A hand up, not a hand out – Health Blog


As many of you did, I followed the recent debt ceiling saga closely and am relieved that we now have some sort of compromise. House Republicans demanded a lot of things, most of which they didn’t get, but one area where they prevailed was tightening work requirements for food (SNAP) and income (TANF). They somehow believe that there are countless “working” people sitting on their couches collecting government benefits, a myth that goes back to Ronald Reagan’s welfare queen stereotype and has long supported work requirements as a means to an end. :

Ironically, according to the CBO, enacted work requirements could actually increase federal spending by up to $2 billion and increase the number of monthly recipients by up to 80,000 people, but who’s counting?

All of this seems timely because of some new studies that show once again that, yes, poverty is bad for people’s health, and helping them get even a little further out of poverty improves their health.


The first study, by Richterman et al. further, examined the effects of cash transfers—that is, giving poor people little or nothing—on adult and child mortality. I might add parenthetically that the study looked at programs in low- and middle-income countries, for which some might argue that, well, America is neither, so the results don’t apply.

To which I would counter. um, have you looked at the percentage of americans below the poverty line? Have you looked at the number of Americans who go hungry every night? Have you looked at our mortality rates, especially maternal and child mortality? Have you looked at the health statistics for disadvantaged populations in the US? Undoubtedly. we have low- and middle-income colonies in our country to combine the title of Chris Hayes’s blistering book about criminal justice in America.

Dr. Richterman and his colleagues examined longitudinal data on nearly 7 million individuals—4 million adults, 3 million men—from 29 countries that had cash transfer programs. The transfers were often small, sometimes as little as $100, but the impact was not. The result.

Our primary finding was that these programs were associated with significant reductions in under-5 mortality for women and children, demonstrating the important role these anti-poverty initiatives have played in promoting population health over the past 20 years.

The reduction in mortality was 20% for women and 8% for children under 5 years of age and increased over time.

Importantly, the effects were greatest among populations that started with the lowest health care costs and the shortest life expectancy. The biggest impact was among women. The authors note: “This adds to previous evidence that cash transfers may disproportionately benefit women or be more effective when women are the primary beneficiaries.”

Critics fear such payments could be misused, such as to buy junk food, drugs or alcohol, but Audrey Pettifor, a social epidemiologist at the University of North Carolina who studies such things (but was not involved in this study), said: The New York Times“Data just doesn’t back up.”

The second study, by Dillman et. among others NEJM Catalyst, looked directly at SNAP; Specifically, SNAP enrollment had effects on health and cost outcomes. It looked at health care utilization (inpatient hospitalizations, ER visits, and unscheduled care) and health care costs (medical, pharmacy, and total care costs) during the first two years of SNAP versus a matched comparison group without SNAP.

The results were again astounding. SNAP enrollees had 16% lower medical costs and 21% lower pharmacy costs in the first year of enrollment, and 16%/20% lower costs in the second year. That’s remarkable.

If, for example, you’ve been responsible for the state Medicaid program, you might want to think about that when your representatives and/or state legislators start talking about limiting SNAP benefits.

A third study, Pollack et. among others JAMA Network, looked at what happens to the incidence of asthma among children when their families have the opportunity to move from disadvantaged, low-income, urban neighborhoods to low-poverty neighborhoods. Asthma is known to be more common in such high-poverty neighborhoods, due to substandard housing stock and other environmental factors.

The results: asthma attacks (“exacerbations”) fell by more than half after such a move (from 0.88 per person per year to 0.40). “Measures of stress, including social cohesion, neighborhood safety, and urban stress, all improved with movement and were estimated to mediate between 29% and 35% of the association between movement and asthma exacerbations.”

It is reasonable to assume that exposure to other health conditions, such as COPD, diabetes, obesity, gun violence, drug overdose, would also show similar positive results.


The New Yorker recently profiled public health researcher Arlene T. The weather. the extraordinary stress of ordinary life in an unjust society. “Environment” in this context refers to the cumulative stress of racial and economic inequality, such as inadequate medical care, an unsafe living environment, or an inadequate diet.

The result, as Professor Jeronimus found, is that “people who endure chronic stress and other forms of structural violence may biologically age faster than their peers.” So the various disparities in morbidity and mortality that we see and cash transfer programs can help improve.

If all of this sounds like I’m arguing for guaranteed income programs, that’s because I am. I’ve written about universal income programs (UBI) and baby bonds because what we’re doing now isn’t working. The COVID relief payments, perhaps the closest the US has come to a UBI, may now be seen by some conservatives as wasteful spending, but it had a “historic” impact on lifting more families out of poverty.

I’m thrilled that there are 130 guaranteed income programs in places like Stockton (CA), Atlanta, Austin, Chicago, Jackson (MS), Long Beach, NY, Philadelphia, and St. Paul (MN), and the proof is that such programs work. But they are still very few, very little impact.

If some politicians can’t get over their “moral” or political principles against guaranteed income, perhaps the aforementioned studies can help convince them that the improvements in health/healthcare costs associated with such programs are in everyone’s financial interest.

The New Yorker the article quotes Dr. Vicente Navarro, professor emeritus of health and public policy at Johns Hopkins University; “Inequalities are not what kill people. They are responsible for these inequalities that are killing people.’

We are those people. We can do better.

Kim is a former Head of Marketing at Blues Mainstream, editor of the late and lamented Tincture.io, and now a regular contributor to THCB.r:

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