Advance in the control of diseases linked to poverty but not through policies based on access to new drugs but by combating the most basic needs at their roots. This is the objective of the monetary transfer programs conditions that have been operating worldwide for years and consist of offering cash to poor households in exchange for meeting certain health and education conditions, such as regular attendance at school and health checks for children in prisons. established. Now, the largest existing program to date, which impacts a population of 54.5 million people vulnerable in Brazil, demonstrates once again and more forcefully than ever the effectiveness of this international strategy to achieve the eradication of poverty and the global health problems associated with it.
He Family Grant Program (BFP) in Brazil, one of the largest conditional cash transfer programs in the world, has managed to reduce by more than half the number of tuberculosis cases and deaths among people living in extreme poverty and indigenous groups in the Amazon. This is demonstrated by the results of an extensive study coordinated by the Barcelona Institute for Global Health (ISGlobal), center promoted by the Foundation La Caixahe Collective Health Institute and the Cidacs-Fiocruz of Brazil and published in the journal ‘Nature Medicine’.
The new conclusions “have important implications for public policies for social protection and tuberculosis control around the world,” he says in statements to ABC. Davide Rasellacoordinator of the study, head of the ISGlobal Health Impact Assessment group and collaborating professor at the Collective Health Institute.
Since 2004, the BFP has provided financial aid to Brazil’s poorest families, on the condition that they meet certain requirements, such as ensuring that their children They go to school and periodically go to medical visits. On average, families receive help of 120 dollars per family -116 euros- per month (about 43 dollars per capita -41.7 euros-). Although these programs are known to reduce economic and social inequalities, improvements in health have also been shown, including reductions in infant mortality, maternal mortality, and in cases and HIV deaths, point out from ISGlobal. “It is not the same help for all families; their needs and starting situation are studied in detail,” says the person responsible for the study.
Tuberculosis (TB), one of the main infectious causes of death In Brazil and other low- and middle-income countries, it is closely linked to poverty. “We know that TB is a product of poverty, but until now the effect of monetary transfers on the disease had not been evaluated, especially in most vulnerable populations,” explains Rasella. It also underlines the importance of the results, both for “their forcefulness” and for the fact that they are supported by “such a large sample of people in vulnerable situations.”
Almost 8,000 deaths from tuberculosis
Rasella and his colleagues in Brazil analyzed data, including ethnic and socioeconomic conditions, of 54.5 million Brazilians with low income between 2004 and 2015. They compared the incidence of tuberculosis (number of new cases), mortality (number of deaths in the population) and the case fatality rate (how many people affected by the disease die) among those who received support of the program (23.9 million people) or did not receive it (30.6 million people). In total, there were 159,777 new diagnoses and 7,993 deaths due to tuberculosis in the studied cohort.
The study, consulted by this newspaper, concludes forcefully that cases of tuberculosis and deaths from the disease decreased significantly among the beneficiaries of monetary transfers. The decrease was more than 50% among extremely poor people and more than 60% among indigenous populations. Although the program reduced the incidence of the disease in all groups, its effect was smaller in the least pooryeswhere no significant reduction in deaths from the disease was observed. The fatality rate (that is, how many of those affected die) was also lower among Bolsa Família beneficiaries than among non-beneficiaries, although the difference between both groups was not statistically significant.
«Among the indigenous population that received aid, the incidence fell 63% and deaths 65%. Among the most vulnerable people in favelas and urban environments who received economic support, cases were reduced by 50% and mortality by 40%. “These are the most important data collected so far in a study on the impact of these programs,” explains the study coordinator.
The effect of Bolsa Família on cases and deaths from tuberculosis is easy to explain. “We know that the program improves access to food, both in quantity and quality, which reduces food insecurity and malnutrition -one of the main risk factors for tuberculosis- and, consequently, strengthens people’s immune defenses. It also reduces barriers to accessing healthcare,” he says. Gabriela Jesusco-author of the study along with Priscilla Pintoboth from Fiocruz.
«The expansion of the Bolsa Familia program can help Brazil address the worrying increase in tuberculosis cases among vulnerable populations following the Covid-19 pandemic. However, the study findings have repercussions that go beyond Brazil»those responsible for the investigation emphasize.
“Our study has far-reaching implications for policymaking in all countries with a high burden of tuberculosis», says Rasella, who, with the results in hand, sends a forceful message: «Social protection programs not only contribute to reducing poverty and malnutrition, but can also play a fundamental role in achieving the goals of the global strategy to control tuberculosis. If we help people in extreme poverty eat better and have a more optimal basic state of health, we also reduce the risk of them contracting diseases linked to a lack of resources. The objective is to eradicate poverty to improve health,” concludes the head of the Health Impact Assessment group of the ISGlobal.
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