It's easy to feel like one person
can't make a difference. The problems the world faces
seem so vast, and we seem so small. Sometimes you can have
the best intentions, and work hard,
and still not have much effect. Now, it's true that many common ways
people try to do good have less impact
than you might think at first. But some ways of doing good
have allowed certain people to achieve an extraordinary impact.
How is that possible? And what does it mean for
how you can make a difference? We'll s
tart by looking at doctors
and end up at nuclear war. If you want to save lives,
an obvious choice is to become a doctor.
The work of medical professionals is enormously important.
But how many lives does a doctor really save
over the course of their career? You might assume it's in the hundreds
or thousands. But the surprising truth is that,
according to an analysis carried out by Dr. Greg Lewis,
a former medical doctor, the number is far lower
than you'd expect. Since the 19th century,
life ex
pectancy has skyrocketed. But that's not just
because of medicine. There are loads of contributing
factors, like improved nutrition, sanitation, workplace safety,
and just increased wealth generally. Estimating how many years of life
are saved by medicine alone is really difficult.
Despite this difficulty, one attempt from researchers
at Harvard and King's College London found that medical care
in developed countries increases the life expectancy
of each person in these countries
by around five
years. Most developed countries
have around three doctors per 1,000 people.
So, if this estimate is right, each doctor saves
around 1,670 years of life, over the course of their career.
Using the World Bank's standard conversion rate
of 30 extra years of healthy life to one "life saved",
that's around 50 lives saved per doctor. But that's actually
a substantial overestimate. Doctors are only one part
of the medical system, which also relies on nurses
and hospital staff, as well as administration
and equipment and everything else. And more importantly,
there are already a lot of doctors in the developed world.
So if you don't become a doctor, someone else will be available
to perform the most critical medical procedures.
Additional doctors only allow society to carry out additional,
usually less important, procedures. Look at this graph
from the analysis by Dr. Greg Lewis we quoted earlier.
Each point is a country. The vertical axis shows
disability-adjusted-life-years per 100,000 peopl
e.
You can think of that figure as roughly how many years
of disability a group of 100,000 people
has to endure on average. Therefore, the fewer, the better.
Lower numbers represent better health outcomes.
This, of course, varies a lot from country to country.
The horizontal axis shows the number of doctors
per 100,000 people in each country. As you can see,
countries with more doctors have better health outcomes.
But notice how the curve goes nearly flat once you have more
than around 150 docto
rs per 100,000 people. After this point
(which almost all developed countries meet), additional doctors
only achieve a small impact on average.
In fact, at 300 doctors per 100,000 people,
an additional doctor saves only around 200 years of life
throughout their career. So, when you take all this
into account, including some accounting
for the impact of nurses and other parts
of the medical system, it looks more like the average doctor
saves only around three lives through the course of their car
eer.
Still an admirable achievement, but perhaps less
than you may have imagined. But that's the average doctor.
Some doctors have had much more impact than that.
By 1968, we knew how to prevent deaths from cholera.
The main cause of death was dehydration due to bad diarrhoea.
The treatment for this was relatively cheap:
just salt and glucose, dissolved into water.
But millions of people were still dying every year.
The problem was that this salt and glucose solution
needed to be administered by
a feeding tube,
or an intravenous drip straight into the bloodstream.
Delivering this kind of treatment is far from simple,
which meant that many cholera victims died from extreme dehydration
before they could even reach medical care.
Enter Dr. David Nalin. He was an American doctor
sent to work at a refugee camp, just on the border
of Bangladesh and Myanmar. In a groundbreaking study, Dr. Nalin
showed if everything was dissolved at the right concentration,
and consumed at the right rate, just
drinking a solution of salt
and glucose could rehydrate cholera patients
pretty much as effectively as intravenous fluids.
This meant the treatment could be used anywhere,
even remote villages, and using only extremely cheap
and widely available ingredients. Since then,
this astonishingly simple treatment has been used all over the world,
and the annual rate of child deaths from diarrhea has plummeted
from around 5 million to 1.5 million. If Dr. Nalin had not been around,
someone else would prob
ably have discovered
this treatment eventually. However, even if we imagine
that he sped up the roll-out by only five months,
his work alone would have saved around 500,000 lives.
This is a very approximate estimate, but it makes his impact
more than 100,000 times greater than that of the average doctor.
And even just within medical research, Dr. Nalin
is far from the most extreme example of a high-impact career.
Take blood transfusions. Today, they're a routine,
life-saving procedure. But over
a century ago,
transfusions were risky endeavours that often ended in death.
At the dawn of the 20th century, doctors simply didn't understand
why some blood transfusions worked, while others were fatal.
Lives were being lost and medicine was stumped.
That all changed thanks to the work of Austrian biologist
Karl Landsteiner. In 1901, after years of meticulous
laboratory research, Landsteiner identified three blood groups: A, B,
and O (although, shockingly, he called them "A", "B", and "C".
This
groundbreaking discovery unlocked the mystery
behind the deaths caused by early blood transfusions.
Landsteiner found that transfusions with incompatible blood types
were potentially fatal. But when blood types
matched between donor and patient, transfusions were safe and effective.
With this knowledge, doctors could begin matching donor
and patient blood types for the first time.
Landsteiner's insights allowed blood transfusions
to save lives rather than endangering them.
It was a pivotal adva
ncement in medicine. The value of
Landsteiner's research became abundantly clear
during the First World War. Setting up blood banks
near field hospitals allowed for rapid access
to typed blood to treat wounded soldiers.
Transfusions went from risky last ditch efforts
to standard life-saving procedures over the course of the war.
In the decades since, Landsteiner's system
has enabled millions of successful blood transfusions
for patients with blood loss
from trauma or surgery, those undergoing ca
ncer treatment,
and many more. The analysis by Greg Lewis
puts Karl Landsteiner's discovery of blood groups
as saving tens of millions of lives. This is a very uncertain estimate.
It could easily be off by a factor of ten or more, and seems more likely
to be too high than too low. It's possible
that speeding up the discovery wouldn't have had much impact at all.
Most of the lives saved were in the modern era,
when people were rapidly gaining access to other medical advancements
which could save
their lives, or prevent the need for transfusions
completely. On the other hand, the discovery of blood groups
probably made other scientific advances possible,
and we're ignoring their impact. Nevertheless, the basic point
stands: Landsteiner's impact was likely vastly greater
than even David Nalin's. There are also many more examples
you might not have heard about (unless you watch this channel),
like Viktor Zhdanov. In the 20th century,
smallpox killed around 400 million people,
far more than
died in all the century's wars
and political famines. Zhdanov single-handedly lobbied
the World Health Organization to start a campaign,
which eventually led to the complete elimination
of smallpox. Without his involvement, smallpox would not
have been eliminated until much later,
and possibly not at all. But who saved
the most lives in history? One top candidate
is Stanislav Petrov, a little-known Soviet
Lieutenant Colonel who may have saved your life.
He was just another late night shift for
Stanislav Petrov in the secret
Serpukhov-15 bunker outside Moscow. As a duty officer,
he settled into the commander's chair to monitor the Soviet Union's
early-warning satellites over the United States.
Little did he know this routine shift was about to thrust him
into one of the most harrowing incidents
of the Cold War. Petrov's instructions were clear:
if the United States launched nuclear missiles,
he was to report that immediately to his superiors,
who had a policy of striking back immediate
ly
with their own nuclear weapons. Shortly after midnight,
the screens showed five ICBMs launched from the United States,
heading towards the Soviet Union. For five excruciating minutes,
he turned over the evidence again and again in his mind.
Petrov reasoned that, if the US were starting
a nuclear war, they'd probably launch hundreds
of missiles, not just five. So he reported it as a false alarm.
And he was right. No missiles had, in fact,
been launched. The world was safe, at least for now.
If
Petrov had triggered a strike, it's possible that someone else
could have called off the launch process.
But there's at least a reasonable chance
that the Soviet Union would have retaliated,
and hundreds of millions would have died. The two countries
may even have ended up engaged in an all-out nuclear war,
leading to billions of deaths. And Petrov's decision
may have done much more than "just" save a billion people
from nuclear catastrophe. As we saw in our video
on longtermism, focusing on po
tential risks
to the long-term future can be even more high-impact
than saving lives today. The nuclear war that Petrov prevented
could have devastated scientific, artistic, economic
and all other forms of progress, and possibly even led
to the end of civilization itself. Every human
who will live in the future will be alive,
in part, because of Petrov. So we've seen people's careers
have had huge positive effects, some vastly more than others.
A large component is luck. Nalin, Landsteiner and P
etrov
were in the right place at the right time.
You can't guarantee you'll make
an important medical discovery. But it wasn't all luck: Landsteiner
and Nalin chose to use their medical knowledge
to solve some of the most
devastating health problems of their day.
And it was somewhat foreseeable that someone high up
in the military of a nuclear power could have the opportunity
to prevent nuclear conflict. So what does this mean for you?
People often wonder how they can "make a difference,"
but if
some careers can result in thousands of times
more impact than others, this may not be the right question.
Two different career options can both "make a difference,"
but one could be dramatically better than the other.
Instead, the key question is: what are some of the best ways
to make a difference? In other words,
what can you do to have the highest-impact career you can?
This video was adapted from part of the new 80,000 Hours Career Guide,
which attempts to answer exactly that question.
The
guide covers everything you need to know
about how to find a fulfilling career that does good,
from why you shouldn't just "follow your passion,"
to why medicine and charity work aren't always
the best way to help others. It's full of practical tips
and exercises, and at the end you'll have a draft
of your new career plan. Just go to 80000hours.org/rational
to find out more. We all want to make a difference.
If you think carefully about how, the best ways to help others
could end up doing a lot
more good than you'd ever think possible.
Identify society's most pressing problems,
develop expertise to address them, and who knows?
You might, like Petrov, help to literally save the world.
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