Abstract
BackgroundSocioeconomic disadvantage is a fundamental cause of morbidity and mortality. One of the most important ways that governments buffer the adverse consequences of socioeconomic disadvantage is through the provision of social assistance. We conducted a systematic review of research examining the health impact of social assistance programs in high-income countries.MethodsWe systematically searched Embase, Medline, ProQuest, Scopus, and Web of Science from inception to December 2017 for peer-reviewed studies published in English-language journals. We identified empirical patterns through a qualitative synthesis of the evidence. We also evaluated the empirical rigour of the selected literature.ResultsSeventeen studies met our inclusion criteria. Thirteen descriptive studies rated as weak (n = 7), moderate (n = 4), and strong (n = 2) found that social assistance is associated with adverse health outcomes and that social assistance recipients exhibit worse health outcomes relative to non-recipients. Four experimental and quasi-experimental studies, all rated as strong (n = 4), found that efforts to limit the receipt of social assistance or reduce its generosity (also known as welfare reform) were associated with adverse health trends.ConclusionsEvidence from the existing literature suggests that social assistance programs in high-income countries are failing to maintain the health of socioeconomically disadvantaged populations. These findings may in part reflect the influence of residual confounding due to unobserved characteristics that distinguish recipients from non-recipients. They may also indicate that the scope and generosity of existing programs are insufficient to offset the negative health consequences of severe socioeconomic disadvantage.
Highlights
IntroductionOne of the most important ways that governments buffer the adverse consequences of socioeconomic disadvantage is through the provision of social assistance
Socioeconomic disadvantage is a fundamental cause of morbidity and mortality
The overall results of our systematic review suggest that evidence on the health impacts of social assistance remains patchy
Summary
One of the most important ways that governments buffer the adverse consequences of socioeconomic disadvantage is through the provision of social assistance. Decades of epidemiological research has demonstrated that socioeconomic resources such as wealth, income, and employment – often referred to as the social determinants of health – are “fundamental causes” of health inequalities [1, 2]. They are fundamental in the sense that they influence the everyday conditions, experiences, and exposures that influence health status. Social assistance refers to government programs that provide a minimum level of income support to individuals and households living in poverty. Theory predicts that social assistance programs offer an important means of protecting the health of socioeconomically disadvantaged groups and mitigating the extent of socioeconomic health inequalities [9, 10]
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