Financial support may not improve health of low-income children in rich countries

Lucas P, McIntosh K, Petticrew M, Roberts HM, Shiell A

Published Online:

July 16, 2008

The association between low income and poor outcome in all dimensions of child health is strong and consistent across countries and time. Disadvantage in childhood is often associated with lifetime poor outcomes. This review aimed to assess whether additional monies provided to socially or economically disadvantaged families could affect children's health, well-being and educational attainment. Nine studies were identified that met inclusion criteria. There was tentative evidence of benefit in early language development, but given lack of effect on all other outcomes authors conclude that the evidence did not show an effect on child outcomes in the short to medium term in response to direct financial benefits to families. In the context of the monetary value of interventions observed, and the conditions placed on receipt of benefits authors conclude this is a statement of "no evidence of effect" rather than of "evidence of no effect". Implications for research and practice are noted.

Abstract (click to read)

Background:

A strong and consistent relationship has been observed between relative poverty and poor child health and wellbeing even among rich nations. This review set out to examine evidence that additional monies provided to poor or disadvantaged families may benefit children by reducing relative poverty and thereby improving children's health, well-being and educational attainment.

Objectives:

To assess the effectiveness of direct provision of additional monies to socially or economically disadvantaged families in improving children's health, well-being and educational attainment

Search strategy:

In total 10 electronic databases were searched including the Cochrane library searched 2006 (Issue 1), Medline searched 1966 to May 2006 , Econlit searched 1969 to June 2006 and PsycINFO searched 1872 to June 2006, together with 3 libraries of working papers (MDRC, SSRN, SRDC). The general search strategy was [terms for income and financial benefits] and [paediatric terms] and [RCT filter]

Selection criteria:

Studies selected provided money to relatively poor families (which included a child under the age of 18 or a pregnant woman), were randomised or quasi-randomised, measured outcomes related to child health or wellbeing and were conducted in a high income country.

Data collection and analysis:

Titles and abstracts identified in the search were independently assessed for eligibility by two reviewers. Data were extracted and entered into RevMan, synthesised and presented in both written and graphical form (forest plots).

Main results:

Nine trials including more than 25,000 participants were included in this review. No effect was observed on child health, measures of child mental health or emotional state. Non-significant effects favouring the intervention group were seen for child cognitive development and educational achievement, and a non-significant effect favouring controls in rates of teenage pregnancy.

Authors' conclusions:

The review set out to examine the potential of financial support to poor families to improve circumstances for children. However, on the basis of current evidence we can not state unequivocally whether financial benefits delivered as an intervention are effective at improving child health or wellbeing in the short term. Our conclusions are limited by the fact that most of the studies had small effects on total household income and that while no conditions were attached to how money was spent, all studies included strict conditions for receipt of payments. We note particular concerns by some authors that sanctions and conditions (such as working hours) placed on families may increase family stress.

This record should be cited as:

Lucas P, McIntosh K, Petticrew M, Roberts HM, Shiell A. Financial benefits for child health and well-being in low income or socially disadvantaged families in developed world countries. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD006358. DOI: 10.1002/14651858.CD006358.pub2

Assessed as up to date:

July 3, 2006

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Primary Review Group:

Developmental, Psychosocial and Learning Problems Group

Health topics:

Developmental, psychosocial, and learning problems > Other

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Financial support may not improve health of low-income children in rich countries

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