Some worry that charities decide what people need without really listening to them, imposing outside ideas about what counts as help. It's a fair concern: if the people receiving support aren't understood or consulted, the help is less likely to work, which defeats the whole purpose.
Because effective altruism is decentralized, different organizations approach this in different ways. Some support GiveDirectly, which gives no-strings cash transfers to people in poverty and leaves it entirely up to them how to spend the money, rather than funding services a community may not actually want. Other charities provide services like vaccinations or nutrition, where the benefit is clear enough that recipients are very likely to value it, and better health, in turn, can help people improve their own circumstances in ways outsiders can't. In other cases, charities run evaluations and surveys to learn how recipients actually feel about the help they're getting; these aren't always reliable, but they're often the best available.
It gets harder still when those affected can't be consulted at all, as with animals or future generations. There, people do their best to research what they would plausibly want. Groups like Rethink Priorities and the Welfare Footprint Institute, for instance, study how much and how long different animals suffer under different conditions, work that helps advocates push for stronger welfare standards. In some cases, the answer is obvious: pigs clearly don't want to be permanently confined to 'gestation crates' in which they cannot turn around, and future generations won't want to inherit a planet on which humans cannot easily live.
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