Led by partners Dr. Mona Hanna-Attisha at the MSU-Hurley Pediatric Public Health Initiative and Dr. Luke Shaefer, faculty director of the University of Michigan’s Poverty Solutions center, Rx Kids is a transformational effort to address child poverty and health equity. 

Consistent with practices in other countries, Rx Kids boldly tackles a root cause of health disparities: poverty. A first-of-its-kind program, Rx Kids will provide unconditional cash allowances to pregnant moms and babies in Flint.

Rx Kids—a first-in-the-nation program—is the solution to uplifting babies and young children out of poverty and into better health. In partnership with health care providers and community-engaged outreach, Rx Kids plans to prescribe all expectant mothers in Flint a one-time prenatal allowance ($1,500) and all infants (0-1 year) monthly allowances ($500/month). What sets Rx Kids apart from existing cash allowance programs is its intentional impact on maternal and infant health outcomes at a community level. 

The anticipated reach of Rx Kids within the City of Flint during the intervention period (2024-2028) is over 6,000 families.

“Rx Kids is something that has never been done before,” says Hanna-Attisha. “It is a citywide effort to disrupt poverty and improve health equity. Flint is the poorest city in the state. Our child poverty rates are about three times state and national averages and families are most poor when the babies are just born. Right before birth and in that first year of life, poverty spikes.

“And for me as a pediatrician, that is maddening because that is the same time that child development is the most critical. Babies' brains actually double in size in that first year of life and that's when families are the poorest. It's so frustrating that we just band-aid so many problems that are associated with poverty and that we don't do something preventative.

“I was tired of shrugging my shoulders, and I was tired of band-aiding. We do big things. We do hard things. Why not prescribe something that can lift our families out of poverty during this most critical time of child development? That's how the idea was born. We're going to give every pregnant mom in Flint a prenatal allowance, and then every baby until the age of 12 months will get a monthly cash allowance.

“This is huge and transformative and has never been done before at a citywide level. There are a lot of great pilots across the country with sample sizes of 100 or 200, but this is big. This is going to be for the whole city. There are about 1,200 babies born in Flint a year, which is one of the reasons we can do this in Flint. It's a small big city. We also have great need, and we also have this built academic community partnership and this long history of the university investing in this city humbly working with community partners to do big things to improve health equity and to reduce disparities.”

Why are cash allowances the best solution?

“Families tend to know what they need the most,” says Shaefer. “Some families need food, some families need help paying the rent, some families need it for childcare, and some families need it to buy books and toys to help kids thrive. This is the beauty of cash. Milton Friedman was a huge proponent of using cash to help families, and it just empowers families. A couple of the other pieces of the puzzle on this is sometimes we have programs that only serve very poor families. We have other programs that serve middle class families. Part of the vision of Rx Kids that starts with Dr. Mona is that we're going to serve all the kids. Raising kids is expensive and it's hard. Society has a reason to come alongside parents in that work.

“We're going to do something simple and come alongside all the families. And by doing that, we don't risk making it a stigmatized program that somehow is a marker that we're only giving it to families who aren't making it or aren't able to make ends meet that says something about them not being able to do that.

“The messaging is incredibly different. We have seen cash allowances repeatedly, all around the world, work for families. And we've learned so many interesting things. There are some countries where we've been able to see as child benefits roll out, alcohol and tobacco spending among parents goes down. Sometimes people worry that there might be some folks who don't use the money in the right way. But in this case, it looks like probably because sometimes substance use is a reaction to stress and not having enough money is a big stressor that the effect is the opposite. We have all of that evidence, and we can bring it to bear on this program and do something in the United States that we have never done before.”

How will Rx Kids change the trajectory of childhood poverty in Flint?

“We think it's going to impact those critical maternal and infant health outcomes first,” continues Hanna-Attisha. “We think more folks will go to their prenatal visits and get connected with all the interventions and services in that space. That's going to improve birth outcomes like birth weight and prematurity and infant mortality and maternal morbidity, all these important and very costly health outcomes.

“We think it's going to increase and support that relationship between moms and babies and their medical provider, both at prenatally and in the pediatric space like improving well visits, immunization rates, and necessary screenings and developmental things that happen there. We think for adults and parents, we're going to see decreased stress, which is seen throughout these kinds of programs. We're going to look at things like substance abuse, but also, we're going to measure things like happiness and hope and dignity and trust in government and institutions.

“It's fair to say that in places like Flint, there's not much trust in government for many reasons, for longstanding neglect and disinvestment and systemic inequities. And we're hoping we will be able to measure an increase in that social contract between those critical institutions and the people who have been neglected for so long. This might play out with increased civic engagement, increased voting rates, increased engagement in neighborhood clubs, and participation in all kinds of different things. Some of my favorite things that we're going to measure are things at a community level because this has never been done at a community level.

“What's going to happen to things like population stability? Are fewer people going to leave Flint? Will people move into Flint? These dollars are going to largely be spent in the community, and that's going to be an economic jolt for the community that's going to benefit all kinds of people, including local businesses and small businesses.

“There are a whole slew of things that we're going to look at, and a lot of them are short term. We'll be able to see findings right away, but a lot will take years and maybe decades to play out. How does this impact things like kindergarten readiness and third grade reading and economic productivity and chronic disease rates and life expectancy? If you really lean on that science of early childhood, we understand that milieu of early childhood really portends life course trajectories. And if we can build a nutrient rich environment in early childhood, we think we'll be able to impact those life course outcomes for decades and maybe generations to come.”

Talk about some challenges and opportunities as you work towards these goals.

“One is actually how you distribute the money,” continues Shaefer. “We are incredibly lucky to be working with Give Directly, which is the international leader on how to do that exactly right. And they've done cash transfers like this all over the world. They've learned how to communicate with folks very clearly in an accessible way and how to troubleshoot. We’re doing a ton of planning on this. The community infrastructure in Flint is stronger than any other place that I've ever worked. People are really communicating with each other and in sync with each other. That is what makes it possible.

“We do have a lot of social welfare programs. They often do a little of this or a little of that. A lot of them are incredibly important. Those programs don't always work together as well as they should. Sometimes it seems like they're built up in silos. We're lucky to have great partners at the State of Michigan that are really helping us to figure out how to make sure somebody's food assistance isn't impacted, for example, by receiving this transfer where they wouldn't end up any better off than they were before.”

“The biggest challenge right now is raising the dollars we need to make this happen,” Hanna-Attisha says. “We are honored and humbled by the $15 million challenge grant from the Mott Foundation. We have to raise another $15 million to unlock that grant. We have been writing grants and talking to foundations and funders and governments to try to bring in the necessary funds to do this, not just for a few years and not just for five years, but we want to do this for a long time. The most acute challenge right now is raising the dollars, and I'm confident that we will be able to raise these dollars and that we will get the match. If folks want to contribute, they can go to FlintRxKids.com. Every bit counts.

“We hope to have this go live in 2024. And just like everything that we've done in Flint, it hasn't been about Flint, it's been about kids and communities everywhere. Even now, before we even started this program, we're already thinking about how we can make sure that every kid in Michigan and in this country benefits from Rx Kids.

“Another thing that I love about this program is it's being led by two folks from two different institutions that don't often get along. This is another great example of how folks can come together for a common purpose. And the team that we're rooting for is team kids. And both our public universities have amazing strengths and assets, and this is one of the great examples where this community-based work on behalf of moms and babies is for a higher purpose than what happens on those Saturday football games.”

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