‘An infusion of joy’: How a Flint pediatrician hopes to improve health and dismantle poverty

Updated, 10: 09 a.m., 4/30/23

Dr. Mona Hanna-Attisha often wakes up not to the sound of an alarm clock these days, but from being too “giddy and excited” to sleep.

“I literally can’t stop smiling,” Hanna-Attisha said.

In Flint, where systemic racism and governmental failures left the Black-majority city to drink lead-contaminated water beginning in 2014 — a crisis that Hanna-Attisha’s research helped to expose — the pediatrician is now feeling immense hope for a place and people she so deeply loves. 

Likely beginning in 2024, every Flint resident who is pregnant will be eligible to receive direct cash payments during their pregnancy and throughout the first year of their child’s life as part of a new program led by Hanna-Attisha.

As long as it secures the necessary funding to launch, the Rx Kids program will work to improve residents’ health by alleviating poverty in Michigan’s poorest city through providing a total of $7,500 in cash to Flint families. That includes a one-time $1,500 payment to expectant individuals in midpregnancy, which will be followed by $500 payments per month for the first year of a child’s life. Extensive research has found that poverty and low-income status are associated with a long list of health issues, including shorter life expectancy and higher rates of infant mortality, asthma, depression, and substance abuse.

There will be no income requirement or means testing for the program; the only requirement for eligibility will be that the pregnant person is a Flint resident. Rx Kids is a collaboration between Michigan State University and University of Michigan and has secured up to $15 million from the Flint-based Charles Stewart Mott Foundation.

For a city where the childhood poverty rate is approximately 50% — and where 35.5% of the entire city lives in poverty — according to federal data, those funds could be transformational and empower people in a place where there has been a severe erosion of trust in government and hope for the future can be difficult to come by, Hanna-Attisha said.

“I literally see it as an infusion of joy,” Hanna-Attisha said of the Rx Kids program. “Hope is hard to find in places like Flint, not only because of what we’ve gone through in the last years but because of the longstanding inequities and longstanding lost trust in government and in institutions designed to keep people safe and healthy.

“I see this as a renewal of the social contract; I see it as an ability for that trust to be rebuilt,” added Hanna-Attisha, the associate dean for public health and a public health professor at MSU’s College of Human Medicine. 

In a city that has been poisoned because of government action — the water crisis began after emergency managers appointed by Republican Gov. Rick Snyder in 2014 tried to save money by switching the city’s water supply from Detroit to the Flint River without implementing anti-corrosion treatments — this program could be instrumental in building bridges between citizens and those meant to represent them, Hanna-Attisha said.

“We’re sending this message that society, institutions and government are walking alongside families during this really difficult time, and we trust and believe in you,” said Hanna-Attisha, who is also the founding director of the MSU-Hurley Children’s Hospital Pediatric Health Initiative, which launched to mitigate the impact of the Flint water crisis. “It restores trust and dignity.”

Fueled by what’s known as a $15 million “challenge” grant from the Flint-based Charles Stewart Mott Foundation, the Rx Kids program needs to secure at least another $15 million in order to receive the funding from the Mott Foundation. Hanna-Attisha and others involved with the program are working to secure at least $55 million in order to run the program for five years — during which time she hopes the initiative will become a blueprint for public policy and programs state- and nationwide.

That this blueprint will stem from Flint is especially empowering for residents who have long been disenfranchised, said H. Luke Shaefer, who is the director of U of M’s Poverty Solutions initiative and is partnering with Hanna-Attisha to launch Rx Kids.

“This is something where Flint becomes a leader for the nation; that’s a really powerful thing,” Shaefer said. 

“We’ve already spent time at the White House, at the U.S. Capitol, in Lansing, and I’ve never had a project like this where people get this happy,” Shaefer said. “I’ve been working in poverty for a long time, and I think the design of this and values imbued in it are fundamentally different than other efforts.” 

When first thinking about a program like Rx Kids, Hanna-Attisha initially contacted Shaefer because of his work around alleviating poverty in the country. 

“I’m sick of Band-Aid-ing; I want to address child poverty,” Hanna-Attisha said. “For so long people have shrugged at that. Then, as a nation we did with the child tax credit expansion.” 

Shaefer, who has long championed the idea of governments providing direct financial assistance to residents as a way to fight poverty, led research that found federal programs, like the child tax credit expansion, resulted in people faring far better during the COVID-19 pandemic than initially feared. According to federal data, the expanded child tax credit lifted 2.9 children from poverty nationwide.

The expanded child tax credit was temporarily provided by the federal government as part of a COVID-19 relief deal in 2021. That expanded tax credit, which has since ended nationwide, allowed more low-income families, including those with no income at all, to claim up to $3,600 for each child up to age 6, and up to $3,000 per child ages 6 to 17. For the first time, families received the child tax credit funds in monthly installments. 

For Hanna-Attisha and Shaefer, it was important to them to not have income requirements as part of their program, in large part because it significantly increases access to the program by eliminating hoops that residents would need to jump through in order to receive funding. 

“This is a bold, innovative way to build on the pandemic programs,” Hanna-Attisha said. “…We’re not talking about picking a few winners, like other pilots; every expectant mom is eligible.”

Providing that funding in a way that gives families agency on how to spend it has been proven to be incredibly effective in reducing poverty in other countries that have adopted similar initiatives, Shaefer noted. South Korea, Japan, the Czech Republic, Austria and Denmark, for example, offer mothers 52 weeks or more of paid leave. Cities across the U.S., like Los Angeles and Atlanta, have also begun piloting programs that provide a guaranteed income to some residents, though many of those programs have income requirements.

“Country after country have adopted programs like this, not just for infants but for families all through childhood; every time that happens, poverty plummets,” Shaefer said. “I really think of child benefits as evidence-based policy.”

That money without strings attached means families can choose to spend it on whatever they need most, from rent and groceries to childcare and transportation.

“What a lot of families in places like Flint really need is cash, particularly new moms and babies in households that don’t have access to enough cash,” said Neal Hegarty, vice president of programs at the Mott Foundation.

Like Hanna-Attisha and Shaefer, Hegarty said the no-strings-attached aspect of the program is crucial and will alleviate poverty by not restricting access to funds. That doesn’t mean that people with millions of dollars will be using a program they don’t need but rather that lower-income individuals who may have been dissuaded from applying for a program with a lot of requirements will be able to benefit from it, those involved with the initiative said.

“Flint residents, like everybody else, deserve the best that life can offer, and far too often they are getting the short end of the deal,” Hegarty said.

It’s that idea that those involved with Rx Kids cite time and again: The people of Flint have largely not known a world in which they are supported. More often, they have known a world in which it seems as though their own government has waged a war on them. 

Now, however, is a time when Flint residents could not only benefit from a pilot program meant to empower them but will lead the country in research that could help to entirely transform poverty nationwide.

As part of their efforts, Hanna-Attisha noted that they are “going to measure hope and happiness and joy and civic engagement” as part of the Rx Kids initiative. 

The healthier and more financially secure people are, the more able they will be to participate in the world around them, the pediatrician noted. Flint may be known for its water crisis now, but those involved with this program hope that someday they’ll be renowned for dismantling poverty and elevating a city where an ever-increasing number of grassroots advocates are healthy enough to annihilate everything from systemic racism to voter suppression.

“I think this is an effort that will restore democracy and restore things like voting rights because of its community-wide scale,” Hanna-Attisha said.