Are conditional cash incentive schemes effective and desirable public health interventions?

Can giving poor families money or free food on condition their children regularly attend school and their local health centre improve their health? That is the idea behind an increasingly popular government programme across the world. The hope is that as well as improving families‘ income, the cycle of poverty that often continues from one generation to the next will be broken by raising children that are healthier and better educated. This research will try to find out whether these programmes actually meet their aims, and if so, whether any elements are critical to their success and might be copied more widely.

This research is important because improvement in families‘ health will not be achieved through medical technology alone. And for the worst off families, who typically suffer more illness, we need to know what policies are most likely to improve their health and how to deliver them, both in the UK and abroad.

The research uses information collected from Colombia and will be carried out by the Department of Public Health and Epidemiology at University College London. The Department has an outstanding track record at investigating the causes of ill health, both in the UK and internationally.

Introduction: An outstanding need in public health is to identify effective social interventions to improve health and reduce health inequality. Econometric techniques to analyse complex and non-randomised programmes may have novel application to public health interventions in this regard. Conditional cash transfer schemes (CCTS) are new programmes in middle-income countries which offer disadvantaged families cash or food incentives if they comply with fixed conditions, such as minimum school attendance and regular antenatal care. They may, however, worsen health outcomes, in particular childhood obesity. In the UK conditional cash incentive schemes are well established for doctors and school pupils, but not for patients. We are on the cusp of seeing the idea of patient incentives enter the national health policy arena.

Aim: To determine whether conditional cash incentive schemes are effective and desirable public health interventions.

Design: Analysis of panel data from Familias, a Colombian CCTS comprising data from 40,340 individuals over three surveys; acquisition of new childhood obesity variables as the programme expands.

Objectives and methods: 1) to evaluate the health impact of Familias, through regression analysis, applying and appraising econometric methods such as instrumental variables regression; 2) to acquire and analyse new data on childhood obesity, childrens‘ dietary and activity patterns and dimensions of inequality over two phases during the urban expansion of Familias; 3) to critically review the role of patient incentives to reduce health inequalities in high income countries, through literature review and engagement with the UK Government, the King‘s Fund and other bodies.

Scientific opportunities: A key aspect of this proposal is its interdisciplinary nature. Experimental designs are often impossible in public health research and economists have an array of techniques to evaluate complex social interventions that are little used by epidemiologists. This proposal gives me training in these and other methods. I will critically appraise their utility for epidemiological research. Research output will include: development of novel methodological approaches for evaluating the impact of complex social interventions; greater understanding of the role of patient cash incentives as tools to tackle health inequalities in high incomes countries and peer reviewed methodological and analysis papers.