Financial incentives to promote social mobility

BMJ 2009; 339 doi: (Published 26 August 2009) Cite this as: BMJ 2009;339:b3219
  1. Ian Forde, MRC clinical research training fellow1,
  2. Dagmar Zeuner, consultant in public health2
  1. 1Department of Epidemiology and Public Health, University College London, London WC1E 6BT
  2. 2Hammersmith and Fulham NHS and Council, London W6 9DL
  1. Correspondence to: I Forde i.forde{at}
  • Accepted 5 July 2009

Conditional cash transfer schemes have been shown to improve health and health behaviours in poorer countries. Ian Forde and Dagmar Zeuner wonder whether a similar strategy can work in the UK

As part of its strategy to promote social mobility, the government is piloting a scheme of child development grants.1 Disadvantaged families will be offered up to £200 (€233; $335) as long as they attend and take up services offered by Children’s Centres, including parenting advice, liaison with job centres, and identification of children with special educational needs. The idea is modelled on the conditional cash transfer schemes from Latin America that offer disadvantaged families money if mothers attend parenting seminars, infants attend health check-ups, and other stipulations are met such as compliance with immunisation and school enrolment. Although increasingly imitated, such schemes are controversial because they explicitly intertwine social mobility with behaviour change. Some unfavourable health, education, and nutrition choices cluster with, and partly determine, socioeconomic disadvantage, and engagement with public services is thought to stimulate positive behaviour change. Conditional cash transfer schemes further assume that targeted cash incentives will secure such engagement. The same reasoning underpins the UK government’s child development grants.

Here we consider UK experience in promoting social mobility and behaviour change and review the international evidence on conditional cash transfer schemes to throw light on how such schemes should be designed.

UK programmes

Social mobility, or the degree to which people’s social status changes between generations, can be viewed as a measure of the equality of life opportunities and a reflection of parental influence, individual talents, motivation, and luck.w1 All sources agree on the crucial role of the home environment in early life, such as provision of consistent discipline. Developmental measures are worse in poorer children as early as 22 months and continue to fall …

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