health facilities.

Another really bad takeaway, more from the US studies than this one, would be that cash has no health effects at all, even in the Global South. Among very poor, malnourished people who cannot afford regular medical care, there are strong intuitive reasons to think cash does something for their health. While lower monthly payments, like Kenya’s $45 a month, almost certainly won’t cause infant mortality to fall by half, they might help people’s health on the margin. See, for example, this study, which found improvements in height-for-age among children born to young cash transfer recipients in Malawi. Of course, whether or not cash is the best or most cost-effective way to promote child health is a different question — and one where cash does worse.

Writing about cash programs is a funny thing. For most topics, readers exhibit a negativity bias: They click more on bad news. But I’ve found that when I write about cash, big flashy headlines about all the good it does get lots of hits, while nuanced pieces about benefits and limitations don’t. (Bad omen for this piece, I guess.)

That’s a bad set of incentives, and I’m trying my best to resist them. People are working hard to understand what cash can and can’t do. It does them a disservice to only share the good things they learn.