American health policymakers have an opportunity to learn from their Latin American peers how to successfully address this challenge.
There has been a growing consensus in the public health community about social determinants of health, with poverty being recognized as the “cause of the causes.” Economists who have studied poverty have recognized that key drivers of poverty include not just financial constraints but also limited human capital investments as well as a lack of economic empowerment among women.
Part of the reason poor people remain poor is that their subjective beliefs about the value of health visits and educational attainment are not in line with the actual long-term value of these investments, which can lead to reduced investments in their own and the next generation’s health and skill accumulation.
Hence, lack of knowledge about the true long-term potential and value of human capital investments can cause poor people to remain impoverished and others to fall into poverty.
Conditional cash transfer (CCTs) programs, which first started in Latin America but now have spread throughout the globe, aim to directly address these factors. CCTs give periodic cash handouts to women in poor households, conditional upon their adherence to a set of requirements, such as ensuring that their children regularly attend school or that the women make regular health-care visits (particularly if they are pregnant or nursing).
CCTs serve as a direct mechanism for improving maternal and child health by increasing uptake of health-care services by the marginalized, helping make progress toward universal health-care utilization.
In addition, by giving cash to women — who are more likely to spend it on health-care needs for themselves and their children than are men — CCTs indirectly help reduce financial barriers with respect to consumption of nutritious foods and transportation to health-care facilities.
When women in turn use the cash to invest in their own businesses or in other assets, this can lead to a more sustainable stream of future cash flow. Furthermore, school enrollment may have long-term effects by enabling children to become more skilled for the labor market and improving their expected lifetime earnings, which increases the chances that they will escape poverty and makes them less vulnerable to health crises.
Recent reviews of CCTs have found that these programs have in fact lead to decreases in short-term poverty, increased health-care utilization and increased schooling.
In terms of long-term change, some studies of the oldest CCT programs in Latin America have found promising results, particularly with regard to schooling. Still, more studies need to be done on how CCTs impact final health outcomes, paying particular attention to the pathways through which they may affect participants, including the role of empowering women in improving their own health and the health of future generations.
This will enable policymakers — here in the U.S. and around the world — to continue to learn and focus on the most important components for crafting successful programs to improve maternal and child health and reduce poverty.