Food Is Medicine? Maybe Money Is Medicine

In Nature Medicine on Friday, a striking new study from Brazil suggested that a conditional cash transfer program might have a strong effect on reducing incidence and mortality from tuberculosis in persons with extreme poverty and disadvantaged ethnic backgrounds. In fact, researchers documented more than a halving of risk. It’s quite popular to argue that food is medicine, but perhaps it might be equally or more true that money is medicine.

First author Gabriela Jesus said these findings should not be surprising:

“We know that the program improves access to food, both in quantity and quality, which reduces food insecurity and malnutrition – a major risk factor for TB – and strengthens people’s immune defences as a result. It also reduces barriers to accessing healthcare.”

Conditional Cash Transfers

These researchers conducted a careful analysis of the relationship between participating in the world’s largest cash transfer program (the Bolsa Família Program or BFP) and tuberculosis incidence and deaths. Of course, this is observational, not experimental, research. But the analysis is robust and the authors are quite clear about their limitations. The authors noted:

“Even with different methodological approaches, BFP effect estimates were still strong and statistically significant.”

Professor Seema Jayachandran explains the design of the BFP:

“The philosophy of conditional cash transfers was to break the cycle of poverty by investing in the younger generation. And it’s through two prongs: One is making sure they get educated, they grow up healthy with access to health care. And then the second is giving the family money so that they can have better food or school uniforms.”

Suggestive, Not Definitive Evidence

So what we have is evidence that is strongly suggestive, but not definitive, for supporting the thought that money might be as essential as medicine for overcoming tuberculosis.

This is similar to the evidence for cash transfers to reduce the risk of overweight and obesity. A recent systematic review concluded that the evidence is not yet robust:

“Overall, the studies were suggestive that CT programs either have no impact or decrease the risk of overweight and/or obesity in children, adolescents, and adults, but no firm conclusions can be drawn from the available evidence.”

We are living in a time of economic disparities that are greater than they have been for a century. As those disparities have risen, we have seen a parallel rise in obesity and other health conditions related to nutrition.

This is a difficult challenge to meet, but ignoring the effects of social and economic stress on health outcomes would be unwise. Especially if we wish to overcome obesity.

Click here for the TB study from Nature Medicine and here for the systematic review of cash transfers in obesity prevention. For further perspective, click here, here, and here.

Soldiers at the Gare de l’Est Rail Station, painting by Maximilien Luce / WikiArt

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January 5, 2025