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Government social assistance programmes are failing to protect the health of low-income populations: evidence from the USA and Canada (2003–2014)
  1. Faraz Vahid Shahidi1,
  2. Odmaa Sod-Erdene1,
  3. Chantel Ramraj1,
  4. Vincent Hildebrand1,2,
  5. Arjumand Siddiqi1,3
  1. 1 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  2. 2 Department of Economics, Glendon College, York University, Toronto, Ontario, Canada
  3. 3 Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Faraz Vahid Shahidi, Dalla Lana School of Public Health, Social and Behavioural Health Sciences Division, University of Toronto, Toronto, ON M5T 3M7, Canada; faraz.vahidshahidi{at}


Background Social policies that improve the availability and distribution of key socioeconomic resources such as income, wealth and employment are believed to present the most promising avenue for reducing health inequalities. The present study aims to estimate the effect of social assistance recipiency on the health of low-income earners in the USA and Canada.

Methods Drawing on nationally representative survey data (National Health Interview Survey and the Canadian Community Health Survey), we employed propensity score matching to match recipients of social assistance to comparable sets of non-recipient ‘controls’. Using a variety of matching algorithms, we estimated the treatment effect of social assistance recipiency on self-rated health, chronic conditions, hypertension, obesity, smoking, binge drinking and physical inactivity.

Results After accounting for underlying differences in the demographic and socioeconomic characteristics of recipients and non-recipients, we found that social assistance recipiency was associated with worse health status or, at best, the absence of a clear health advantage. This finding was consistent across several different matching strategies and a diverse range of health outcomes.

Conclusions From a public health perspective, our findings suggest that interventions are warranted to improve the scope and generosity of existing social assistance programmes. This may include reversing welfare reforms implemented over the past several decades, increasing benefit levels and untethering benefit recipiency from stringent work conditionalities.

  • health inequalities
  • poverty
  • policy
  • social epidemiology
  • social inequalities
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  • Contributors FVS, OS-E, CR, VH, AS: planned and conceptualised the study. FVS, OS-E: acquired and analysed the data. FVS, OS-E, CR, VH, AS: interpreted the data, wrote the manuscript and revised it critically for intellectual context. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding AS is supported by the Canada Research Chair in Population Health Equity. The study was partially funded by the Ontario Ministry of Community and Social Services.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethics approval was not required, as the study relied on de-identified secondary survey data available publicly through the National Center for Health Statistics (NHIS) or by review and approval through Statistics Canada (CCHS).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement NHIS data are publicly available through the National Center for Health Statistics ( CCHS data are available through formal request by eligible researchers to the Statistics Canada Research Data Centre Network (

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