I mostly believe in Worms

Worms and other parasites are known to influence behavior. If you give money to someone whose decisions are being influenced by a parasite, are you really giving the money to them, or are you giving it to the parasite?

People give Aid so things the giver wants to happen happen. As such, you can talk about ROI in terms of achieving the givers goals.

> ROI as a concept only makes sense when you're trying to achieve your own goals. If you're really empowering other people, then they are the ones who should be evaluating the ROI on their decisions, not you.

While a noble concept in theory, people are notoriously both selfish and short-sighted. Especially when basic infrastructure is missing, and assuming the giver-goals are unbiased, I would expect that an observer would typically say that the society helped by giver-goal aid is better off than the society helped by receiver-goal aid.

Receivers, being selfish and shortsighted, will be unlikely to invest in things like a local hospital, or sewage, water, and electricity. They'll buy themselves a trip to a hospital to get taken care of, and purchase a private well, a septic tank (or just a longer pipe to the local canal) and a generator. If they get a propane tank, propane delivery service, and a modern furnace and stove, that's great for them, but the observer would probably say it would be better to run natural gas to all the houses rather than individual propane tanks to a small number of residents. And you may have better results in the short term by giving people money to buy the generator they want rather than a solar array that puts out fewer watts per dollar, but the city will eventually be covered in smog. Or they might invest in better tires for their vehicle to navigate the potholed roads, but they won't pay to pave or maintain them. And while individual smartphones are a wonderful luxury, many more people would benefit if you put PCs in the local library.

Perhaps these things would have eventually sorted themselves out when the empowered receivers start using their elevated position on Maslow's hierarchy of needs to become wealthier. They would then contribute more to the tax base and eventually an effective government will have the funds to start investing in these public works that eventually people realize they want for a few percent of their wealth. But I think it's more effective to skip that "perhaps" stage.

Appreciate the sentiment, but it was actually a quite deliberate comparison because (i) the very poor in developing countries where cigarettes are very cheap often have a cigarette budget which comes before investment and improved nutrition (ii) I'm well aware that despite the startling prevalence of smoking amongst poor men, increased tobacco use isn't a significant factor in studies of how poor people spend donor cash.

(i) pretty much underlines my point about the things people choose to spend their money on not necessarily being what's best for them. And in the short term it's not an inexplicable phenomenon because cheap tobacco probably does provide more pain and stress relief than slightly better nutrition.

(ii) is partly because surveys like those you've posted accurately represent people tending not alter their habits of smoking cheap cigarettes (or frowning on tobacco) after receiving a sudden windfall; there's a limit to how much one can smoke and stockpiling makes no sense when for people who don't even have a waterproof roof. But it's also because poor people are smart enough to realise that people quizzing them on their lifestyle and unexpected windfalls from foreign donors aren't unrelated, and the natural response is to tailor responses to what they think the foreign donors want to hear, resulting in any increases in spending on cigarettes and alcohol (whilst likely low relative to increases in spending on roofs or microbusiness investments anyway) being systematically underreported.

Soil-transmitted helminths infect 2 billion people. http://www.who.int/mediacentre/factsheets/fs366/en/

More than a few will benefit, because in many areas with high infection rate, the majority of children really do have worms. Regarding Ascaris infection specifically: "In areas of poor sanitation virtually 100% of the population harbor the parasite."[Markell & Voge's Medical Parasitology p.241]

Do you understand how extraordinarily arrogant your white knighting is when I've already pointed out elsewhere in the thread that (i) the prevalence of smoking amongst poor males in most developing countries unambiguously is high irrespective of donations and even given a reason why low-cost tobacco might appear preferable in a tobacco/nutrition tradeoff and (ii) acknowledged that GiveDirectly-sized donations (as opposed to the one-pack-of- twenty-Rockets cost of a deworming tablet in the tradeoff comparison I actually made) tend to be invested in useful capital goods but explained why studies associated with donations likely systematically underreport tobacco consumption and other vices relative to studies not associated with donations anyway. And even edited my original post to explicitly state that I wasn't arguing that GiveDirectly was a bad idea.

I think it's probably more condescending, and certainly more harmful, to assume that extreme poverty bestows upon the global poor some mystical ability to make optimal spending decisions that for some reason doesn't apply to comparatively wealthy people in developed countries entitled to access heavily-funded collective healthcare and social insurance systems.

The market does not have charity in mind; it will allocate capital to maximize the total size of the economy.