Did the Scottish Child Payment improve health and reduce health inequalities in the early years: a protocol for a natural experiment evaluation

Child poverty is detrimental to health and wellbeing, but how best to implement poverty alleviation policies that translate to health benefits is disputed. In response to the one in four children in relative poverty in Scotland in 2021, the Scottish Government introduced the Scottish Child Payment (SCP). Initially the payment provided low-income families with £10 per week for every child aged 0-5y. The value was doubled in 2022 and later that year, increased further to £25, with eligibility extended to 6–15y olds. This protocol describes our plans to evaluate the impacts of the SCP on child health and multiple axes of health inequalities. We will use Interrupted Time Series analysis, to examine whether trends in health and health inequalities (in mothers and children followed until age 6-years) were altered after the introduction of the SCP. The population of interest is children born in Scotland 2014–2020 (pre-intervention) and 2021–2025 (post intervention). We will use linked administrative data, consisting of birth registrations and various health records. Primary outcomes are maternal mental health and, among children, developmental concerns and hospitalisations. Secondary outcomes include second-hand smoke exposure, immunisation, and childhood overweight/obesity. Additional analyses to examine sources of potential bias may include controlled ITS and the use of negative controls. We will interpret results appropriately, in the context of the sample sizes, assumptions, and sensitivity analyses. This protocol outlines a rigorous, natural experiment evaluation of the health impacts of a major early years cash transfer policy in Scotland. This will provide much needed evidence to Scottish policymakers to inform future decisions around the SCP, as well as for decision-makers in other countries where similar payments might be introduced. Results will be disseminated to various audiences, through peer-reviewed conference abstracts, journal publications, policy briefings and lay summaries, with input from stakeholders.