Cash transfer programs, which provide money directly to recipients, are growing in the United States, but face significant scrutiny, with questions over their value. In addition, some contend that these payments can lead to harm—recipients, they claim, will use the cash to immediately buy alcohol or drugs, leading to injury or death.
However, a new 11-year study of a long-standing cash-transfer program in Alaska finds no evidence that direct cash payments increase the risk of traumatic injury or death.
The paper, authored by researchers at New York University, the University of California San Francisco (UCSF) School of Medicine, and Alaska's former chief medical officer, appears in the American Journal of Epidemiology.
"Past research has shown that cash transfers are an effective tool for reducing poverty, but their implementation is often limited by critics who worry about irresponsible spending that can lead to tragedy," says NYU sociologist Sarah Cowan, founder and executive director of the university's Cash Transfer Lab , which conducted the study. "Those fears are unfounded. Our long-term study of a state's population shows no connection between cash transfers and serious injury or death."
The study focused on Alaska's Permanent Fund Dividend (PFD).
"As a practicing emergency physician I worried about yearly PFD leading to immediate harm, but as Alaska's chief medical officer and public health official, I know how important it is to review the data objectively," adds Anne Zink, chief medical officer for the State of Alaska from 2019 to 2024 and now a senior fellow at the Yale School of Public Health. "This study provides the kind of population-level evidence that public health officials and policymakers need when evaluating guaranteed income programs. When looking across the entire state's population over 11 years, there was no evidence of increased trauma or mortality temporally associated with the PFD cash transfer."
Some previous studies have also found no association between cash transfers and injury or death while others have found such a link. However, the new American Journal of Epidemiology research, the authors note, considers all traumatic injuries and deaths in Alaska and over a longer period of time than does earlier work. It also examines the effects of providing cash transfers to an entire state—a much more diverse population than considered in other guaranteed-income studies.
The study also included Ruby Steedle, a researcher at the Cash Transfer Lab and the paper's lead author, and Tasce Bongiovanni, an associate professor of surgery at UCSF's School of Medicine.
Since 1982, the state has sent an annual check to each of its residents. The amount varies each year, but typically ranges from $1,000 to $2,000 for all Alaskans. This form of cash transfer offers researchers the opportunity to examine how a universal basic income, and other cash transfer programs, work in practice.
In their study, the researchers examined 2009-2019 data on all traumatic injuries in the state that were treated in Alaska hospitals, drawn from the state's trauma registry, and all reported deaths, which were obtained from vital records.
Overall, the authors found that, throughout the state, Alaska's annual cash distribution does not increase rates of serious traumatic injury or death by unnatural causes in the short term. These results were consistent across numerous robustness checks. For instance, injuries and deaths did not increase one week to one month following payments, which are typically made in the fall. Notably, this pattern held in the state's urban areas, which are similar to small- and medium-sized cities in the continental US, indicating the findings are generalizable beyond a single state.
"Together, these findings provide strong evidence that narratives about short-term harm from cash payments are unfounded," the authors conclude.
The paper's other authors were NYU Cash Transfer Lab researchers Robert Pickett, Hailie Dono, and Erica Hobby and Byungkyu Lee, an assistant professor in NYU's Department of Sociology.
