Behavioral Interventions Contributing to Reducing Poverty and Inequities

Abstract

Behavioral science has a long history of engaging in efforts to understand and address socially important issues. Poverty and inequities in health and development are among the most important and complex social issues facing the world today. With its Sustainable Development Goals (SDGs), the United Nations (2015) has focused attention and guidance on addressing key global challenges, including to “end poverty” (SDG 1), “ensure good health and well-being for all” (SDG3), and “reduce inequality within and among countries” (SDG 10). In this paper, we provide a framework and illustrative examples of contributions of behavioral science to these issues. We feature illustrative behavioral interventions at the individual, relationship, community, and societal levels. We highlight the diversity of issues, intervention methods, and settings reflected in applications of behavioral science. By joining methods from behavioral science, public health, and other disciplines—and the experiential knowledge of those most affected by inequities—behavioral methods can make significant contributions to collaborative efforts to assure health and well-being for all.

In 2015, the United Nations established 17 Sustainable Development Goals (SDGs) as a blueprint for achieving a better and more sustainable future for all (United Nations, 2015). In this paper, we focus on behavioral interventions that address three of the SDGs: SDG1: End poverty in all its forms everywhere; SDG3: Ensure healthy lives and promote well-being for all at all ages (linked to work on health inequities); and SDG10: Reduce inequality within and among countries. Behavioral science has a long history of engaging in efforts to understand and address socially important issues (e.g., Baer & Wolf, 1987; Baer et al., 1968; Heward et al., 2022), with particular attention to issues of poverty, health, and other inequities. In this paper, we describe how behavioral interventions are being used to address environmental conditions, behaviors, and outcomes related to problems and inequities in health and human development. From a social determinants perspective (World Health Organization, 2008), the focus is on taking action to address conditions—including social, environmental, and economic conditions—that produce unfair and unequal outcomes experienced disproportionally by some individuals and groups.

The World Health Organization’s conceptual framework for social determinants calls attention to the intermediary determinants of inequities in health and development outcomes (Solar & Irwin, 2010), including (a) Differential exposures (e.g., to stress, violence) and opportunities (e.g., for employment); (b) Differential vulnerabilities (e.g., related to power, disabilities, gender) and capabilities (e.g., education, skills); and (c) Differential access (e.g., to health care) and consequences (e.g., discrimination related to race, social class). These and other social determinants can be addressed by reasonable means, including through established behavioral (and other types of) interventions. In this paper, we describe behavioral approaches grounded in the Centers for Disease Control and Prevention’s (CDC’s) Social-Ecological Model (Dahlberg & Crug, 2002), which conveys the complex interplay among influences at multiple levels—including individuals, relationships, communities, and society.

The illustrative set of examples discussed in this paper, and those included in Tables 1 and 2, are not exhaustive. Rather, they offer a perspective on the diversity of possible applications, no doubt with some emphasis on those with which the authors are more familiar. The next section describes examples that address poverty, inequities, and their connections at the individual and relationship levels; and the following section offers examples at community and societal levels. Because there are reciprocal and relational connections among all levels, the two sections are best viewed as interlocked.

Table 1.

Illustrative behavioral interventions addressing poverty, by sector or setting engaged, and type and level of intervention

Behavioral interventions addressing poverty	Sector or setting engaged	Type/level of intervention used
Research on contingency management for substance use (e.g., Silverman et al., 2019)	– Policymakers – Universities – Health Organizations – Community/civic organizations	– Providing information and enhancing skills – Modifying access, barriers, and opportunities – Changing consequences Level: Individual
Development and implementation of the “therapeutic workplace” which provides jobs to individuals with a history of substance use contingent on abstinence from substances (Silverman et al., 2018)	– Clients – Human Service Organizations – Health Organizations	– Providing information and enhancing skills – Enhancing supports and services – Modifying access, barriers, and opportunities – Changing consequences Level: Individual
Emerging research on psilocybin treatment for substance use (Bogenschutz et al., 2015; Johnson et al., 2017	– Policymakers – Health Organizations	– Providing information and enhancing skills – Modifying access, barriers, and opportunities Level: Individual
Development of the Community Reinforcement Approach (CRA) model for treatment of substance use (Hunt & Azrin, 1973; Azrin, 1976)	– Clients – Human Service Organizations – Health Organizations	– Providing information and enhancing skills – Enhancing supports and services – Modifying access, barriers, and opportunities – Changing consequences Level: Individual/Relationships
Development of the Community Reinforcement and Family Training (CRAFT) training family members of substance use treatment-resistant individuals to modify environments and provide reinforcement to support the sober behavior of their family member (Johnson, 1986)	– Clients – Families – Human Service Organizations – Health Organizations	– Providing information and enhancing skills – Enhancing supports and services – Modifying access, barriers, and opportunities – Changing consequences Level: Individual/Relationships
Modifications of the CRA model to support adolescents (Dennis et al., 2004), seniors (Moyers et al., 2013)	– Adolescents – Supporters (Family, Peers) – Human Service Organizations – Health Organizations	– Providing information and enhancing skills – Enhancing supports and services – Modifying access, barriers, and opportunities – Changing consequences Level: Individual/Relationships
Reduction of risk for poverty through a school-community initiative to reduce adolescent pregnancy (Paine-Andrews et al., 1999; Paine-Andrews et al., 2002)	– Businesses – Community/Civic Organizations – Education/Schools – Health Organizations – Human Service Organizations – Media – Neighborhoods	– Providing information and enhancing skills – Enhancing services and supports – Modifying access, barriers, and opportunities – Changing consequences Level: Community
Reduction of risk for poverty through a community coalition to prevent substance abuse (Fawcett, et al., 1997).	– Businesses – Community/Civic Organizations – Education/Schools – Health Organizations – Human Service Organizations –Media –Neighborhoods	– Providing information and enhancing skills – Enhancing services and supports – Modifying access, barriers, and opportunities – Changing consequences Level: Community
Community change capacity building intervention in urban neighborhood coalitions (Thompson et al., 2008).	– Community/Civic Organizations – Education/Schools – Community/Civic Organizations – Neighborhoods	–Providing information and enhancing skills –Enhancing services and supports –Modifying access, barriers, and opportunities –Changing consequences –Modifying policies and broader systems Level: Community
Implementation and evaluation of training programs for staff of poverty self-help organizations to learn helping skills (Fawcett et al., 1976) and counseling and problem-solving skills (Whang et al., 1982), enhance leadership skills (Seekins et al., 1984), and make referrals for low-income families to access needed services (Mathews and Fawcett, 1979).	– Human Service Organizations – Community/Civic Organizations – Neighborhoods	–Providing information and enhancing skills –Enhancing services and supports Level: Individual/Community
Implementation and evaluation of a training program for those most affected by issues to give personal testimony about their experiences in efforts to change public policies (Seekins et al., 1987a).	– Policymakers – Community/Civic Organizations – Advocates	– Providing information and enhancing skills – Enhancing services and supports – Modifying access, barriers, and opportunities Level: Individual/Community
Implementation and evaluation of a community concerns report method for local agenda setting in a low-income neighborhood (Schriner and Fawcett, 1988).	– Policymakers – Universities – Community/Civic Organizations – Advocates	– Providing information and enhancing skills – Enhancing services and supports – Modifying access, barriers, and opportunities Level: Community
Construction of cultural practices consistent with social justice (Biglan, 1995, 2015, 2016, 2020)	– Policymakers – Behavioral scientists – Activists – Community members	– Providing guidelines for changing cultural practices to support a just and inclusive society Level: Societal
Outline of advocacy practices supporting social justice as defined by fair dispersal of benefits and burdens in society (Ardila Sánchez, Richling, et al. 2020b; Mattaini et al., 2020; Mattaini & Roose, 2021; Devlin-Foltz et al.,2012)	– Policymakers – Behavioral scientists – Activists – Teachers – Community members	– Presenting analytic and evaluative tools for advocacy consistent with economic justice with specific emphasis on systemic analysis and experimentation Level: Community/Societal
Implementation and evaluation of the Programa Bolsa Familia, a program in Brazil that provides direct and conditional support for families experiencing poverty (Fava & Vasconcelos, 2017).	– Families – Policymakers – Education/Schools – Health Organizations	– Providing financial contingencies, information and enhancing skills – Enhancing services and supports – Modifying access, barriers, and opportunities – Changing consequences Level: Relationships/Societal
Implementation of Opportunity NYC, a government sponsored program based on Programa Bolsa Familia, to provide direct and conditional support for families experiencing poverty (Holtyn et al., 2017)	– Families – Policymakers – Education/Schools – Health Organizations	– Attempted to use financial incentives producing minimal results Level: Relationships/Societal
Promotion of intersectoral action to address chronic poverty and social exclusion (Freitas Lemos & Todorov, 2020)	– Policymakers – Funders – Behavioral scientists – Activists – Community members	– Describing and analyzing a study focused on a large-scale intervention across actors and sectors, with results indicating that intersectoral arrangements increased the supply and demand of apprenticeship positions and apprenticeship increased school attendance on average. Level: Societal
Examination of the role of participatory community development in alleviating colonial relations and supporting independence between western and African nations (Smilak & Putnam, 2022)	– Policymakers – Community members – Funders – Supporting agencies	– Identifying and presenting issues of colonial relations and reciprocal and dominating/dependent relationships to funders – Recognizing collaboration as key – Expanding research in this area Level: Societal

Table 2.

Illustrative behavioral interventions addressing inequities in health and development, by social determinants addressed, and type and level of intervention

Behavioral interventions addressing inequities	Social determinant addressed	Type/level of intervention used
Financial incentives to increase participation in HIV treatment (Brantley et al., 2018)	– Differential exposures – Differential vulnerabilities – Differential consequences	– Enhancing services and supports –Modifying access, barriers, and opportunities – Changing consequences Level: Individual
Financial incentives to improve medication adherence and increase vaccinations (Nowalk et al., 2010)	– Differential exposures/opportunities – Differential vulnerabilities/capabilities – Differential access/consequences	– Enhancing services and supports – Modifying access, barriers, and opportunities – Changing consequences Level: Family/Relationships
Financial incentives to increase health screenings (Malotte et al., 1998)	– Differential exposures/opportunities – Differential vulnerabilities/capabilities – Differential access/consequences	– Enhancing services and supports – Modifying access, barriers, and opportunities – Changing consequences Level: Family/Relationships
Analysis of potential behavioral contributions to a socially just framework for integration of immigrants to the US (Rakos & Switzer, 2021)	– Differential exposures – Differential vulnerabilities and capabilities – Differential access/consequences	– Analytic publication of possible enhancements to contemporary policies – Active consultations with organizations providing immigrant services Level: Community/Societal
Integration of Behavioral Community Psychology in practice with homeless families (Switzer & Rakos, 2022)	– Differential exposures – Differential vulnerabilities and capabilities – Differential access/consequences	– Development and publication of theory-driven enhancements to contemporary policies for providing stability for homeless families – Active consultations with organizations providing homelessness services Level: Community/Societal
Analysis of behavioral dynamics of police violence directed toward minority populations (Mattaini & Rehfeldt, 2020)	– Differential exposures – Differential vulnerabilities and capabilities – Differential access/consequences	– Analytic publication of possible enhancements to contemporary policing and legal policies and community services – Presentations to advocates of improved relations between police and communities Level: Community, Societal
Analysis of alternative interventions for youth actively involved with street violence (Aspholm, 2020)	– Differential exposures – Differential vulnerabilities and capabilities – Differential access/consequences	– Conducting and publishing onsite research – Presentations to community and scientific groups, and advocates involved in violence prevention Level: Individual/Community
Development and initiation of alternative service center for homeless youth (Holtschneider, 2021)	– Differential exposures – Differential vulnerabilities and capabilities – Differential access/consequences	– Establishing an alternative, and alternatively funded center on the South Side of Chicago – Providing access to multiple developmental opportunities onsite through extensive fundraising – Establishing political support – Establishing connections to needed community services Level: Individual/Community
Provision of principles and successful examples of advocacy for funding from federal state and local governments (Baron & Hoeksema, 2021)	– Differential exposures – Differential vulnerabilities and capabilities – Differential access/consequences	– Identifying and explaining the advocacy ecosystem – Analyzing and presenting how staffers and legislators get and use research information within the financial appropriation process – Identifying actionable steps to support science in legislation Level: Societal
Scientific analyses of dynamics of cultural change with focus on vulnerable populations (Biglan, 1995, 2015, 2016, 2020)	– Differential exposures – Differential vulnerabilities and capabilities – Differential access/consequences	– Publication of analysis and evaluations of cultural change consistent with stated values – Conference presentations on analysis and evaluations of cultural change consistent with stated values – Development of community Action Circles to reduce toxic biological and social experiences and promote prosocial behavior Level: Community/Societal
Analysis and advocacy for increased emphasis on contributions of behavioral systems science to leadership for a new progressive movement integrating Israel Goldiamond’s constructional approach and M. K. Gandhi’s constructive program (Mattaini, 2015; Mattaini & Aspholm, 2016; Roose & Mattaini, 2020)	– Differential exposures – Differential vulnerabilities and capabilities – Differential access/consequences	– Publishing on advocacy and activist options for behavioral science – Offering collaborative conference presentations encouraging progressive advocacy options for behavioral scientists – Offering presentations to advocacy groups, and candidates for such groups Level: Community/Societal
Construction of multisector matrices to develop strategic options for groups working for social justice (Seniuk et al., 2019; Mattaini, 2013).	– Differential exposures – Differential vulnerabilities and capabilities – Differential access/consequences	– Integration into academic coursework – Integration into high school coursework – Presentations to professional groups Level: Community/Societal
Community centered application and evaluations of the “Actively Caring for People” model (Geller, 2014).	– Differential exposures – Differential vulnerabilities and capabilities – Differential access/consequences	– Extensive evaluation research in community settings – Publication of multiple books and other publications accessible to most community members – Multiple professional publications and presentations Level: Community
Advocacy with congressional representatives and staff to integrate and evaluate science to policy dynamics (Crowley et al., 2018; Devlin-Foltz, et al.,2012)	– Differential exposures – Differential vulnerabilities and capabilities – Differential access/consequences	– Instructions for building relationships with legislators and similar officials Level: Societal
Outlining strategic advocacy practices supporting social justice as defined by fair dispersal of benefits and burdens in society (Ardila Sánchez, Cihon, et al., 2020a; Mattaini et al., 2020; Mattaini & Roose, 2021; Devlin-Foltz, et al.,2012)	– Differential exposures – Differential vulnerabilities and capabilities – Differential access/consequences	– Sharing outline of core values, principles, and practices of scientific advocacy – Sharing outline of core advocacy repertoires – Sharing outlines of key cultural systems technologies including nested contingencies mapping, force field analysis, and use of systemic matrices Level: Community, Societal
Effects of poverty clients' agenda on resource allocations by community decision makers (Fawcett, Seekins et al., 1982; Seekins & Fawcett, 1987)	– Differential opportunities – Differential access/consequences	– Providing information – Changing consequences – Modifying policies and broader systems Level: Community
Effects of public polling data on policy consideration of utility subsidies for low-income families (Seekins, Maynard-Moody et al., 1987b)	– Differential exposures – Differential access/consequences	– Providing information – Changing consequences – Modifying policies and broader systems Level: Community
Effects of agency-based voter registration on voter registration by low-income individuals (Fawcett, Seekins, & Silber, 1988)	– Differential opportunities – Differential access	– Providing information and enhancing skills – Enhancing services and supports – Modifying access, barriers, and opportunities Level: Community
Implementing a community health concerns report and microgrant program to expand initiatives for low-income residents (Paine et al., 1994, Fawcett, Seekins et al., 1982)	– Differential opportunities – Differential access/consequences	– Providing information and enhancing skills – Enhancing services and supports – Modifying access, barriers, and opportunities Level: Community
Implementing and evaluating multi-sector coalitions in low-income communities to reduce health disparities related to chronic disease (Collie-Akers et al., 2009; Schultz et al., 2009; Collie-Akers, et al., 2013)	– Differential opportunities – Differential vulnerabilities and capabilities – Differential access/consequences	– Providing information and enhancing skills – Enhancing services and supports – Modifying access, barriers, and opportunities – Changing consequences – Modifying policies and broader systems Level: Community
Developing and disseminating open-source, online tools for building capacity for promoting community health and development; reaching over 6 million unique users from 300 countries in past year (Community Tool Box http://ctb.ku.edu/; Holt et al., 2013)	– Differential exposures and opportunities – Differential capabilities – Differential access	– Providing information and enhancing skills – Enhancing services and supports – Modifying access, barriers, and opportunities Level: Community/Societal
Community mobilization to enroll low-income residents in health insurance coverage through the Affordable Care Act. (Fawcett, Sepers, et al., 2015b)	– Differential exposures and opportunities – Differential vulnerabilities and capabilities – Differential access/consequences	– Providing information and enhancing skills – Enhancing services and supports – Modifying access, barriers, and opportunities – Changing consequences – Modifying policies and broader systems Level: Community
Assuring health access and culturally competent health services through a Latino health coalition (Fawcett et al., 2018)	– Differential exposures and opportunities – Differential vulnerabilities and capabilities – Differential access/consequences	– Providing information and enhancing skills – Enhancing services and supports – Modifying access, barriers, and opportunities – Changing consequences – Modifying policies and broader systems Level: Relationship/Community
Examining the relationship between community programs and policies to prevent childhood obesity and BMI in children of different races/ethnicities (Strauss et al., 2018; Fawcett, Collie-Akers et al., 2015a)	– Differential exposures and opportunities – Differential vulnerabilities and capabilities – Differential access/consequences	– Providing information and enhancing skills – Enhancing services and supports – Modifying access, barriers, and opportunities – Changing consequences – Modifying policies and broader systems Level: Community/Societal
Evaluating multi-sector, multi-level responses to the Ebola outbreak in Liberia (Munodawafa et al., 2018; Hassaballa, Fawcett, Sepers, et al., 2019) and the COVID-19 pandemic in different African countries (Phori, P.M., Fawcett, S.B., Nikiema Nidjergou, et al. in press; Mwakisha, Adika et al., in press)	– Differential exposures and opportunities – Differential vulnerabilities and capabilities – Differential access/consequences	– Providing information and enhancing skills – Enhancing services and supports – Modifying access, barriers, and opportunities – Changing consequences – Modifying policies and broader systems Level: Community/Societal
Examining factors enabling and impeding COVID-19 response activities and incidence of cases of COVID-19 in a local public health system (Holt et al., 2021).	– Differential exposures and opportunities – Differential vulnerabilities and capabilities – Differential access/consequences	– Providing information and enhancing skills – Enhancing services and supports – Modifying access, barriers, and opportunities – Changing consequences –Modifying policies and broader systems Level: Community
Implementing and evaluating the effects of policy research information on adoption of child passenger safety legislation at state level (Fawcett et al., 1987; Seekins et al., 1988).	– Differential exposures and opportunities – Differential vulnerabilities and capabilities – Differential access/consequences	– Providing information and enhancing skills – Enhancing services and supports – Modifying access, barriers, and opportunities – Changing consequences – Modifying policies and broader systems Level: Community/Societal
Examining effects of environmental design and police enforcement on violations of handicapped parking spaces and access for people with disabilities (Suarez de Balcazar, Fawcett et al., 1988).	– Differential exposures and opportunities – Differential vulnerabilities and capabilities – Differential access/consequences	– Providing information and enhancing skills – Enhancing services and supports – Modifying access, barriers, and opportunities – Changing consequences – Modifying policies and broader systems Level: Community
Gathering and communicating information for policymakers on common concerns of disabled Americans [Issues and options presented to U.S. Congress, during debate on the Americans with Disabilities Act]. (Suarez de Balcazar, Bradford et al., 1988).	– Differential opportunities – Differential vulnerabilities and capabilities – Differential access/consequences	– Providing information and enhancing skills – Enhancing services and supports – Modifying access, barriers, and opportunities – Changing consequences – Modifying policies and broader systems Level: Community/Societal
Implementing and evaluating an advocacy training program for people with disabilities to influence city policy related to disability rights (Balcazar et al., 1990).	– Differential opportunities – Differential vulnerabilities and capabilities – Differential access/consequences	– Providing information and enhancing skills – Enhancing services and supports – Modifying access, barriers, and opportunities Level: Individual/Community

Individual and Relationship-Focused Interventions Using Behavioral Approaches

Over the past 50 years, the field of behavior science has developed a body of research on behavioral interventions addressing poverty and inequities at the individual and relationship (particularly family) levels. (Many of these could potentially be scaled into community-wide interventions and larger-scale policy solutions.) The descriptions of behavioral interventions convey the diversity of issues and intermediary determinants addressed, sectors or settings engaged, and types of behavioral intervention components used. See Tables 1 and 2 for a fuller set of interventions

Supporting Children and Families: Education

Many behavioral interventions have been developed and implemented to improve educational outcomes for children in low-income families and neighborhoods. For instance, established in 1961, the Juniper Gardens Children’s Project (JGCP) has a sustained program of research to improve the educational experiences of children, especially of those living in low-income areas of Greater Kansas City (Kansas and Missouri). Part of the Life Span Institute of the University of Kansas, the JGCP has worked to address a number of education issues disproportionally affecting low-income families, including quality of early childhood education, school readiness, and school performance (Greenwood, 2006; Hall, Schiefelbusch et al., 2006). The Juniper Garden’s team has also played a leadership role with the Bridging the Word Gap (BWG) Research Network that aims to reduce the vocabulary gap by enriching early language experiences of young children in poverty (Greenwood, Carta et al., 2017). The BWG Research Network, a collaboration among over 100 researchers and practitioners, aims to scale up impact by disseminating information and fostering widespread adoption of education activities that promote language acquisition and school readiness.

Additional important work by Rob Horner and colleagues in Portland, Oregon, in establishing the Positive Behavioral Interventions and Supports (PBIS) program has been effective in improving learning and social relations in thousands of schools across the United States (Horner & Kittelman, 2021). Other key examples include the multinational Comprehensive Application of Behavior Analysis to Schooling (CABAS) directed by R. Douglas Greer, which has produced dramatic results for children with disabilities and emotional disturbance, as well as mainstream students (Greer, 1997); and Morningside Academy in Seattle (Johnson & Street, 2014), which emphasizes Precision Teaching and the Morningside Model of Generative Instruction (MMGI, Johnson et al., 2021).

Individual Interventions: Treatment Contexts

A wealth of behavioral research and intervention focuses on the intersections of poverty, health, and social conditions. To illustrate, we focus on the work of the Center for Learning and Health, Department of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine. Silverman and colleagues from that center suggested two levels of intervention for poverty and health: proximal, promoting healthy behaviors directly, and distal, targeting risk factors for poor health to impact health indirectly (Silverman et al., 2019). With respect to proximal interventions, Silverman and colleagues (2019) indicate that the most effective application of behavioral approaches to addressing substance abuse and associated poverty is to use direct reinforcement of abstinence, offering an incentive for providing proof of abstinence (e.g., urinalysis). Monetary rewards have been shown to be the most effective in this type of research (e.g., Benishek et al., 2014; Davis et al., 2016). Reinforcement or incentives, in the form of monetary vouchers, has been successful in increasing the probability of enrollment in treatment for opiate abuse (e.g., Holtyn et al., 2021), promoting abstinence from alcohol (e.g., Koffarnus, DeFulio et al., 2021), cocaine (e.g., Silverman et al., 1996), opiates (e.g., Robles et al., 2002), and other applications (e.g., polydrug abuse, injection substance users).

Another example of an incentive-based intervention is Brantley and colleagues’ (2018) research with clients diagnosed with HIV, which found that financial incentives increased engagement in care; with 70.1% of participants engaged in HIV treatment at enrollment increasing to 98.6% during the first year of the study, and 96.3% during the second year of the study. As a result, levels of viral suppression increased from 57.7% of participants at enrollment to 82.7% after 12 months of participation in the program. Financial incentives have also been used to improve medication adherence and increase vaccinations (e.g., Nowalk et al., 2010), and promote health screenings (e.g., Malotte et al., 1998)—all behavioral interventions related to health with implications for poverty and financial stability.

The “therapeutic workplace” is another example of a context for applying incentives to improve financial stability (Silverman et al., 2018; Silverman et al., 2001). In this behavioral intervention, unemployed adults with a history of substance abuse are employed and receive a salary, and in some cases are able to earn an increased salary contingent upon proof of drug abstinence and/or taking addiction treatment medications (e.g., methadone). Such cash incentives improved attendance and performance in these training programs (e.g., Silverman et al., 2018; Koffarnus, DeFulio et al., 2013; Koffarnus, Wong et al., 2013b). Following training, participants may participate in the therapeutic workplace in which they demonstrate abstinence through urine samples, or comply with abstinence-promoting medication regimens to maintain their employment and/or to receive maximum pay for their work.

Family Interventions: Bolsa Família

Compared to the robust history of behavioral research on treatment issues such as substance abuse, research on addressing poverty is still emerging. Some behavioral interventions have been implemented as part of large-scale anti-poverty programs targeting employment, education, and heath. The Programa Bolsa Família is a government funded cash transfer program designed to support Brazilian families by intervening directly on the causes of poverty. The program has three phases: direct income transfer for immediate relief of poverty; conditional income transfer upon meeting certain program requirements; and supplementary programs to support sustained social and economic vulnerability (Fava & Vasconcelos, 2017). In the conditional phase, families must meet specific goals relating to school attendance and not allowing children and adolescents to work, vaccine schedules, prenatal and postnatal medical care for pregnant people, and participation in services designed to strengthen family ties. Researchers have analyzed the program from a behavior-analytic perspective focusing on rule-governed behavior (Kaiser et al., 2016), and as a cultural intervention (Freitas Lemos & Todorov, 2020; Valderlon & Elias, 2019). Outcomes have been widely studied, with positive effects on school attendance (Bourguignon et al., 2002), child mortality and poverty-related infectious diseases (e.g., Nery et al., 2017; Rasella et al., 2013), maternal mortality (Rasella et al., 2021), birth weight (Rasella et al., 2013), child labor (Rawlings et al., 2005), and suicide rates (Alves et al., 2018). Programa Bolsa Família was replaced in November of 2021 by a new program, Auxílio Brasil; and the results of associated changes in eligibility and program elements are not yet known.

Based on Brazil’s Bolsa Familia Program, the government-sponsored Opportunity NYC (New York City) provided financial incentives to families living in poverty for achieving goals related to education, health care, and employment (described in Silverman et al., 2019). The program was associated with reducing poverty and extreme poverty in the incentive group, increased savings for some families, and increased usage of preventive dental care (Riccio, 2010). Employment rates between groups were similar, 63% in the incentive group and 65% in the control group; participation in education and training classes was low for both groups (less than 6% of the families); both groups had low employment rates (and low wages) after the program ended (Holtyn et al., 2017).

Family Interventions: Homelessness

Switzer and Rakos (2022), who are active in efforts to combat family homelessness, provided a behavioral community psychology1 analysis for addressing poverty related homelessness while working within the guidelines of the federal Housing First/Rapid Re-Housing (HF/RRH) approach. Grounded in the federal 2009 Homeless Emergency Assistance and Rapid Transition to Housing Act, Housing First acknowledges that “housing itself is a precondition for resolving risks to housing stability such as mental health and substance abuse, incomplete education, and unemployment/underemployment” (Switzer & Rakos, 2022, p. 5). Switzer and Rakos have developed a comprehensive approach that reflects cultural, sociological, and ecological factors that influence the behaviors of multiple persons interacting in families and groups; they offer potential points of intervention that could improve health and development outcomes for low-income families.

Community and Societal Interventions Using Behavioral Approaches

Community Interventions

Behavioral scientists have been interested in community-level interventions since quite early in the development of the discipline in the 1960s and 1970s (Fawcett, 1991; Watson-Thompson et al., 2020). Both the Journal of Applied Behavior Analysis, and the Behaviorists for Social Action Journal2 (now Behavior and Social Issues) were established, demonstrating strong commitment to the application of behavioral methods to address issues of social significance (Baer & Wolf, 1987; Baer et al., 1968). The subdiscipline of behavioral community psychology, which drew on other disciplines, particularly public health and human development, significantly engaged with issues of poverty and inequities. For instance, researchers in the department of applied behavioral science (and the Center for Community Health and Development) at the University of Kansas established a 50+ year commitment to this work, viewing community development as both a process and a product that required community engagement over time (Fawcett, 2021). Such community-engaged research was guided by a core set of values, including (a) Community researchers should form collaborative relationships with the participants with whom they do research; (b) Community research should provide information about the variety of behavior-environment relationships of importance to communities; and (c) Community action should occur at the level of change and timing likely to optimize beneficial outcomes (Fawcett, 1991).

This perspective has proven helpful in the development and expansion of community interventions supporting health and development, in partnership with community members and organizations. Among projects in which faculty and students from this program have focused over time include those promoting healthy youth development (e.g., Watson-Thompson et al. 2008; Watson-Thompson et al., 2013), reductions in substance abuse (e.g., Anderson-Carpenter et al. 2016), and building multisectoral partnerships for population health and health equity (Fawcett et al., 2010). To build capacity for this work of promoting community health and development, the Center for Community Health and Development at the University of Kansas developed and maintains the Community Tool Box (http://ctb.ku.edu/). Begun in 1994, this open-source resource reaches six million unique users annually in 300 countries (Holt et al., 2013).

Prevention science is another important approach to community intervention; it often uses behavioral interventions to reduce risk factors, and increase protective factors, especially for behaviors and outcomes related to child and youth health and development. Prevention researchers (e.g., Hawkins et al., 2002) identified a matrix of risk factors for adolescent behaviors related to poverty and inequities such as substance abuse, violence, delinquency, and dropping out of school. Such matrix thinking reflects the reality that most social issues are embedded in multiple interactive and systemic processes (Biglan, 1995; Seniuk et al., 2019). In the spirit of application, Anthony Biglan, an important behavior scientist at the Oregon Research Institute, and other prevention scientists have developed the Values to Action Coalition, which works to bring together a “community of scientists, clinicians, and concerned citizens that seeks to leverage behavioral science, effect change, and make the world a better place for everyone” (https://www.valuestoaction.org/), as well as organizing “action circles” to strengthen local communities in applying behavioral science for social change.

There are many other behavioral scientists involved in reducing social problems by strengthening communities. For instance, E. Scott Geller (2014, 2017) from Virginia Tech has developed and actively researched community intervention for over 50 years in the United States and other nations. This includes applications to increase work and traffic safety, prevent substance abuse, reintegrate incarcerated felons, and strengthen community commitment of police officers; often by increasing rates of public positive reinforcement within organizational structures. In another example, the LYTE Collective in Chicago, which has developed a new form of locally grounded partnership with homeless youth, has worked to develop a culture of respectful, reciprocal relationships (consistent with Biglan’s and Geller’s approaches); in part this is due to some lead participants’ exposure to behavioral science principles during education at Jane Addams College of Social Work at the University of Illinois Chicago (Holtschneider, 2021).

Societal Interventions

Many of the examples included for Individual, Relationship, and Community levels could only be implemented through advocacy efforts seeking policy and systems change at multiple levels. Research on social justice and social policy is common in several behavioral science journals. For example, a scan of Perspectives on Behavior Science includes 231 references to “social policy”; Behavior and Social Issues includes 229, and the Journal of Applied Behavior Analysis, 236. For instance, Seekins and Fawcett (1986) published a paper entitled “Public Policy Making and Research Information”, and two years later the Association for Behavior Analysis (now the Association for Behavior Analysis: International—ABAI) sponsored a statement from their Task Force on Public Policy, accompanied by an article by Fawcett et al. (1988) titled “Behavior Analysis and Public Policy.” Faculty and students from a number of different university research centers have been engaged in such work since the 1980s.

There are many other useful models of behavioral scientists working at the policy level. For instance, in 1995, Biglan published an inspiring and valuable book, Changing Cultural Practices: A Contextualist Framework for Intervention Research. That volume presented a general framework for cultural change, and included policy discussions related to tobacco use, childrearing practices, sexist behaviors, and environmentally harmful practices (see also Biglan, 2016, for an update). Biglan and colleagues have made continuing contributions to policy advocacy ever since, including two more heavily policy-focused books (Biglan, 2015, 2020). Mattaini and Aspholm (2016), in the paper “Contributions of Behavioral Systems Science to Leadership for a New Progressive Movement,” called for widespread social action and advocacy, including promoting and sustaining scientific activism, advanced systems science education, and protecting and caring for those harmed by unjust environments, all in collaboration with existing non-governmental organizations (NGOs).

Many other behavioral scientists have engaged in advocacy and systems change efforts addressing poverty and inequities. Examples include research and action to address chronic poverty and social exclusion in Brazil (Freitas Lemos et al., 2019; Freitas Lemos & Todorov, 2020); challenging conditions related to colonialism in Africa (Smilak & Putnam, 2022); increasing supports for people immigrating to the United States (Rakos & Switzer, 2021); and working on improvements in services for unhoused persons in the United States (Holtschneider, 2021; Switzer & Rakos, 2022). Mattaini and colleagues have also developed an analysis of possible ways to reduce violence by police in the United States (Mattaini & Rehfeldt, 2020), promote youth activism as violence prevention (Aspholm & Mattaini, 2017; Roose & Mattaini, 2020), and (referencing Gandhi) establish a “constructive program” for the twenty-first century (Mattaini, 2015).

Effective policy advocacy typically requires applications of strategic influence skills (Baron & Hoeksema, 2021). Such influence may be directed specifically toward the actions of decision-makers, but it is more common to focus at least in part on individuals and organizations in positions to establish or modify the actions of decision-makers. In most cases, those policy changes require engagement of those most affected as well as people and organizations that can influence decision makers. Such engagement is often required over extended periods of time to build ongoing relationships necessary to influence policy adoption and implementation.

Some Challenges and Opportunities for Contribution

This paper outlines ways that behavioral approaches have been used to address poverty and inequities in health and human development. The focus is on taking action to address conditions—including social, environmental, and economic conditions—that cause poverty and produce unfair and unequal outcomes in health and human development. Widespread behavior change will be needed—including among those most affected and those with the power to change programs, policies, and practices—if we are to assure the conditions for health and development for all.

Behavioral science brings particular strengths to this work, especially in measurement and intervention. Behavioral science methods have been developed for the reliable and valid measurement of behavior (e.g., different health behaviors such as healthy eating and physical activity) and the products of those behaviors, including healthy weight (Fischer et al., 2022). It has also developed methods for measuring changes in the community and system (e.g., new or modified programs, policies, and practices) and their association with community-level outcomes (e.g., Fawcett, Collie-Akers, et al., 2015a; Strauss et al., 2018). Behavioral science has contributed to a wide variety of evidence-based interventions grounded in the science of behavior (as illustrated by Tables 1 and 2).

There are a number of challenges to be engaged to realize the potential of behavioral science methods for helping address poverty and inequities in health and development. First, the bulk of tested behavioral interventions use relatively weak forms of behavior change (e.g., providing information and enhancing skills), rather than stronger forms (e.g., modifying policies and broader systems) that are often less feasible to implement. Second, the preponderance of behavioral interventions have been tested at lower socio-ecological levels (i.e., individuals, relationships), not at broader levels (i.e., community, society). Third, to achieve greater impact, behavioral interventions will need to be designed and implemented with greater strength and broader reach (for instance, more comprehensive forms that include modifying barriers/opportunities and policy and systems change). Fourth, efforts to change conditions that produce inequities will meet with resistance and opposition (e.g., delaying, denying, discrediting). To bring about needed systems change, behavioral scientists and practitioners must join with advocacy groups —and organized groups of those most affected—to exert necessary influence on decision makers (Fawcett, 1999).

Collaborative partnerships provide a promising context for the contribution of behavioral scientists and practitioners to address poverty and inequities in health and development (Fawcett et al., 2010). They assure structures for sharing risks, resources, and responsibilities for the work needed to change conditions in multiple sectors, settings, and levels. By joining methods from behavioral science, public health, and other disciplines—and experiential knowledge of those most affected by inequities—we can work more effectively to assure conditions for health and well-being for all.

Authors’ Contributions

The authors agree that all authors contributed equally to this work.

Data Availability

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

Declarations

Conflicts of Interest

The authors have no known conflict of interest to disclose.