Which strings attached: Ethical considerations for selecting appropriate conditionalities in conditional cash transfer programmes

Carleigh B. Krubiner, Maria Merritt

Research output: Contribution to journalArticle

Abstract

Conditional cash transfers (CCTs) present a promising approach to simultaneously tackle chronic poverty and poor health. While these programmes clearly embody beneficent aims, questions remain regarding the ethical design of CCTs. Limited guidance exists for the ethical evaluation of the defining feature of these programmes: the conditionalities. Drawing upon prominent public health ethics frameworks and social justice theories, this paper outlines five categories of morally relevant considerations that CCT programme designers should consider when assessing which behaviours or outcomes they select as conditionalities for payment: (1) likelihood of yielding desired health outcomes, (2) risks and burdens, (3) receptivity, (4) attainability and (5) indirect impacts and externalities. When evaluating potential conditionalities across these five categories of considerations, it is important to recognise that not all beneficiaries or subgroups of beneficiaries will fare equally on each. Given that most CCTs aim to reduce inequities and promote long-term health and prosperity for the most disadvantaged, it is critical to apply these considerations with due attention to how different segments of the beneficiary population will be differentially affected. Taken on balance, with due reflection on distributional effects, these five categories represent a comprehensive set of considerations for the moral analysis of specific conditionalities and will help ensure that CCT designers structure programmes in a way that is both morally sound and effective in achieving their goals.

Original languageEnglish (US)
Pages (from-to)167-176
Number of pages10
JournalJournal of Medical Ethics
Volume43
Issue number3
DOIs
StatePublished - Mar 1 2017

Fingerprint

Health
Social Justice
Vulnerable Populations
Poverty
Ethics
health
Public Health
prosperity
social justice
pricing
public health
Population
moral philosophy
Strings
Conditionality
poverty
evaluation
Beneficiaries
Designer
Social Theory

ASJC Scopus subject areas

  • Health(social science)
  • Issues, ethics and legal aspects
  • Arts and Humanities (miscellaneous)
  • Health Policy

Cite this

Which strings attached : Ethical considerations for selecting appropriate conditionalities in conditional cash transfer programmes. / Krubiner, Carleigh B.; Merritt, Maria.

In: Journal of Medical Ethics, Vol. 43, No. 3, 01.03.2017, p. 167-176.

Research output: Contribution to journalArticle

@article{0032df56b32c45cc8c3f35cb4a9766d1,
title = "Which strings attached: Ethical considerations for selecting appropriate conditionalities in conditional cash transfer programmes",
abstract = "Conditional cash transfers (CCTs) present a promising approach to simultaneously tackle chronic poverty and poor health. While these programmes clearly embody beneficent aims, questions remain regarding the ethical design of CCTs. Limited guidance exists for the ethical evaluation of the defining feature of these programmes: the conditionalities. Drawing upon prominent public health ethics frameworks and social justice theories, this paper outlines five categories of morally relevant considerations that CCT programme designers should consider when assessing which behaviours or outcomes they select as conditionalities for payment: (1) likelihood of yielding desired health outcomes, (2) risks and burdens, (3) receptivity, (4) attainability and (5) indirect impacts and externalities. When evaluating potential conditionalities across these five categories of considerations, it is important to recognise that not all beneficiaries or subgroups of beneficiaries will fare equally on each. Given that most CCTs aim to reduce inequities and promote long-term health and prosperity for the most disadvantaged, it is critical to apply these considerations with due attention to how different segments of the beneficiary population will be differentially affected. Taken on balance, with due reflection on distributional effects, these five categories represent a comprehensive set of considerations for the moral analysis of specific conditionalities and will help ensure that CCT designers structure programmes in a way that is both morally sound and effective in achieving their goals.",
author = "Krubiner, {Carleigh B.} and Maria Merritt",
year = "2017",
month = "3",
day = "1",
doi = "10.1136/medethics-2016-103386",
language = "English (US)",
volume = "43",
pages = "167--176",
journal = "Journal of Medical Ethics",
issn = "0306-6800",
publisher = "BMJ Publishing Group",
number = "3",

}

TY - JOUR

T1 - Which strings attached

T2 - Ethical considerations for selecting appropriate conditionalities in conditional cash transfer programmes

AU - Krubiner, Carleigh B.

AU - Merritt, Maria

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Conditional cash transfers (CCTs) present a promising approach to simultaneously tackle chronic poverty and poor health. While these programmes clearly embody beneficent aims, questions remain regarding the ethical design of CCTs. Limited guidance exists for the ethical evaluation of the defining feature of these programmes: the conditionalities. Drawing upon prominent public health ethics frameworks and social justice theories, this paper outlines five categories of morally relevant considerations that CCT programme designers should consider when assessing which behaviours or outcomes they select as conditionalities for payment: (1) likelihood of yielding desired health outcomes, (2) risks and burdens, (3) receptivity, (4) attainability and (5) indirect impacts and externalities. When evaluating potential conditionalities across these five categories of considerations, it is important to recognise that not all beneficiaries or subgroups of beneficiaries will fare equally on each. Given that most CCTs aim to reduce inequities and promote long-term health and prosperity for the most disadvantaged, it is critical to apply these considerations with due attention to how different segments of the beneficiary population will be differentially affected. Taken on balance, with due reflection on distributional effects, these five categories represent a comprehensive set of considerations for the moral analysis of specific conditionalities and will help ensure that CCT designers structure programmes in a way that is both morally sound and effective in achieving their goals.

AB - Conditional cash transfers (CCTs) present a promising approach to simultaneously tackle chronic poverty and poor health. While these programmes clearly embody beneficent aims, questions remain regarding the ethical design of CCTs. Limited guidance exists for the ethical evaluation of the defining feature of these programmes: the conditionalities. Drawing upon prominent public health ethics frameworks and social justice theories, this paper outlines five categories of morally relevant considerations that CCT programme designers should consider when assessing which behaviours or outcomes they select as conditionalities for payment: (1) likelihood of yielding desired health outcomes, (2) risks and burdens, (3) receptivity, (4) attainability and (5) indirect impacts and externalities. When evaluating potential conditionalities across these five categories of considerations, it is important to recognise that not all beneficiaries or subgroups of beneficiaries will fare equally on each. Given that most CCTs aim to reduce inequities and promote long-term health and prosperity for the most disadvantaged, it is critical to apply these considerations with due attention to how different segments of the beneficiary population will be differentially affected. Taken on balance, with due reflection on distributional effects, these five categories represent a comprehensive set of considerations for the moral analysis of specific conditionalities and will help ensure that CCT designers structure programmes in a way that is both morally sound and effective in achieving their goals.

UR - http://www.scopus.com/inward/record.url?scp=85028234113&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85028234113&partnerID=8YFLogxK

U2 - 10.1136/medethics-2016-103386

DO - 10.1136/medethics-2016-103386

M3 - Article

C2 - 27707877

AN - SCOPUS:85028234113

VL - 43

SP - 167

EP - 176

JO - Journal of Medical Ethics

JF - Journal of Medical Ethics

SN - 0306-6800

IS - 3

ER -