Can Guaranteed Income Improve Health?

This article was originally published in Hopkins Bloomberg Public Health magazine,

When the Stockton, California, city government gave $500 a month for two years to a group of randomly selected residents in a low-income neighborhood—no conditions attached—the impact reached beyond the recipients’ pocketbooks.

Researchers studying Stockton’s pilot program found that regular payments, begun in 2019, stabilized families’ finances and boosted full-time employment. But they also found that many of the 150 participants also showed improved mental health outcomes, including decreased depression and anxiety, and increased energy and emotional well-being. And researchers found that over two years of the program, participants moved from “likely to have a mild mental health disorder” to “likely mental well-being” on a scale that measures psychological distress. Some recipients said they felt well enough to stop taking anti-anxiety drugs.

As more communities experiment with guaranteed income as an anti-poverty policy, epidemiologists are particularly interested in the effects such programs may have on the persistent health problems that often afflict people living in poverty. We do.

lessons from stockton

One year into the program, participants’ outcomes include …

  • 28% to 40% had full-time jobs before the program
  • 46.4% fluctuation in monthly income (the control group reported 67.5% fluctuation)
  • 38%—the average portion of participants’ monthly payments used for food
  • 22.7% – Average portion of monthly payments used for merchandise
  • 11.2%—the average portion of a monthly payment used for auto care
  • Less than 1% – Average share of monthly payment for alcohol

“I see guaranteed income as a policy solution to issues of structural racism and economic inequality, yet the links to health are unclear for high-income countries like the US,” says Lorraine T. Dean, an associate professor in epidemiology who expect to get more health information from a guaranteed income pilot launched in Baltimore this fall.

Guaranteed Income is based on the belief that people know best what they need to improve their lives. Instead of vouchers for government-defined essential items, participants receive regular, unconditional cash transfers for whatever they want: rent, car payments, insurance co-pays, etc. — but prom dresses or birthday cake. Things like that too, points out Savely Sangun, an epidemiology PhD student who worked with the dean and who helped advocate for the California Guaranteed Income Pilot Project, a new program that would distribute grants to pilot programs across the state.

“Guaranteed income provides an opportunity for governments and public health agencies to re-imagine how our systems can work better for people than what they think is good for them,” says Snagon. . “This is an important paradigm shift that is not new to the public health values ​​of prioritizing lived experiences and offering tools so that communities can make the best decisions for themselves.”

Snguon says the policy challenges the notion that people in poverty are “lazy” to work, or that they will spend money on things like alcohol.

Instead, preliminary studies have found that full-time employment increased among guaranteed income recipients and that participants spent excessively on food, utilities, transportation needs and household items.

Most guaranteed income programs are targeted to particular populations, potentially making it a powerful tool for addressing income inequality and systemic inequities, Snguon and Dean explain.

That’s why Baltimore, with its own entrenched inequalities caused by redlining and other discriminatory policies, is a ripe candidate for a guaranteed income program, the researchers say.

Baltimore Mayor Brandon Scott’s office began exploring a guaranteed income program last year and partnered with Mayors for a Guaranteed Income, which works with more than 80 cities that have launched similar pilots.

“Guaranteed income gives people the resources to invest in their happiness or save for their future. It humanizes people and is part of creating a more compassionate security system that recognizes that people have needs that we always Can’t point.”

Sewli Sangun

epidemiology phd student

Ultimately, the group decided to design Baltimore’s pilot for a group particularly hard-hit during the pandemic: young parents ages 18-24 who live at or below 300% of the federal poverty level. – About $69,000 for a family of three.

The Baltimore Young Families Success Fund, as it has been dubbed, will be administered to 200 applicants drawn from a lottery and funded through the American Rescue Plan and private donors. Calling the project a “$6 million investment in the future of our city,” Scott’s office says the money will pay dividends by boosting the economy and reducing spending on other safety-net services.

“These are usually families with beautiful young children, so something like this can change the whole trajectory of a child’s life,” says Alexandra Smith, Baltimore’s assistant deputy mayor for Equity, Health and Human Services. “Having a source of guaranteed income for 24 months can give parents the confidence to be able to plan. They can take a half-day off from work and afford to go to job interviews that are close to their Might be better for.” family.”

During the program’s onboarding process, parents shared some of their dreams. One mother said $1,000 a month could allow her to attend flight attendant training and start a new career. Others said money would prevent them from choosing between things like clothes for their children and paying the electricity bill.

Many families said the money would give them the freedom to move out of the shelter or their relative’s home and into their own place. About 14% of the pilot’s applicants were homeless.

Through the pilot, city officials and researchers from the Bloomberg School (and their partners from the University of Pennsylvania and ABT Associates) will examine the impact of guaranteed income on young families’ economic status as well as their overall health and well-being.

Through data collected in self-reported surveys, researchers will measure reported changes in housing, employment, debt and food insecurity, as well as reported changes in stress, sleep, energy, hope and self-esteem.

The Baltimore program will highlight any changes in the well-being of the entire family, reflected in childcare, quality time spent with children, and any unmet health needs.

Hopefully, the researchers say, these new data points will help reshape the national conversation around safety net programs.

“Guaranteed income gives people the resources to invest in their happiness or save for their future,” Snagun said. “It humanizes people and is part of building more compassionate safety net systems that recognize that people have needs that we can’t always pinpoint.”

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