A New Paradigm for Resource Distribution

Apr 23, 2021Global Health, Perspectives, Strategy, US Health

As we near a year of coronavirus and lockdowns, what started with debilitating fear of infection, peaked at pandemic fatigue, and now is beginning to curtail with the chance of vaccine-induced safety, one of the most pressing questions of development presents itself yet again: How does one distribute scarce resources?

Decision making in the face of scarce resources is undoubtedly difficult, and in many ways often presents truly impossible choices. In such situations, being strictly utilitarian (where ‘future, largely economic, benefit to society’ is the unit of utility measurement) often feels like one way in which to simply move forward, to break free from the debilitating anxiety of having to make a decision in impossible circumstances, and of at least doing something. Yet, always choosing utility as our sole compass leaves us in another bind. If we always choose to give to those people who have the highest potential return on investment (ROI), then when will those who truly need the resource get a turn?

In many ways, our systems, our societies, and even our philanthropic communities are very often not set up to actually elevate the needs of the people whose circumstances are truly desperate. As a result, true need is very rarely addressed in situations of scarcity. Instead, time and time again, across numerous contexts, societal ROI trumps true need as a decision-making criterion, and ultimately holds back our collective ability to progress.  

Take for example, the calculus that poor parents make every day when they choose to send sons to school over daughters. While a daughter’s education-less future might be far bleaker (uneducated women, as compared to educated ones, tend to have more children, earlier, with riskier pregnancies, and less healthy newborns, and are at greater risk of gender-based violence[1]) and while the argument could be made that she ‘needed’ it more, poor parents often find themselves too lacking in resources to think this way. They must make calculated choices about how to spend their limited means and, to them, boys have a far better chance of future employment hence boys get sent to school.

This utilitarian decision-making is not just limited to other parts of the world. A well-known example can be found in the case of the Admissions and Policies Committee of the Seattle Artificial Kidney Center at Swedish Hospital, more commonly known as the “God committee.”  Formed in 1961, it was this committee’s (made up of seven citizens selected by the King County Medical Society) job to choose which patients would get hooked up twice a week to a one of a kind “artificial kidney” that could offer them a chance at life.  Ultimately the committee relied on criteria based on ‘social worth[2]’ which itself was heavily weighted toward economic status that reflected the committee’s own values and biases (excerpt from the committee: “If we are still looking for the men with the highest potential of service to society, then I think we must consider that the chemist and the accountant have the finest educational backgrounds of all five candidates….”). Were patients more at-risk given priority, or were patients who had more ‘social worth’ given precedence? Once again, in the face of scarce resources, the availability of only one machine, there was no room to prioritize those who ‘needed it’ the most.

Similarly, in the philanthropic community, how many grants require visible results in the near term? And in turn, how many local NGOs must carry out their programing not in the districts where it is most needed, but, rather, in the districts in which their programs will show impact most quickly, guaranteeing them future funding and an ability to continue to exist to serve additional people? Districts which show impact quickly often do so because there are other factors in place – infrastructure, norms, expertise – that support programming in being successful. Conversely, very needy districts are the districts lacking in those things – they will likely have limited or non-existent programming, infrastructure, or supportive norms, and to put it candidly, non-existent hope too, for those that truly need it.

The fundamental issue with focusing on utility in the form of societal ROI is that it leaves us, somewhat ironically, as a society, no better than before. A few families or individuals may benefit in the short-term, but as a collective, instead of overall progress, we see deepening inequality. Conversely, by truly focusing on the neediest, we may see less progress in the short term, but we fundamentally improve long term possibilities. Enabling this paradigm change, however, will require a transformative shift in how the global development sector does business.

At the outset, we must all play the long game. The philanthropic community must, as it is beginning to do, begin moving to longer terms grants with less strings attached. By allowing people in communities to no longer perceive their grants to be ultra-scarce, red-taped resources, we begin to give them breathing room so they can bring creativity and flexibility into their programming, and so they can focus where they know there is need, rather than on where they think their own survival as an organization depends.

Secondly, we must challenge norms and the basic premises of utilitarian thinking. Perhaps it seems a boy is more employable after schooling, but what does he do once he is employed? Numerous studies show that when women have access and control over the household income, they are more likely than men to invest in the health and welfare of their families. Maternal income for example has been shown to increase family nutrition by 4-7 times more than the income of fathers[3]. When women have the education and capacity to work, they can end a vicious cycle that prevents them from earning and saving the money they need to achieve a brighter future for themselves and for their families. This is powerful. This, and the whole body of research like this, must be talked about more.

And thirdly, we must be willing to take a stand. To give to the needy because that is the right thing to do, and because that will spur the innovation required to no longer have them be the neediest anymore. At the Swedish Hospital, when the inventing doctor finally received a refusal that he simply could not fathom (a 16-year-old girl in the prime of her life), do you know what he did? He spurred the invention of a much smaller, more manageable dialysis machine that changed the stakes. His innovation led to much needier patients having access and to the eventual dissolution of the God Committee.

May we reach a point too, in philanthropy, and in the global development sector at large, where we manage to fund and support the kinds of initiatives that truly focus on the needy. May we ask the questions that help us identify the people who need resources the most, and may we do everything in our power to ensure that we get them the resources that they need. Ultimately, this is the only path forward that will help to raise people, collectively, out of poverty and that will make it so they too can finally take care of their most needy without having to always calculate the opportunity cost of doing so. 


[1] https://www.concernusa.org/story/girls-education/

[2] Social worth based on a combination of factors, including age, sex, marital status, number of dependents, income, net worth, emotional stability, educational background, occupation, past performance and future potential

[3] Thomas, D. (1990). Intra-Household Resource Allocation: An Inferential Approach. The Journal of Human Resources, 25(4), 635-664. doi:10.2307/145670