The Bolsa FamÃlia Program (BFP) in Brazil stands as one of the largest conditional cash transfer initiatives globally. Since its inception in 2004, the BFP has offered monetary assistance to Brazil’s most impoverished families, with the stipulation that they meet certain requirements such as regular healthcare visits for their children and ensuring that they attend school. While these programs are widely recognized for narrowing economic and social disparities, they have also demonstrated improvements in health metrics, including reductions in child mortality, maternal deaths, as well as cases and fatalities related to HIV.
Tuberculosis (TB) remains one of the top infectious killers in Brazil and in numerous low- and middle-income nations, largely associated with poverty. According to Davide Rasella, coordinator of the study and head of the Health Impact Assessment and Evaluation group at ISGlobal, “We know that TB is driven by poverty, but until now, the effects of cash transfers on disease outcomes among the most vulnerable populations had not been fully analysed.”
Rasella and his Brazilian colleagues examined data from 54.5 million low-income individuals between 2004 and 2015, focusing on ethnic and socioeconomic backgrounds. They evaluated TB incidence (new cases), mortality (deaths in the population), and case fatality rate (the death rate among those infected) between those who received BFP support (23.9 million) and those who did not (30.6 million). In total, they recorded 159,777 new TB diagnoses and 7,993 TB-related deaths within this group.
Greater impact on indigenous and extremely impoverished individuals
The findings reveal a significant decline in both TB cases and fatalities among individuals who received cash transfers. The reductions exceeded 50% among the extremely poor and surpassed 60% in indigenous communities. While the program successfully lowered TB cases across all demographics, its impact was less pronounced among those who were moderately poor, and there was no notable decline in TB-related deaths in that segment. Additionally, the TB case fatality rate was lower in those benefiting from the Bolsa FamÃlia compared to those who did not, although the difference wasn’t statistically significant.
The positive impact of the BFP on TB outcomes can be attributed to its promotion of better access to sufficient and nutritious food, which alleviates food insecurity and malnutrition—key risk factors for TB—and enhances immune responses. “It also helps eliminate barriers to healthcare access,” explains Gabriela Jesus, a co-first author of the study along with Priscila Pinto, both affiliated with FIOCRUZ.
Wider implications
By broadening the scope of the BFP, Brazil could combat the alarming rise in TB cases among vulnerable groups resulting from the COVID-19 pandemic. However, the significance of these findings resonates beyond Brazil.
“Our study has substantial implications for policy-making in countries that bear a high burden of TB,” states Rasella. The conclusion is unmistakable: social protection programs not only aid in diminishing poverty and malnutrition but also play an essential role in fulfilling the objectives of the END-TB strategy and the Sustainable Development Goals.
