The Chances-6 research programme, led by the LSE’s Care Policy Evaluation Centre, has been analysing the impact of conditional cash transfers in youth mental health and future life chances in six low- and middle-income countries over the past four years. This is the second blog in the series that summarizes the findings and gives a closer look at the experience of two Latin American countries: Brazil and Colombia. We highlight the need to adopt an intersectoral approach and broaden the way anti-poverty programmes are currently conceptualized.
Anti-poverty programmes and mental health: is there an impact?
There is an intrinsic and bidirectional linkage between social disadvantage and poor mental health – both as a cause and as a consequence –, which has been supported by substantial research. Initiatives such as The Lancet Commission on Global Mental Health and Sustainable Development summarise the evidence and analyse the interactions between mental health and these social determinants. These types of initiatives aim to improve mental health for whole populations and to reduce the overall contribution of mental distress to the Global Burden of Disease.
In this context, the Chances-6 research programme emerged. This initiative aims to understand the dynamics between poverty, mental health, and the future life chances of young people from economically deprived backgrounds. It is led by the LSE’s Care Policy Evaluation Centre (CPEC) and it involves analysis of data across six low- and middle-income countries in Latin America and Africa: Brazil, Colombia, Mexico, South Africa, Liberia, and Malawi.
As part of this project, an international and interdisciplinary research team analysed whether existing welfare programmes could provide a vehicle to improve youth mental health and life chances, especially considering that 61% of the world’s poor are under 24 years of age. They focused on the most popular anti-poverty policy in low- and middle-income countries today: cash transfers. This policy emerged 25 years ago in Latin America as an alternative to anti-poverty top-down programmes, which were often perceived as inefficient and poorly targeted. It consists of transferring relatively small amounts of cash to poor households, often with conditions such as pre-specified investments in the human capital of their children, focusing on health and education. For example, common conditionalities are educational attendance, immunizations, and health checks. Cash transfers aim to mitigate current and immediate poverty while reducing its inter-generational transmission.
It is important to note that mental health problems constitute one of the most important global health challenges of our time. They account for 16% of the global burden of disease and injury in people aged 10–19 years, and in 2021 they were the leading cause of years lived with disability for those under 20 years of age. Moreover, amidst the COVID-19 pandemic, the overall number of cases of mental health problems rose exponentially worldwide, with depression and anxiety reporting an additional 76.2 million and 53.2 million cases respectively.
So, could cash transfer programmes provide a vehicle to improve youth mental health and life chances? How could they be used to optimize the mental health and life chances of young people, especially in a post-pandemic world?
To provide a forum to discuss these issues, the findings of Chances-6 were presented on March 29th at an LSE student event, with presenters from the CPEC, LSE, and partner institutions in Brazil, Colombia, and South Africa, as well as a panel of students from the LSE, King’s College London, Mackenzie University in Sao Paulo, the University of Los Andes in Bogota, and the University of Cape Town.
The experience of Latin America
Brazil: Bolsa Família Programme
Focusing on Latin America, quantitative and qualitative results of the research carried out in Brazil evidenced that participation in the Bolsa Família Programme (BFP) – the biggest cash transfer initiative in the country – was not enough to improve youth’s mental health.
Interpretation of this null association between programme participation and improved mental health outcomes is consistent with the fact that young people living in poverty are at a higher risk of developing mental health problems. They tend to have high rates of mental health diagnoses, low socio-emotional competences, and are exposed to stressful life events, such as community and domestic violence. None of these risk factors are adequately addressed by BFP. A quote by a young woman who was interviewed by the research team is particularly illustrative in this regard:
“I think poverty for the people is not having anything to eat. But for me, it’s more of a health issue… I don’t know how to explain it (laughs). Like I’m poor, but I’m fine and I have my family. I eat every day. For me, poverty is when you die inside, not just when you starve yourself. Yeah, when you die inside. When you don’t care about anyone or anything. For me this is poverty. It’s because, when a person goes through this, he tries to get help and people don’t help. He ends up affecting himself inside, dying inside, with depression, stuff like that.” (Female, 19, Sao Paulo)
Colombia: Familias en Acción & Jóvenes en Acción programmes
Additionally, quantitative and qualitative analyses of the effects of “Familias en Acción” and “Jóvenes en Acción” on adolescent mental health in Colombia were presented. The findings evidenced positive outcomes only on externalizing behaviours – such as interpersonal relationships – rather than on internalizing behaviours – such as anxiety, fear, and sadness.
Furthermore, the qualitative interviews with the beneficiaries showed a sample split of about 50:50 on whether programme participation had a positive effect on mental health. Those who agreed with the proposition said that cash transfers do give hope, provide stress relief, and allow time for leisure activities. On the other hand, those who disagreed with the proposition stated that the programme does not provide access to mental healthcare nor mitigates mental health stigma and that it only provides a small relief and does not change the structural conditions of poverty. For example, a participant highlighted the way in which poverty negatively affects perceived self-worth:
“There are days when we don’t believe in anything anymore, we don’t want to have life or anything anymore. We are afraid to search [for a job] because we think we don’t know how to talk… If I say something wrong in a job interview, suddenly I feel that they will throw stones on me. Why am I going to do this if I can stay here all day in my house with anxiety? This makes us not want to get out of bed or anything” (Male, 20, Bogota)
Cash transfers represent an important policy opportunity to reduce poverty and promote development. However, growing evidence – including Chances-6 findings – show that they on their own are insufficient for improving mental health significantly.
A targeted approach is needed to improve youth mental health, including complementary psychosocial interventions to adequately address the social determinants of mental distress.
These determinants do not only include the economic domain, but also other domains such as demographics (sex, age, ethnicity); neighbourhood (water and sanitation, housing, and community infrastructure); environment (exposure to violence, natural disasters, war, and migration); and sociocultural aspects (social capital, culture, social support, and education).
This approach to addressing the dynamics between poverty and mental health is compatible with Amartya Sen’s conceptualization of development as the expanding of human freedoms. It is crucial to understand poverty as a reality that goes far beyond the lack of money. It is about structural life conditions that limit people’s life chances and development opportunities, especially among young people. Let’s not forget to address this reality as global health and development practitioners.
The views expressed in this post are those of the authors and in no way reflect those of the Global Health at LSE Blog or the London School of Economics and Political Science.
Photo by Youth Dynamics