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Logo of jepicomhInstructions for authorsCurrent TOCJournal of Epidemiology and Community Health
J Epidemiol Community Health. Nov 1999; 53(11): 725–730.
PMCID: PMC1756807

Randomised studies of income supplementation: a lost opportunity to assess health outcomes

Abstract

BACKGROUND: Despite the wealth of evidence linking low income to ill health, there is little information from randomised studies on how much and how quickly these risks can be reversed by improvements in income. OBJECTIVE: To conduct a systematic review of randomised studies of income supplementation, with particular reference to health outcomes. DESIGN: Extensive searches of electronic databases and contact with previous authors. As well as searching for trials that were specifically designed to assess the effects of increased income, studies of winners and losers of lotteries were also sought: if winning is purely chance, such studies are, in effect, randomised trials of increased income. RESULTS: Ten relevant studies were identified, all conducted in North America, mostly in the late 1960s and 1970s. Five trials were designed to assess the effects of income supplementation on workforce participation and randomised a total of 10,000 families to 3- 5 years of various combinations of minimum income guarantees and reduced tax rates. Two trials were designed to assess re-offending rates in recently released prisoners and randomised a total of 2400 people to 3-6 months of benefits. One trial was designed to assess housing allowances and randomised 3500 families to three years of income supplements. One trial assessed the health effects of 12 months of income supplementation in 54 people with severe mental illness. Finally, one study compared three groups of people who won different amounts of money in a state lottery. In all these studies the interventions resulted in increases in income of at least one fifth. However, no reliable analyses of health outcome data are available. CONCLUSIONS: Extensive opportunities to reliably assess the effects of increases in income on health outcomes have been missed. Such evidence might have increased the consideration of potential health effects during deliberations about policies that have major implications for income, such as taxation rates, benefit policies, and minimum wage levels. Randomised evidence could still be obtained with innovative new studies, such as trials of full benefit uptake or prospective studies of lottery winners in which different sized winnings are paid in monthly installments over many years.

 

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Selected References

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  • Smith GD, Bartley M, Blane D. The Black report on socioeconomic inequalities in health 10 years on. BMJ. 1990 Aug 18;301(6748):373–377. [PMC free article] [PubMed]
  • Adler NE, Boyce WT, Chesney MA, Folkman S, Syme SL. Socioeconomic inequalities in health. No easy solution. JAMA. 1993 Jun 23;269(24):3140–3145. [PubMed]
  • McDonough P, Duncan GJ, Williams D, House J. Income dynamics and adult mortality in the United States, 1972 through 1989. Am J Public Health. 1997 Sep;87(9):1476–1483. [PMC free article] [PubMed]
  • Stevens-Simon C, Dolgan JI, Kelly L, Singer D. The effect of monetary incentives and peer support groups on repeat adolescent pregnancies. A randomized trial of the Dollar-a-Day Program. JAMA. 1997 Mar 26;277(12):977–982. [PubMed]
  • Skaer TL, Robison LM, Sclar DA, Harding GH. Financial incentive and the use of mammography among Hispanic migrants to the United States. Health Care Women Int. 1996 Jul-Aug;17(4):281–291. [PubMed]
  • Vinokur AD, van Ryn M, Gramlich EM, Price RH. Long-term follow-up and benefit-cost analysis of the Jobs Program: a preventive intervention for the unemployed. J Appl Psychol. 1991 Apr;76(2):213–219. [PubMed]
  • Elesh D, Lefcowitz MJ. The effects of the New Jersey-Pennsylvania Negative Income Tax Experiment on health and health care utilization. J Health Soc Behav. 1977 Dec;18(4):391–405. [PubMed]
  • Thoits P, Hannan M. Income and psychological distress: the impact of an income-maintenance experiment. J Health Soc Behav. 1979 Jun;20(2):120–138. [PubMed]
  • Lafave HG, de Souza HR, Prince PN, Atchison KE, Gerber GJ. Partnerships for people with serious mental illness who live below the poverty line. Psychiatr Serv. 1995 Oct;46(10):1071–1073. [PubMed]
  • Mulrow CD. Rationale for systematic reviews. BMJ. 1994 Sep 3;309(6954):597–599. [PMC free article] [PubMed]
  • Thompson Dennis. The ethics of social experimentation: the case of the DIME. Public Policy. 1981 Summer;29(3):369–398. [PubMed]
  • Roos NP. Contrasting social experimentation with retrospective evaluation: a health care perspective. Public Policy. 1975 Spring;23(2):241–257. [PubMed]
  • Oakley A. Experimentation and social interventions: a forgotten but important history. BMJ. 1998 Oct 31;317(7167):1239–1242. [PMC free article] [PubMed]

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