Is Health of the Aging Improved by Conditional Cash Transfer Programs? Evidence From Mexico

Abstract

Conditional cash transfer (CCT) programs link public transfers to human capital investment in the hopes of alleviating current poverty and reducing its intergenerational transmission. Whereas nearly all studies of their effects have focused on youth, CCT programs may also have an impact on aging adults by increasing household resources or inducing changes in allocations of time of household members, which may be of substantial interest, particularly given the rapid aging of most populations. This article contributes to this underresearched area by examining health and work impacts on the aging for the best-known and most influential of these programs, the Mexican PROGRESA/Oportunidades program. For a number of health indicators, the program appears to significantly improve health, with larger effects for recipients with a greater time receiving benefits from the program. Most of these health effects are concentrated on women.

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Fig. 1

Notes

  1. 1.

    The average age of the world population is projected to increase from 28.3 years in 1995 to 32.6 years in 2020 (United Nations 1996). Among the major world regions, LAC is projected to have the greatest increase in average age (24.4–31.0), followed by Asia (25.2–30.4), Europe and North America (35.2–39.0), and finally Africa (24.7–28.2) (Behrman et al. 2003).

  2. 2.

    PROGRESA is an acronym for the original name of the program (Programa de Educacíon, Salud y Alimentacíon; Program for Education, Health and Nutrition) introduced by the Zedillo government. When the Fox government came into power after the 2000 election, some aspects of the program were modified (e.g., coverage of grants at the high school level, and extension into more urban areas) and renamed “Oportunidades.”

  3. 3.

    These include a variety of approaches, such as exploiting the original experimental design to estimate enrollment effects (Schultz 2004) and transition matrices for entering, exiting, progressing, and repeating school grades (Behrman et al. 2005); using matching estimators for longer-run effects (Behrman et al. 2009, 2011); using sibling estimators to control for unobserved family background (Parker et al. 2009); and using structural models based on the baseline data and validated by the experiment to explore counterfactual policies (Attanasio et al. 2011; Todd and Wolpin 2006).

  4. 4.

    For example, Behrman and Hoddinott (2005), Gertler (2004), and Rivera et al. (2004) presented estimates of the impact on early childhood growth. For summaries and reviews of many of the studies undertaken of PROGRESA/Oportunidades, see Behrman and Skoufias (2006), Levy (2006), Levy and Rodriguez (2004), Parker et al. (2008), and Skoufias (2004).

  5. 5.

    In the longer run, aging household members also may benefit from increased income earned by younger (present or former) household members because of their enhanced human resources induced by the program. However, not enough time had passed for such effects to be observed in the data that we use for this article.

  6. 6.

    Most previous studies of PROGRESA/Oportunidades have used the experimental design and concentrated on the short-run program impacts before the experimental design ended. Diaz and Handa (2006) presented estimates informative for our study that are successful at replicating PROGRESA/Oportunidades short-term impacts on school and work, using nonexperimental methods (cross-sectional matching).

  7. 7.

    In 2006, a pension for the elderly was added to the program, providing a monthly payment to each adult aged 70 or older who is part of a PROGRESA/Oportunidades family, equal in 2006 to 250 pesos monthly (about 22 USD). The data that we use and analyze were collected before the introduction of this pension.

  8. 8.

    Rubalcava et al. (2009) suggested that providing transfers to women in the PROGRESA/Oportunidades program shifts the distribution of household expenditure toward investment in the future, but we are unaware of any evidence on how transfers to elderly females versus younger females may affect household spending.

  9. 9.

    The comparison T1998 versus T2000 is slightly different than the other two comparisons in that it is based on comparing two groups receiving the program, with one receiving benefits for a longer time than the other, whereas the other two comparisons are with respect to a comparison group that has never received benefits. Thus, smaller impacts in the T1998 versus T2000 comparison might be expected both because of a smaller differential in time receiving the program and because receiving the program may allow the T2000 group to “catch up” to the T1998 group.

  10. 10.

    Attrition is the result of both migration and mortality. Comparing T1998 versus T2000, we estimate the impact of the program on mortality for the population aged 50 and older at baseline and find that although the T1998 group has slightly lower mortality levels, these differences are not statistically significant. We cannot do the same for the C2003 sample because we do not have good information on who in the C2003 sample was in the household in 1997 and thus cannot construct measures of mortality and attrition for the C2003 sample.

  11. 11.

    The localities that were included in the sampling frame for C2003 were initially selected by matching on locality characteristics. This first matching procedure to determine the comparison group localities from which households were sampled is distinct from the finer matching that we perform to obtain our estimates, which uses both household- and individual-level data in selecting the matches.

  12. 12.

    In addition to women receiving the transfers, girls in school receive higher grants than boys at the postprimary school levels, and there is an important prenatal and postnatal health component.

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Acknowledgements

This project was supported by Grant Number P30-AG-012836 from the National Institute on Aging. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Aging or the National Institutes of Health. An earlier version of this article was commissioned by the National Academy of Science Panel on the Social Determinants of Adult Health and Mortality: Phase II. The authors alone are responsible for all contents of this article. We thank three anonymous referees for useful comments.

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Correspondence to Susan W. Parker.

Appendix

Appendix

Table 9 Estimated impacts of PROGRESA/Oportunidades on health and worka: Men and women ages 50 and older pre-program. Robustness: Nearest-neighbor matching and local-linear regression matching. T1998 versus C2003

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Behrman, J.R., Parker, S.W. Is Health of the Aging Improved by Conditional Cash Transfer Programs? Evidence From Mexico. Demography 50, 1363–1386 (2013). https://doi.org/10.1007/s13524-013-0199-z

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Keywords

  • Health
  • Aging
  • Conditional cash transfers
  • Mexico