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Picking a neglected cause makes change easier

When you’re embarking on a career, you want to know the cause you’re working on is important and likely to make an impact. And you’re going to be estimating your odds of making an impact in a context where people are already mobilized and working on problems.

The smart thing to do is to scan the landscape and look for gaps in mobilization, places where a little more effort or investment could make a big difference, as opposed to intractable problems where billions of dollars and millions of people are already working.

I’ve been lucky to know and report on some enterprising individuals who’ve been particularly good at identifying neglected topics and making incredible progress on them. In these cases, the activists or social entrepreneurs in question identified a problem that was easier to make headway on precisely because attention on the issue was scarce. That meant that few people before them had pushed hard or pushed with many resources at their disposal.

A favorite example of mine is pesticide suicide prevention. Suicides that use pesticide poisoning as a method take some 110,000 people’s lives every year, mostly in the developing world. These are preventable deaths: When Sri Lanka banned a set of particularly lethal pesticides, the national suicide rate fell by half. But for years there wasn’t much of a movement internationally to pass similar regulations to save lives.

So in 2016, Leah Utyasheva and Michael Eddleston, a human rights consultant and University of Edinburgh toxicology professor respectively, founded the Center for Pesticide Suicide Prevention, a group that works to enact similar controls in developing countries. So far, the group has helped bar some lethal pesticides in Nepal, which should save around 380 lives per year. As the group works in more and more countries, that number should rise. Utyasheva and Eddleston found a neglected problem and are tackling it.

Or take an example close to my heart (literally): kidney and other organ donation. The large majority of transplant organs in the US come from deceased donors: people with healthy organs who have died and opted to have their organs donated. That, combined with the fact that there’s a long waitlist for many organs (particularly kidneys), means that increasing the share of organs from deceased people that are being donated would save many thousands of lives.

The key groups here are known as organ procurement organizations (OPOs), which are government-contracted nonprofits that have a monopoly on distributing organs from the recently deceased to living people in need. There are 57 OPOs in the US now, each with a different regional focus.

Recently, a couple of activists — Greg Segal of the nonprofit patient advocacy group Organize and Obama administration alum Jennifer Erickson — helped put together a bipartisan coalition, from Sen. Chuck Grassley (IA) on the right to former NAACP president Ben Jealous on the left, in favor of reforming OPOs so they use more deceased donor organs and are less likely to decline deceased donors with perfectly good organs (a decision they were perversely incentivized to make before). Segal, Erickson, and their allies pushed through a reform that could boost the number of organs OPOs distribute by 7,300 per year.

That’s some 7,300 lives saved, every year. And while their work wasn’t easy — the OPOs fought back hard — it wasn’t nearly as difficult or as long-fought to create big change in this relatively neglected area as, say, reorienting the whole K-12 education system would be.

The opportunity presented by Secret Congress

A key reason why change in OPOs was easier: It was not a politically polarized issue the way that, say, raising the minimum wage is. There is no Democratic or Republican position on OPOs, really. It’s possible for unlikely allies, like liberal Rep. Karen Bass (D-CA) and Sen. Todd Young (R-IN), to come together on it.

While it doesn’t seem like it from the outside, a lot of policymaking in DC is like this: Big changes happening quietly through strong collaboration between the parties. Sure, there’s polarization and gridlock, but if you’re paying attention, you also see the things that do get done.

Simon Bazelon and Matt Yglesias at Slow Boring have coined the term “Secret Congress” to refer to the vast variety of legislation that Democrats and Republicans come together to pass on topics that don’t earn much public attention or outrage. Secret Congress is a very real phenomenon; hugely consequential legislation has been passing pretty regularly on a bipartisan basis over the last decade, even as partisan battles have reached an ever-more fevered pitch.

Here are just a few examples:

These examples may seem small-bore, but they’re not. Raising the tobacco age to 21 will save hundreds if not thousands of lives. Expert Casey Michel said of the money laundering legislation, “Banning anonymous shell companies in the U.S. would be the biggest anti-money laundering move the country has taken in nearly 20 years—and potentially ever.” The 45Q credit put a real price on removing carbon, a sort of carbon tax lite that could still be important in fighting climate change.

So what does this mean for you, someone deciding which cause to take up? It implies that you might want to look for stuff that Secret Congress could or is working on and focus your energy there rather than on big topics prone to lobbying and conflict. I find tax policy fascinating, but raising taxes on the rich or cutting taxes for corporations are not “neglected” causes: There are literally thousands of people in DC working on each of those causes as we speak, and they have millions, if not billions, of dollars at their disposal.

But suppose you found a modest chemical regulation that could save thousands of lives (such as bans on pesticides that are used in suicides). The American Chemical Society might fight you. But a private battle against one lobby is cheaper and easier to win than a massive public battle. And if all you care about is saving lives, picking the easier battle is a good call.

Find your neglected cause

Public policy is the area of life I know the most about, so naturally the examples of neglected causes that come to my mind most easily are in that area.

But there are other ways to make change. You can make this kind of change through science, too. Katalin Karikó, a microbiologist, has spent much of her career on an area of research that funders and other scientists were neglecting: the potential for mRNA to become a tool for vaccine development. It took years, but Karikó’s cause selection paid off in spectacular fashion in 2020 when the idea she devoted her career toward became essential to developing Covid-19 vaccines. Karikó’s work has already saved millions of lives and will likely save many millions more as mRNA vaccines are developed for new diseases.

If you’re an engineer or scientist outside medicine, there are plenty of opportunities too. Think about the technologies that would be most helpful in saving lives and promoting economic growth in the future — and think about which ones aren’t trendy right now. Geothermal energy is one example; the writer Eli Dourado makes a compelling case that specific kinds of work, like developing harder drill bits and better methods for locating heat in the earth, could dramatically improve geothermal and expand our supply of clean energy.

If you’re entrepreneurial in spirit, there are plenty of opportunities too. The company Sendwave saw that fees for remittances (which represent some $540 billion in cash flows, mostly to poor countries from rich ones, annually) were quite high and developed an app with lower processing costs that could save migrant workers money on their remittance payments. Sendwave isn’t a charity, but it is a socially minded organization whose success depends on saving millions or billions of dollars for its users, and alleviating global poverty in the process. There are surely other opportunities like this out there.

Or, if you’re still looking for a cause, think about the trillions of humans who will live in the future, and find opportunities to fight potential causes of extinction, like pandemics or nuclear war (an area where philanthropists are currently pulling funds and which needs more help).

This is all, of course, easier said than done. But the broader point is worth lingering on: There’s a big world out there with lots of problems to tackle. Finding a neglected but consequential cause and making progress on it is some of the most meaningful work the world offers.

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