“This is How We're Supposed to Care for Each Other.” Direct Giving Initiative Tackles Poverty in Flint


You may not recognize the name Mona Hanna-Attisha, but you’ve certainly heard of her work. Hanna-Attisha is the pediatrician who first identified the Flint water crisis and brought it to the attention of the Flint community and the world.

Now Hanna-Attisha has a new project: an ambitious plan to tackle poverty in the city of Flint. The program, called Rx Kids, will provide expectant mothers $7,500 in direct cash payments. To create the program, Hanna-Attisha, who is the Associate Dean for Public Health and C. S. Mott Endowed Professor of Public Health at Michigan State University College of Human Medicine, teamed up with H. Luke Shaefer. Shaefer is a professor of social work at the University of Michigan and the inaugural director of Poverty Solutions, which works with communities and policymakers to prevent and alleviate poverty. Shaefer, along with Katheryn Edin, co-authored “$2.00 a Day: Living on Almost Nothing in America,” has conducted wide-ranging research on poverty, presented his findings at the White House and other government agencies, and has testified before the U.S. Senate. 

Rx Kids will launch with funds from the Charles Stewart Mott Foundation, which is providing a three-year, $15 million matching commitment. Mott is the first funder to step up so far, but Hanna-Attisha and Shaefer said they’ve had interest from an array of local and national philanthropies. It’s just the latest example of a philanthropy-backed effort to test the viability and impact of direct cash payments or universal basic income. The practice has drawn increasing attention, especially during the COVID-19 pandemic, when both the federal government and private funders embraced distributing cash as a way to soften the blow of economic hardship.

Regular cash payments can be used to stop the bleeding, but they can also have lasting impacts. For Hanna-Attisha, who directs the Pediatric Public Health Initiative, poverty is as much a healthcare issue as lead in drinking water, which is itself a product of structural economic inequality. At the individual and family level, poverty leads to any number of negative health impacts resulting from lack of care, poor nutrition, stress, trauma and more. It is something Hanna-Attisha has been wanting to tackle for a long time in her home city of Flint, which has among the highest rates of poverty in the country.

“Much of my work as a pediatrician is making sure the kid in front of me is healthy,” she said. “But more importantly, my job as a pediatrician — and really, our job as a society — is to make sure that kids have the brightest, healthiest future possible. We’ve always known that poverty is bad for your health, but the science is increasingly clear in terms of what happens when you’re born into and grow up in poverty. And when it’s early in life and it’s deep and concentrated and all your neighbors are poor, too, poverty can absolutely alter your entire life course trajectory. We now know what that does to the bodies and brains of children. I was tired of not having something I could prescribe for this. We can fix it.”

Hanna-Attisha says the fledgling program already has support from many in the Flint community, which was both devastated and galvanized by the water crisis. “There’s a determination in the community to no longer accept the status quo,” she said. “We’re not going to tolerate our kids being poisoned, and we’re not going to tolerate all these other things that make life hard. We do big things, and we do hard things. And we’re going to do this child allowance.”


Rx Kids is a version of what many on the forefront of antipoverty efforts believe is one of the most effective ways to tackle the problem: direct cash assistance, also called guaranteed income or universal basic income when distributed regularly and on a large scale. Different approaches to the same idea are happening in other parts of the country, too; the New York Times reports that, around the country, more than 48 guaranteed income programs have been introduced since 2020. 

Rx Kids will work like this: Expectant mothers will receive a one-time payment of $1,500 in mid-pregnancy, then $500 per month during the first year of their child’s life. Enrollment is expected to begin in 2024. 

When Mona Hanna-Attisha approached Luke Shaefer with the idea, he was eager to get involved. “I’ve watched in country after country as programs like the one Mona is proposing are adopted, and every time, for babies through 18 years old, you see child poverty plummet and food hardship drop, and children and families do better on so many metrics,” Shaefer said. “This is evidence-based policymaking.”

Many experts agree with Shafer, including UNICEF, which has called for universal child benefits to address the 385 million children around the world who live in extreme poverty. “Cash transfers are a proven, practical intervention to address poverty and improve children’s wellbeing across a range of outcomes, including health, nutrition and education,” according to the organization’s website.

Rx Kids will be administered by GiveDirectly, a global NGO established in 2009 by a group of economists who wanted to provide a way for donors to give cash payments to people in need. Since 2009, GiveDirectly has provided over $650 million to 1.4 million people living in poverty. The organization, which started its work in Kenya, has since launched efforts in 14 countries, including the United States. During COVID, its Project 100+ provided support for close to 200,000 American households; it also provides emergency relief in the U.S. and around the globe. GiveDirectly has administered guaranteed income programs in Chicago, Cook County and Georgia.

GiveDirectly has received funding from a number of major philanthropies and philanthropists that support the concept of direct giving, including Charles and Lynn Schusterman Family Philanthropies, which stepped up its efforts during the pandemic, as IP’s Liz Longley reported in 2020. MacKenzie Scott has also supported GiveDirectly’s work, as has Google.org, as IP reported earlier this year. Other funders and partners include Blue Meridian Partners, George Kaiser Family Foundation, GiveWell, and the Wend Collective.

GiveDirectly has also received backing from prominent tech billionaires, including Twitter co-founder Jack Dorsey, and its current owner, Elon Musk, according to a 2022 Forbes report. Disgraced cryptocurrency entrepreneur Sam Bankman-Fried, who has since been charged with defrauding investors, was also a donor, according to Forbes. (Be sure to check out Philip Rojc’s post on why tech donors are drawn to guaranteed income.)

GiveDirectly staff have examined the research on the impact of providing direct cash payments to alleviate poverty, and have also conducted their own. “There has been extensive research both abroad, and now domestically, of these guaranteed income programs,” said Emma Kelsey, senior manager at GiveDirectly. “We’ve seen, across the board, very positive findings about the impact of cash. I think one of the main reasons it’s effective is that it allows people to make the decisions that are best for their families. So one household may need to put money toward rent or getting a more stable home, and another needs it to send their children to school or to get child care.” 

GiveDirectly has worked to counter common assumptions about what happens when people are given cash relief with no strings attached — and it takes them head-on. “And no, people don’t just blow it on booze,” reads a passage on its website. “It’s OK. Many people think that at first.” The organization goes on to challenge these myths by illustrating the many ways individuals choose to use their cash payments: “people use cash on medicine; cows and goats and chickens; school fees; water; solar lights; tin roofs; irrigation; motorcycles to jumpstart taxi services; businesses to generate income; and more.”

In fact, research on Stockton, California’s guaranteed income initiative, which was conducted for two years beginning in 2019, found that participants not only experienced improved mental and physical health, but the economic boost provided the stability many needed to find full-time employment. 

“The A Team”

For the Charles Stewart Mott Foundation, the fact that Mona Hanna-Attisha and Luke Shaefer are leading the Rx Kids initiative made it particularly attractive. As Ridgway White, Mott’s president and CEO, put it, “You always want to bet on the A Team, right?”

Mott was also impressed, White says, by the focus on expectant mothers and newborns. “[Hanna-Attisha and Shaefer] have made a compelling argument that, instead of waiting and taking remedial action, let’s start at the beginning when a baby’s brain grows exponentially, and let’s try to relieve one of the biggest trauma inducers, which is poverty,” he said. “Rx Kids will do that by providing additional resources for mothers and babies in that first year of life.”

Mott is a longtime funder of education, the environment and civil society in the U.S. and around the world, and it has always made Flint, its home base, a priority. White emphasized that Mott’s $15 million commitment is a challenge grant (the announcement describes it as “a one-to-one match that will unlock once Rx Kids raises an additional $15 million from other sources”) and is urging other funders to step up, too. 

“The Mott Foundation supports communities all across the United States and globe, and yet it’s really hard to get other foundations to support us and support our home community,” White said. “I hope that foundations, and the government, will view this as an opportunity to test something that is new and innovative and can have an impact not only in Flint, but hopefully, at some point, on babies across the country.”

When we spoke to Hanna-Attisha and Shaefer recently, they were about to get on a plane for meetings with potential donors, and said more conversations are in the works. They’ve also had communication with and interest from the Biden administration. Like Ridgway White, they believe that Rx Kids could serve as a model for other communities around the country, and hope other funders recognize the potential.

“This isn’t just one silo of philanthropy,” Hanna-Attisha said. “It’s not just early childhood. It’s not just economic justice. It’s community-building, it’s democracy, it’s racial justice, it’s arts and humanities. Hopefully, philanthropies will answer this challenge and be part of this legacy work.” 

For Hanna-Attisha, Rx Kids also represents hope for a community that has been repeatedly let down by institutions that are meant to serve and protect it. “We’re actively looking at how to make this as celebratory as possible, to really share with folks that this is how we’re supposed to care for each other,” she said. “This is how we rebuild the social contract.”