Social Policy Interventions and Health

While reading about CCTs (conditional cash transfers) in this weeks’ material, I was reminded of the first paper I wrote for this class about the different approaches taken to combat homelessness in America. I found the success of CCTs in several Latin American countries pleasantly surprising, because similar programs implemented in the United States were not as successful; a radically different approach has been shown to work instead.

CCTs force the people they help to begin helping themselves before gaining access to funds they need. Parents have to send their kids to school, and if attendance goes down, social workers are sent to check in. This has increased the rates of school attendance, says the article, and kids are learning instead of working in “degrading or hazardous conditions.” The article makes an important point, however, when describing the visits of these social workers when they do have to happen: “the programme emphasizes opportunities for greater well-being, rather than punitive measures for poor performance.”

This is an important distinction to make, because it is precisely the idea of “punitive measures” that has made similar condition-based approaches ineffective when it came to the homeless of America. The 100,000 Homes Campaign is a radical program based on the idea of housing first, a concept that gives homes to the most vulnerable (based on medical history, emergency room visits, etc) with no terms or conditions. In their manifesto, the Campaign says,

“Most homeless people were told they had to earn their way to permanent housing by checking these supplementary boxes [that they were attending job training, addiction counseling, etc].While the intentions behind this approach were good, the unfortunate result was that very few people ever escaped the streets.100,000 Homes communities believe this traditional approach is backwards, and the data agrees with them. Countless studies have now shown that we must offer housing first, not last, if we want to help people out of homelessness.”

Housing first argues that creating a system where recipients must fulfill certain requirements before getting help is “imposing”, and discourages autonomy, which is a key factor in mental health and self esteem. People need the freedom to make their own choices, and when given that freedom, the program argues, those people are more likely to make the right decisions.

So why have conditional-help programs worked for Brazil’s poor families, but not for America’s homeless? Perhaps the data for each must be studied in greater detail- cultural differences could be to blame; or perhaps familial poverty and individual homelessness are different beasts that must be attacked in different ways. Regardless, it is clearly important to have an open conversation about the pros and cons of each approach and how they would help when thinking about implementing social policy and wellness programs.

 

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