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The Center for Global Development — Support for Research and Advocacy to Reduce Lead Exposure (December 2021)

Note: This page summarizes the rationale behind a GiveWell Incubation Grant to the Center for Global Development (CGD). CGD staff reviewed this page prior to publication.

Summary

In December 2021, GiveWell recommended a $1.2 million grant over two years to the Center for Global Development (CGD) to support research into the effects of lead exposure on economic and educational outcomes, and run a working group that will author policy outreach documents and engage with global policymakers. The grant was funded by the Effective Altruism Global Health and Development Fund.

Published: January 2022

How this fits into GiveWell's work

Over the past few years, GiveWell has been exploring giving opportunities within public health regulation that we believe could be highly cost-effective.1 One of the areas we've identified as particularly promising is lead exposure, which we believe contributes to a large disease burden but is relatively neglected by other funders.2

The organization

The Center for Global Development (CGD) is an organization focused on research and policy advocacy to reduce global poverty and improve lives.3 GiveWell has recommended funding to CGD in the past.

Planned activities and budget

The grant is structured around two key components, research and advocacy:4

  • Research – CGD plans to conduct three studies in parallel to better understand the effects of lead exposure on children's social, economic, and health outcomes:5
    • A retrospective study utilizing a natural experiment to determine the effect of removing lead from gasoline in several African countries.
    • A retrospective study utilizing a natural experiment to determine the effect of cleaning up lead-contaminated sites.
    • A longitudinal study tracking adults whose blood lead levels (BLLs) were measured in childhood, and comparing life outcomes at different BLLs.
  • Advocacy – CGD will organize a working group intended to generate support among global policymakers for lead reduction efforts in low- and middle-income countries (LMICs).6

Below, we provide a rough breakdown of how CGD plans to allocate funding from this grant:7

  • Staff time ($550,000—46% of the budget)
  • Field research ($380,000—32% of the budget)
    • Longitudinal study ($230,000—19% of the budget)
    • Retrospective study on cleanup of lead-contaminated sites ($150,000—13% of the budget)
    • Retrospective study on removal of leaded gasoline (no costs beyond staff time)
  • Overhead ($150,000—13% of the budget)
  • Working group ($115,000—10% of the budget)8

The case for the grant

Note: Unless otherwise stated, the case for the grant laid out below reflects our thinking at the time we recommended the grant.

We recommended this grant because:

  • Our previous investigation suggests lead exposure reduction is a promising area within public health regulation because of its effects on childhood outcomes and relative neglectedness.
  • Our understanding is that the U.S. government's current interest in lead exposure means there is a significant opportunity over the next few years to generate attention and support for lead reduction in LMICs.9
  • The research CGD plans to conduct is relatively inexpensive (see budget breakdown above), and will add to the currently sparse evidence base for the effects of lead exposure in LMICs.10
  • Our general impression is that CGD and its staff leading this grant produce high-quality work. Open Philanthropy's review of CGD's past work suggests that CGD has a relatively strong track record of achieving policy outcomes through its research and advocacy.11
  • We think it makes intuitive sense for us to support this grant, because of our interest in reducing lead exposure and the relative lack of other philanthropic funders in that space.12

Risks and reservations

  • A recently published joint report by UNICEF and Pure Earth discussed the effects of lead pollution on children and provided recommendations for reducing lead exposure.13 We considered whether the advocacy activities CGD plans to undertake (e.g., producing a final report with policy recommendations) would be duplicative of this previous work. However, based on our communication with CGD, we expect that its reputation and relationships within the international development community can be leveraged to generate significant additional attention to lead exposure as a policy priority.14
  • We have not reviewed CGD's proposed study methodology in depth. CGD highlighted some limitations of its proposed research:
    • At least one of the quasi-experimental retrospective studies will not include measurement of blood lead levels, meaning that it will be difficult to extrapolate effect sizes to other settings.15
    • The longitudinal study will be susceptible to confounding.16
  • We are unsure of the exact mechanism through which policy advocacy will result in measurable change (see our predictions below for possible outcomes of the grant).

Internal forecasts

We are recording the following forecasts on the advocacy17 and research18 outcomes of this grant:

Advocacy outcomes

Confidence Prediction By time
10% Best case: The U.S. government, other international actors (e.g., bilateral and multilateral donors), and/or national LMIC governments take measurable action to reduce lead exposure—for example, through increased funding for lead mitigation and research, increased monitoring of lead exposure, and/or enactment of regulations. End of grant period (2 years)
50% Median case: Discourse on lead exposure increases at relevant global forums, lead is prioritized within the World Bank's Human Capital Project, LMIC governments make commitments to address lead exposure, and/or additional research and lead mitigation projects are funded by other donors. End of grant period (2 years)
40% Disappointing case: There are no clear commitments or action taken outside of increased discussion on lead exposure from members of CGD's working group. End of grant period (2 years)

Research outcomes

Confidence Prediction By time
12.5% 0 out of the 3 studies produce results we have confidence in. End of grant period (2 years)
35% 1 out of the 3 studies produces results we have confidence in. End of grant period (2 years)
40% 2 out of the 3 studies produce results we have confidence in. End of grant period (2 years)
12.5% All 3 studies produce results we have confidence in. End of grant period (2 years)

Our process

This grant was investigated at a relatively shallow level. It was recommended through our light-process grantmaking budget.

  • We identified lead exposure as a promising area, as part of our work to find giving opportunities within public health regulation.
  • We spoke with CGD about our interest in lead exposure, after which it sent us its concept note for a grant proposal.
  • We discussed the grant internally, and also reviewed the quality of previous research studies conducted by CGD staff leading the grant.
  • We spoke with Open Philanthropy and Pure Earth to understand their view of the grant.
  • We had one additional conversation with CGD.

Sources

Document Source
CGD, "About CGD" Source (archive)
CGD, Concept note on grant for lead exposure reduction, 2021 (redacted) Source
GiveWell, "Public health regulation update," 2021 Source
GiveWell, "Pure Earth — Support for reducing lead exposure in low- and middle-income countries," 2021 Source
GiveWell's non-verbatim summary of a conversation with the Center for Global Development, November 10, 2021 Source
Hares, Silverman, and Crawfurd, "Biden wants to eliminate lead poisoning in American children. We propose an even more ambitious goal: global eradication," 2021 Source
Open Philanthropy, "Center for Global Development — General support 2016" Source (archive)
Rees and Fuller 2020 Source (archive)
Silverman et al. 2019 Source (archive)
  • 1.

    See more on our "high-leverage" giving, and the giving opportunities we've funded to date, on this page.

  • 2.

    For details on why we believe lead exposure reduction is a promising focus area, see this page on a grant we recommended to Pure Earth in 2021. For an overview of different areas we've considered within public health regulation, see this page.

  • 3.

    "We work to reduce global poverty and improve lives through innovative economic research that drives better policy and practice by the world's top decision makers [...] Impact can take many forms—from shaping the academic consensus to turning proposals into policy." CGD, "About CGD"

  • 4.

    "CGD proposes a 2-year, $1.2 million work program designed to: (1) produce rigorous evidence on the importance of lead poisoning as a human capital and global welfare issue; (2) generate actionable strategies and recommendations to better surveil and reduce the burden of global lead poisoning; and (3) increase the salience of lead poisoning and mobilize support for mitigation within the global health/international education/advocacy communities. The two-pronged work program would include: (1) empirical research on the links between lead exposure and adverse health, economic, education, and other welfare outcomes in an LMIC [low- and middle-income country] setting; and (2) a multi-stakeholder working group on lead abatement." CGD, Concept note on grant for lead exposure reduction, 2021 (redacted), Pg. 4

  • 5.
    • "The two-pronged work program would include: (1) empirical research on the links between lead exposure and adverse health, economic, education, and other welfare outcomes in an LMIC setting; and (2) a multi-stakeholder working group on lead abatement [...] Given the need to look at long-term effects of lead poisoning, our focus is on retrospective studies using natural experiments to identify causal effects. We propose three alternative study designs, which we hope to pursue in parallel - budget dependent, to provide complementary evidence using multiple techniques from multiple settings." CGD, Concept note on grant for lead exposure reduction, 2021 (redacted), Pg. 4
    • "For the empirical research prong of the program, CGD proposes three studies, to be pursued in parallel:
      • Part 1: Study the effect of removing leaded gasoline in Africa, which was banned in most African countries around 2005. CGD would merge spatial data on road networks with geographically identified data on social outcomes.
      • Part 2: Study the effect of polluted sites and/or cleanup efforts, by focusing on a case study of one or more specific toxic waste exposure sites. CGD anticipates needing bespoke survey data collection to credibly estimate the causal effect of the exposure and/or cleanup on later life outcomes.
      • Part 3: Study longitudinal correlations between lead poisoning in early life (measured in existing studies) and later life outcomes (measured through new follow-up surveys). This study would trace a direct link from blood levels in early childhood to adult life outcomes, by doing long-term tracking of individuals who were sampled for blood lead testing in childhood." GiveWell's non-verbatim summary of a conversation with the Center for Global Development, November 10, 2021, Pg. 1

  • 6.

  • 7.

    Rachel Silverman, Policy Fellow, CGD, email to GiveWell, November 5, 2021 (unpublished)

  • 8.

    The working group budget includes the costs of one in-person meeting, two pieces of commissioned research or analysis, and publication and dissemination of a final report. Rachel Silverman, Policy Fellow, CGD, email to GiveWell, November 5, 2021 (unpublished)

  • 9.

  • 10.

    "Our objective is to provide direct, rather than modeled, empirical estimates of the impact of lead exposure on adult life outcomes for children living in low- and lower-middle income countries. Our reading of the literature suggest that whilst there is medical research on the pathological effects of lead poisoning which should transfer well across contexts, well-identified causal evidence on the effects of lead on social outcomes (such as education or crime) largely comes from high-income countries, and here effects may not transfer so well across contexts. We propose to start to fill this gap with original research, combining both desk-based analysis of existing data sets and primary data collection in lead ‘hot spots’." CGD, Concept note on grant for lead exposure reduction, 2021 (redacted), Pg. 4

  • 11.

    "Based on our case studies, we think it is likely that at least one or two of CGD’s initiatives have produced a few billion dollars of value for people in low-income countries. (We focused on the few cases that seemed to have the clearest and largest impact because our impression is that the overall policy impacts of think tanks are usually driven disproportionately by a small number of large successes, but we also think it is likely that CGD has produced smaller humanitarian benefits through numerous other projects.) Given that CGD has spent on the order of $150 million during its 15-year history, it seems reasonable to us to estimate that CGD has produced at least 10 times as much value for the global poor as it has spent, though we consider this more of a rough lower bound than an accurate estimate. Although we are far from certain whether our grant funding will enable CGD to have a similar impact in the future, we think that CGD’s fairly long track record of plausibly producing big wins for the global poor is a good reason to believe that additional unrestricted funding could help produce similar results in the future." Open Philanthropy, "Center for Global Development — General support 2016"

  • 12.

    See this page for an overview of funding in lead exposure.

  • 13.

    Rees and Fuller 2020

    • "Relatively low levels of lead exposure that were previously considered 'safe' have been shown to damage children's health and impair their cognitive development. Lead is a potent neurotoxin that, with even low-level exposure, is associated with a reduction in IQ scores, shortened attention spans and potentially violent and even criminal behaviour later in life. Children under the age of 5 years are at the greatest risk of suffering lifelong neurological, cognitive and physical damage and even death from lead poisoning." Pg. 1
    • "Addressing lead pollution and exposure among children requires a coordinated and concerted six-pronged approach across the following areas: improving monitoring and reporting systems; improving prevention and control; improving management, treatment and remediation; improving public awareness and behaviour change; improving legislation and policies; and global and regional action. Achieving these goals will require international action by governments, public-private partnerships and industry." Pg. 57

  • 14.
    • "The Toxic Truth report, a joint report by UNICEF and Pure Earth, already presents valuable research. CGD expects its working group to add value, because:

  • 15.
    • "Limitations of the research
      • The first research study will not be able to track blood lead levels of the participants, so a null result would be unable to distinguish between proximity to roads not being a good proxy for exposure to leaded gasoline, versus exposure to leaded gasoline having little effect on outcomes.
      • For part 2, the researchers are looking for more mechanisms to track lead exposure, such as environmental measures of lead or young adult blood lead levels, to get more data so that null results would be more compelling." GiveWell's non-verbatim summary of a conversation with the Center for Global Development, November 10, 2021, Pg. 2

  • 16.

    "How to mitigate the risks of confounding in the [longitudinal study].

    • In the US, exposures are generally easy to trace, however in LMIC settings, those thought to be in the control group may have other lead exposures. This risk could be mitigated with specific site studies, but cross-country studies based on Demographic and Health Survey (DHS) data may be less accurate.
    • In part 3, results will likely not be confounded as cleanly as they would be in the US, where lead exposure is so highly correlated with poverty. In LMICs, confounding exists, but does not seem as unidirectional." GiveWell's non-verbatim summary of a conversation with the Center for Global Development, November 10, 2021, Pg. 2

  • 17.

    The advocacy outcomes to which we assigned different confidence levels were provided to us by CGD in Rachel Silverman, Policy Fellow, CGD, email to GiveWell, November 5, 2021 (unpublished)

    We plan to evaluate the outcomes of the grant through a conversation with CGD at the end of the two-year grant period and subsequent internal discussion. We don't expect to take these different scenarios as strict conjunctions. Rather, our forecast will be resolved by the grant investigator deciding which scenario he believes best describes the outcome of this grant, with review from other GiveWell researchers.

  • 18.

    Program Officer James Snowden, who led the investigation and recommendation of this grant, will make an evaluation of the credibility of CGD's studies, which will then be vetted by other senior researchers at GiveWell. The benchmark we are using for "credible" is determined by the typical study on which we currently base our estimate of the effect of lead on long-run outcomes (see more here).