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Toward a science of delivering aid with dignity
How can governments and nonprofits design aid programs that afford dignity and facilitate beneficial outcomes for recipients? We conceptualize dignity as a state that manifests when the stigma associated with receiving aid is countered and recipients are empowered, both in culturally resonant ways. Yet materials from the largest cash transfer programs in Africa predominantly characterize recipients as needy and vulnerable. Three studies examined the causal effects of alternative aid narratives on cash transfer recipients and donors. In study 1, residents of low-income settlements in Nairobi, Kenya (N = 565) received cash-based aid accompanied by a randomly assigned narrative: the default deficitfocused “Poverty Alleviation” narrative, an “Individual Empowerment” narrative, or a “Community Empowerment” narrative. They then chose whether to spend time building business skills or watching leisure videos. Both empowerment narratives improved self-efficacy and anticipated social mobility, but only the “Community Empowerment” narrative significantly motivated recipients’ choice to build skills and reduced stigma. Given the diverse settings in which aid is delivered, how can organizations quickly identify effective narratives in a context? We asked recipients to predict which narrative would best motivate skill-building in their community. In study 2, this “local forecasting” methodology outperformed participant evaluations and experimental pilots in accurately ranking treatments. Finally, study 3 confirmed that the narrative most effective for recipients did not undermine donors’ willingness to contribute to the program. Together these studies show that responding to recipients’ psychological and sociocultural realities in the design of aid can afford recipients dignity and help realize aid’s potential.
Journal Article
The Deserving Poor, the Family, and the U.S. Welfare System
Contrary to the popular view that the U.S. welfare system has been in a contractionary phase after the expansions of the welfare state in the 1960s, welfare spending resumed steady growth after a pause in the 1970s. However, although aggregate spending is higher than ever, there have been redistributions away from non-elderly and nondisabled families to families with older adults and to families with recipients of disability programs; from non-elderly, nondisabled single-parent families to married-parent families; and from the poorest families to those with higher incomes. These redistributions likely reflect longstanding, and perhaps increasing, conceptualizations by U.S. society of which poor are deserving and which are not.
Journal Article
Social Welfare as Small-Scale Help: Evolutionary Psychology and the Deservingness Heuristic
Public opinion concerning social welfare is largely driven by perceptions of recipient deservingness. Extant research has argued that this heuristic is learned from a variety of cultural, institutional, and ideological sources. The Present article provides evidence supporting a different view: that the deservingness heuristic is rooted in psychological categories that evolved over the course of human evolution to regulate small-scale exchanges of help. To test predictions made on the basis of this view, a method designed to measure social categorization is embedded in nationally representative surveys conducted in different countries. Across the national- and individual-level differences that extant research has used to explain the heuristic, people categorize welfare recipients on the basis of whether they are lazy or unlucky. This mode of categorization furthermore induces people to think about large-scale welfare politics as its presumed ancestral equivalent: small-scale help giving. The general implications for research on heuristics are discussed.
Journal Article
Population Health Impact and Cost-Effectiveness of Community-Supported Agriculture Among Low-Income US Adults: A Microsimulation Analysis
Objectives. To estimate the population-level effectiveness and cost-effectiveness of a subsidized community-supported agriculture (CSA) intervention in the United States. Methods. In 2019, we developed a microsimulation model from nationally representative demographic, biomedical, and dietary data (National Health and Nutrition Examination Survey, 2013–2016) and a community-based randomized trial (conducted in Massachusetts from 2017 to 2018). We modeled 2 interventions: unconditional cash transfer ( $300/year) and subsidized CSA ($ 300/year subsidy). Results. The total discounted disability-adjusted life years (DALYs) accumulated over the life course to cardiovascular disease and diabetes complications would be reduced from 24 797 per 10 000 people (95% confidence interval [CI] = 24 584, 25 001) at baseline to 23 463 per 10 000 (95% CI = 23 241, 23 666) under the cash intervention and 22 304 per 10 000 (95% CI = 22 084, 22 510) under the CSA intervention. From a societal perspective and over a life-course time horizon, the interventions had negative incremental cost-effectiveness ratios, implying cost savings to society of – $191 100 per DALY averted (95% CI = –$ 191 767, – $188 919) for the cash intervention and –$ 93 182 per DALY averted (95% CI = – $93 707, –$ 92 503) for the CSA intervention. Conclusions. Both the cash transfer and subsidized CSA may be important public health interventions for low-income persons in the United States.
Journal Article
The Impact of Medicaid on Labor Market Activity and Program Participation: Evidence from the Oregon Health Insurance Experiment
In 2008, a group of uninsured low-income adults in Oregon was selected by lottery for the chance to apply for Medicaid. Using this randomized design and 2009 administrative data, we find no significant effect of Medicaid on employment or earnings. Our 95 percent confidence intervals allow us to reject that Medicaid causes a decline in employment of more than 4.4 percentage points, or an increase of more than 1.2 percentage points. Medicaid increases food stamps receipt, but has little, if any, impact on receipt of other measured government benefits, including SSDI.
Journal Article