Brazil’s Bolsa Familia Program (BFP) is one of the largest conditional cash transfer programs implemented worldwide. Since 2004, the BFP has provided financial support to the poorest families in Brazil, on the condition that they meet certain conditions, such as taking their children to the doctor and ensuring school attendance. While these programs are well known for reducing economic and social inequalities, they have also been shown to improve health outcomes such as infant mortality, maternal deaths, and HIV cases and deaths.
Tuberculosis (TB), a leading cause of infectious death in Brazil and other low- and middle-income countries, is closely linked to poverty. “We know that tuberculosis is driven by poverty, but until now, the effects of cash transfers on disease progression among the most vulnerable populations have not been fully analyzed,” says study coordinator Davide Rasella, head of the Health Impact Assessment. and ISGlobal Evaluation Group and collaborating professor at the Collective Health Institute.
Rasella and his colleagues in Brazil analyzed data, including ethnic and socioeconomic conditions, from 54.5 million low-income Brazilians between 2004 and 2015. They compared tuberculosis incidence (number of new cases), mortality (number of deaths in population) and lethality. rate (how many people with the disease die) among people who received BFP support (23.9 million) or not (30.6 million). In total, there were 159,777 new tuberculosis diagnoses and 7,993 tuberculosis deaths in the study cohort.
Stronger effects among indigenous and extremely poor peoples
The results show a large decrease in tuberculosis cases and deaths among those who benefit from cash transfers. The decrease was more than 50% among extremely poor people and more than 60% among indigenous populations. Although the program reduced tuberculosis cases in all groups, its effect was smaller in those who were less poor and there was no significant reduction in tuberculosis deaths in that group. The tuberculosis case fatality rate (that is, how deadly the disease is in those affected) was also lower among Bolsa Família beneficiaries compared to non-beneficiaries, although the difference between the two groups was not statistically significant.
The reason behind BFP’s effect on tuberculosis outcomes is not a mystery. “We know that the program improves access to food, both in quantity and quality, which reduces food insecurity and malnutrition – a major risk factor for tuberculosis – and, as a result, strengthens people’s immune defenses It also reduces barriers to accessing medical care,” says Gabriela Jesús, co-first author of the study with Priscila Pinto, both from FIOCRUZ.
Global implications
Expanding the BFP can help Brazil address the worrying increase in tuberculosis cases among vulnerable populations following the COVID-19 pandemic. But the implications of these findings extend beyond Brazil.
“Our study has far-reaching implications for policy-making in all countries with a high burden of tuberculosis,” says Rasella. The message is clear: social protection programs not only help reduce poverty and malnutrition, but can also play a crucial role in achieving the goals of the END-TB strategy and those of the Sustainable Development Goals.