In 2015, Dr Mona Hanna-Attisha alerted the world that children were being poisoned by lead in the water of her home town of Flint, Michigan. Now, as Flint marks the 10-year anniversary of the crisis, she’s set her sights on another target: the underlying poverty that she says allowed it to all happen.
“For a long time, I have literally wished for the ability to prescribe an antidote to poverty,” Hanna-Attisha said. Study after study has shown poverty-related stress and lack of resources can damage everything from babies’ physical health to children’s abilities to learn and later thrive in careers. In Flint, which has a majority Black population, an astounding 47.6% of children live in poverty, according to a 2022 analysis of census data.
In January Hanna-Attisha launched RX Kids, a program that gives new moms one year of guaranteed, no-questions-asked income. Through a combination of state and philanthropic funding, all pregnant and new moms – regardless of income – in Flint are eligible for a one-time payment of $1,500 during their pregnancy and $500 a month for the first year of their baby’s lives.
“It’s about not being OK with poisoned water and it’s about not being OK with babies growing up in poverty,” Hanna-Attisha said.
On 25 April 2014, the near-bankrupt city of Flint, then under emergency management by the state, switched its water supply to draw from the Flint River in what was supposed to be a money-saving move. The water was not property treated to avoid corrosion, allowing lead from the city’s pipes to leach into the water supply and into the mouths of children.
In 2015, Hanna-Attisha obtained blood test results, revealing that the percentage of young children with above-average amounts of lead in their blood doubled – and, in some areas, tripled – after the switch.
Since then, a flood of attention has flowed to the community to replace lead service lines and provide wraparound services to children affected by exposure.
But the devastating health impacts of poverty persist. In her pediatric clinic at Michigan State University, Hanna-Attisha has seen children taken away from their parents because the family had no money for heat or food. In one case, a mother couldn’t bring in her tiny, four-day-old premature baby for a checkup because she had to return to work.
“Poverty has been linked to almost everything that is related to health,” said Hanna-Attisha, naming malnutrition and obesity from lack of access to healthy food to toxic stress and trauma from family separation. “I see it in the bodies of my children. And I see it in their health, but most importantly, I see it in their potential.”
Luke Shaefer, a University of Michigan social work professor who co-directs the RX Kids program with Hanna-Attisha, said that they had initially hoped to design a program that would guarantee income to all families with young children, but that proved prohibitively expensive.
So they focused on the first year, which is statistically shown to be the hardest on family finances.
“Income really starts to decline for families a couple of months before birth, as expectant moms are able to work less, and it stays low for the first year,” Shaefer said. “When you start to combine that with the added expenses of bringing on new family members, you have this sort of perfect storm of increased poverty.”
Maddeningly, he said, this hits in the months that are the most critical for child development.
Hanna-Attisha and Shaefer have raised $43m of the $55m they need to run the program for five years. “We’ve already enrolled about 550 moms and prescribed over a million dollars of cash,” said Hanna-Attisha.
RX Kids taps into existing federal funds through the Temporary Assistance for Needy Families program (Tanf), and most of the rest of the funding comes from philanthropic grants.
‘The first light of hope’
Teagan Medlin, 25, remembers showering in the discolored Flint water when she was a teenager and has always wondered how it might have affected her.
Now she is the mother of a three-month-old and has been in recovery from drug addiction for 14 months. For her, the RX Kids program ended up being the key to reuniting her young family.
Her older children, a four-year-old boy and three-year-old girl, had been removed from her care and sent to live with a grandparent before she started recovery. She was working at a dollar store last year, but lost her job when she became sick during her recent pregnancy. She has stable housing through her drug recovery program, but the court required her to prove she could pay for basic necessities before returning her older children to her.
“I was really afraid,” she said. “How am I supposed to get my kids back if I don’t have any income?”
Medlin described RX Kids as “the first light of hope”. She’s gotten her children back and will soon train to become an addiction recovery coach. “It sort of gave you a foothold to where you could build a life for yourself and your kids.”
Tatiana Lopez-Marshall and her husband, Michael Marshall, both have jobs at Hurley hospital – Tatiana as a patient representative and Michael in the kitchen’s nutrition program. Yet they too were struggling to make ends meet after their son Matteo was born.
They can’t afford daycare, so Michael scaled back his hours at the hospital to stay with Matteo and his two older siblings. Tatiana wasn’t sure at first whether she could afford to take the full 12 weeks of maternity leave allotted by federal law.
Then they received their first RX Kids payment. “This could not have come at a better time,” said Tatiana, who was able to take leave and have enough left over to buy diapers, clothes and a new baby mattress for the baby, as well as the new brakes and tires they needed for their car. “I really wasn’t sure what I was going to do.”
The program mirrors direct payment programs that offset the cost of raising children around the world, including in the UK, the Netherlands, Australia, Canada and Hungary.
Several studies have shown that these programs – a form of universal basic income – pay off. In Manitoba, Canada, a similar program was shown to reduce pre-term birth and low birth weight. Researchers in the US found that cash transfers to families reduced food insecurity and unstable housing for children, both which correlate to poor health outcomes. A 2022 study by Columbia University researchers found that every $1 provided to supplement the incomes of families with a tax credit for children would result in $10 in eventual benefits to society, including reduced infant mortality, less need for child welfare services and decreased crime.
In February, Michigan’s governor, Gretchen Whitmer, allotted $24m to communities that “identify innovative approaches to support expectant parents and newborns”, a move Hanna-Attisha and Shaefer hope will help RX Kids expand across the state – and inspire similar programs around the nation.
“Our goal was never just about Flint,” said Hanna-Attisha. “This was about creating a replicable kind of playbook of how to do this in other places.”
