Assessing heterogeneity in the health effects of social pensions among the poor elderly: evidence from Peru

This paper exploits the discontinuity around a welfare index of eligibility to assess the heterogeneous health impacts of Peru’s social pension program Pension 65, which focuses on elderly poor individuals. The heterogeneity is analysed with regards to the treatment exposure (short vs long run), the accessibility to health care infrastructure (near vs distant facilities), and gender. Overall, we find improvements in anaemia, mortality risk markers, cognitive functioning, mental health, and self-reported health among eligible individuals; yet there is an increase in the risk of obesity among women, as well as an increase in reported chronic diseases. The program improves the quality of nutrition and health care access, but reduces the frequency or intensity of physical activities. About half of the effects on the analysed outcomes persist in the longer run and living in a district with good access to facilities stands out as the most relevant characteristic enhancing the beneficial program effects. Overall thus, the resulting health benefits in areas of under-nutrition are at most modestly compensated by deterioration in over-nutrition related conditions. As the program evolves further, policymakers need to confront the challenge of continuing to ensure the health benefits in terms of reducing nutritional deficits and the lack of health infrastructure while avoiding potential undesirable side effects in terms of over-nutrition in a geographically diverse country like Peru.