Reductions to government social support programs have costs, and they can be particularly severe for vulnerable populations. Budget cutbacks have been implemented as a solution to the recession that has gripped Brazil since 2015, but a study led by Dr. Thomas Hone of Imperial College of London indicates that these austerity measures could result in significant collateral damage to public health.
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Since 2015, Brazil has been mired in a severe economic crisis, with GDP falling more than 8%. This recession has led to increasing unemployment, particularly among low-income populations, and an increase in the rate of people living below poverty.
Consequentially, the austerity measures implemented by the government will result in significant cuts to two critical programs for poverty alleviation and health care: the Bolsa Familia Programme (BFP) and the Estrategia Saude da Familia (ESF).
- The BFP covers about 25% of Brazil’s population, and provides cash transfers for families in need if they meet conditions of school attendance, vaccinations, and health checkups for children, and prenatal and postnatal doctor’s visits for new mothers.
- The ESF provides community-based primarily healthcare to local populations in need, with family health teams providing services including basic curative care, health promotion and education, and targeted programs for HIV/AIDS, cardiovascular health, and other issues.
For this study, researchers from Imperial College and their collaborators modeled the potential impacts to child mortality in Brazil from cuts to these two programs. They employed a microsimulation approach that models individual-specific characteristics and probabilities in order to provide greater accuracy of policy effects compared to traditional methodologies, which use only the average values in a population. Using municipal-level data, researchers simulated changes in poverty rates and other socioeconomic variables through 2030 and then used these results to project mortality and hospitalization rates for children younger than 5 years old.
This simulation was carried out across three different economic scenarios, corresponding with durations of economic crisis ranging from 3 to 7 years old, as well as different rates of poverty increase. Health outcomes were then compared across two policy scenarios: one in which fiscal austerity measures are maintained through 2030, and one in which BFP and ESF coverage is preserved and allowed to keep up with changes in the poverty rate.
The results of this modeling study are sobering, indicating a substantial increase in childhood mortality even under a mild crisis scenario if austerity measures remain in place:
- Mild Crisis (3 years): 7% increase in child mortality rate, with nearly 14,000 avoidable childhood deaths
- Medium Crisis (5 years): 8.6% increase in child mortality rate, with nearly 20,000 avoidable childhood deaths
- Prolonged Crisis (7 years): 9.5% increase in child mortality rate, with more than 23,000 avoidable childhood deaths
Across all scenarios, cuts to these programs have disproportionate impacts on at-need municipalities, reversing a trend in declining inequality in health outcomes in Brazil and compromising efforts to achieve the UN Sustainable Development Goals (SDGs).
These research findings have the potential to influence not only Brazil’s policies but those of countries around the world. While there have been several studies examining the impacts of economic crises on health outcomes in high-income countries, research on impacts in low- and middle-income countries (LMICs) has been lacking. This study helps to fill that gap, providing support for maintaining social support and healthcare programs even in the midst of economic challenges in these contexts.
Imperial College of London’s Dr. Hone worked with a team of researchers from Brazil as well as the US to conduct this study. Co-authors represented the Universidade Federal da Bahia, the René Rachou Institute in Minas Gerais, the Institute for Applied Economic Research in Rio de Janeiro, and the University of São Paulo in Brazil, and Stanford and Harvard Universities in the U.S.
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