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Effective givingGlobal health & developmentResearch summaryCash transfers
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This is a linkpost for https://www.nature.com/articles/s41586-023-06116-2

The study was published in Nature on May 31st, 2023.

Key Points:

  • Cash transfer programs had the following observed effects:
    • Deaths among women fell by 20%
      • Largely driven by decreases in pregnancy-related deaths
    • Deaths among children less than 5 fell by 8%
    • No association between cash transfer programs and mortality among men
    • Temporal analyses suggest reduction in mortality among men over time, and specific subgroup analysis (rather than population wide) found a 14% morality reduction among  men aged 18-40
  • 37  low and middle income countries studied, population wide
    • 4,325,484 in the adult dataset
    • 2, 867,940 in the child dataset 
  • No apparent differences between the effects of unconditional and conditional cash transfers
  • Factors that lead to larger reductions in mortality: 
    • Programs with higher coverage and larger cash transfer amounts 
    • Countries with higher regulatory quality ratings
    • Countries with lower health expenditures per capita
    • stronger association in sub-Saharan Africa relative to outside sub-Saharan Africa

 

Citation: Richterman, A., Millien, C., Bair, E.F. et al. The effects of cash transfers on adult and child mortality in low- and middle-income countries. Nature (2023). https://doi.org/10.1038/s41586-023-06116-2

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Lizka6
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Thanks for sharing this, I appreciate it! I'm really excited about the study. 

I haven't read the full study yet, but I came across a Twitter thread by one of the authors, and I thought it was helpful: https://twitter.com/aaronrichterman/status/1663957463291265032?s=46&t=A7sa4lqau2E-U-pxX7DJWQ

Key points from the thread (on top of what you summarized in the post): 

Table with results

We used difference-in-difference models[1] to show these programs led to a 20% reduction in mortality for women, and an 8% reduction in risk of death for children under 5

Image

Mortality reductions in different groups over time

Mortality reductions began within 2 years of program introduction and generally got larger over time

Image

(Can someone make a more easily parsable version of this graphic? The data from the study is publicly available..)

  1. ^

    I didn't know this term, but it's the method that I was imagining. From Wikipedia: [This method] calculates the effect of a treatment [...] on an outcome [...] by comparing the average change over time in the outcome variable for the treatment group to the average change over time for the control group.

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Denis 2
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Thanks for sharing this! 

Cash-transfers are such a promising route to help people, who typically understand what they need far better than we do. 

I suppose the obvious question is whether this can be translated into some unit like WELLBY's/$100K or whatever. Of course the lives saved is only part of what the cash does*, but if we could show that already looking only at that it was competitive, that would be a powerful message. 

I just skimmed the article, it seems very well written (well, it's Nature, it would be!) and I'll read it more carefully later. Some very crude calculations follow: 

The median seems to be 11% of GDP per capita. So if imagine GDP per capita as about $1,626 (representative for Sub-Saharan Africa), then 11% of this is about $140/year. There were 30 million adult person-years, so let's estimate 15 million person-years were for women. Three were 127,000 deaths, so let's assume 64,000 women deaths, which represented a 20% reduction. So 16,000 women's lives were saved with 15 million x $140 = $2,100m, or about $131K/life saved. Given that most of this was related to mortality at birth, we can further assume that these women would live an extra 50 years, so that just on lives saved alone, direct cash-transfers to women in sub-Saharan Africa can deliver about 50/1.31 = about 40 WELLBY's/$100K. Given that this is only a small part of the total impact of cash-transfers (see quote below), this seems like an important validation of direct cash transfers to the poorest people. 

(Very happy to have anyone correct my calculations or show me where someone has done a full analysis of this, I am just trying to get an order-of-magnitude here. Hopefully I didn't miss too many factors of 10 ...) 

 

 

*this is a quote from the article: "Large-scale, government-run cash transfer programmes have been successful in reducing poverty and improving economic autonomy, school attendance, child nutrition, women’s empowerment and health-service use among beneficiaries23,24. A few studies have also documented population-wide effects such as greater economic activity in communities where beneficiaries reside25, and—in the case of infectious diseases such as HIV—reduced new infections following the introduction of cash transfer programmes26. The improvements seen with cash transfers could be driven by the removal of economic and psychological barriers of poverty as a result of receiving cash transfers, as well as spillover effects on non-beneficiaries27,28,29,30,31,32."

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