At the Africa Evidence Summit 2026, held in Nairobi on July 24, 2026, Juba Kafumba, Ph.D., of the University of Malawi and the Transfer Project at the UNC Carolina Population Center, presented research examining the long-term and intergenerational effects of social protection on health among young adults in Malawi. The presentation, titled “Inter-Generational Effects of Income Support on Health among Young Adults in Malawi,” explored whether receiving income support during adolescence could influence physical and mental health many years later, after beneficiaries had reached young adulthood.
The study was presented against the background of a rapidly growing global youth population and the limited evidence available on the long-term effects of social protection programmes on health. Kafumba emphasized that adolescence represents a particularly important stage in human development because experiences during this period can influence health, behaviour, education, employment, and well-being throughout adulthood. However, much of the existing social-protection literature has focused on outcomes measured during the period when programmes are being implemented or shortly thereafter. The study therefore sought to address an important evidence gap by asking whether cash transfers received during adolescence could produce health benefits that persisted well into young adulthood.
Kafumba began by highlighting the demographic significance of young people globally. He noted that approximately 1.8 billion people between the ages of 15 and 29 live around the world, representing approximately 23 percent of the global population. This large and growing youth population makes understanding the factors that shape young people's long-term health and well-being an important development priority.
The presenter explained that adolescence is a particularly sensitive period because it represents a transition between childhood and adulthood during which physical, psychological, and social development accelerates. Poor nutrition, poverty, inadequate access to healthcare, psychosocial stress, and limited economic opportunities during adolescence can have consequences that persist into adulthood.
Despite this, Kafumba observed that most evaluations of social-protection programmes have traditionally concentrated on immediate or short-term outcomes. Researchers have examined whether cash transfers improve household consumption, school attendance, nutrition, or child labour while beneficiaries are receiving support. Much less evidence has examined whether such interventions continue to influence health after young people have left the programme and entered adulthood.
The study therefore sought to move the discussion from the question of whether social protection works in the short term to a broader question of whether income support during adolescence can shape health trajectories over the long term.
Kafumba reviewed several areas in which previous research had documented the effects of social protection. He explained that earlier studies had demonstrated that income-support programmes could influence outcomes related to poverty, education, nutrition, and child labour.
For example, research associated with the Kenya Cash Transfer for Orphans and Vulnerable Children programme had examined poverty-related outcomes. Other studies, including work by Kilburn and colleagues, had examined education, while research by de Groot and colleagues had considered nutrition. De Hoop and Rosati had examined the relationship between social protection and child labour.
However, the presenter emphasized that the evidence concerning long-term health outcomes among young adults remained comparatively limited. In particular, there was little evidence showing whether exposure to social protection during adolescence could affect physical and mental health many years later.
The Malawi study was therefore designed to fill this gap by following individuals who had been exposed to a social cash-transfer programme during adolescence and measuring their health outcomes when they were young adults.
The research focused on Malawi's Social Cash Transfer Programme (SCTP), which is implemented by the Ministry of Gender, Children, Disability and Social Welfare.
Kafumba explained that the programme had been operating since 2013 and remained ongoing. It targeted ultra-poor and labour-constrained households, meaning households that faced severe economic deprivation and had limited capacity to generate labour income.
The SCTP provided an unconditional cash transfer of approximately US$8 per month, with the amount varying depending on household characteristics, including household size and the number of school-age children.
An important characteristic of the programme was that the cash transfer was unconditional. Beneficiary households therefore received financial support without having to meet conditions such as school attendance or participation in particular health services.
The researchers were interested in whether providing this relatively modest but regular income support could generate effects extending beyond immediate consumption and household welfare, particularly among adolescents who were exposed to the programme during an important stage of their development.
The study was based on a cluster randomized controlled trial involving 29 village clusters in Salima and Mangochi districts of Malawi.
Kafumba explained that the research began in 2013, when the baseline sample consisted of young people aged approximately 13 to 19 years. At that stage, eligible households were randomly assigned to treatment or control groups, allowing the researchers to establish a credible basis for estimating the causal effects of SCTP exposure.
The treatment group began receiving the Social Cash Transfer Programme in 2013. A first follow-up was conducted in 2015, when participants were approximately 15 to 21 years old. This first follow-up allowed the researchers to examine the early effects of the programme while participants were still relatively young.
In 2016, the original control group was also brought into the SCTP. This meant that the original treatment group had experienced a longer period of exposure to the programme than the original control group.
The researchers then conducted a major long-term follow-up in 2022, when the participants were approximately 21 to 28 years old. This provided an unusually long observation period for examining whether social-protection exposure during adolescence translated into health outcomes in young adulthood.
The final long-term sample consisted of 2,124 young adults, representing approximately 85 percent retention from the original study population.
One of the most important features of the research was that participants experienced different durations of exposure to the SCTP during adolescence. Some young people had approximately six years of exposure, while others had approximately nine years of exposure.
Kafumba described this as a rare opportunity to examine the long-term effects of adolescent exposure to social protection. Most evaluations of cash-transfer programmes do not have the opportunity to follow participants for such an extended period, particularly from adolescence into young adulthood.
The long-term follow-up also revealed significant changes in participants' lives. By 2022, approximately 55 percent of young adults had moved into a different household from the one in which they had lived at baseline.
This finding was important because it demonstrated that many participants had transitioned into new social and economic circumstances by young adulthood. Some had formed new households, moved for employment or other opportunities, or otherwise changed their living arrangements. The researchers therefore had to consider whether the effects of adolescent social protection persisted even after young people moved away from the original households that had received the cash transfers.
The study was organized around four major research questions.
First, the researchers sought to determine whether exposure to the Social Cash Transfer Programme during adolescence improved physical and mental health in young adulthood.
Second, they examined whether the effects differed between young men and young women.
Third, the researchers wanted to identify which specific health outcomes were responsible for any overall effects observed in the physical-health and mental-health indices.
Finally, the study examined the potential pathways or mechanisms through which adolescent income support could influence health many years later.
These pathways could potentially include improved nutrition, reduced household stress, increased access to healthcare, improved living conditions, greater educational opportunities, reduced economic insecurity, and changes in household decision-making.
To estimate the effects of SCTP exposure, the researchers used ordinary least squares (OLS) regression models. The main outcomes included a physical-health index, a mental-health index, and individual health indicators.
The analysis incorporated treatment status as the principal explanatory variable and adjusted for a range of pre-treatment characteristics. These included individual, caregiver, and household characteristics, as well as district-level administrative-area fixed effects.
Standard errors were clustered at the village-cluster level, reflecting the clustered nature of the original randomized intervention.
The researchers also carefully examined attrition. Kafumba reported that the study achieved approximately 85 percent retention at the 2022 follow-up. Importantly, there was no significant evidence of differential attrition between treatment and control groups across baseline characteristics. This strengthened confidence that the long-term comparison remained credible despite the passage of nearly a decade.
The study used a broad set of health indicators to capture both physical and psychological well-being.
Physical health was measured through indicators including blood pressure and hypertension, body mass index (BMI), disability status, ability to perform activities of daily living, and self-rated health.
The researchers also measured several dimensions of mental health. These included perceived stress, assessed using the Cohen Perceived Stress Scale (PSS-10), and depression, measured using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D).
In addition, the researchers measured quality of life using an eight-item scale.
By incorporating multiple indicators rather than relying on a single measure, the study aimed to capture the multidimensional nature of health and determine whether social-protection exposure affected particular aspects of physical or psychological well-being.
Before presenting the estimated effects of the SCTP, Kafumba highlighted a striking feature of the health data: the relatively high prevalence of elevated blood pressure among the young adults in the study.
The study found that approximately 38 percent of participants had high blood pressure at the 2022 follow-up. The presenter compared this figure with an estimated prevalence of approximately 22 percent among people of a similar age in the United States.
The findings also revealed differences by sex. Among the study participants, approximately 34 percent of women and 41 percent of men were reported to have high blood pressure, according to the figures presented.
The comparison highlighted the growing importance of non-communicable diseases and cardiovascular risk among young adults in low- and middle-income countries. High blood pressure is often associated with older populations, but the study demonstrated that elevated blood pressure could already be widespread among young adults in Malawi.
The finding also reinforced the importance of examining long-term health outcomes rather than focusing exclusively on short-term indicators such as household consumption or school attendance.
Kafumba emphasized that the long-term perspective was one of the study's most important contributions. Social-protection programmes are often evaluated based on whether they immediately reduce poverty or improve education, nutrition, or other welfare indicators. However, the effects of economic support may accumulate over time.
For adolescents, an increase in household resources could potentially influence the quality and quantity of food they consume, their ability to remain in school, their exposure to stressful economic circumstances, access to healthcare, and their future employment opportunities. These changes could then influence health behaviours and health conditions years later.
The study therefore sought to determine whether the benefits of income support could persist beyond the period of direct programme exposure and extend into young adulthood.
The research was particularly important from a life-course perspective because it examined how economic conditions during adolescence could shape health later in life.
The presenter emphasized that adolescence should not be viewed simply as a temporary transition between childhood and adulthood. Instead, it is a period during which social, economic, behavioural, and health trajectories can become established.
If income support during this period produces lasting improvements in physical and mental health, then social protection could have implications that extend well beyond poverty reduction. It could potentially contribute to a healthier and more productive adult population.
The study also raised broader questions about whether investments in young people can generate benefits that extend across generations, particularly when improved health, education, and economic opportunities influence the well-being of future households and children.
The study presented important implications for policymakers in Malawi and other African countries considering the design and expansion of social-protection programmes.
First, the findings highlighted the importance of considering long-term health outcomes when evaluating cash-transfer programmes. A programme may generate benefits that are not immediately visible during the intervention period but become apparent years later.
Second, the research demonstrated the value of longitudinal evidence. Following individuals from adolescence into young adulthood allows researchers to understand whether short-term improvements translate into lasting changes in health and well-being.
Third, the study highlighted the potential for social protection to contribute to health policy objectives. If income support during adolescence affects later physical and mental health, cash-transfer programmes could potentially be viewed as part of a broader investment in human capital rather than simply as anti-poverty measures.
Finally, the high prevalence of elevated blood pressure among young adults suggested that social-protection and health policies may need to pay greater attention to non-communicable disease risks among younger populations, particularly in settings undergoing rapid economic and demographic change.
In conclusion, Juba Kafumba's presentation demonstrated the importance of examining the long-term consequences of social protection for young people's health. By following more than 2,100 Malawian participants from adolescence into young adulthood, the study provided a rare opportunity to investigate whether exposure to cash transfers during a formative period of life could have consequences many years later.
The research was particularly significant because it moved beyond the traditional focus on immediate programme outcomes and asked whether income support could influence physical health, mental health, quality of life, and broader life-course trajectories.
The study also highlighted the serious health challenges facing young adults in Malawi, including the unexpectedly high prevalence of elevated blood pressure. At the same time, its longitudinal design offered an important framework for understanding whether social protection can serve not only as an instrument for reducing current poverty but also as a long-term investment in health, human capital, and intergenerational well-being.
Overall, the presentation underscored a central policy message: investments made during adolescence can potentially shape health outcomes far into adulthood, and the true value of social-protection programmes may therefore be considerably greater than what can be observed during the period in which cash transfers are being delivered.
At the Africa Evidence Summit 2026, Juba Kafumba, Ph.D., of the University of Malawi and the Transfer Project at the UNC Carolina Population Center, presented the main findings from a long-term randomized evaluation examining whether exposure to Malawi's Social Cash Transfer Programme (SCTP) during adolescence was associated with improved health outcomes in young adulthood. The study followed participants over an extended period and found that adolescent exposure to unconditional cash transfers was associated with improvements in both physical and mental health, with the effects particularly pronounced among women.
The findings suggested that social protection may have consequences extending far beyond its immediate objective of reducing household poverty. According to the presentation, cash support received during adolescence appeared to generate health benefits that persisted into young adulthood, particularly through reductions in hypertension and depression.
Kafumba reported that the study found a positive association between exposure to the SCTP and both the physical and mental health of young adults. The results indicated that individuals who had been exposed to the programme during adolescence experienced better health outcomes several years later than those in the comparison group.
The findings were particularly important because the SCTP provided relatively modest financial assistance—approximately US$8 per month—yet the health effects observed years later were meaningful. The evidence suggested that even relatively small and regular transfers can potentially generate lasting benefits when they are delivered during an important developmental period.
The results therefore strengthened the argument that social-protection programmes should not be viewed solely as short-term poverty-reduction mechanisms. Instead, they may also represent long-term investments in human development and health.
One of the most notable findings concerned differences between men and women. Kafumba explained that the treatment effects were substantially larger among women.
The improvement in mental health was driven almost entirely by women. In other words, the overall positive effect observed for mental health was largely attributable to improvements among female participants, while the corresponding effect among men was considerably smaller or not statistically distinguishable from zero.
Physical-health improvements, on the other hand, were observed among both men and women, although the effects were again larger for women.
The gender differences raised important questions about the mechanisms through which income support affects health. Women and men may experience poverty, household responsibilities, economic insecurity, and access to resources differently. Consequently, the same cash transfer may generate different health consequences depending on gender and the social and economic circumstances of recipients.
The findings therefore suggested that future social-protection research should pay closer attention to gender-specific pathways and outcomes, rather than assuming that programmes affect all beneficiaries in the same way.
The researchers further examined individual health indicators to understand which specific outcomes were responsible for the overall improvements in physical and mental health.
Kafumba reported that the principal drivers of the treatment effects were hypertension and depression.
On the physical-health side, the most important finding was a substantial reduction in high blood pressure among participants who had been exposed to the cash-transfer programme during adolescence. On the mental-health side, reductions in depression appeared to account for much of the improvement in the overall mental-health index.
These findings were particularly significant because hypertension and depression are not merely short-term health conditions. Both can have persistent consequences for individuals' quality of life, economic productivity, healthcare needs, and long-term health risks.
The presenter highlighted the potential long-term significance of the reduction in hypertension.
The study found that approximately 41 percent of young adults in the control group had high blood pressure, compared with approximately 34 percent among those in the treatment group. This represented a reduction of roughly 7 percentage points.
Kafumba explained that this reduction could potentially have substantial implications for future cardiovascular disease (CVD) risk. Using hazard ratios reported by Yano et al. (2018) together with population-attributable-fraction calculations, the researchers estimated that the reduction in hypertension could translate into a meaningful reduction in the share of cardiovascular disease risk attributable to hypertension.
Their calculations suggested that the hypertension-attributable fraction of cardiovascular disease could decline from approximately 23.4 percent to 15.1 percent, representing an estimated 8.3 percentage-point reduction, or roughly a 35 percent decline in attributable cardiovascular risk.
The presenter emphasized that this was an estimate derived from existing epidemiological relationships rather than a direct measurement of cardiovascular disease incidence among study participants. Nevertheless, the calculation illustrated the potential long-term health significance of reducing hypertension at a relatively young age.
The finding suggested that an intervention costing approximately US$8 per month during adolescence could potentially contribute to lower future cardiovascular risks, with implications not only for individual well-being but also for future healthcare expenditures.
Kafumba then discussed several plausible mechanisms that could explain why income support during adolescence produced health benefits many years later.
Reduced Poverty-Related Stress
The first potential pathway was through reduced poverty and financial stress.
The presenter explained that cash transfers could reduce some of the anxiety and uncertainty associated with household financial insecurity. When families have additional resources, they may experience less pressure concerning food, education, healthcare, housing, and other basic needs.
Reduced economic stress could, in turn, improve psychological well-being and potentially influence physical health. Chronic financial stress can affect physiological processes, including stress-hormone responses such as cortisol. Over time, reductions in chronic stress may contribute to better mental and physical health.
The presentation linked this potential mechanism to previous research, including work by Haushofer and Shapiro and research on the relationship between stress, poverty, and health.
Thus, the cash transfer may have affected health not only because recipients could purchase more goods and services but also because it reduced the psychological burden associated with persistent poverty.
Improved Nutrition During a Critical Developmental Period
The second potential mechanism was improved nutrition during adolescence.
Kafumba explained that previous evidence from the Malawi SCTP suggested that cash transfers could increase food consumption and dietary diversity. This could be particularly important during adolescence because nutrition during this period can influence long-term physical development and cardiovascular health.
Adolescence represents a critical developmental window during which nutritional status can influence future health trajectories. Additional household resources may enable families to purchase more diverse and nutritious foods, thereby improving adolescents' nutritional intake.
The study therefore suggested that some of the long-term health effects of cash transfers could originate from better nutrition during adolescence, with benefits continuing into adulthood.
The presenter connected this pathway to evidence from the Carolina Population Center and broader research on adolescent development and long-term health, including work by Patton and colleagues.
Longer Exposure Produces Larger Benefits
A third potential mechanism involved the duration of exposure to the cash-transfer programme.
The research compared participants who had experienced approximately six years of exposure with those who had received approximately nine years of exposure. Kafumba reported that individuals with the longer exposure experienced significantly larger health gains.
This pattern suggested that the effects of cash transfers might accumulate over time rather than quickly reach a plateau.
If longer exposure produces progressively greater improvements, this would imply that sustained social protection may be more effective than short-term interventions. It would also suggest that policymakers should consider the duration and continuity of programmes when designing social-protection systems.
The evidence therefore pointed toward a possible cumulative process in which repeated improvements in household resources, nutrition, reduced stress, and living conditions gradually contribute to better health.
The findings led to an important broader policy interpretation. Kafumba argued that cash transfers targeted at young people should potentially be understood not merely as instruments for addressing current poverty but as long-term investments in health and human capital.
The study followed participants across approximately eight to nine years between baseline and endline, providing a rare opportunity to observe whether an intervention introduced during adolescence could influence outcomes in young adulthood.
The evidence from the 29-village cluster randomized evaluation involving 2,124 participants suggested that unconditional cash transfers were associated with improvements in both physical and mental health. The principal health outcomes driving these effects were reductions in hypertension and depression.
The findings were especially notable among women, who experienced the strongest improvements in mental health and larger physical-health gains than men.
The potential reduction in hypertension also carried implications for future health-system costs. Cardiovascular diseases are increasingly important causes of morbidity and mortality in low- and middle-income countries, while treatment of chronic conditions can place significant financial and institutional demands on health systems.
If social-protection interventions can reduce hypertension earlier in the life course, they may potentially prevent or delay some future cardiovascular disease and thereby reduce healthcare needs and expenditures.
The presenter therefore suggested that policymakers should consider the health returns to social protection alongside traditional measures such as poverty reduction, consumption, education, and employment.
From this perspective, the benefits of an unconditional cash transfer may extend across several dimensions: the transfer can reduce immediate poverty, improve household welfare, potentially improve nutrition and psychological well-being, and contribute to healthier trajectories in adulthood.
The central policy message emerging from the presentation was that cash transfers to adolescents can be viewed as long-term investments rather than temporary safety nets.
The Malawi evidence suggested that income support received during adolescence was associated with better physical and mental health several years later. The strongest effects were observed in reductions in hypertension and depression, while women appeared to benefit particularly strongly.
The results also indicated that longer exposure may generate larger benefits, suggesting that sustained social-protection programmes could produce greater long-term returns than short-duration interventions.
Overall, Kafumba's presentation demonstrated that the value of social protection may extend well beyond the immediate reduction of poverty. By supporting vulnerable households during adolescence, governments may also influence health trajectories that continue into adulthood. In particular, the observed reduction in hypertension suggested the possibility of substantial future cardiovascular benefits, potentially reducing both individual health burdens and future pressure on healthcare systems.
The study therefore presented a compelling case for integrating long-term health considerations into the design, financing, and evaluation of social-protection policies, particularly programmes targeting young people in low- and middle-income countries.
The study was presented against the background of a rapidly growing global youth population and the limited evidence available on the long-term effects of social protection programmes on health. Kafumba emphasized that adolescence represents a particularly important stage in human development because experiences during this period can influence health, behaviour, education, employment, and well-being throughout adulthood. However, much of the existing social-protection literature has focused on outcomes measured during the period when programmes are being implemented or shortly thereafter. The study therefore sought to address an important evidence gap by asking whether cash transfers received during adolescence could produce health benefits that persisted well into young adulthood.
Kafumba began by highlighting the demographic significance of young people globally. He noted that approximately 1.8 billion people between the ages of 15 and 29 live around the world, representing approximately 23 percent of the global population. This large and growing youth population makes understanding the factors that shape young people's long-term health and well-being an important development priority.
The presenter explained that adolescence is a particularly sensitive period because it represents a transition between childhood and adulthood during which physical, psychological, and social development accelerates. Poor nutrition, poverty, inadequate access to healthcare, psychosocial stress, and limited economic opportunities during adolescence can have consequences that persist into adulthood.
Despite this, Kafumba observed that most evaluations of social-protection programmes have traditionally concentrated on immediate or short-term outcomes. Researchers have examined whether cash transfers improve household consumption, school attendance, nutrition, or child labour while beneficiaries are receiving support. Much less evidence has examined whether such interventions continue to influence health after young people have left the programme and entered adulthood.
The study therefore sought to move the discussion from the question of whether social protection works in the short term to a broader question of whether income support during adolescence can shape health trajectories over the long term.
Kafumba reviewed several areas in which previous research had documented the effects of social protection. He explained that earlier studies had demonstrated that income-support programmes could influence outcomes related to poverty, education, nutrition, and child labour.
For example, research associated with the Kenya Cash Transfer for Orphans and Vulnerable Children programme had examined poverty-related outcomes. Other studies, including work by Kilburn and colleagues, had examined education, while research by de Groot and colleagues had considered nutrition. De Hoop and Rosati had examined the relationship between social protection and child labour.
However, the presenter emphasized that the evidence concerning long-term health outcomes among young adults remained comparatively limited. In particular, there was little evidence showing whether exposure to social protection during adolescence could affect physical and mental health many years later.
The Malawi study was therefore designed to fill this gap by following individuals who had been exposed to a social cash-transfer programme during adolescence and measuring their health outcomes when they were young adults.
The research focused on Malawi's Social Cash Transfer Programme (SCTP), which is implemented by the Ministry of Gender, Children, Disability and Social Welfare.
Kafumba explained that the programme had been operating since 2013 and remained ongoing. It targeted ultra-poor and labour-constrained households, meaning households that faced severe economic deprivation and had limited capacity to generate labour income.
The SCTP provided an unconditional cash transfer of approximately US$8 per month, with the amount varying depending on household characteristics, including household size and the number of school-age children.
An important characteristic of the programme was that the cash transfer was unconditional. Beneficiary households therefore received financial support without having to meet conditions such as school attendance or participation in particular health services.
The researchers were interested in whether providing this relatively modest but regular income support could generate effects extending beyond immediate consumption and household welfare, particularly among adolescents who were exposed to the programme during an important stage of their development.
The study was based on a cluster randomized controlled trial involving 29 village clusters in Salima and Mangochi districts of Malawi.
Kafumba explained that the research began in 2013, when the baseline sample consisted of young people aged approximately 13 to 19 years. At that stage, eligible households were randomly assigned to treatment or control groups, allowing the researchers to establish a credible basis for estimating the causal effects of SCTP exposure.
The treatment group began receiving the Social Cash Transfer Programme in 2013. A first follow-up was conducted in 2015, when participants were approximately 15 to 21 years old. This first follow-up allowed the researchers to examine the early effects of the programme while participants were still relatively young.
In 2016, the original control group was also brought into the SCTP. This meant that the original treatment group had experienced a longer period of exposure to the programme than the original control group.
The researchers then conducted a major long-term follow-up in 2022, when the participants were approximately 21 to 28 years old. This provided an unusually long observation period for examining whether social-protection exposure during adolescence translated into health outcomes in young adulthood.
The final long-term sample consisted of 2,124 young adults, representing approximately 85 percent retention from the original study population.
One of the most important features of the research was that participants experienced different durations of exposure to the SCTP during adolescence. Some young people had approximately six years of exposure, while others had approximately nine years of exposure.
Kafumba described this as a rare opportunity to examine the long-term effects of adolescent exposure to social protection. Most evaluations of cash-transfer programmes do not have the opportunity to follow participants for such an extended period, particularly from adolescence into young adulthood.
The long-term follow-up also revealed significant changes in participants' lives. By 2022, approximately 55 percent of young adults had moved into a different household from the one in which they had lived at baseline.
This finding was important because it demonstrated that many participants had transitioned into new social and economic circumstances by young adulthood. Some had formed new households, moved for employment or other opportunities, or otherwise changed their living arrangements. The researchers therefore had to consider whether the effects of adolescent social protection persisted even after young people moved away from the original households that had received the cash transfers.
The study was organized around four major research questions.
First, the researchers sought to determine whether exposure to the Social Cash Transfer Programme during adolescence improved physical and mental health in young adulthood.
Second, they examined whether the effects differed between young men and young women.
Third, the researchers wanted to identify which specific health outcomes were responsible for any overall effects observed in the physical-health and mental-health indices.
Finally, the study examined the potential pathways or mechanisms through which adolescent income support could influence health many years later.
These pathways could potentially include improved nutrition, reduced household stress, increased access to healthcare, improved living conditions, greater educational opportunities, reduced economic insecurity, and changes in household decision-making.
To estimate the effects of SCTP exposure, the researchers used ordinary least squares (OLS) regression models. The main outcomes included a physical-health index, a mental-health index, and individual health indicators.
The analysis incorporated treatment status as the principal explanatory variable and adjusted for a range of pre-treatment characteristics. These included individual, caregiver, and household characteristics, as well as district-level administrative-area fixed effects.
Standard errors were clustered at the village-cluster level, reflecting the clustered nature of the original randomized intervention.
The researchers also carefully examined attrition. Kafumba reported that the study achieved approximately 85 percent retention at the 2022 follow-up. Importantly, there was no significant evidence of differential attrition between treatment and control groups across baseline characteristics. This strengthened confidence that the long-term comparison remained credible despite the passage of nearly a decade.
The study used a broad set of health indicators to capture both physical and psychological well-being.
Physical health was measured through indicators including blood pressure and hypertension, body mass index (BMI), disability status, ability to perform activities of daily living, and self-rated health.
The researchers also measured several dimensions of mental health. These included perceived stress, assessed using the Cohen Perceived Stress Scale (PSS-10), and depression, measured using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D).
In addition, the researchers measured quality of life using an eight-item scale.
By incorporating multiple indicators rather than relying on a single measure, the study aimed to capture the multidimensional nature of health and determine whether social-protection exposure affected particular aspects of physical or psychological well-being.
Before presenting the estimated effects of the SCTP, Kafumba highlighted a striking feature of the health data: the relatively high prevalence of elevated blood pressure among the young adults in the study.
The study found that approximately 38 percent of participants had high blood pressure at the 2022 follow-up. The presenter compared this figure with an estimated prevalence of approximately 22 percent among people of a similar age in the United States.
The findings also revealed differences by sex. Among the study participants, approximately 34 percent of women and 41 percent of men were reported to have high blood pressure, according to the figures presented.
The comparison highlighted the growing importance of non-communicable diseases and cardiovascular risk among young adults in low- and middle-income countries. High blood pressure is often associated with older populations, but the study demonstrated that elevated blood pressure could already be widespread among young adults in Malawi.
The finding also reinforced the importance of examining long-term health outcomes rather than focusing exclusively on short-term indicators such as household consumption or school attendance.
Kafumba emphasized that the long-term perspective was one of the study's most important contributions. Social-protection programmes are often evaluated based on whether they immediately reduce poverty or improve education, nutrition, or other welfare indicators. However, the effects of economic support may accumulate over time.
For adolescents, an increase in household resources could potentially influence the quality and quantity of food they consume, their ability to remain in school, their exposure to stressful economic circumstances, access to healthcare, and their future employment opportunities. These changes could then influence health behaviours and health conditions years later.
The study therefore sought to determine whether the benefits of income support could persist beyond the period of direct programme exposure and extend into young adulthood.
The research was particularly important from a life-course perspective because it examined how economic conditions during adolescence could shape health later in life.
The presenter emphasized that adolescence should not be viewed simply as a temporary transition between childhood and adulthood. Instead, it is a period during which social, economic, behavioural, and health trajectories can become established.
If income support during this period produces lasting improvements in physical and mental health, then social protection could have implications that extend well beyond poverty reduction. It could potentially contribute to a healthier and more productive adult population.
The study also raised broader questions about whether investments in young people can generate benefits that extend across generations, particularly when improved health, education, and economic opportunities influence the well-being of future households and children.
The study presented important implications for policymakers in Malawi and other African countries considering the design and expansion of social-protection programmes.
First, the findings highlighted the importance of considering long-term health outcomes when evaluating cash-transfer programmes. A programme may generate benefits that are not immediately visible during the intervention period but become apparent years later.
Second, the research demonstrated the value of longitudinal evidence. Following individuals from adolescence into young adulthood allows researchers to understand whether short-term improvements translate into lasting changes in health and well-being.
Third, the study highlighted the potential for social protection to contribute to health policy objectives. If income support during adolescence affects later physical and mental health, cash-transfer programmes could potentially be viewed as part of a broader investment in human capital rather than simply as anti-poverty measures.
Finally, the high prevalence of elevated blood pressure among young adults suggested that social-protection and health policies may need to pay greater attention to non-communicable disease risks among younger populations, particularly in settings undergoing rapid economic and demographic change.
In conclusion, Juba Kafumba's presentation demonstrated the importance of examining the long-term consequences of social protection for young people's health. By following more than 2,100 Malawian participants from adolescence into young adulthood, the study provided a rare opportunity to investigate whether exposure to cash transfers during a formative period of life could have consequences many years later.
The research was particularly significant because it moved beyond the traditional focus on immediate programme outcomes and asked whether income support could influence physical health, mental health, quality of life, and broader life-course trajectories.
The study also highlighted the serious health challenges facing young adults in Malawi, including the unexpectedly high prevalence of elevated blood pressure. At the same time, its longitudinal design offered an important framework for understanding whether social protection can serve not only as an instrument for reducing current poverty but also as a long-term investment in health, human capital, and intergenerational well-being.
Overall, the presentation underscored a central policy message: investments made during adolescence can potentially shape health outcomes far into adulthood, and the true value of social-protection programmes may therefore be considerably greater than what can be observed during the period in which cash transfers are being delivered.
At the Africa Evidence Summit 2026, Juba Kafumba, Ph.D., of the University of Malawi and the Transfer Project at the UNC Carolina Population Center, presented the main findings from a long-term randomized evaluation examining whether exposure to Malawi's Social Cash Transfer Programme (SCTP) during adolescence was associated with improved health outcomes in young adulthood. The study followed participants over an extended period and found that adolescent exposure to unconditional cash transfers was associated with improvements in both physical and mental health, with the effects particularly pronounced among women.
The findings suggested that social protection may have consequences extending far beyond its immediate objective of reducing household poverty. According to the presentation, cash support received during adolescence appeared to generate health benefits that persisted into young adulthood, particularly through reductions in hypertension and depression.
Kafumba reported that the study found a positive association between exposure to the SCTP and both the physical and mental health of young adults. The results indicated that individuals who had been exposed to the programme during adolescence experienced better health outcomes several years later than those in the comparison group.
The findings were particularly important because the SCTP provided relatively modest financial assistance—approximately US$8 per month—yet the health effects observed years later were meaningful. The evidence suggested that even relatively small and regular transfers can potentially generate lasting benefits when they are delivered during an important developmental period.
The results therefore strengthened the argument that social-protection programmes should not be viewed solely as short-term poverty-reduction mechanisms. Instead, they may also represent long-term investments in human development and health.
One of the most notable findings concerned differences between men and women. Kafumba explained that the treatment effects were substantially larger among women.
The improvement in mental health was driven almost entirely by women. In other words, the overall positive effect observed for mental health was largely attributable to improvements among female participants, while the corresponding effect among men was considerably smaller or not statistically distinguishable from zero.
Physical-health improvements, on the other hand, were observed among both men and women, although the effects were again larger for women.
The gender differences raised important questions about the mechanisms through which income support affects health. Women and men may experience poverty, household responsibilities, economic insecurity, and access to resources differently. Consequently, the same cash transfer may generate different health consequences depending on gender and the social and economic circumstances of recipients.
The findings therefore suggested that future social-protection research should pay closer attention to gender-specific pathways and outcomes, rather than assuming that programmes affect all beneficiaries in the same way.
The researchers further examined individual health indicators to understand which specific outcomes were responsible for the overall improvements in physical and mental health.
Kafumba reported that the principal drivers of the treatment effects were hypertension and depression.
On the physical-health side, the most important finding was a substantial reduction in high blood pressure among participants who had been exposed to the cash-transfer programme during adolescence. On the mental-health side, reductions in depression appeared to account for much of the improvement in the overall mental-health index.
These findings were particularly significant because hypertension and depression are not merely short-term health conditions. Both can have persistent consequences for individuals' quality of life, economic productivity, healthcare needs, and long-term health risks.
The presenter highlighted the potential long-term significance of the reduction in hypertension.
The study found that approximately 41 percent of young adults in the control group had high blood pressure, compared with approximately 34 percent among those in the treatment group. This represented a reduction of roughly 7 percentage points.
Kafumba explained that this reduction could potentially have substantial implications for future cardiovascular disease (CVD) risk. Using hazard ratios reported by Yano et al. (2018) together with population-attributable-fraction calculations, the researchers estimated that the reduction in hypertension could translate into a meaningful reduction in the share of cardiovascular disease risk attributable to hypertension.
Their calculations suggested that the hypertension-attributable fraction of cardiovascular disease could decline from approximately 23.4 percent to 15.1 percent, representing an estimated 8.3 percentage-point reduction, or roughly a 35 percent decline in attributable cardiovascular risk.
The presenter emphasized that this was an estimate derived from existing epidemiological relationships rather than a direct measurement of cardiovascular disease incidence among study participants. Nevertheless, the calculation illustrated the potential long-term health significance of reducing hypertension at a relatively young age.
The finding suggested that an intervention costing approximately US$8 per month during adolescence could potentially contribute to lower future cardiovascular risks, with implications not only for individual well-being but also for future healthcare expenditures.
Kafumba then discussed several plausible mechanisms that could explain why income support during adolescence produced health benefits many years later.
Reduced Poverty-Related Stress
The first potential pathway was through reduced poverty and financial stress.
The presenter explained that cash transfers could reduce some of the anxiety and uncertainty associated with household financial insecurity. When families have additional resources, they may experience less pressure concerning food, education, healthcare, housing, and other basic needs.
Reduced economic stress could, in turn, improve psychological well-being and potentially influence physical health. Chronic financial stress can affect physiological processes, including stress-hormone responses such as cortisol. Over time, reductions in chronic stress may contribute to better mental and physical health.
The presentation linked this potential mechanism to previous research, including work by Haushofer and Shapiro and research on the relationship between stress, poverty, and health.
Thus, the cash transfer may have affected health not only because recipients could purchase more goods and services but also because it reduced the psychological burden associated with persistent poverty.
Improved Nutrition During a Critical Developmental Period
The second potential mechanism was improved nutrition during adolescence.
Kafumba explained that previous evidence from the Malawi SCTP suggested that cash transfers could increase food consumption and dietary diversity. This could be particularly important during adolescence because nutrition during this period can influence long-term physical development and cardiovascular health.
Adolescence represents a critical developmental window during which nutritional status can influence future health trajectories. Additional household resources may enable families to purchase more diverse and nutritious foods, thereby improving adolescents' nutritional intake.
The study therefore suggested that some of the long-term health effects of cash transfers could originate from better nutrition during adolescence, with benefits continuing into adulthood.
The presenter connected this pathway to evidence from the Carolina Population Center and broader research on adolescent development and long-term health, including work by Patton and colleagues.
Longer Exposure Produces Larger Benefits
A third potential mechanism involved the duration of exposure to the cash-transfer programme.
The research compared participants who had experienced approximately six years of exposure with those who had received approximately nine years of exposure. Kafumba reported that individuals with the longer exposure experienced significantly larger health gains.
This pattern suggested that the effects of cash transfers might accumulate over time rather than quickly reach a plateau.
If longer exposure produces progressively greater improvements, this would imply that sustained social protection may be more effective than short-term interventions. It would also suggest that policymakers should consider the duration and continuity of programmes when designing social-protection systems.
The evidence therefore pointed toward a possible cumulative process in which repeated improvements in household resources, nutrition, reduced stress, and living conditions gradually contribute to better health.
The findings led to an important broader policy interpretation. Kafumba argued that cash transfers targeted at young people should potentially be understood not merely as instruments for addressing current poverty but as long-term investments in health and human capital.
The study followed participants across approximately eight to nine years between baseline and endline, providing a rare opportunity to observe whether an intervention introduced during adolescence could influence outcomes in young adulthood.
The evidence from the 29-village cluster randomized evaluation involving 2,124 participants suggested that unconditional cash transfers were associated with improvements in both physical and mental health. The principal health outcomes driving these effects were reductions in hypertension and depression.
The findings were especially notable among women, who experienced the strongest improvements in mental health and larger physical-health gains than men.
The potential reduction in hypertension also carried implications for future health-system costs. Cardiovascular diseases are increasingly important causes of morbidity and mortality in low- and middle-income countries, while treatment of chronic conditions can place significant financial and institutional demands on health systems.
If social-protection interventions can reduce hypertension earlier in the life course, they may potentially prevent or delay some future cardiovascular disease and thereby reduce healthcare needs and expenditures.
The presenter therefore suggested that policymakers should consider the health returns to social protection alongside traditional measures such as poverty reduction, consumption, education, and employment.
From this perspective, the benefits of an unconditional cash transfer may extend across several dimensions: the transfer can reduce immediate poverty, improve household welfare, potentially improve nutrition and psychological well-being, and contribute to healthier trajectories in adulthood.
The central policy message emerging from the presentation was that cash transfers to adolescents can be viewed as long-term investments rather than temporary safety nets.
The Malawi evidence suggested that income support received during adolescence was associated with better physical and mental health several years later. The strongest effects were observed in reductions in hypertension and depression, while women appeared to benefit particularly strongly.
The results also indicated that longer exposure may generate larger benefits, suggesting that sustained social-protection programmes could produce greater long-term returns than short-duration interventions.
Overall, Kafumba's presentation demonstrated that the value of social protection may extend well beyond the immediate reduction of poverty. By supporting vulnerable households during adolescence, governments may also influence health trajectories that continue into adulthood. In particular, the observed reduction in hypertension suggested the possibility of substantial future cardiovascular benefits, potentially reducing both individual health burdens and future pressure on healthcare systems.
The study therefore presented a compelling case for integrating long-term health considerations into the design, financing, and evaluation of social-protection policies, particularly programmes targeting young people in low- and middle-income countries.